# Sticky  Improved community MAOI FAQ and sticky



## Gillman fan

Hi gang,
Right now we have a good number of posters who are experienced with and knowledgeable about MAOIs, great sources of information. Right it is very hard to find accurate information on MAOIs on the internet, and if we work together we can become the #1 best source of info pretty easily.

Our existing FAQ stickies are crap. No mention of Parnate in the "Nardil FAQ," Dr. Gillman's website should be listed in the first paragraph. Existing FAQs have a ton of anecdotes but are pretty poorly organized. Quite frankly I don't think anyone should just be reading anecdotes about which foods various people have been able to eat without including Dr. Gillman's work.

There is a ton of great information we (as a community) have about these meds that you can't find anywhere else on the internet, including:
- more comprehensive listing of side effects for each med, e.g. Apexio's doctor said that muscle weakness is not an "official" side effect but it is quite apparent that it happens a lot.
- comedications used to treat side effects or potentiate them
- Some information on Nardil vs. Parnate - this question comes up a LOT
- Optional links to good scholarly articles
- Information on asking your doctor how to get an MAOI prescribed
- Other recommendations for MAOI therapy that are not mentioned in "official" sources, such as monitoring blood pressure / degree of hypotension, various over the counter meds that can alleviate side effects.

Just as an example, we could use a structure like this:
Intro - 1 paragraph summary of information in FAQ
A) 1 sentence explanation of what MAOIs do, 1 sentence on effectiveness
B) Summary of safety issues - link to Dr. Gillman's work on this
C) Asking Dr. to prescribe MAOI
D) Nardil vs Parnate
E) Initial titration to therapeutic dose
1) Cessation period for different SSRIs (e.g Fluvoxamine - 3 weeks!), bridge meds
2)Common side effects, some indication of how often they occur
3)Common experiences as dosage rises (e.g. Nardil hits depression first, Parnate is really good at high dose)
4) Monitoring blood pressure - link to Dr. Gillman page
5)Medications to treat short term side effects
6)Recommended meds to augment therapeutic response
7) possible details on sleep meds since almost everyone experiences MAOI insomnia, sleep meds are practically required

F) Long term maintenance
1)Poop out - how often does it happen? How to prevent / reverse
2)Common long term side effects, long term safety record (very well known!)
3)Meds used for treatment of long term side effects 
4)Utility of norepinephrine reuptake inhibitor to block pressor response

G) More detailed explanation of diet/drug issues
1) brief summary of how MAO inhibition works 
2)serotonin toxicity 
3)pressor response 
4)Links to relevant Dr. Gillman pages on this topic.

H) Treatment anecdotes.

I) If MAOIs are so good, why don't more doctors prescribe them?

J) Relevant scholarly articles or other links.

Maybe a list of pros and cons compared to other med classes?

So I know some of what I would write in these different categories, but I really do believe we can get better results as a team. We could do this via something like google docs OR just by editing last forum post. I haven't worked on google docs with many contributers, but I think the way to do this would be to give a couple of people permission to be editors rather than opening the doc up to EVERYONE since the doc could get deleted, vandalized etc.

We could fold some of the existing forum anecdotes into the FAQ. I just don't want the FAQ to be nothing but anecdotes.

I listed my suggestion for organizing FAQ, we can do something else, but I do think we need to *have* a structure and any contributions to FAQ should try to divide up the response into neat little chunks that fit under the FAQ headings.

Input is welcome. I will check in to the community from time to time, I love helping people with this sort of stuff and talking about my own cocktail, but I would love to finish an FAQ as a sort of magnum opus.

Alex are you ready to down some Vyvanse and write the entire FAQ in one sitting? :O
Or we could have Ultrashy summarize everything as easily as "MAOIs RULE! no side effects ***** the FDA"
Dave can tell everyone how awesome recreational drugs are on MAOIs 
Zeus is our nootropic expert
I think jaiho has a healthy degree of skepticism that would be welcome, too. He can be the devil's advocate > After all, there are 1000 published scholarly articles that claim all antidepressants are equally effective! ROFL
Anecdotes are always welcome from anyone! And sorry if I didn't list your name here, just a little inside jokes for some of the regulars


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## SFC01

@Gillman fan, great idea that could be extremely helpful for people, and i`ll help anyway I can.

I`ll check with my lawyer first about whether my section on recreational drugs is a good idea or not


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## watertouch

Hahaha yeah 'That'll Be the Day'. A really, really long day... :grin2:
Naa i'll pass, besides i think that i might have dyslexia.

But i like your initiative to write this!


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## watertouch

It should atleast be a new sticky that links to Dr Gillmans PDF about MAOI Diet Drug Interactions.
I have probable posted a link to it some 78 times...

http://psychotropical.com/images/Publications-pdfs/MAOI_diet_drug_interactions_2017.pdf


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## zeusko87

Gillman fan said:


> Zeus is our nootropic expert


what to say. I am a nootropic guru :grin2:

Now for real. From my experience nootropics work better and with less side effects than many prescription medications.

Some of my favorite nootropics:

1.) Depression (Tianeptine)
2.) Anxiety (L-theanine, Lemon Balm, Phenibut)
3.) ADD/ADHD (Phenylpiracetam, Bromantane, Selegiline)
4.) Fatigue (Modafinil, Ventolin, Caffeine, echinacea)
5.) Cognitive enhancement (Ginkgo Biloba, B-complex, Noopept)


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## Apexio

Great idea, I like your structure. SAS is already the best source for maoi-info, but they are all over the place... Maybe we could also provide a list of doctors in different places who like to work with maois.


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## Gillman fan

I think what I will do is just create a google doc with the skeleton outline, people can start posting whatever they want in there.... I literally have to catch a cab right now so I don't have time yet, I will try to get on it later tonight.. I will send out invitations for people to have editor status, basically anyone who asks who has been on these forums a few months actively posting.

Anyone have a webhosting ideas? This would be much much better even as a basic HTML document, dunno if forum supports that. Maybe we can host FAQ on forum but have link to separate site. Maybe Dr. Gillman would host? Reminder to self - I really owe that guy a donation.


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## watertouch

We could make a "group" where we write and talk about the FAQ.
http://www.socialanxietysupport.com/forum/groups/

And make another thread here where everyone can post about their experiences of MAOIs.


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## Caedmon

I would be happy to pass on whatever information I have on MAOI augmentation strategies.


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## Gillman fan

*FAQ is started, links have been sent! You can type directly in the shared Google Document! It is time to contribute!*
Everyone who has received a link should have permission to edit the document. If anyone else wants to request access to the FAQ please PM me.

I encourage everyone to write directly in the Google Document. Right now I am just trying to _structure_ and _coordinate_ this thing, not pick and choose exactly what goes in each category. You do not need my permission to contribute - just post your information directly into the shared google doc. There are just a few rules that will make this easier on everyone:

1. Don't delete anyone else's content - just write what you want to separately under the appropriate heading. 
2. If you want a new heading (e.g. finding an MAOI doctor) just write it at the end of the FAQ
3. The FAQ is divided into a 1 page "idiot" section and a longer "semi-educated moron" section. Try to keep anything in the idiot section really really short and avoid big words. The organization and topics of the idiot section are completely up for grabs, feel free to write your own version of the entire idiot section if you want. 
4. Feel free to add comments directly to the FAQ, Google docs has a comment feature, look in the upper right hand corner of the screen.

*Everyone can contribute something* - there is plenty of work to do. I typed some crap out while on the plane but left a lot of notes for myself where links should be inserted, statistics verified, etc. Feel free to write a new version of whatever I have posted - I am trying hard but I tend towards using big words and scientific detail... we might be better off with 12th grade English.

Everyone can contribute one or two sentence "blurbs" as well as longer "anecdotes."
Negative experiences or information are fair game as well. E.g. "I just couldn't stand the side effects," "I waited 5 months but Nardil didn't kick in," etc. We might want to insert these into relevant sections of the FAQ later... I have heard that morons like it when a dense section on drug interactions is broken up with some inspiring quotation.

This forum and some other places on the internet contain a gold mine of blurbs and anecdotes. You can just search for old posts and copy them directly into the FAQ - just attribute quotes properly please. Chop Suey was one prolific poster who is no longer around and had good info and quotes. Chairman MAO on Dr. Bob's forums is another guy I want to re-read his posts. 
Maybe people who have been around a while can contact old forum posters they know who might want to contribute?

There are lots of headings that are completely blank for now. You don't need to be the world's greatest expert to contribute here... eventually everything in the FAQ should be vetted by multiple people.

Links to journal articles are good - the purpose here is not to try to make a scholarly documents with footnotes on every sentence, but to provide a resource where readers can dig deeper.

*This is the first round of the writing process. *
This goal right now isn't to produce a finished and polished FAQ, we should just gather all the information we can and then decide what to put in the FAQ later. _Don't get hung up on details_, and remember that this is ultimately an MAOI FAQ, lets try not to get too sidetracked on extraneous matters like the pros and cons of benzodiazepines

*Long term goals - *
At some point I would like to close things off to new content and we focus on narrowing things down, we can discuss which info is most important, or try to resolve clashing information, etc. Our collective consciousness should really provide some good insights here.

Eventually, we can polish and finalize the FAQ. I reserve the right to just do this myself or maybe appoint a few people who would have exclusive responsibility over certain headings.

Then a final round of approval and vetting, including with Dr. Gillman, mainly looking for errors in order to ensure accuracy. Dr. Gillman should have final say on any health/safety issue and we aren't going to argue with him, we are just kind of summarizing what he wrote with links to his website for more detail where necessary. We should be able to finish this whole project in a few months. Also we should figure out where to host FAQ, and make it into a sticky, insert HTML links to navigate around the document, etc.

If someone wants to argue with me about any of this, go ahead, but we will have plenty of time to re-organize things later, delete entire headings, add new ones in etc. The purpose of the FAQ structure right now is to make it easy for everyone to contribute while maintaining enough organization that we can easily reach consensus on particular topics.

On a personal level, I am in remission but I have a long period of my life I need to make sense of, put behind me. Using the lessons I learned to help others helps give my personal tragedy meaning and closure. I am proud to be working on this and I don't think there is any other corner of the internet that can compare to this forum when it comes to patient expertise and knowledge on MAOIs. I really think if we put our heads together we can make the best source of information for patients on the internet.


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## Gillman fan

So.. no contribution or feedback in 2 days. I guess people aren't as interested as I had hoped. Is there anything holding people back that would make it easier to contribute?


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## watertouch

^
Im on an ASUS laptop with no backlit keyboard and a "smart touch pad" I was actually gonna message you and ask if there is any saved copy of the text...
* Im scared that i might accidentaly delete the whole thing!*

Yeah im re-reading the Norwegian book Psykofarmaka from 2015, its basicly where we stand in "Scandinavistan"... Sweden, Norway, Denmark

Problem is that its in Norwegian, and it was a page in it about MAOI that i took a picture of, and contacted Dr. Gillman about, I Showed him the picture and a translation. 
He went:  :um :mum !

Its written by Trond Aarre, specialist in psychiatry
https://www.ncbi.nlm.nih.gov/pubmed/?term=Aarre%20TF%5BAuthor%5D&cauthor=true&cauthor_uid=12888407

And the "dinosaur" Odd Lingjaerde
Odd Lingjærde, Professor Emeritus, is a physician and specialist in psychiatry. He has been a professor of psychiatry at the University of Tromsø and Oslo and has conducted extensive research, especially within psychopharmacology. Lingjærde was for a number of years head of department at Gaustad Hospital. He is an honorary member of the Norwegian Society for Biological Psychiatry and the Scandinavian College of Neuropsychopharamacology.
https://www.ncbi.nlm.nih.gov/pubmed/?term=Lingjaerde O[Author]&cauthor=true&cauthor_uid=8256649


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## Gillman fan

In google docs you can see any changes and revert them under "see revision history." So basically it is being automatically saved and it is easy to see changes or go back to an earlier version.


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## SFC01

@*Gillman* fan, had a brief look through the doc but have been hectic at work and a bit mind ****ed at the end of the day (i look at spreadies and docs all day at work !!)

Hopefully will have a good look through tomorrow.


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## scarpia

zeusko87 said:


> 5.) Cognitive enhancement (Ginkgo Biloba, B-complex, Noopept)


What brand ginkgo do you take? You know a couple of years back the New York State attorney general's office found that there was no ginkgo in several brands of ginkgo. 
https://www.washingtonpost.com/news...fake-herbals/?utm_term=.6ce89d15fbcb#comments


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## Sweeto

Probably little bit off topic but anyway

Is there any other med as effective as Nardil for depression/lifting mood beside all typical ADs like SSRIs etc.? Thanks


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## Gillman fan

Sweeto said:


> Probably little bit off topic but anyway
> 
> Is there any other med as effective as Nardil for depression/lifting mood beside all typical ADs like SSRIs etc.? Thanks


You are right. This is *off topic*. Please limit discussion to stuff relevant to the FAQ.

I am still interested in this, but for now the whole schedule is being opened up... I typed 8 pages or so myself, but I can't write a "community FAQ" myself.

Hopefully people will feel better, be less busy etc. and interest will grow in working on this. For me at least, I learned a lot on these forums and this is my way of giving back.


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## Cassoulet94

Gillman fan said:


> Sweeto said:
> 
> 
> 
> Probably little bit off topic but anyway
> 
> Is there any other med as effective as Nardil for depression/lifting mood beside all typical ADs like SSRIs etc.? Thanks
> 
> 
> 
> You are right. This is *off topic*. Please limit discussion to stuff relevant to the FAQ.
> 
> I am still interested in this, but for now the whole schedule is being opened up... I typed 8 pages or so myself, but I can't write a "community FAQ" myself.
> 
> Hopefully people will feel better, be less busy etc. and interest will grow in working on this. For me at least, I learned a lot on these forums and this is my way of giving back.
Click to expand...

Hey, I m willing to participatr but there are two things that bother me in the fac:
- it looks a bit like a ken gillman fan page. I respect the guy for his knowledge about maois and his dedication but I think we need to diversify the sources. I can help with that.
- Let's not forget this is a forum about social anxiety. A lot of us are/were also suffering of depression but the focus should be on SA. So for example we need to mention that parnate, albeit having less side effects than nardil, has been less studied that the former when it comes to sa. It is also something to take into consideration when you have to chose between both of them. Let's try to stay neutral as much as possible.

I don't say that to be a pain in the ***, I think a fac is a good initiative, but I like to speak my mind.


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## watertouch

*^
*yes, good catch!
Got me thinking about Blancos article from 2010. It mentions 2 studies of Parnate for SAD. 
This also has some good info about Nardil.

*Psychopharmacology for SocialAnxiety Disorder*
Carlos Blanco, Franklin R. Schneier, Mayumi Okuda, and Michael R. Liebowitz
http://sci-hub.bz/10.1016/B978-0-12-375096-9.00019-5



> Two open trials studying the effect of the MAOI tranylcypromine on SAD have also been published. In the first one, Versiani, Mundim, Nardi, and Liebowitz (1988) treated 32 patients with SAD for up to one year. Of the 29 patients who completed at least one month of treatment, 62% showed marked improvement, 17% showed moderate improvement,
> 
> In a second study, an eight-week open trial including 81 patients, Versiani, Nardi, and Mundim (1989) found statistically significant reductions in both CGI Scale severity and Liebowitz Social Anxiety Scale (LSAS) scores.


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## harrys

why are mods so keen on shilling specifically MAOIs on this forum? in the poll they didn't even get that great an approval rating, somethinglike 2:1 positive


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## watertouch

harrys said:


> why are mods so keen on shilling specifically MAOIs on this forum? in the poll they didn't even get that great an approval rating, somethinglike 2:1 positive


What poll would that be?


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## ParnateOrg

Currently the MAOI group is right at π times better than SSRIs in the poll (3.142661).


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## Cassoulet94

harrys said:


> why are mods so keen on shilling specifically MAOIs on this forum? in the poll they didn't even get that great an approval rating, somethinglike 2:1 positive


That's way better than other AD classes. Also a lot of people here are treatment resistant and were not helped by ssris.


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## harrys

Cassoulet94 said:


> That's way better than other AD classes. Also a lot of people here are treatment resistant and were not helped by ssris.


true enough and now it's got over 3:1 positive feedback which is impressive

http://www.socialanxietysupport.com...medications-have-been-succesful-for-your.html this is the poll we're talking about by the way

forgive me for being skeptical, just never so many people keen on an anti-depressant


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## Cassoulet94

harrys said:


> Cassoulet94 said:
> 
> 
> 
> That's way better than other AD classes. Also a lot of people here are treatment resistant and were not helped by ssris.
> 
> 
> 
> true enough and now it's got over 3:1 positive feedback which is impressive
> 
> http://www.socialanxietysupport.com...medications-have-been-succesful-for-your.html this is the poll we're talking about by the way
> 
> forgive me for being skeptical, just never so many people keen on an anti-depressant
Click to expand...

Well they are no miracle pills for sure they don't work some and can have a lot of side effects, especially nardil. But for sa, when it comes to ad, they are the most likely to help you.


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## Cassoulet94

harrys said:


> Cassoulet94 said:
> 
> 
> 
> That's way better than other AD classes. Also a lot of people here are treatment resistant and were not helped by ssris.
> 
> 
> 
> true enough and now it's got over 3:1 positive feedback which is impressive
> 
> http://www.socialanxietysupport.com...medications-have-been-succesful-for-your.html this is the poll we're talking about by the way
> 
> forgive me for being skeptical, just never so many people keen on an anti-depressant
Click to expand...

Also they may be a bit overhyped around here.


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## ParnateOrg

You say "Also they [MAOIs] may be a bit overhyped around here". Is that because such a forum as this may well be *over-represented* by treatment-RESISTANT cases, whether of SA or DEP? This would simply mean that MAOIs are stronger medicines. I have pulled every single... every single... EVERY SINGLE (according to the research librarians at a prominent school in the science and health-science libraries) study on extracellular serotonin levels on MAOIs.

Does anyone care to know how much more POWERFUL MAOIs are versus SSRI/SNRIs vis-a-vis serotonin increase?


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## neonknight77

ParnateOrg said:


> You say "Also they [MAOIs] may be a bit overhyped around here". Is that because such a forum as this may well be *over-represented* by treatment-RESISTANT cases, whether of SA or DEP? This would simply mean that MAOIs are stronger medicines. I have pulled every single... every single... EVERY SINGLE (according to the research librarians at a prominent school in the science and health-science libraries) study on extracellular serotonin levels on MAOIs.
> 
> Does anyone care to know how much more POWERFUL MAOIs are versus SSRI/SNRIs vis-a-vis serotonin increase?


Sure.


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## ParnateOrg

.... nah... I mean why bother, when we can just let Pharma companies tell us things like,


> "our new anti-depressant is [a super mother-****ing] improvement over [the other ADs ... THAT WORK BY THE VERY SAME MECHANISM...]


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## Cassoulet94

ParnateOrg said:


> You say "Also they [MAOIs] may be a bit overhyped around here". Is that because such a forum as this may well be *over-represented* by treatment-RESISTANT cases, whether of SA or DEP? This would simply mean that MAOIs are stronger medicines. I have pulled every single... every single... EVERY SINGLE (according to the research librarians at a prominent school in the science and health-science libraries) study on extracellular serotonin levels on MAOIs.
> 
> Does anyone care to know how much more POWERFUL MAOIs are versus SSRI/SNRIs vis-a-vis serotonin increase?


I do think they are a little overhyped here, yes. Threads like "nardil the road toward hapiness" or "nardil and parnate, are they ever ineffective" sounds a little ridiculous to me. Also some people here really seem to hate ssris and speak about them as if they were the devil. It doesn't mean I don't think MAOIs are the most powerful AD. Just, sometimes, some people get carried away.

How about maois vs ssris when it comes to serotonin increase ?


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## ParnateOrg

SSRIs - let's all be honest and include Trintellix and Viibryd - are limited because _their mechanism of action is inferior_. But psychiatrists across the board believe them (vis-a-vis MAOIs) to be "safe", none having kept up to date on the now trivial (read: completely safe in normal portions) amount of tyramine in foods. Psychiatrists (and i do mean 98% +) also couldn't tell you the difference between Serotonin Syndrome (Toxicity) and Neuroleptic Malignant Syndrome or for that matter, a completely unrelated headache that they doltishly attributed to the (first) MAOI they just prescribed.


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## ParnateOrg

2 ppl care. "Fascinating". will gbty asap


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## neonknight77

ParnateOrg said:


> SSRIs - let's all be honest and include Trintellix and Viibryd - are limited because _their mechanism of action is inferior_. But psychiatrists across the board believe them (vis-a-vis MAOIs) to be "safe", none having kept up to date on the now trivial (read: completely safe in normal portions) amount of tyramine in foods. Psychiatrists (and i do mean 98% +) also couldn't tell you the difference between Serotonin Syndrome (Toxicity) and Neuroleptic Malignant Syndrome or for that matter, a completely unrelated headache that they doltishly attributed to the (first) MAOI they just prescribed.


Must remember both have different mechanisms, so each will be better suited toward specific individuals. MAOI's let neurotransmitter do their things, while SSRI's and or new-generation AD's actually try to control the way neurotransmitters work. Big difference. Although with this generation of people, I am not surprised they tend to prescribe SSRI's. Some people just don't have the right mindset to be flourishing.


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## ParnateOrg

"Must remember both have different mechanisms, so each will be better suited toward specific individuals. " - neonknight77

The fact that MAOIs and SRI drugs have different mechanisms of action means in no way that the two classes are equivalent or equipotent, or that one class will be necessarily or inherently better suited to one individual or another. Their purpose is the following, (and BTW drives the multi-billion dollar AD development industry) : to increase serotonin (and in the case of MAOIs, dopamine and noradrenaline) in the synapse.

Will give proper analysis soon, but suffice it to say FOR NOW at least, that we are looking at ~ a 2,000% versus %500 increase. Yes. 4 times difference. At least. With Tranylcypromine even greater.

I'll post research with citations, and welcome - defy - anyone to gainsay the results. A nice discussion may come out of it. The data, as they say, are howsoever, in the "majorest" of ways, on my side.


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## ParnateOrg

I should emend the following... there may well be ways in which SRI drugs and MAOI drugs work differently for different patients - it does, however, seem to be on the side of the MAOI drugs, i.e., volume transmision, etc. By being specific, the SSRIs have limited their scope of therapeutic effect. But,... let's all remember..., they're.. "safe".
Horse****.


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## neonknight77

ParnateOrg said:


> "Must remember both have different mechanisms, so each will be better suited toward specific individuals. " - neonknight77
> 
> The fact that MAOIs and SRI drugs have different mechanisms of action means in no way that the two classes are equivalent or equipotent, or that one class will be necessarily or inherently better suited to one individual or another. Their purpose is the following, (and BTW drives the multi-billion dollar AD development industry) : to increase serotonin (and in the case of MAOIs, dopamine and noradrenaline) in the synapse.
> 
> Will give proper analysis soon, but suffice it to say FOR NOW at least, that we are looking at ~ a 2,000% versus %500 increase. Yes. 4 times difference. At least. With Tranylcypromine even greater.
> 
> I'll post research with citations, and welcome - defy - anyone to gainsay the results. A nice discussion may come out of it. The data, as they say, are howsoever, in the "majorest" of ways, on my side.


I will just give you a basic understanding real quick, because you seem interested.

New-generation AD's such as SSRI's (what you are quoting) yes, only work in the synapse. Brain. They "may" have an effect on other area's of body where its destination receptors are affected, but it is neglectable compared to next statement.

MAOI's increase neurotransmitters (by inhibiting its recycle) found all along the body, not the just brain. If you are not educated yet that neurotransmitters are found below the neck, then please educate yourself. Half, if not more, of serotonin is found inside your gut, for example. Some studies estimate that 90% of serotonin is synthesized in the digestive tract. Something MAOI's also react on.

This subject is very complex, so please check it out .

Modern therapy aims to improve symptoms, not cure disease at the moment. Look in to Stahl's new method of therapy, which unfortunately is still symptom based, just precisioned toward specific circuits. I do not much agree, but I will let the "founding fathers" do their work before their time comes and goes, and they see different methods. Probably just not as well $$$ intended.


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## Cassoulet94

ParnateOrg said:


> I should emend the following... there may well be ways in which SRI drugs and MAOI drugs work differently for different patients - it does, however, seem to be on the side of the MAOI drugs, i.e., volume transmision, etc. By being specific, the SSRIs have limited their scope of therapeutic effect. But,... let's all remember..., they're.. "safe".
> Horse****.


I must say I m pretty skeptical since phenelzine is supposed to inhibit more mao A than tranycypromine and thus to have a more potent effect regarding serotonin. Also you figures don't make a lot of sense if you don't mention where the serotonin increase happens. Levels vary according to the part of your brain/body you consider.

Anyway, I'm waiting for the "proper analysis".


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## ParnateOrg

Hi and thanks for the responses. Let me apologize for my annoyed mood in my previous post(s). 



What makes me frustrated is that we have 60 year old drugs that are stronger than the newer ones, but when a patient doesn't respond to SSRI + (anxiolytic/mood-stabilizer/stimulant, etc) the next phase is to have the patient spend $thousands on ECT/TMS/Vagus Nerve Therapy etc., rather than try an MAOI that could alleviate patient suffering 1) often better/longer and 2) much cheaper. 

A quick review on microdialysis studies. These microdialysis studies are done in the brain, and although any particular ROI may be measured, very common ROIs are PFC and Raphe Nuclei (esp Dorsal). The challenge as I go through the study data is to make ensure I compare apples to apples, for example, a study that measures levels in the Striatum can't be compared with one that measures levels in the MRN. There are several other factors to be considered, for example time between probe insertion and dialysate measurement

Just a reminder - I'm looking at MAOIs as a class versus SSRIs as a class, not differences within classes (say, Tranylcypromime versus Phenelzine). Tranylcypromine does seem to have a greater effect on Serotonin increase after 100% MAOI inhibition, and psychiatrists report therapeutic effect above full inhibition. The reasons for this aren't fully known, although some speculations could be made. Sorry to get off track.


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## ParnateOrg

A previous study seems to match what I've found so far:


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## neonknight77

ParnateOrg said:


> A previous study seems to match what I've found so far:


Are you surprised by this information? MAOI's like previously mentioned, increase overall neurotransmitter found throughout the whole body. New-generation AD's typically only elevate neurotransmitters in the brain which are not as profound (as you can infer).

Can you explain the relativistic difference in SSRI's ability increase serotonin to a greater degree than TCA's?

And you say that we have drugs that are older (TCA's) and much better than SSRI's, yet they do not increase serotonin as much. How can you explain this? Just purely curious.


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## ParnateOrg

I'm not in the least surprised, no. I do hope you are not missing the point that these microdialysis studies are done in the brain. They are not taking into account SER levels in the bloodstream. This is key.

The difference in serotonin increase shown by SSRIs relative to TCAs: Only 2 TCAs have truly strong affinity for the SERT (serotonin membrane transporter): Clomipramine and Imipramine. Amitriptyline is mediocre, although has never caused Serotonin Toxicity when combined with MAOIs. Other TCAs have low or no affinity for SERT, and act more strongly at Norepinephrine, Histamine, Muscarinic-cholinergic receptors. 

In other words, taken as a group, TCAs are hardly serotonergic at all. But Clomipramine has to this day one of the highest affinities for the Serotonin Transporter (Ki ~ 0.13 if I remember correctly.)


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## ParnateOrg

As serotonin doesn't cross the blood-brain barrier (or 1 - 2%) your point about isolating measurements to extracellular fluid in the brain is a good one. I should mention that SRI drugs (whether SSRIs or TCAs) also do increase plasma serotonin levels, not just MAOIs.*

*Serotonin and fluoxetine levels in plasma and platelets after fluoxetine treatment in depressive patients.Blardi P, De Lalla A, Leo A, Auteri A, Iapichino S, Di Muro A, Dell'Erba A, Castrogiovanni P
J Clin Psychopharmacol. 2002 Apr; 22(2):131-6.


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## Gillman fan

ParnateOrg - welcome to the SAS forums. I am also using Parnate but I am ludicrously treatment-resistant, even to 150 mg Parnate, so I have a special cocktail to potentiate Parnate.

I just want to remind everyone that this thread is dedicated to an MAOI FAQ. Cassoulet feels MAOIs are overhyped, the purpose of the FAQ is not really to "sell" MAOIs but to be informative and *concise*

Talking about the pros and cons of MAOIs compared to other med classes would be great for the FAQ.

Remember - this is an FAQ thread and *anyone can contribute to the FAQ*. The idea is to start with an intro for idiots, move on to a larger explanation, and then finally if people are still interested we can include all the studies at the bottom of the FAQ.

I am sending out links to people so you can view and edit the FAQ.

Also - Cassoulet - if you have authoritative sources on diet/drug interactions other than Gillman go ahead and post them. I am not trying to stop you. Just put it in the FAQ! We can neaten it up later. Also your point re social anxiety is well taken. This is why I want a community FAQ! I am just trying to organize it so the whole community can contribute. I personally had issues more along the lines of social anhedonia than anxiety per se, and my cocktail is working amazingly well.


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## zapped

*Parnate and jaw clenching*

I seem to be experiencing some repetitive clenching of my teeth or jaw with Parnate.

I am about a week into a titration to 10 mg 3 times a day.

I haven't spoken with my doc yet about this, but will at my next appointment.

My blood pressure is holding at normal levels despite eating a little parmesan and cheddar cheese.

There seem to be a small number of reports of jaw clenching type problems. It's like I find myself closing my mouth and tightening my bite over and over; I'm trying to stay conscious of this and not do it so much.

Otherwise, I feel well, except for some fatigue, and achy and run-down feelings which I don't see listed as side effects anywhere.

I've been taking Ativan / lorazepam during a transition from Viibryd to Parnate, which helps some with anxiety. I do feel paradoxically more activated and fatigued, but I am getting some beneficial improvement in mood (spontaneously found myself cleaning the kitchen and humming a little tune, etc.) Panic seems to be about the same. I'm still having a lot of trouble leaving the house to go into town, but I think I do feel less fearful overall when I am out in public, and haven't noticed many obvious signs of acute anxiety.

I hope this is appropriate here, and helpful.


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## zapped

*Parnate and Jaw Clenching*

Hi, I'm trying to post this again because I don't think I finished the registration process the first time:

I seem to be experiencing some repetitive clenching of my teeth or jaw with Parnate.

I am about a week into a titration to 10 mg 3 times a day. I started it as an antidepressant, and did not know it was useful for social anxiety!

I haven't spoken with my doc yet about this problem and this aspect of the med, but will at my next appointment.

My blood pressure is holding at normal levels despite eating a little parmesan cheese with spaghetti for dinner and some cheddar cheese in a chili relleno for lunch.

There seem to be a small number of reports of jaw-clenching type problems. It's as if I find myself closing my mouth and tightening my bite over and over; I'm trying to stay conscious of this and not do it so much.

Otherwise, I feel well, except for some fatigue, and achy and run-down feelings which I don't see listed as side effects anywhere.

I've been taking Ativan / lorazepam during a transition from Viibryd to Parnate, which helps some with anxiety. I do feel paradoxically more activated and fatigued, but I am getting some beneficial improvement in mood (spontaneously found myself cleaning the kitchen and humming a little tune, etc.) Panic seems to be about the same. I'm still having a lot of trouble leaving the house to go into town, but I think I do feel less fearful overall when I am out in public, and didn't many obvious signs of acute anxiety despite 2 A.A. meetings and buying a refrigerator in a home improvement store today.

I hope this is appropriate here, and helpful.


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## watertouch

Feel that Sven Ulrich review article on tranylcypromine need to be linked in here.

Tranylcypromine in mind Part 1 review of pharmacology
Sven Ulrich, Roland Ricken, Mazda Adli
http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30252-3/fulltext

Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression
Roland Ricken, Sven Ulrich, Peter Schlattman, Mazda Adli
http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30230-4/fulltext


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## UKguy

watertouch said:


> Feel that Sven Ulrich review article on tranylcypromine need to be linked in here.
> 
> Tranylcypromine in mind Part 1 review of pharmacology
> Sven Ulrich, Roland Ricken, Mazda Adli
> http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30252-3/fulltext
> 
> Tranylcypromine in mind (Part II): Review of clinical pharmacology and meta-analysis of controlled studies in depression
> Roland Ricken, Sven Ulrich, Peter Schlattman, Mazda Adli
> http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30230-4/fulltext


Where is the google doc that you guys are talking about... I can't see the link?
Also the above links don't seem to work for me..

Maybe my eyes/brain/internet have just crapped out this morning.


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## watertouch

UKguy said:


> Where is the google doc that you guys are talking about... I can't see the link?
> Also the above links don't seem to work for me..
> 
> Maybe my eyes/brain/internet have just crapped out this morning.


For the google doc you need an invitation from @*Gillman fan*

The Links above in PDF
Part 1
http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30252-3/pdf

Part 2
http://www.europeanneuropsychopharmacology.com/article/S0924-977X(17)30230-4/pdf

Hope them works


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## poopypants

zapped said:


> Hi, I'm trying to post this again because I don't think I finished the registration process the first time:
> 
> I seem to be experiencing some repetitive clenching of my teeth or jaw with Parnate.
> 
> I am about a week into a titration to 10 mg 3 times a day. I started it as an antidepressant, and did not know it was useful for social anxiety!
> 
> I haven't spoken with my doc yet about this problem and this aspect of the med, but will at my next appointment.
> 
> My blood pressure is holding at normal levels despite eating a little parmesan cheese with spaghetti for dinner and some cheddar cheese in a chili relleno for lunch.
> 
> There seem to be a small number of reports of jaw-clenching type problems. It's as if I find myself closing my mouth and tightening my bite over and over; I'm trying to stay conscious of this and not do it so much.
> 
> Otherwise, I feel well, except for some fatigue, and achy and run-down feelings which I don't see listed as side effects anywhere.
> 
> I've been taking Ativan / lorazepam during a transition from Viibryd to Parnate, which helps some with anxiety. I do feel paradoxically more activated and fatigued, but I am getting some beneficial improvement in mood (spontaneously found myself cleaning the kitchen and humming a little tune, etc.) Panic seems to be about the same. I'm still having a lot of trouble leaving the house to go into town, but I think I do feel less fearful overall when I am out in public, and didn't many obvious signs of acute anxiety despite 2 A.A. meetings and buying a refrigerator in a home improvement store today.
> 
> I hope this is appropriate here, and helpful.


I had this the first 6 weeks of taking Nardil. I actually had increased anxiety that entire time (and I'm prone to anxiety-induced jaw clenching). It's pretty much gone away but I still experience soreness. My dentist said my teeth are fine and that the pain should fade now that the clenching has stopped. I still wear a mouth guard at night just in case 

From the sounds of it, you're a "recovering alcoholic"? I am as well, which I think made the initial MAOI anxiety way worse than for most people. I'd recommend discontinuing the Ativan as soon as you can. Trust me, I know how good Ativan feels but the longer you take it the more you'll suffer. I was given clonazepam for a year and getting off of it was hell on earth.

I found an evening dose of Gapapentin helped me taper off and eventually quit zoplicone (a different GABA sleeping med), and now I'm off the Gabapentin. You could consider Ativan -> Gabapentin before tapering to something even more light.


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## Gillman fan

I have been MIA for the forums for quite some time, and there is some activity in this thread, but it seems people are not sure what the thread was originally for or where the FAQ is right now.

The original idea was not for _me_ to write an FAQ but for a _community_ project, with multiple people contributing, discussing areas of disagreement, and ultimately producing a document that is simple and easy for anyone to understand. I mainly wrote an *outline* in order to give people ideas on the main topics that we should try to cover.

Anyone can edit the FAQ, you need the link, but you can get the link from other people. If you want a link, PM me, or you can also PM anyone else who has the link!

When (if?) more people get involved, I will get more involved, but I am not going to write the whole d*mn thing. I know nothing about Nardil and I have a very hard time using language that someone with a high school (12th grade) education would understand. We can write extra parts of the FAQ that delve into stuff like scholarly journals, neurotransmitters etc. but the people who are educated enough to understand that sort of thing are not the ones who need the help of an FAQ, since they can find information on their own.

If someone wants to sit down tomorrow and write ten pages go ahead! Right now, *there is no FAQ*. No one else contributed except for a few scholarly journals... which do not meet the goals of a document that is "simple and easy for anyone to understand." I wrote an outline and a few pages and that is it.


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## tcprocks

Count me on.


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## tcprocks

For those that need to take a large TCP dose (or not so large) I have experienced the following:


If you are taking a high dose vitamin B6 supplement reconsider that. B6 can interact with drug absorption *and* seems to be needed for MAO synthesis so the MAOI dosage needs to be larger.



You can take the TCP every third day with minimal loss of effectiveness if any. You can increase the dose 10-20% if you feel the need. The total amount of TCP taken weekly is enormously decreased.


Cheers. 



Disclaimer: YMMV as usual


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## SteveOReno

"Right now, *there is no FAQ*."

Why have a sticky thread saying it is a FAQ when it has no answers?

So I thought I would add an answer to a frequently asked question.

*What are the side effects of MAOIs?*

Here is a list of common potentially dangerous side effects of Nardil:
Chills
cold sweats
confusion
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
overactive reflexes
shakiness in the legs, arms, hands, or feet
sudden jerky movements of the body
swelling
trembling or shaking of the hands or feet
Less common potentially dangerous side effects of Nardil:
Abdominal or stomach pain
actions that are out of control
blindness
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
change in consciousness
clay-colored stools
dark urine
decrease in frequency of urination
decrease in urine volume
difficult or troubled breathing
difficulty in passing urine (dribbling)
disorganized thoughts
dizziness
drowsiness
false or unusual sense of well-being
fast, pounding, or irregular heartbeat or pulse
fear or nervousness
fever
general feeling of discomfort, illness, or weakness
headache
high blood pressure
increased sweating
irregular, fast or slow, or shallow breathing
irritability
itching
lack of emotion or feelings
loss of appetite
loss of consciousness
loud or fast speech
low blood pressure
muscle tremors
muscle twitching
nausea or vomiting
nervousness
no emotion or expression in speech
painful urination
pale or blue lips, fingernails, or skin
rapid, deep, or shallow breathing
rash
restlessness
seeing or hearing things that are not there
seizures
shakiness and unsteady walk
shortness of breath
slow or irregular heartbeat
stomach cramps
sweating
swelling of the feet or lower legs
talking, feeling, and acting with excitement
uncontrolled eye movements
unpleasant breath odor
unsteadiness, trembling, or other problems with muscle control or coordination
unusual paleness
unusual tiredness or weakness
vomiting of blood
weakness
yellow eyes or skin

Here is a list of typical, but not dangerous, side effects of Nardil:
Constipation
decreased interest in sexual intercourse
diarrhea
dry mouth
inability to have or keep an erection
indigestion
loss in sexual ability, desire, drive, or performance
loss of appetite
not able to have an orgasm
passing of gas
sleeplessness
stomach pain, fullness, or discomfort
trouble sleeping
unable to sleep
unusually deep sleep
unusually long duration of sleep
weight gain
blurred vision
decreased vision
eye pain
redness, swelling, or soreness of the tongue
tearing


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