Can an MAOI like Parnate be prescribed for someone who is on methadone? I keep reading conflicting things on this issue. Some say its ok and others say its risky. On many of the side effect profiles it dosen't list methadone.

NO, absolutely not!!! IT IS VERY DANGEROUS! You could go into a coma! Why would you go on an MAOI? That is like the very last resort to an antidepressant. And if you read the insert that comes with one, when filled, it has an extensive list of interactions with almost all medications and even some foods and wine, etc. MAOI's are really risky alone! Change to another class like an SSRI or Tricylcic. Especially is you are on Methadone!!

Of all the MAOIs, the one you mention is the most dangerous. It is abused because of its stimulant action, and it can cause sudden hypertension. And like the above poster says, MAOIs are contraindicated for patients on opioids. There should even be a 2 week gap between taking both drugs.

well right now I am on a SSRI and wellbutrin. But I still am having depression and I hear Parnate works really well. I'm disappointed since I can't use it now. When I looked at the interactions for Parnate and methadone I found this

CONTRAINDICATED: The coadministration of narcotic analgesics and monoamine oxidase inhibitors (MAOIs) may rarely result in hypotension, respiratory depression, or coma. The mechanism is unknown but may be related to additive CNS and respiratory depressant effects. Rare case reports of severe hypotensive reactions have included propoxyphene (with multiple medications), morphine, and methadone, although others have reported the safe use of MAOIs with narcotic analgesics including methadone and morphine.

So it seems really confusing since others say its safe and for other people it is not

Well, all interactions are possible interactions. There's no guarantee that the 2 drugs will interact, but there's a high enough possibility for it to be considered too risky.

How long have you been on SSRIs? How many have you tried? What about tricyclics, or related?

Bear in mind that for some seriously depressed patients, who may be suicidal, the risk/benefit is considered differently compared to patients with moderate depression.

There are many alternative treatments available for severe depression. Risking the combo of Parnate and methadone, in my view, is not a worthwhile risk.
Even if the original poster is talking about Treatment Resistant Depression, it would be safer to investigate very low dose buprenorphine with his doctor before messing with Parnate.
Hopefully, a practicing physician hasn't actually suggested combining these drugs, has he?

Ive been on them for years now. Have tried alot of them like Prozac, Elavil, Cymbalta, effexor, Celexa, wellbutrin. I have really bad anhedonia(inablity to experience pleasure) and motivation is mundane. The wellbutrin has somehow helped a little, but Im still struggling. It seems the MAOIs are alot more effective than the newer stuff, but being on MMT probably takes away this option. So I don't know. Maybe selegiline since it only affects MAO-B? The main thing is whether methadone increases seratonin enough to warrent a seratonin syndrome risk from an MAOI.

I'd always put anhedonia down to nothing ever nice happening anyway.

Have you considered the tricyclic-related drugs such as mianserin or trazodone? You've already taken drugs which inhibit re-uptake of serotonin; amitriptyline for example does this but is not selective, hence it cannot be called an SSRI. But most antidepressants do inhibit re-uptake of serotonin; some people thinks that only the SSRIs do that, but that isn't the case.

Imipramine is a tricyclic which has more effect on noradrenaline than serotonin. Patients who are withdrawn rather than agitated rend to respond best to the these type of drugs, compared to the sedating tricyclics.

Of course, all this should really be discussed with your specialist, since this isn't a DIY job.

well apprently my MD told me that I have more of a dopmaine problem rather than a seratonin problem. Regular SSRIs make me zobmish and hurt my energy and motivation. Yet I do not want to go the stimulant route because of addiction problems and crashing. If I could find an antideppressant that had the anti-depressant effects of a stimulant minus the addiction and side effects that would be great. Thats why I had brought Parnate up. Survector looks like something that would help me greatly too, but it isnt sold in the US and is hard to get

Methadone is not *particular* unsafe with MAOIs. It's meperidine that's problematic. Most people know very little about how dangerous MAOIs are. As long as your blood pressure is monitored and you restrict intake of things that may trigger hypertension, you will be reasonably safe. I have seen Parnate combined with methadone safely, also with bupropion, sertraline and selegiline. Parnate can also be combined with selegiline. But the important thing is to do it step-wise, one at a time and using small dose increases. You can also combine Parnate with Adderall or Dexedrine, it often only takes very small doses.

If you don't know how to do this, it's important to be under supervision of a qualified person.

Also, do not go anywhere without a blood pressure medicine such as nimodipine or nifedipine.

But if you think you will get a stimulant effect from Parnate you will be dissappointed. It's marginally stimulating, only 1/10 of amphetamine and your doses will usually stay below 60 mg/day. Some feel it's stimulating but that has not been my experience.

You could try Parnate combined with ritalin and/or selegiline. If you want to avoid a strict diet, you can use moclobemide and selegiline as a substitute for Parnate. Moclobemide don't bind very tightly to MAO-A so it's relativily safe with a normal diet. You can take selegiline sublingually so you will not have trouble there.

The important part is the stimulant. Not much will work without it. If I were you I would just use ritalin or dexedrine and combine it with a SNRI, that will be much less problematic. Also, a NMDA antagonist to stop tolerance buildup.

Note that methadone may be causing your depression in the first place. It makes people fat, sweaty and lazy, especially in high doses. Maybe if you get off it, your depression will get better.

PS: All the contradictions and interactions you see with MAOIs are listed to make the general patient population safe from even the slightest risk(and the companies safe from lawsuit). Most of these can be overridden under the supervision of a specialist.

Please, if anyone is reading this, DO NOT DO IT. Tranylcypromine with methylphenidate is extremely dangerous, and to add selegiline is just ordinarily dangerous.

These warnings are not from the manufacturer, but from any respectable source that is not at at all trying to cover its arse.

Maybe I can clear things up a bit for you. Using the combination of an MAO inhibitor and a stimulant drug like Adderall makes absolutely no sense from a medical point of view. None.
Even so, there are many participants on web sites like socialanxiety.com and psychobabble.com who have managed to convince themselves that in spite of how clinically unwarranted this is, they do it anyway and love to rave about it.
A recent poster here, "Gillettecava something" tried to convince everyone that this was the greatest wonder combo since dogs and trees. It is not.
Nor is combining methadone with an MAOI. Why on Earth would anyone risk the potential side effects of this combination when there are so many other medications that are less risky?
Reading your advice lately is leaving me wondering if the medical information available in Denmark exists in some kind of parallel universe with the rest of the world.
LOL

(combining different MAOIs and/or stimulants is not necessarily dangerous. It merely needs to be done under the supervision of a specialist doctor. It's primarily restricted to treatment resistant patients. This why they are doing it, because other drugs don't work)
--------------
J Clin Psychiatry. 1985 Jun;46(6):206-9.

Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.

Feighner JP, Herbstein J, Damlouji N.

Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative
therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.

PMID: 3997787 [PubMed - indexed for MEDLINE]

----
J Clin Psychopharmacol. 1991 Apr;11(2):127-32.

CNS stimulant potentiation of monoamine oxidase inhibitors in
treatment-refractory depression.

Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.

Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center,
Chicago,
Illinois.

We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard
antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.

PMID: 2056139 [PubMed - indexed for MEDLINE]

Yes these combinations are occasionally used under strict supervision in extreme cases and by specialists, but the patient hasn't even tried monotherapy with phenelzine yet or moclobemide, which may be effective, so you're somewhat jumping the gun.

Did you notice that I wrote to add one medication at a time, stepwise?

No offence but why not read what I write rather than reply to what I don't write?

Also, you are incorrect again(surprise), it's not used in only extreme cases. It's used in treatment resistant depression which is not that extraordinary. Extreme would be to use deep brain stimulation for depression and this is also occasionally done.

Besides, you are grossly overestimating the danger of MAOI's and the risk of hypertensive crisis.

Try look at this:
Subarachnoid Hemorrhage: One Case in 35 Years: Hypertensive crises occur in less than 1%. The authors report an individual with a recent increase in MAOI dosage taking the medicine close to meal time and using a half tablespoon of soy sauce as probably causing the first case of subarachnoid hemorrhage reported in the last 35 years. The patient recovered, apparently fully. Can J Psychiatry 2004 Aug;49(8):573-4. Hay fever and cold remedies have caused hypertensive crises, but spontaneous ones have also occurred.

I must add that the risk of hypertension can be reduced even more by carrying a rapid acting blood pressure medication.

The danger of being depressed is many times higher than of being on MAOI's. The risk of suicide is around 2 to 9%, possiblys as high as 15%. Then add all the other health risks and you will see that to recommend people to stay away from a treatment that may work, is rather bad advice. In fact it may be dangerous advice if I must stay in your terminology(which I will not). Depression also causes changes, if not damage to the brain that can be prevented by timely treatment. That is, treatment that actually works.

In 2K there was about 30.000 suicides in USA alone. Do I need to say more?

Have you looked at the dates of your copius "Google" information? It's amazing what has been learned in the medical field over the last 15-20 years.
If you ever had to actually deal with the after-effects of an MAO inhibitor adverse reaction, you possibly would better understand the serious importance of warning unaware patients about these potential consequences rather than quoting bits and pieces of old research articles you found on the Internet.

Then you recommend carrying around a blood pressure med just in case?


Show me one out of the hundreds of members here suffering from depression who take your cocktail. Good luck finding one. Your definition of extreme probably doesn't include death.

I think the one who recommends dangerous medications is the one who behaves like a gladiator.

Would you REALLY like me to quote EVERY source that shows dangerous interactions between tranylcypromine and CNS stimulants? Because I won't, due to not having enough years left to live. Do it yourself and learn, instead of spouting out rubbish based on one or two studies.

I notice that you cannot find one single patient on here out of the hundreds of severely depressed who have been prescribed your magic cocktail.

I have provided references to the use of MAOIs and stimulants under the supervision of an expert. There is nothing dangerous about it.

This debate could go on forever, but I will say that nephro is VERY knowledgeable (VERY) about his information. Both he and I have been on this board for some time and he often has more information than I do in my medical books from school.

The point he was trying to make was: DON'T GIVE OUT MEDICAL ADVICE IN REGARDS TO COMBINING MEDICATIONS!

There is ALWAYS a danger with MAOIs and stimulants, even with specialist supervision. It is just that the benefit is considered to outweigh the risk. Tranylcypromine is ESPECIALLY HAZARDOUS and NOT recommended.

Noone gets hurt by correct information. Anyone can verify what I wrote since I provided references.

Source: BNF 58 - the most respectable and reliable source of pharmaceutical information in the world.


How many more respectable sources do you want me to provide which quote this interaction?




www.medicinescomplete.com/mc/stockley/current/x18-3478.htm



http://www.netdoctor.co.uk/adhd/methylphenidate.htm



http://www.nami.org/Template.cfm?Section...ContentID=66273


I challenge you to show me ONE patient out of the many severely depressed patients on this site who have been prescribed your cocktail.

Will you dodge this simple task again? I think you will. Prove me wrong. Please.

Wrong again. I am advising Renty and everyone else here to stay away from YOUR medical advice. They should see a doctor, who will NOT put them on your deadly cocktail.