Tricyclic Antidepressants

I'd love to hear your suggestions – MAOI(r) case

Question:

Hello everyone, I have been posting about the case taking MAOI(r) and the transition from Imipramine; how it is better as Imipramine is much like a hammer, etc. At this point, I would say that the side effects of MAOI(r) are beginning to show – it IS better than Imipramine, BUT there is one side effect which just may make it unfeasible – ANXIETY.  Is this common in anyone’s experience. There is another problem with this case of Miss X. She is very reluctant to keep trying drug after drug after drug – and I cannot blame her.  I’m very worried. I think this may be something a lot of people go through, and I do wish I could find a solution as to the right drug.  Her doctor just goes by the book I think, not really knowing much more than she does. Any suggestions? Thank you kindly Squiggles

Response:

> Hello everyone, > I have been posting about the case taking MAOI(r) > and the transition from Imipramine; how it is better > as Imipramine is much like a hammer, etc. > At this point, I would say that the side effects > of MAOI(r) are beginning to show – it IS better > than Imipramine, BUT there is one side effect which > just may make it unfeasible – ANXIETY.  Is this > common in anyone’s experience.

Forgive me, Squig, but I’ve heard so many peoples’ stories, I might be mixing things up; was there not also a history of benzodiazepine useage here? There is a long-term dysregulation of GABA-receptor function following withdrawal from benzos. It can take many months for the body to achieve homeostasis. > There is another problem with this case of Miss X. > She is very reluctant to keep trying drug after drug > after drug – and I cannot blame her.  I’m very worried. > I think this may be something a lot of people go > through, and I do wish I could find a solution as > to the right drug.  Her doctor just goes by the book > I think, not really knowing much more than she does. > Any suggestions?

Ummm, yes, patience for one. I know very well how hard it is to be patient during the time it takes to see if side-effects spontaneously resolve or not. Antidepressants, unfortunately, cannot be administered solely to the brain; they are systemic meds, and affect the whole body. MAO, the enzyme affected by moclobemide, is found throughout the body. It "tips the balance" of a number of processes. For some of them, the body re-establishes balance (i.e. side-effects disappear over time). For others, the body cannot/does not (i.e. side-effects remain). The only way to know is to wait it out. That’s one of the reasons the doctor cannot predict what will happen. He’s nothing more than a patient observer. Focussing on the side-effects can have  the effect of making them feel larger. Consider the emergency room visit over what might have been simple gastroenteritis. Cognitive stress-relief ideas might be useful. E.g. meditation, hobbies, music, etc. Distractions, ya know? > Thank you kindly > Squiggles

You’re welcome, kindly. Larry

Response:

- Hide quoted text — Show quoted text -> Hello everyone, > I have been posting about the case taking MAOI(r) > and the transition from Imipramine; how it is better > as Imipramine is much like a hammer, etc. > At this point, I would say that the side effects > of MAOI(r) are beginning to show – it IS better > than Imipramine, BUT there is one side effect which > just may make it unfeasible – ANXIETY.  Is this > common in anyone’s experience. > Forgive me, Squig, but I’ve heard so many peoples’ stories, I might be > mixing things up; was there not also a history of benzodiazepine useage > here? There is a long-term dysregulation of GABA-receptor function following > withdrawal from benzos. It can take many months for the body to achieve > homeostasis.

Hi Larry, I understand what it is like to monitor so many cases on the Net – it get confusing sometimes- good exercise for memory; I have noticed one thing – it so much preferable to have access to your own memory than to do tedious filing. Well, you do have the right details connected to the right person here, i.e. me – yes I am to be associated with benzos.  But I am not speaking of myself here, but Miss X who has a completely different medical history. – Hide quoted text — Show quoted text -> There is another problem with this case of Miss X. > She is very reluctant to keep trying drug after drug > after drug – and I cannot blame her.  I’m very worried. > I think this may be something a lot of people go > through, and I do wish I could find a solution as > to the right drug.  Her doctor just goes by the book > I think, not really knowing much more than she does. > Any suggestions? > Ummm, yes, patience for one. I know very well how hard it is to be patient > during the time it takes to see if side-effects spontaneously resolve or > not. Antidepressants, unfortunately, cannot be administered solely to the > brain; they are systemic meds, and affect the whole body. MAO, the enzyme > affected by moclobemide, is found throughout the body. It "tips the balance" > of a number of processes. For some of them, the body re-establishes balance > (i.e. side-effects disappear over time). For others, the body cannot/does > not (i.e. side-effects remain). The only way to know is to wait it out. > That’s one of the reasons the doctor cannot predict what will happen. He’s > nothing more than a patient observer.

That’s very helpful. I guess you’re a doctor too.  So, perhaps, it is still too early to predict how Miss X will ride the side effects, so to speak. > Focussing on the side-effects can have  the effect of making them feel > larger. Consider the emergency room visit over what might have been simple > gastroenteritis. Cognitive stress-relief ideas might be useful. E.g. > meditation, hobbies, music, etc. Distractions, ya know?

Yup.  Thanks very much for your advice.  BTW, I notice your sympatico address, but I forget where you are in Canada. Squiggles

Response:

– Hide quoted text — Show quoted text -> Forgive me, Squig, but I’ve heard so many peoples’ stories, I might be > mixing things up; was there not also a history of benzodiazepine useage > here? There is a long-term dysregulation of GABA-receptor function following > withdrawal from benzos. It can take many months for the body to achieve > homeostasis. > Hi Larry, > I understand what it is like to monitor so many cases on > the Net – it get confusing sometimes- good exercise for memory; > I have noticed one thing – it so much preferable to have access > to your own memory than to do tedious filing. > Well, you do have the right details connected to the right person > here, i.e. me – yes I am to be associated with benzos.  But > I am not speaking of myself here, but Miss X who has a completely > different medical history.

OK, clear now. – Hide quoted text — Show quoted text -> > Any suggestions? > Ummm, yes, patience for one. I know very well how hard it is to be patient > during the time it takes to see if side-effects spontaneously resolve or > not. Antidepressants, unfortunately, cannot be administered solely to the > brain; they are systemic meds, and affect the whole body. MAO, the enzyme > affected by moclobemide, is found throughout the body. It "tips the balance" > of a number of processes. For some of them, the body re-establishes balance > (i.e. side-effects disappear over time). For others, the body cannot/does > not (i.e. side-effects remain). The only way to know is to wait it out. > That’s one of the reasons the doctor cannot predict what will happen. He’s > nothing more than a patient observer. > That’s very helpful. I guess you’re a doctor too.  So, perhaps, > it is still too early to predict how Miss X will ride the side > effects, so to speak.

I’m a patient observer, dispassionate in the sense of not having emotional ties to the observed person. Yes, far too soon, going by the "newer" protocol of ramping up doseage of each med until persistent side-effects prove to be intolerable. Just as the dose makes the poison, the dose is critical for relief from depression. A fair  trial of a med is long and involved process. Doctors have come to believe that a thorough test of a med is appropriate, rather than hopping from one med to another too soon. > Focussing on the side-effects can have  the effect of making them feel > larger. Consider the emergency room visit over what might have been simple > gastroenteritis. Cognitive stress-relief ideas might be useful. E.g. > meditation, hobbies, music, etc. Distractions, ya know? > Yup.  Thanks very much for your advice.  BTW, I notice your > sympatico address, but I forget where you are in Canada.

I hope it’s useful advice. I’m in Peterborough, about one hour’s drive NE of Toronto. Larry

Response:

Filed under: Imipramine