doxylamine
Greenlighter
- Joined
- Aug 8, 2010
- Messages
- 47
So I'll spare everyone a short novel regarding my long mental health history and dive right in....
I've been on a myriad of medications (SSRIs, SNRIs and NRIs) for what time has shown to be treatment resistant depression and general/social anxiety for most of my life. Nothing has even barely worked except propranolol, which only helps my physical anxiety symptoms - it doesn't touch the mind. I have taken benzodiazepines in the past but they are nothing but bad news for me - abuse, self-harm, suicide attempts, you get the idea. TCAs and antipsychotics are also off the table for me as anything with significant neuroleptic or anticholinergic properties seem to ruin my ability to do anything for +24 hours and I cannot afford that in my line of work.
Anyway, my previous experience has led me to give MAO inhibitors a try. Being vegan, my diet is pretty limited already so I decided to ask my doctor about Moclobemide first. Being a reversible inhibitor of MAO-A it has a much lower risk of hypertensive crisis when combined with foods high in tyramine and it seems most people don't have to abstain from particular foods at all with this medication. This with the low incidence of side effects was also highly appealing and so far I am tolerating it quite well. In fact, my sexual performance has increased tremendously. The only problem is, I'm not really experiencing much benefit in my mood, if any.
I've done extensive reading lately and it seems a lot of people report much of the same, some claiming it is plain useless when compared to the non-selective irreversible MAO inhibitors, Phenelzine and Tranylcypromine and to just go straight for those. While I am impressed by the many rave reviews I have seen for these two medications, and intrigued by the possible benefits of the GABA-T inhibition and dopamine releasing properties of Phenelzine and Tranylcypromine respectively, I am not certain I am ready to make the leap just yet...
Through my research I have also stumbled across the idea of combining Moclobemide with Selegiline. In low doses, Selegiline is an irreversible inhibitor of MAO-B that also happens to lack the need for dietary restriction (as tyramine is metabolised by MAO-A) however as dosage is increased it loses selectivity and will also irreversibly inhibit MAO-A. I feel I grasp the concept of how this all works quite well but what I do not understand is why it seems one does not need to adhere to the MAOI diet with either Moclobemide or Selegiline until they are combined, especially if MAO-A is only being inhibited reversibly by Moclobemide and the dose of Selegiline is kept low enough to remain selective for MAO-B. This doesn't logically make sense to me.
Can anyone comment on this combination and the tyramine issue? I feel like I'm missing something here. Would the dietary restrictions really be necessary with reversible MAO-A and irreversible MAO-B inhibition? And also, would the dietary restrictions be just as necessary as if I were to irreversibly inhibit both with Phenelzine, Tranylcypromine or high dose Selegiline on its own?
Additionally, I understand beta-blockers are contraindicated in cases of hypertensive crises due to unopposed agonism at alpha adrenergic receptors, paradoxically worsening the hypertension even though these drugs main clinical use is in lowering blood pressure. Would continuing to use propranolol lower my risk of potential hypertensive crisis up to a certain point and then put me in greater danger beyond it or would it be riskier from the get go?
Thanks in advance everyone. I hope I posted this in the right forum.
I've been on a myriad of medications (SSRIs, SNRIs and NRIs) for what time has shown to be treatment resistant depression and general/social anxiety for most of my life. Nothing has even barely worked except propranolol, which only helps my physical anxiety symptoms - it doesn't touch the mind. I have taken benzodiazepines in the past but they are nothing but bad news for me - abuse, self-harm, suicide attempts, you get the idea. TCAs and antipsychotics are also off the table for me as anything with significant neuroleptic or anticholinergic properties seem to ruin my ability to do anything for +24 hours and I cannot afford that in my line of work.
Anyway, my previous experience has led me to give MAO inhibitors a try. Being vegan, my diet is pretty limited already so I decided to ask my doctor about Moclobemide first. Being a reversible inhibitor of MAO-A it has a much lower risk of hypertensive crisis when combined with foods high in tyramine and it seems most people don't have to abstain from particular foods at all with this medication. This with the low incidence of side effects was also highly appealing and so far I am tolerating it quite well. In fact, my sexual performance has increased tremendously. The only problem is, I'm not really experiencing much benefit in my mood, if any.
I've done extensive reading lately and it seems a lot of people report much of the same, some claiming it is plain useless when compared to the non-selective irreversible MAO inhibitors, Phenelzine and Tranylcypromine and to just go straight for those. While I am impressed by the many rave reviews I have seen for these two medications, and intrigued by the possible benefits of the GABA-T inhibition and dopamine releasing properties of Phenelzine and Tranylcypromine respectively, I am not certain I am ready to make the leap just yet...
Through my research I have also stumbled across the idea of combining Moclobemide with Selegiline. In low doses, Selegiline is an irreversible inhibitor of MAO-B that also happens to lack the need for dietary restriction (as tyramine is metabolised by MAO-A) however as dosage is increased it loses selectivity and will also irreversibly inhibit MAO-A. I feel I grasp the concept of how this all works quite well but what I do not understand is why it seems one does not need to adhere to the MAOI diet with either Moclobemide or Selegiline until they are combined, especially if MAO-A is only being inhibited reversibly by Moclobemide and the dose of Selegiline is kept low enough to remain selective for MAO-B. This doesn't logically make sense to me.
Can anyone comment on this combination and the tyramine issue? I feel like I'm missing something here. Would the dietary restrictions really be necessary with reversible MAO-A and irreversible MAO-B inhibition? And also, would the dietary restrictions be just as necessary as if I were to irreversibly inhibit both with Phenelzine, Tranylcypromine or high dose Selegiline on its own?
Additionally, I understand beta-blockers are contraindicated in cases of hypertensive crises due to unopposed agonism at alpha adrenergic receptors, paradoxically worsening the hypertension even though these drugs main clinical use is in lowering blood pressure. Would continuing to use propranolol lower my risk of potential hypertensive crisis up to a certain point and then put me in greater danger beyond it or would it be riskier from the get go?
Thanks in advance everyone. I hope I posted this in the right forum.
