Ped said: The usefulness of MAOI antidepressants is at best unclear. These medications target the serotonin hypothesis of depression, which believes that depression is largely or wholly mediated by serotonin. We now know that serotonin is just one piece of a much larger puzzle. MAO inhibition may have a role in the treatment of some depressive phenotypes, but its role in treating depression on the whole probably isn't very broad.
Ped said: While MAOIs to might be useful to some, they are not a solution to depression unto themselves.
-- Despite their potential side effects, the older MAOIs (phenelzine, tranylcypromine, isocarboxazid, and selegiline) have all been proven effective in depression; some studies have found them more effective than tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs).1,2
1. Thase ME, Mallinger AG, McKnight D, et al. Treatment of imipramine-resistant recurrent depression; IV; a double-blind crossover study of tranylcypromine for anergic bipolar depression. Am J Psychiatry 1992;149:195-8.
2. Thase ME, Trivedi MH, Rush AJ. MAOIs in the contemporary treatment of depression. Neuropsychopharmacol 1995;12(3):185-219. --
Source: Cole J, Bodkin A. MAO inhibitors: An option worth trying in treatment-resistant cases. Current Psychiatry, Vol. 1, No. 6, June 2002
That's significant, as you praised TCAs, above.
Ped said: Generally speaking, I'm not a big fan of MAOIs, because the risk-benefit ratio usually isn't high enough. MAO inhibition comes with a host of drug interactions and ancillary effects on metabolism, both of which present some significant dangers. While MAO inhibition might be useful to many people, and while this shouldn't be discounted, I tend to feel that other treatment strategies are surely preferable, provided of course they are viable in their own right.
The MAOI warnings I always hear about sound incredibly uninsightful to me. Even my old psychiatrist shook his head and said 'I've never seen it' when sspeaking of 'the cheese effect.' And before I even continue I'd like to point out that if one of those foods is consumed when on a beta-carboline, the beta-carboline will simply be kicked out of your system, allowing you to metabolize the offending stuff as normal. It is only with the so-called irreversible MAOIs where the effect of the MAOI cannot be reversed. Anyway, the restricted food are classified as follows:
Hypertensive crises with MAOIs have occurred in some patients following ingestion of foods containing large amounts of tyramine or tryptophan. In general, patients taking MAOIs should avoid protein foods that have undergone protein breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
Foye's Principles of Medicinal Chemistry, Seventh Edition. Thomas L. Lemke, Ph.D., David A. Williams, Ph.D., Victoria F. Roche, Ph.D., S. William Zito, Ph.D. 2013.
That's pretty narrow and many of those foods are expensive. The type of cheese used on pizza simply doesn't contain enough tyramine to present a problem. It is only aged cheese.
-Can I still get drunk on it and eat pepperoni pizza? -Yes. 05-02-2014 - http://www.socialanxietysupport.com/forum/1072244025-post515.html
I drink beer on Nardil all the time. 4 is the most I've ever had and I've never once had a sneaking suspicion that I was putting myself in danger. 08-09-2008 - http://www.socialanxietysupport.com/forum/651105-post7.html
Most store bought beer is pasteurized, where the tyramine has decomposed. 'Raw' beer is an issue, however but once again that's an exotic thing. Some MAOI guides warn that beer on tap can be unpasteurized.
MAOI "diet" by psychiatrists - a joke?
A person in the above thread says that even when he did eat something he truly wasn't supposed to eat, all he got was a splitting headache.
It's very rare to have a hypertensive crisis while on MAOIs, but the danger is there and you can get one when you least expect it. Took me two years to find out how it felt like. I ate spoiled meat and it gave me a splitting headache, felt like my head was about to explode. Before that incident i had been eating everything and paid the diet no concern at all.
I still don't care about the diet, but gourmet cheese and spoiled food should be avoided at all costs.
This is a good read:
MAO Inhibtors: Risks, benefits, and lore. Wimbiscus, Molly MD; Olga Kostenk, MD; Donald Malone, MD. Cleveland Clinic Journal of Medicine. vol. 77, no. 12, Dec 2010
From the above article:

The first reference in this post (Cole) states that combining MAOIs with tricyclics has been determined to be safe.
We have found all antidepressants that do not involve significant serotonin reuptake inhibition (e.g., bupropion, trazodone, and tricyclics other than clomipramine) can be safely administered with MAOIs. Combination therapy is worth considering because it may be effective when other approaches have failed.
There are two people on SocialAnxietySupport.com who are combining MAOIS with amphetamines:
-- Im not taking Nardil but I'm taking 80mg Parnate. Recent studies show that if you're MAOI resistant stimulants can help. I'm taking 70 mg of Vyvanse and Ritalin (not Adderal). My blood pressure is normal and the MAOI started working. Some people go as high as 120mg with stimulants. Just watch your blood pressure. Of course the higher you go the dietary restrictions become more pertinent.
7/2/2014 MRDIGBY http://www.socialanxietysupport.com/forum/1073591857-post542.html
NOTE: 120 mg is two times the APA maximum recommended dose and such a dose has received acknowledgement by professionals:
Jay Amsterdam at the University of Pennsylvania goes up as high as 120 mg of Parnate(tranylcypramine) and claims fewer side effects at higher doses.
This Month’s Expert: Jonathan Cole, M.D. Reflections on the Use of MAOIs | Psych Central Professional
Stimulant + MAOI journal --
As for Melatonin and Nardil being contraindicated, a lot of this stuff is just theoretical, I take 3mg evey night without problem. I have also taken LSD in large doses on Nardil without problem. They just make anything that effects the seritonin system contraindicated as a matter of course.
zendog78 04-13-2010 http://www.socialanxietysupport.com/forum/f30/the-greenhorns-guide-to-nardil-51461/#post1343284
Here's a report of soemone who took MDMA, MDA, and MDE in combination with oral DMT:
Jezebel. Fun, Plus 'Ghost People': An Experience with Ayahuasca, Mushrooms, MDMA, MDE, MDA, LSD, LSA, Blue Lotus, Cannabis, Alcohol, & Opium (ID 24742). Erowid.org. Jun 24, 2003. erowid.org/exp/24742
So, MAOIs don't sound that 'contraindicated' afterall. You also seem to be neglecting the fact that people aren't exactly so stupid that they wouldn't abide by relevant restrictions. Seems to me like a few restrictions on things you probably weren't going to ingest anyway is worth it if it's an effective medication...that seems to be the consensus on SocialAnxietySupport.com
Ped said: They really aren't very similar. The similarities essentially begin and end with indole. All the substitutions and functional groups are different, not the least of which is the additional ring structure.
Perhaps in spite of the number of changes, those changes are not very "deep."
Someone on Bluelight argued that minaprine was closer to serotonin...
Edited by s240779 (03/16/15 01:54 PM)
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