5 ms·

https://en.m.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#Hypertensive_crisis https://en.m.wikipedia.org/wiki/Monoamine_oxidase_inhibitor#...

noname120 3y ago
How is that related in any way to “leftovers” (whatever it's supposed to mean)? You're probably conflating it with the risk of serotonin toxicity when combined with SSRIs or without a proper washout period of 1-3 weeks depending on the SSRI. ———— Serotonin toxicity in the context of MAOIs is — just like the hyper[1] (and hypo!) tensive effects — a heavily exaggerated risk that we know how to avoid and manage thanks to the 50 years of experience we have with MAOIs. Excerpts from [1]: > The first mistaken assumption to tackle is this: the idea that a tyramine reaction will raise someone’s BP, higher and higher, until their head explodes. That simply is not a plausible scenario. > Second, the degree of elevation of BP caused by ingestion of tyramine is generally no greater than elevations produced by a host of other factors. These include, exercise, sex, stress, driving, anxiety, lifting weights — in fact just living. There is a detailed and extensively referenced commentary about that here. ———— About serotonin toxicity see these excerpts from [2]: > If somebody is already taking an SSRI antidepressant and you want to start an MAOI then you need to allow 3 to 5 half lives before doing that, that means 3 to 5 days for most drugs. Hardly a major problem. > It is perfectly possible, and often quite sensible, to try a tricyclic antidepressant like nortriptyline before an MAOI. That can act as a bridging antidepressant prior to starting an MAOI. > So, just add NTP to the SSRI, cease the SSRI immediately, or after a few days (tapering-off of the SSRI is usually not needed, unless the dose was very high); then once the SSRI is out of the system the MAOI can be started in combination with the TCA, since it is quite safe to administer TCAs and MAOIs concurrently. ———— [1] https://www.psychotropical.com/acute-tyramine-hypertension/ https://www.psychotropical.com/acute-tyramine-hypertension/ [2] https://www.psychotropical.com/maois-misconceptions-and-questions-2/ https://www.psychotropical.com/maois-misconceptions-and-ques...
- david-gpu 3y ago
  > How is that related in any way to “leftovers” (whatever it's supposed to mean)? Leftovers, as in "food left over from a previous meal". Quote from the Wiki link provided earlier (first paragraph): > People taking MAOIs generally need to change their diets to limit or avoid foods and beverages containing tyramine, which is found in products such as cheese, soy sauce, and salami.[21] If large amounts of tyramine are consumed, they may develop a hypertensive crisis, which can be fatal.
  - noname120 3y ago
    It's a highly exaggerated risk and should in no way scare doctors into depriving patients from an effective and safe treatment. We are talking about an article with the title “physically healthy 28-year-old woman schedules euthanasia due to depression” here.

noname120 3y ago

How is that related in any way to “leftovers” (whatever it's supposed to mean)? You're probably conflating it with the risk of serotonin toxicity when combined with SSRIs or without a proper washout period of 1-3 weeks depending on the SSRI. ———— Serotonin toxicity in the context of MAOIs is — just like the hyper[1] (and hypo!) tensive effects — a heavily exaggerated risk that we know how to avoid and manage thanks to the 50 years of experience we have with MAOIs. Excerpts from [1]: > The first mistaken assumption to tackle is this: the idea that a tyramine reaction will raise someone’s BP, higher and higher, until their head explodes. That simply is not a plausible scenario. > Second, the degree of elevation of BP caused by ingestion of tyramine is generally no greater than elevations produced by a host of other factors. These include, exercise, sex, stress, driving, anxiety, lifting weights — in fact just living. There is a detailed and extensively referenced commentary about that here. ———— About serotonin toxicity see these excerpts from [2]: > If somebody is already taking an SSRI antidepressant and you want to start an MAOI then you need to allow 3 to 5 half lives before doing that, that means 3 to 5 days for most drugs. Hardly a major problem. > It is perfectly possible, and often quite sensible, to try a tricyclic antidepressant like nortriptyline before an MAOI. That can act as a bridging antidepressant prior to starting an MAOI. > So, just add NTP to the SSRI, cease the SSRI immediately, or after a few days (tapering-off of the SSRI is usually not needed, unless the dose was very high); then once the SSRI is out of the system the MAOI can be started in combination with the TCA, since it is quite safe to administer TCAs and MAOIs concurrently. ———— [1] https://www.psychotropical.com/acute-tyramine-hypertension/ https://www.psychotropical.com/acute-tyramine-hypertension/ [2] https://www.psychotropical.com/maois-misconceptions-and-questions-2/ https://www.psychotropical.com/maois-misconceptions-and-ques...

david-gpu 3y ago
> How is that related in any way to “leftovers” (whatever it's supposed to mean)? Leftovers, as in "food left over from a previous meal". Quote from the Wiki link provided earlier (first paragraph): > People taking MAOIs generally need to change their diets to limit or avoid foods and beverages containing tyramine, which is found in products such as cheese, soy sauce, and salami.[21] If large amounts of tyramine are consumed, they may develop a hypertensive crisis, which can be fatal.
- noname120 3y ago
  It's a highly exaggerated risk and should in no way scare doctors into depriving patients from an effective and safe treatment. We are talking about an article with the title “physically healthy 28-year-old woman schedules euthanasia due to depression” here.