Posted by ed_uk2010 on July 31, 2010, at 14:34:52
In reply to Re: All my drugs work for 2-7 days then stop working, posted by tiopenster on July 30, 2010, at 18:05:53
>Would I have to go off my Remeron and Geodon to go on Nardil?
Difficult one. The safety of combining these drugs with MAOIs is not clear (due to lack of study). One potential problem is that Geodon is a weak serotonin reuptake inhibitor. SRIs can cause serious reactions when combined with MAOIs.
>My psych didn't want to try the MAOI's because he knows how I respond to serotonin.
When you react badly to an SSRI, you are not 'responding to serotonin', you are responding to potent serotonin reuptake inhibition ie. the blockage of serotonin reuptake from the synaptic cleft into the presynaptic neuron. Reuptake is the process which terminates the effects of serotonin at the synapse.
Serotonin is a vital neurotransmitter which is of great relevance to a wide variety of psychiatric problems. Most psych drugs affect serotonin neurotransmission, some directly, some indirectly. The important thing to bear in mind is that serotonin neurotransmission is affected differently by different classes of drugs. We all need serotonin, you can't say 'serotonin is bad for me'. What you can say is that 'potent serotonin reuptake inhibitors cause problems for me, but other drugs affecting serotonin neurotransmission in different ways might be beneficial'.
At the moment, you are on two drugs which substantially affect serotonin neurotransmission: mirtazapine and ziprasidone. Both drugs affect serotonin function in a different way to SSRIs.
Mirtazapine:
Mirtazapine blocks certain serotonin receptors, notably 5-HT2 and 5-HT3 subtypes. It is claimed to indirectly increase serotonin neurotransmission via 5-HT1a receptors - although I am not sure to what extent this occurs in reality.
Ziprasidone:
Ziprasidone blocks certain serotonin receptors, especially 5-HT2 and 5-HT1d. It stimulates 5-HT1a receptors and weakly inhibits serotonin reuptake.
>Why do you say that it affects serotonin in a different way? I'm very intrigued by the idea of a new class of medication.
MAOIs certainly have a different mechanism of action to SSRIs: this is one of the reasons that they are often useful in treatment-resistant depression and severe anxiety disorders. Unlike SSRIs, they do not prevent serotonin from being removed from the synapse by the reuptake pump. As I explained above, reuptake is the process which terminates the effect of serotonin at the synapse. In contrast, MAOIs inhibit the metabolism (breakdown) of serotonin inside the pre-synaptic neuron. This increases the amount of serotonin which is available for release. In addition, MAOIs inhibit the breakdown of norepinephrine, dopamine and trace amines. Phenelzine (Nardil) increases levels of GABA by interfering with its metabolism; this may contribute to Nardil's effectiveness in anxiety disorders. Parnate does not have this effect, but it does have some additional stimulant-like properties which Nardil lacks. The MAOIs really are a complex group of drugs. I know you are concerned about the possibility of an adverse reaction to MAOIs due to 'increased serotonin'.... but to be perfectly honest, you can't predict what your response to MAOIs will be based on your response to SSRIs and related drugs. There are just so many differences between MAOIs and SSRIs.
>Thanks for you help!You're welcome.
The worst thing about Nardil is that it does cause side effects very frequently. You also have to educate yourself about the necessary dietary restrictions and drug interactions. The best thing about Nardil is its efficacy. It's really not a drug for mild depression or mild anxiety. For severe cases it can make a huge impact.
If you do decide to try Nardil, you will need to start with a low dose and increase gradually. It certainly can be a difficult process - but it's worth the hassle if it gets rid of your anxiety.
In order to take Nardil safety, you do need a psychiatrist who is experienced with the use of MAOIs. They are not easy drugs to use, and many psychiatrists lack the knowledge and confidence to use them safely. Younger psychiatrists in particular may never have prescribed them. Some may believe that they are 'bad, dangerous drugs'. This type of comment tends to come from psychiatrists who are not familiar with MAOIs and have (usually) never used them. Steer clear of this type of doctor, they are usually the same ones who think the latest 'wonder drugs' can treat everyone. If only that were true!
Take care,
Ed_UK
poster:ed_uk2010
thread:956187
URL: http://www.dr-bob.org/babble/20100731/msgs/956578.html