Posted by Molybdenum on May 25, 2008, at 19:54:11
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.., posted by undopaminergic on May 25, 2008, at 18:14:31
Thanks for all the suggestions undopa. I really appreciate it.
>Be *very* careful about using moclobemide with venlafaxine. The combination has the potential to precipitate hyperserotonergia (serotonin syndrome), >and deaths have been reported. Make sure you have cyproheptadine at hand as an antidote, and take a tablet if you find your temperature on the rise, as >the condition can sometimes progress rapidly to the point where consciousness is lost.
Yeah...I am a bit concerned. I've just taken my 3rd 150mg Moclobemide tab (over 3 days). I feel "slightly dizzy" but not enough to stop me driving, etc. Otherwise I have noticed my anxiety has reduced a lot. Time will tell if this is due to the drug or not. I have to remain hopeful, else why take anything? Doc said the anxiolytic effects were best at low doses, which is good. FYI, the data sheet says peak plasma concentration is reached at 7 days, so by then I guess I'll know if I'm going to get serotonin syndrome or not. ;)
I'd never heard of your suggested antidote "cyproheptadine" so I looked it up & found that it also sounds like a good sleeping pill. In fact it says "cyproheptadine enhances sleep quality and quantity whereas benzodiazepines tend to decrease sleep quality". Only downside is that is causes sedation. No good for me because it would be negating the effect of my ADs I suppose. Pity, sounds good otherwise.
>Benzos bind to GABA-A receptors, and I think gabapentin (Neurontin) and pregabalin (Lyrica) also work on the GABAergic system, so cross-tolerance >may be an issue. Perhaps alternating between GABAergic drugs (such as benzos) and opiates would be a better idea, as opiates work on their own set of >receptors rather than GABA.
Opiates are very hard to get here on account of their abuse potential. I've taken 60mg codeine with paracetamol as a pain medication post surgery & found that it really affected me mentally. I know you'd like me to be more precise but the best description I can come up with is that I felt very "out of it". So I think I'll have to pass on the codeine.
>Alcohol isn't a problem with MAOIs. Besides, there is a potential chemical solution to tyramine sensitivity, namely noradrenaline reuptake inhibitors, >such as reboxetine or even methylphenidate. Unfortunately, this solution remains theoretical as long as people don't dare try it.
I read a bit about the MAOI diet in my quest. Even Dr Bob has a page on it: http://www.dr-bob.org/tips/maoi.html#avoid From what I read, it's the tyramine content that is the main issue, and predicting how much tyramine is in the food you're about to eat is not so easy. The older the food is (aged cheese or wines) the more tyramine. I even read that spoiled fish has a lot more tyramine than fresh, but who the hell would intentionally eat spoiled fish??? If you thought it was fresh, you'd eat it. If you thought it was spoiled, you wouldn't. Beats me... So I think the level of dietary restriction you choose depends on how high your MAOI dose is and how cautious you want to be.
Good thing for me while I'm trying out moclobemide is that it doesn't really have any dietary restrictions. From the manufacturer's data sheet: "Thus an interaction with tyramine rich foods is of no clinical importance during moclobemide treatment under normal conditions..". If I choose to leave this world any time soon, I think "death by cheese" will be very low down on my list.... ;) Funny, have you ever seen this film? - have a quick read: http://en.wikipedia.org/wiki/La_Grande_Bouffe
Thanks again to all for the help. I've made a list in case the moclobemide turns out to be a dud...!
:)
M.
poster:Molybdenum
thread:830647
URL: http://www.dr-bob.org/babble/20080519/msgs/831121.html