# what's the best MAOI?



## kev (Jan 28, 2005)

I'm going to ask my doctor about prescribing an MAOI? Which is the best (in your opinion)? I've heard they are particularly helpful for atypical depression, which is the kind I have. What distinguishes MAOI's from SSRI's in how they work?


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## crayzyMed (Nov 2, 2006)

Nardil works for some, Parnate for other, Nardil is seen as the most effective one for social anxiety.


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## Vini Vidi Vici (Jul 4, 2009)

SSRIs only raise one chemical in the brain: serotonin. MAOIs raise serotonin and also dopamine. Dopamine is the primary neurotransmitter responisble for drive, motivation, and pleasure in the brain. When serotonin is raised, dopamine is usually lowered.....this is why SSRIs have negative side effects such as apathy, low motivation, and sexual dysfunction. MAOIs have a lower risk of causing such side effects, and much better/more effective antidepressant ability. 

--A good thing to do before your appointment is to get online and find a list of the foods to avoid. Specific foods and OTC medications (cough syrup/decongestants) need to be avoided while on MAOIs, if you eat them you will have a hypertensive crisis. Show the list to your doctor, and show him that you are completely familiar with all the interactions and prepared to take the proper precautions. You have a much better chance of getting an MAOI if your doctor knows he/she can trust you to be safe while on the MAOI. Then they won't have to worry about doctor liabilty/insurance and all that stuff.


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## IllusionalFate (Sep 10, 2008)

SSRIs only increase serotonin levels, but MAO is an enzyme responsible for the deamination, or metabolism, of many other neurotransmitters (serotonin, [nor]epinephrine, dopamine, and trace amines such as PEA, DMT, and octopamine).

Tranylcypromine (Parnate) and phenelzine (Nardil) are the two main nonselective MAOIs. Parnate is more energizing, and I've heard it feels kind of like a mild amphetamine. Nardil on the other hand has a metabolite that inhibits the enzyme that breaks down GABA, which makes it the superior anxiolytic/anti-panic agent of the two. Parnate isn't associated with the weight gain Nardil is notorious for, and is also less likely to induce lethargy/daytime somnolence.


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## Vini Vidi Vici (Jul 4, 2009)

IllusionalFate said:


> SSRIs only increase serotonin levels, but MAO is an enzyme responsible for the deamination, or metabolism, of many other neurotransmitters (serotonin, [nor]epinephrine, dopamine, and trace amines such as PEA, DMT, and octopamine).
> 
> Tranylcypromine (Parnate) and phenelzine (Nardil) are the two main nonselective MAOIs. Parnate is more energizing, and I've heard it feels kind of like a mild amphetamine. Nardil on the other hand has a metabolite that inhibits the enzyme that breaks down GABA, which makes it the superior anxiolytic/anti-panic agent of the two. Parnate isn't associated with the weight gain Nardil is notorious for, and is also less likely to induce lethargy/daytime somnolence.


its true....i take parnate 10mg 3 times a day. it is very amphetamine-like....but unfortunately the half life is really short so the effects only last about 1-2 hours. but definetly reminds me of adderral and ritalin...so if u take like 6 pills a day of parnate you could sort of maintain the rush....


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## db0255 (Jul 20, 2009)

MAOIs also have other pros. Not only are they better apparently for atypical depression, but for rejection sensitivity as well.


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## IllusionalFate (Sep 10, 2008)

Vini Vidi Vici said:


> its true....i take parnate 10mg 3 times a day. it is very amphetamine-like....but unfortunately the half life is really short so the effects only last about 1-2 hours. but definetly reminds me of adderral and ritalin...so if u take like 6 pills a day of parnate you could sort of maintain the rush....


Sounds awesome. I just read on Wikipedia that it's an NDRA as well as MAOI (either tranylcypromine itself or a metabolite), so the catecholamine release being potentiated by the MAO inhibition might explain why it has a noticeable psychostimulant effect.


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## McMillan (Sep 7, 2009)

Parnate sounds awesome. 

I've read that one potentially side-effect is death?

MAOI always looked more appealing but the potential side effects freak me out.


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## Saqq (Dec 1, 2008)

Parnate isn't doing much for me, but I'm a freak of natural tolerence, so nothing works on me.

not even about 25mg of phenazepam... shhhh


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## crayzyMed (Nov 2, 2006)

McMillan said:


> Parnate sounds awesome.
> 
> I've read that one potentially side-effect is death?
> 
> MAOI always looked more appealing but the potential side effects freak me out.


There's nothing to freak out about, if you follow the special diet you will be fine Also reboxetine could be added to avoid eating a special diet.


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## IllusionalFate (Sep 10, 2008)

I strongly advise against taking NRIs concurrently with nonselective MAOIs. The dose you would need to sufficiently inhibit the NET would be a dose that would cause severe hypertension.


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## crayzyMed (Nov 2, 2006)

IllusionalFate said:


> I strongly advise against taking NRIs concurrently with nonselective MAOIs. The dose you would need to sufficiently inhibit the NET would be a dose that would cause severe hypertension.


Source for that? I know medline used to take parnate with reboxetine, and it was used succesfully for this purpose in a rat studie.


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## IllusionalFate (Sep 10, 2008)

I don't have a source, and I'm not completely sure if it's true, but it makes sense theoretically. If low doses of the NRI are used, then the NET wouldn't be blocked enough to keep tyramine from reversing it and causing mass efflux of norepinephrine... and if doses are high enough where it is inhibited sufficiently (90%+) then vesicular release would cause NE to flood the synaptic cleft.

A patch form of these medications, like EMSAM (selegiline), seem like they'd be the best options for reducing the risk of a hypertensive emergency.


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## crayzyMed (Nov 2, 2006)

Well, it seems to work in this study:


> Reboxetine prevents the tranylcypromine-induced
> increase in tyramine levels in rat heart
> by
> Dostert P, Castelli MG, Cicioni P, Strolin Benedetti M
> ...


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## IllusionalFate (Sep 10, 2008)

Heart radioactivity levels? what the hell does that have to do with its precise effect on blood pressure? 

It's an interesting study but I'd need to understand the significance of "heart radioactivity levels" before I can comment any further.


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