Everything else has failed; my options are now down to trying an MAOI or ECT. These options kind of suck, but hey, that’s the hand I’ve been dealt. I’ve decided to try the MAOI first. (Nardil, Parnate, Marplan are the brand names.)
I’ve read the literature and done the research. But it’s really, really hard to find people who have any personal experience with these drugs because they’re not used often anymore. I’m hoping that some Dopers out there will have some anecdotes and insights to share.
I’m particularly concerned about how difficult it is to adhere to the diet. My understanding is that the new CW is that what matters is whether or not foods are aged, which can be hard to determine just from looking at them sometimes, especially in a restaurant. (I’m thinking of steaks that are aged as one example.) How the diet affected your life is of interest to me.
I’m also wondering how prevalent/severe the side effects are, and whether hypertensive crisis is (pick one: common, occasional, rare, or never happens) in a typical patient.
I know this probably won’t get a lot of responses, but if you have any experience with these meds at all, I would appreciate hearing from you.
I took Parnate many years ago. The dietary restrictions are a pain in the ass, but the drug was quite effective. Much better than the tricyclic antidepressants which were the main alternative at the time.
After about six months, I developed severe vascular headaches similar to migraines, and had to stop taking Parnate for that reason, but if I hadn’t had the headaches, I would probably have stuck with it for a while.
Gained quite a bit of weight, but just about every antidepressant affects me that way. That’s one reason why I’m now going bare and no longer taking antidepressants.
I took it a long time ago. My experience was that for the most part it had a paradoxical effect (I began to become more depressed and temperamental.) I also developed a craving for booze and caused myself a lot of trouble through poor judgement and bad decisions (This may just be my nature, though–I’m not sure I can blame it on the drug.) Going off it was very unpleasant, as I had all manner of horrifying nightmares. (In contrast, going off imipramine just gave me long drawn out detailed dreams with fantastic landscapes.)
I’m not saying this will happen to you–people react differently to medications so you might have a much better experience than I did.
It may be hard to give up cheese–that’s such a common ingredient in many foods.
I didn’t have much luck with them when I tried them (but SSRIs work quite well for me), and the only side effect I suffered from was an inability to eat. I don’t mean simply not wanting to eat, but actually gagging when I tried to eat.
SSRIs messed me up baaaaad (they make bipolar people like me really unstable). And I could do with a diet (either the cheese syndrome diet or the don’t wanna eat diet, or both), since thanks to atypical depression, I’ve packed on 70 pounds in those 2 years.
Some things I’m concerned about, and maybe you can address them directly:
Weight gain is reported as a side effect, but the majority of anecdotes I’m hearing are from people who lost weight on Nardil or Parnate. KRC, could you weigh in on that one? (ugh, bad pun)
Also, I’m wondering about sexual side effects. I don’t mind a diminished libido much at this point, but Effexor killed it totally and made orgasms positively dull. I don’t think I could live with that level of dysfunction again (not for very long). Because really, if I’m going to give up cheese, I’m not giving up orgasms, too. Those are probably two of the best things in life.
I think my appetite my have improved slightly when I was taking Nardil but I didn’t notice any weight gain. (The weight gain would come later, with the Prozac.)
Hypertensive crises are rare. The first sign is a throbbing headache, so you should always have that investigated asap. There is one patient I met who used to go to Phoenix Park with a bottle of port, smoked ham and some stilton every time he felt suicidal, but he never actually managed to do anything except give himself a bad headache. Not that I’d recommend that you take that kind of risk, of course.
As far as the diet goes; avoiding smoked meats, pickled herring, mature cheese, broad beans, red wine, Marmite/Vegemite, Oxo, Bovril and fermented soy products would be sufficient. Avoid all game and any meat that has been “hung” for longer than usual, so yes, your aged steak is out. The problem is with the amino acid Tyrosine, so food low in protein is safe. Sticking to fresh fruit, vegetables and white meats and avoiding alcohol would be the easiest way of incorporating the dietary restrictions into your life, and would aid weight loss too.
When buying any medications (especially for coughs and colds) check with the pharmacist, as some decongestants, painkillers and cough remedies will not be safe to mix with MAOIs. The dietary and medication restrictions should be followed while taking the MAOI and for 2 weeks after stopping.
Basically the common side effects are dizziness and feeling woozy when you get up too quickly. Every side effect you can imagine has been linked to these drugs, but most are uncommon. I’ve seen some patients who have done really well, and some for whom it has done nothing except made them feel crappy. I think you just have to give it a shot and see.
You may have to stop other meds for a couple of weeks before starting the MAOI, and it could take up to 3 weeks for it to reach full effect. There may be a place for a session of ECT in those 5 or 6 weeks, just to get you over that gap, which is what they offer patients in that position here. Perhaps you could discuss it with your doctor?
You may be depressed, but you’re still quite funny . That made me chuckle.
I tried Parnate many years ago. I actually had hypo tension, and my blood pressure would plummet and, well, so would I. Fortunately, I was inpatient at the time and could get help immediately.
I tried Nardil as well. No BP issues, no weight gain. I can’t speak to the libido effects, since I wasn’t sexually active at the time. It didn’t really help all that much, though, so the risk/inconvenience factor was determined to be greater than the benefit. Hopefully YMWV.
irishgirl has given all the other info I would offer, so I’ll just say good luck!
I was on Nardil for a few months in the 80s. I’m sorry that there aren’t many other options for you. The Nardil “worked” (e.g. less depression and anxiety) but my side effects included, but were not limited to:
-Severe insomnia (early morning waking)
-Horrible constipation -which doesn’t sound that bad but it was really bad.
-No orgasms.
Then there were the dietary restrictions, which happened to be all my favorite foods: cheese, caffeine, chocolate, wine, pickles.
Okay that was enough to really piss me off, but for the first time in my life I wasn’t scared or depressed. So I dealt with it for a while. Then I got a horrible vascular headache that lasted for several days before I went to a doctor. I wished for someone to just knock me out, that’s how painful it was. The doctor took me off the Nardil for two weeks to get me onto meds for the headache, which just went away on its own. I never looked back, and never touched Nardil again.
I, too, took Parnate many years ago. It worked for me and I had no side effects but the dietary restrictions were often inconvenient. On the other hand, the dietary restrictions were not nearly as inconvenient as the depression had been. The life improvement was worth it.
Thanks. I’m heartened by the fact that my weight gain has never been due to an antidepressant. It’s been steadily piling on ever since I got depressed.
But I can reassure my mom that I (probably) won’t be able to kill myself with a block of Cheddar. She’s convinced I will do this, either inadvertently or on purpose. She is well aware of my love affair with cheese.
Thanks. I haven’t seen anyone say this anywhere, and I’m worried about this because you don’t always know if a steak is aged when you order in a restaurant. I guess I’ll just eat my red meat at home.
I plan to. I’m currently on Wellbutrin, Lamictal, and lithium. Probably I will be OK in the interim because of the two mood stabilizers and the fact that the Wellbutrin isn’t doing much.
I don’t really have any prejudice against ECT. My mom just gets upset when I tell her I’m going in for electroshock. In her day, it was an ugly thing.
Thanks. That made me smile.
I’m not sexually active either…with other people, that is. OK, sorry, TMI.
That would be baaaaad. Like many bipolars, my sleep cycles are already way screwed up. Thanks for the heads up on this.
That’s what I’m hoping for. Ideally, I’d like to use the MAOI to get back to an acceptable baseline, then discontinue it and stick with mood stabilizers and maybe Wellbutrin, which has a proven track record of keeping me out of severe/psychotic depression.
Thank you to all. I really appreciate it. I’ll post an update to let you know how it goes, if you want.
OK, sorry, TMI.