Tell me your MAOI depression success story after SSRIs failed you.
April 21, 2017 5:28 PM   Subscribe

YANMD, but that doesn't matter because I'm looking for patients, not doctors. Please share your success story if Nardil (or another MAOI inhibitor) defeated your depression after you tried all of the SSRIs on the market for years without any joy. How did you deal with the dietary restrictions, weight gain, and side effects? Was it worth all the risks and changes?

I have unipolar depression and comorbid anxiety, and I've been on every SSRI that exists over the past 25 years. My psychiatrist wants to go to Nardil next. Having read up on all of the side effects and all of the dietary restrictions, I am more than a little concerned about accidentally eating something that will kill me--not to mention gaining forty pounds in the process, as I am already struggling with the significant amount of weight I've gained from SSRIs over time.

Back when I was 22, I was put on Prozac, and it worked like an incredible perfect dream for about six years--and without any weight gain! After that, no matter how much we upped it, it had no effect. I was then put on every SSRI you can name, one after the other--some for long periods of time (think years of "feels meh-okay, but not at all how I experienced life when the Prozac was working") to very short periods (think 48 hours because of horrific side effects sending me to the hospital).

From what I understand after years of having to do my own research on my illness and my available medication choices, the first line of attack for depression nowadays is SSRIs (which I've exhausted and none do much for me), then tricyclics, and finally MAOI inhibitors, before the depression is declared "atypical" or "treatment resistant." But my psychiatrist wants to jump over tricyclics and go directly to Nardil (MAOI inhibitor).

So, I read up on Nardil and on MAOIs in general, and I'm terrified of trying it for several reasons. Most antidepressants don't have "death" as a possible side effect, even when they're warning you about severe medication interactions, except in extreme edge cases--like 0.001%. Meanwhile, MAOIs pretty much say "common side effects include everything you've ever seen listed as a side effect for an antidepressant plus twenty more, and you will gain thirty to fifty pounds, guaranteed. The best bit is that you'll have a much-better-than-average chance of flat-out dying from things like cerebral hemorrhage or hypertensive crisis, due to either OTC medication interaction (no cough syrup or nasal decongestants for you!) or food interactions (No cheese. No bacon, sausage, or pepperoni. No soy sauce or teriyaki sauce. No pickles. And we're just getting started.)."

The list of forbidden foods for people on MAOI inhibitors makes up most of my diet--even a tiny bit of them can apparently raise blood pressure to death-related levels. Bonus: I already have high blood pressure.

Has anyone gone through all the SSRIs and then found relief with Nardil? Should I risk it? Was it worth it for the weight gain and the food caution? What other complications can I look forward to?
posted by tzikeh to Health & Fitness (10 answers total) 5 users marked this as a favorite
Since I've now had to flag three answers for being "This doesn't answer your question but have you tried X medication?", I guess I have to make it blatant that I'm rather obviously not asking for your suggestions of Wellbutrin or lithium or Zoloft (all of which, yes, I have tried; that is not the fucking question).

Please don't answer this question if you can't actually answer this question. You know, the one that's being asked.
posted by tzikeh at 6:05 PM on April 21, 2017 [8 favorites]

I have a Relative with Treatment Resistant Depression who eventually ended up being prescribed an MAOI. Relative had the same concerns you did, and with some research found that selective/reversible MAOIs (specifically Moclobemide) had far less side effects. The catch - it hasn't been tested/approved by the FDA in the US, though it's been extensively tested and prescribed pretty much everywhere else. But the quality of life improvements (no weight gain, less drug/food interactions, less chance of hypertensive episode) convinced Relative to purchase it from Elsewhere despite the difficulties involved. And now, five years in, it's been literally life-changing for them.

So yes, MAOIs can absolutely work where other medications have failed and there are versions available that are safer than what's commonly prescribed in the US.
posted by givennamesurname at 7:33 PM on April 21, 2017 [3 favorites]

I was on Parnate until my doctor relocated and I couldn't find another doctor that was comfortable working with MAOIs. I lost weight because it made anything with sugars in it taste terrible. I was on 40mg but that was probably a little too much and would have backed down to 30mg if my doctor hadn't moved. I was pretty careful with the diet but had one hypertensive crisis when I ate some day old brisket. The doctor will give you a fast acting vasal dilator to use if you eat something you shouldn't. It won't take too long to find out, a terrible headache and your BP monitor will give you an error message because your BP will be out of range. I learned a lot from the webpage of Dr. Ken Gillman, a real doctor that's a recognized expert on serotonin syndrome. He really likes MAOIs. He comes off a little curmudgeony at times but there's lot of information here.
posted by Grumpy old geek at 8:13 PM on April 21, 2017 [2 favorites]

I took moclobemide for years. No sick feeling side effects like SSRIs or SNRIs all gave me. I would get drunker a very little bit quicker. No dietary restrictions.
Can't say it was effective for depression but that has been my experience of all medication.
posted by Trivia Newton John at 12:55 AM on April 22, 2017

I've been on a lot of different meds, maybe not quite as extensively as you but I've been on a number of SSRIs (and related ones, like Wellbutrin) as well as tricyclics (both by itself and combined with lithium) and finally an MAOI (Parnate).

I definitely felt like the MAOI helped. I also had far less side effects with the MAOI compared to the tricyclics. The tricyclics made me drowsy and also caused some memory loss during the time I took them. I did not have any significant weight gain on the MAOI. I had some minor digestive issues, but that's something you're at risk for with pretty much any antidepressant.

The food restrictions are annoying. Especially since you don't have an easily identifiable ingredient you need to look out for. This can make it tricky if you want to eat and someone else is preparing the food (whether that's friends/family or going out to eat), since you can't just ask someone "hold the tyramine". Other than that it's not too difficult; I found that the risk of a hypertensive crisis was an effective incentive to stay away from the "forbidden" foods. You might want to spend some time finding recipes so you have a few go-tos that you are comfortable putting together. Having a meal plan of some sort can also help when you're shopping.

If you already have high blood pressure, I would really recommend keeping a close eye on it if you start taking an MAOI. Despite being very careful with the diet, my blood pressure still rose. Since things were going okish for me at the time I decided (with my psychiatrist) to stop taking the MAOI. I'm going back to SSRIs now to see if there might be one that has some positive effect. I will have to see how it goes, but if the SSRIs don't pan out I personally think I'll want to discuss with my psychiatrist whether going back to a MAOI might be an option still.

So I guess that's my answer to your main question: If it were me, I'd risk it.
Feel free to MeMail me if you have any questions.
posted by The sock is on the other foot at 2:15 AM on April 22, 2017

My experience with an MAOI was a very long time ago - I can't even remember which one it was - but... the thing that stands out in my memory is *take the warning about sun sensitivity seriously*.

I got the worst sunburn of my life while taking that drug, from a rather insipid level of sun-exposure with my usual level of (somewhat lackadaisical) sunscreen use. I looked like a lobster. I soaked up aloe and moisturizer like a sponge. I blistered, and then I peeled like I was a molting snake. I had tan lines that lasted the better part of a year. Probably significantly increased my chances of getting skin cancer.
posted by Secret Sparrow at 6:19 AM on April 22, 2017

I had great results with Selegiline (MAOI) after striking out with Zoloft and Welbutrin. The diet was a little annoying, but I got used to it after a while. I didn't gain any weight, but I did have some trouble sleeping, especially once I'd hit my target dose, so my doctor prescribed me a low dose of gabapentin to take at night and that helped a bunch.

Also, I couldn't afford it, but they make Selegiline *as a transdermal patch* (Emsam is the brand name) that allows you to eat whatever you want! It's like $1200 a month, but if you have good insurance that covers it, I would recommend it.
posted by ananci at 2:07 PM on April 22, 2017 [2 favorites]

Emsam is an MAOI patch that doesn't come with the food restrictions until you get up to high doses (and most people take the lower doses). The medication restrictions are the same, but avoiding the food restrictions has made it doable where other MAOIs would have been a no-go. The biggest downside is the price: even after insurance, it's about $100 a month for me. But it's been a godsend. And the patent is due to expire in May 2018, so expect generics to likely become available next summer.
posted by decathecting at 2:41 PM on April 22, 2017

Another moclobemide success story, here, if that happens to be an option for you. I take the generic form of moclobemide that's available in Canada, Manerix.

As mentioned, it's a reversible MAOI, so it differs somewhat from the typical MAOIs like Nardil. I've heard that it's not considered to be as heavy-hitting as the irreversible MAOIs, but it might be worth a try first, since it's easy to start/stop—the withdrawal's not bad at all (and often even non-existent) compared to other antidepressants.

I love it. In my experience, so far, it has a very low side effect profile. No diet restrictions (for me, anyway—at the maximum dosage the food restrictions do kick in, but I'm only at half that dose and it's working well). No weight gain, either; I actually lost some weight on this one. No sexual side effects, no drowsiness or trouble concentrating, no stomach issues. The only problem is it's a little harder to sleep through the night, but I find the trade-off's worth it.

Effects-wise, the moclobemide isn't shocking; the effect is subtle but it definitely lifts the weight of depression, enough that I was able to pull myself out of a half-decade rut and start making continuous progress on all sorts of problems with CBT. I find it specifically very helpful for motivation (I actually have it now!) and problem-solving (I can actually do it now, instead of just falling apart!). My social anxiety disappeared entirely, though a lot of my more ruminative anxiety remained.

(Not relevant to the OP's question, but an aside for anyone else who might be reading—if you have any chronic pain issues, the moclobemide decreases my pain by about a third, which was a lovely surprise.)
posted by stellarc at 1:58 AM on April 23, 2017

You might be interested in some of Scott Alexanders’ blogposts on the topic of treatment paths for depression. Specifically:

Prescriptions, Paradoxes & Perversities, in which (amongst other things) it is revealed that Nardil & Parnate have best patient ratings for efficacy of any antidepressant prescribed in the US.
posted by pharm at 6:55 AM on April 23, 2017

« Older What is this plant in this overgrown community...   |   How Much Computer Do I Really Need? Newer »
This thread is closed to new comments.