If anyone is curious about the MAOIs and their effectiveness in terms of ADD, my experience might be of interest.

I take an MAOI (brand name Nardil) that does a marvelous job of alleviating chronic mild depression (a.k.a dysthymia) and social anxiety. I’ve been on it for over 9 years so I have a lot of experience with it. While it does wonders to lift my depression, I began taking it primarily to alleviate social anxiety. Experiencing a high degree of social anxiety truely, truely sucks. It can be extremely limiting and monstrously frustrating - sorta like living behind an invisible fence. You want so much to run and play with all the other dogs in the neighborhood - but you get zapped by anxiety whenever you attempt it. (The anxiety is frequently experienced as a high degree of self-consciousness - never knowing what to say - feeling awkward, and lacking spontenaety. The result is that one becomes a perpetual outsider, in spite of the desire and effort not to be so.)

I had read about MAOIs after some rather desperate research and determined that, if it was the last thing ever I did, I had to try it. Unfortunately, the MAOIs are like the Desoxyn® (methamphetamine) of anti-depressants. A “last line” treatment. So lemmee tell ya - getting doctors to prescribe it is like pulling teeth. And this is a damned shame. Indeed, as one psychiatrist put it, “the MAOIs are supremely effective anti-depressants...” And when he says supremely, he’s not being rhetorical. Not to sound like a teenager - but the MAOIs rock. Yet, despite their potential effectiveness, they are very rarely prescribed because they’re notorious for potentially lethal food and drug interactions.

So, I begged and pleaded - and pleaded and begged - with a couple of docs before landing a prescription. Once I got it, it took six weeks to work, but when it did - holey moley - the effect it had in reducing my social anxiety was astonishing. Finding Nardil was like finding the freakin’ Grail. It boggled my mind that elevating neurotransmitter levels could allow me to come out of my shell as I did. (It unilaterally raises the level of every neurotransmitter in your brain - just so you know.)

For me... I have an excellent tolerance of them - very minimal side effects. At higher doses they can even have a gentle soothing quality. (The increase in GABA?)

Another thing (and shhhh... don’t tell anybody, especially my doctor) - but I eat whatever I want with impunity. Everything on the do not touch list - cheese, aged meats, chocolate, avacados, you name it. I discovered that I could do this by inadvertently eating a piece of cheese once. Realizing I had done this, I panicked a bit, then sat around waiting to die of a stroke. But, gee... no hypertensive reaction. Nothing. So I ate more cheese and still - nothing. After this experience, I gleefully put pizza back on the menu.

Over time, I’ve tried out all the other “off-limit” foods and noticed zero ill effects from any of them - with a couple exceptions: red wine gives me a very mild hypertensive reaction - and... at a fundraising event once, with *donated* beer, I drank half a glass from a keg that was flat and tasted slightly off. This, most definitely gave me a hypertensive reaction. (Tap beers apparently can be dangerous if there’s a buildup of fermentation.)

While foods (for me) are one thing, over-the-counter drugs are entirely another. A thoughtless moment found me swallowing a small cup of Nyquil when I was sick. I didn’t check the label. Oops. It contains an anti-histamine. Anti-histamines and MAOIs don’t mix. Headache, lotsa sweating, and a noticeably increased heartrate were the result. I made it through o.k. - but the worst part is the anxiety - wondering if you’re going to, you know, die. Medical literature and doctors do their best to scare you - and this is doubtless for good reason. Not everyone is likely to tolerate them so well. (I read somewhere, that the actual number of people who have significant problems with food interactions is roughly 1 in 4. I also imagine that, if you are in poor health and at risk for stroke to begin with, an MAOI induced hypertensive reaction will break the camel’s back.)

I’ve gone off my med a couple times in the past, feeling quite “cured”. But, sure enough, give it a couple months and there I am - lethargic, low energy, of mood most foul, and highly self-conscious around people once again. Totally bogus. A couple months of this and, forget it... I’m back on the meds. Like an ever valiant warrior, the MAOI charges back on the scene to subdue the twin spectres of depressed mood and social inhibition. What a champ!

But then, around the corner... there lurks a previously unseen threat - a slovenly beast call Innatentive ADD! This third creature is something I’ve only become aware of in the past year or so. But how well the literature describes him! Wandering thoughts, an excess of ideas from which I have difficulty deciding or sticking with... forgetfulness, piles of clutter, tardiness (over the years, fired twice for this reason), disorganization, small chores appearing like the Hillary Step of Everest... a marvelous collection of unfinished things and backburnered projects I’ll probably never get to, rickety & ridiculous finances, and a job history noted primarily for its degree of under-employment (in spite of high intelligence ‘n’ lotsa talent ‘n’ stuff).

Very unfortunately, the MAOIs appear to do virtually nothing for my inattentive ADD. Indeed, on a higher dose (which energizes me quite noticeably) I find myself, if anything - more scatterbrained. And this is something I don’t quite understand, since this drug most definitely raises the neurotransmitters implicated in ADD. The only theory I can think of: Since it raises the level of every single neurotransmitter in the brain - there remains some sort of static or interference along the brain’s “executive function" pathway.

Also - taking an MAOI precludes using any of the meds available to treat ADD.

So, what to do? Revert back to being a gloomy hermit - but a potentially far more productive gloomy hermit? Or stick with the MAOI and remain buffered from depression and social anxiety - while continuing to live up to my “Spaceboy” nickname? Or, maybe divide the year up - half on one med, half on the other. Sorta like owning a home in the city to be nearer to people and culture, and one out in the country to minimize distractions and get things done. I don’t know.

Anyway - that's my word on the MAOIs and ADD. Comments and suggestions welcome.

Hi Spoonbits;

Thanks for sharing (very eloquently) your story and the corresponding info on MAOIs!

It sounds like quite the dilemma!!

I'm sure you've been asked this a million times, so I'm sorry if this sounds repetitive and frustrating, but are you absolutely sure that none of the other anti-depressant medications (i.e.; the ones you can take with ADD med) can work to alleviate your depression and social anxiety?

Welcome to the forums!

Welcome to the forums!:) It's great that your MAOI's are working so well on your social anxiety. I'm afraid I don't know of any ADD meds that mix well but that doesn't mean there aren't any. IMHO severe anxiety is worse that ADD symptoms. I have anxiety problems (although not social) as well as ADD and find that they are more problematic than the ADD. Have you looked at the list of non medication suggestions given in Hallowell and Ratey's book Delivered from Distraction? Exercise is one holistic medication that mixes well with most everything and is effective in helping improve concentration and focus.

Another thought -- my anxiety was greatly reduced by the ADD medication (this isn't true for everyone but is for many). Perhaps you could try the ADD meds and see which helps you more -- the MAOI's or the ADD meds. Some antidepressant meds work well for both --perhaps a stimulating antidepressand like Wellbutrin or Effexor. Finding a good psychiatrist who understands adult ADD and social anxiety could be a very good thing. Perhaps on ADD medication, behavioral counseling could help with the social anxiety. Sorry -- haven't taken my meds today, so am kind of shot gunning and rambling. Any any case, good luck in finding the right fit for you, and welcome aboard!:)

Scattered

I'm sure you've been asked this a million times, so I'm sorry if this sounds repetitive and frustrating, but are you absolutely sure that none of the other anti-depressant medications (i.e.; the ones you can take with ADD med) can work to alleviate your depression and social anxiety?

Hello addinbc (and Scattered). Long of wind, I reply:
For I’ve been wondering about this myself. Would some kind of drug cocktail prove effective? If I took this for that, and that for the other thing - would it help? I don’t know, of course, not having tried an extensive number. Prior to Nardil, I tried a few of the SSRIs to little effect. Nardil, however, proved so dramatically superior, well, shoot - that was it. I saw no further reason to fool around.

More recently, however, the issue of Innatentive ADD has become a considerable factor to figure. (It’s been there all along, of course, I just didn’t know there was a name for it other than “the absent-minded professor”.) The MAOIs, as mentioned, appear ineffective for ADD. Boo hoo!

Re: the SSRIs - quoting from the website socialfear.com:
“...the vast majority of those who try SSRI's (standalone) for the treatment of Primary Social Anxiety Disorder remain quite discouraged and symptomatic.”

Not to brag and boast too much about my beloved MAOI - but having experienced their efficacy, the SSRIs appeared to me like toys. Semi-kinda-sorta anti-depressants which made me feel uncomfortably buzzed as if I'd just downed waaay too much caffeine. Not to mention - they had zero effect on my social anxiety; I was as self-conscious and uptight as ever in social situations. Two SSRIs into my treatment efforts, and I started getting desperate. "Damn... this stuff ain't doing jack sh*t! Oh my god, what now?" Which is when I started frantically researching anything I could find on social anxiety - and that's when I began reading about the MAOIs - Nardil in particular. It has been described as "the Gold Standard" for treatment.

In comparison to the excess jingley-jangley buzz of the SSRIs, the MAOI - when it first blossomed in my brain after a 6 week germination - felt like a warm, luxurious bath of golden neurotransmitter fluid. Calming and energizing at the same time. And most important... I came out of my shell so substantially that other people were shortly remarking "Wow... you've been talking so much lately! You used to be so quiet - you almost never said anything. What's up?" What was up remained my secret - but those comments (and there were a number of them) were a superb corroboration of how I felt - which is to say, far more comfortable around other people.

After this experience, I began looking down my nose at the "lesser" anti-depressants, the "selective" anti-depressants. After all, why be selective when you can have it all? Sure, I had to give up pizza - but what the hell. (later, as mentioned, pizza was reintroduced to my diet, along with just about everything else.)

There isn't a doctor I've seen since who, upon hearing about my MOAI use, doesn't try to talk me out of it. I'm like, "Dude - it's not open for discussion. Forget it. You're wasting your breath. I'm a starfish, and you're like a child trying to pry me off the MAOI rock. It ain't happenin'.” When it comes to subduing social anxiety, I'm first in line for the “last line” treatment.

Also - when reading books about social anxiety I’ve noticed that the MAOIs are often given a relative footnote - a short paragraph at the end of a list of meds that includes all the SSRIs. Mind you, the paragraph will often say something like "the MAOIs are highly effective in treating social anxiety, but..." The "but", of course, referring to their potential danger - which is certainly a factor. However, the MAOIs (first released in 1961) are also drugs that are long off-patent - consequently there’s very little economic incentive to promote or even study them. See http://www.socialfear.com/ssri_failure_in_sp.html for a discussion of this.


So, um... this colors my perception of other drug treatments. Even still - the absent-minded professor in me (a.k.a. “Spaceboy”) - drives me nuts. Therefor I wonder, would some other kind of treament arrangement work?

I’ve experienced a degree of professional success recently with a couple high-profile projects - but the effort involved in completing them has been gargantuan and utterly maddening. The more important the project, the greater the effort, and the greater the effort, the more half-starts and possiblities I produce. The excess of effort is well described by a quote from Edward Hallowell: “You get one idea and you have to act on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard. It's just that you have all these invisible vectors pulling you this way and that which makes it really hard to stay on task.”

Not to mention - once the creative, conceptual work involved in a project is complete, I often have to wrestle with myself like it’s a confrontation on “WWF SmackDown” in order to get the more tedious production aspects done. I almost invariably finish things at the last possible moment in spite of a great desire not to. It’s like, the earlier I start a project, the more time I have to fiddle around with lots of ideas, variations, and themes - and it’s only the impending deadline that forces a decision, and insists that I tackle the tedium of production.

addinbc and Scattered... thanks for the welcome!
The forums on this website are excellent. Very useful. Lots of info. The first person accounts of ADD and its treatment especially so. I'm glad I found it.

IMHO severe anxiety is worse that ADD symptoms. I have anxiety problems (although not social) as well as ADD and find that they are more problematic than the ADD. I’ve contemplated this before in the form of magic thinking.

Let’s say, for example, that I’m out cleaning the garage, and I discover a rare 1936 vintage can of Mother-Penn 10W-30 Motor Oil in excellent condition. Figuring I could unload this thing on Ebay for a few bucks, I begin cleaning it off. In doing so - whadda ya know! - out comes a friendly genie.

This genie is so pleased to be released from the confines of his oily prison, he grants me a wish. He can entirely eliminate my social anxiety, turning me into a graceful, charming, and gregarious dynamo on the social circuit (with all the benefits that come from that)... or he can zap the ADD, creating a moody, taciturn, and distant workaholic who’s organized, efficient, and highly productive (as a result, the potential of my talent is wonderfully fullfilled.)

So what’s it gonna be? (And boy, answering that question is tough.) First off I’d try to weasle another wish out of the genie (“Whadda ya mean - only one wish?”) but if that option remained unavailable, shoot... I’d have to go with - eliminating social anxiety. Might as well enjoy life.

But then again... it would be so nice to, you know, more easily achieve. It would be so nice to be focused, directed, motivated, and possessed of an iron concentration. It would be so nice to maximize my potential.

Anyway... so much for magic thinking. And yes, that was a long and wordy way of saying that I agree with Scattered - anxiety conditions (esp., for me, social anxiety. I hate it.) can be more debilitating than the frustration of ADD.

But then again...

I have been on a type of MAOI called Aurorix. I also found it very good. Apparently people with ADD are more likely to respond to MAOIs (though you can't take them in combination with stimulants for anyone else reading this who is looking for an antidepressant). Aurorix is a newer MAOI (or a RIMA to be precise) that only effects monoaminie oxydase inhibitor A and not B. Because of that, you can eat all the foods and drink wine. Dunno if the wine thing bothers you. Anyway, I was going to say that different antidepressants work well for different people depending on their physiology. SSRIs sucked for me too but I know people that have done really well on them.

I don't know why MAOIs don't work for ADD but there are actually lots of different types of serotonin, different types of dopamine etc and psychiatrists don't know exactly what the different antidepressants act on. (There is a lot of trial and error in psychiatric treatment of depression.) Also chemicals interact, so types of serotonin impact on release of dopamine and whatever.

(A few thoughts re: social anxiety, ADD, and dopamine levels.)

A little brief I got off the web at socialfear.comregarding Aurorix (moclobemide) and social anxiety:
"During the mid 1990's 2 early studies in South America showed high rates of efficacy for moclobemide in the treatment of social phobia (SP). Unfortunately, two larger North American studies in the late 1990's showed no efficacy at all. While study data is conflicting,real world evidence is that moclobemide is no more effective in the treatment of SP than are the SSRI's. Moclobemide does have some advantages (and disavantages) relative to the SSRI's. Moclobomide is equally effective as an antidepressant and causes no sexual side effects or sedation. However, moclobemide is less effective than the SSRI's in the treatment of most anxiety disorders.

I don't think it's all that well understood what's going on neurochemically re: social anxiety. I've read things like this:
"Dopamine (DA), serotonin (SE), and GABA dysfunction are hypothosized in most cases of moderate to severe SP, in varying degrees depending on the individual."


The MAOIs, it appears, are effective simply because they aren't selective. Anti-depressants that target specific neurotransmitters don't seem to have nearly as much impact.

"There is strong evidence for dopamine dysfunction in SP. Comorbidies with other DA hypofunction disorders such as atypical depression, dysthymia, and attention deficit disorder are common."

This is a curious statement to me. I hit all three of those. (a joyous mixture of comorbid conditions) The one thing I'm really curious about, however, is that (as mentioned in above posts) the MAOIs seem to have no impact on ADD, while being very effective for depression and social anxiety. In raising the level of every neurotransmitter in the brain, the MAOIs, it seems, turn me into a bit more of a hyperactive outgoing ADDer and less of a languid, innattentive ADDer - but I remain an ADDer, nonetheless.

This would seem to suggest that there is, perhaps, a bit more to ADD than simply low dopamine levels - that there's some kind of "static" or "interference" going on as well. The stims may work their magic in that, by significantly increasing dopamine only, (while the other neurotransmitters remain at relatively base levels), this assists in overriding any "static". (I'm entirely conjecturing here. I haven't dissected any brains lately, so I can't really tell you what's up.)

Along these lines - of the folks I know with ADD, more than a few of them are highly outgoing, something also apparent from the literature and from reading these forums. I think that the highly social ADDer is probably more the norm - but they clearly run the inhibited/outgoing spectrum. [Also of note - I know a couple of people with social anxiety, who appear to have no symptoms of ADD whatsoever - they're highly organized, focused, and productive.]

There have been studies of social inhibition and emotional reactivity in monkeys - and it's been a good while since I've read the lit (I have it around somewhere) so don't quote me on this - but I recall reading something along the lines of... the alpha male in a troop was shown to have the highest levels of dopamine in his system relative to the other males. Given a drug that reduced his dopamine levels, he ceased being the alpha male, while another took over. Dopamine levels then noticeably increased in the newly alpha male. So... could a relatively high dopamine level, outgoing, and highly social alpha male also have AD/HD?

Anyway, just tossing some speculation out there.

(Has AD/HD ever been recognized in primates?)

I thought ADDers had lower levels of dopamine. Anyway, there are at least 5 different types of dopamine receptors so it is possible that dopamine is affected in different ways by stimulants and MAOIs. There are some articles that suggest that norepinephine and noradrenaline might play a role as well. Neurochemistry is pretty complex and they haven't got it all figured out yet.

“The truth is, scientists have a slender grasp of possible biological substrates for a few aspects of personality, prominent among them social inhibition and depressive personality. But we are a species of theory builders. Once we begin to believe that personality has biological underpinnings, we act as if the future were already at hand.”

Peter Kramer in Listening to Prozac.


As for my amateur theorizing, I was definitely right about one thing - it had been a long time since I read that article regarding the above mentioned primate study. The neurotransmitter being studied was seratonin. A seratonin increasing drug was shown to make a male rhesus monkey more dominant over an untreated male, and when that same animal was given a seratonin decreasing drug, he became subordinant. (The circumstances of the study were much more elaborate than that, of course. I just don't want to type it all out.)

Dopamine, however, is shown to be somehow related to social inhibition in animal studies. Mentioned along with the above primate study (in a book called The Hidden Face of Shyness) was a study of mice bred over 25 generations to develop a strain that would become inhibited and freeze in response to mild social contact with an unfamiliar mouse. The brains of the selectively bred “shy” mice differed from normal mice primarily in having lower dopamine levels.

I’m only blabbin’ along here cuz I’m intrigued by the MAOIs apparent ineffectiveness (in me) in treating ADD symptoms. When I told my psychiatrist that I was on an MAOI, one of the first things she said was that it should help with my ADD, and she would seem to be correct in that assumption. The MAOIs definitely increase dopamine levels. But the change in me, as noted, is more like going from a sluggish, inhibited ADDer towards a more active and outgoing ADDer. I do find it curious.


5 different kinds of dopamine receptors, you say? Oh well. I give up.

Did you try deprenyl? It's considered a "safe" MAOI.

No, I haven't tried deprenyl (selegiline), nor looked into it much. (I am curious about it though.) Nardil worked beyond my expectations in treating social anxiety, so I saw no reason to look further. This was a little over 9 years ago, and my investigations into the topic pretty much concluded at that point. I’ve only recently (within the last year or so) been looking into ADD treatments. In doing so, one of the primary drawbacks of Nardil has arisen - it’s incompatibility with just about every medication currently used to treat ADD.

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Remarkably, I found an abstract (at the National Center for Biotechnology Information website) under the title: “Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.” (1) After an extensive search of medical literature from 1962 to 2003 it states “No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI.”

I have no idea what to make of this (the entire article can be purchased from the website, but I haven’t done this). I’ve had so few problems with food interactions, despite the many warnings, that I’m fairly open to the idea that “off limit” items might be tenable while on an MAOI. However, the most significant hypertensive experience I’ve had while using Nardil came about after consuming a cup of Nyquil. Nyquil contains an antihistamine (chlorpheniramine maleate), a cough suppressant (dextromethorphan), as well as decongestant (pseudoephedrine). Whatever ingredient(s) it was that caused the hypertension, Nyquil is definitely to be avoided while on an MAOI - as per the label warning. As a consequence of this experience, I pay careful attention to "do not use this medication while on an MAOI" warnings. Also, while the article indicates possible stimulant use while on an MAOI, one's chances of finding a doctor willing to combine the two are probably next to none.


(1) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15554766&dopt=Citation

My doctor told me to keep taking aurorix while I started my dexamphetamine and I was very very uncomfortable the first couple of days - highly anxious, nausea, difficulty making decisions, headaches, very tired coming down, so I went off the aurorix and things immediately got better. The weird thing is, I'm feeling really good just from taking the dex. I feel less socially anxious than when I was on the aurorix and my mood is good among other things. It's weird that I feel even less socially anxious because my mood in terms of depression was great on the aurorix.

My doctor told me to keep taking aurorix while I started my dexamphetamine and I was very very uncomfortable the first couple of days - highly anxious, nausea, difficulty making decisions, headaches, very tired coming down, so I went off the aurorix and things immediately got better. Hello, geckogirl
It sounds like your cocktail (dex/aurorix) went a bit sour in your system. If it went sour, at least it did not go rank (hypertension - stroke). That’s the big concern with the irreversible MAOIs like Nardil. (Consequently, I ain’t touchin’ any stimulants while on Nardil - internet abstract or no.)

It's weird that I feel even less socially anxious than when I was on aurorix. It’s the dopamine, I tell ya. Gotta be. I’ve read more than a few accounts describing increased social comfort while using the amphets.

So... what’s the up and down like with the dexies? Mild, medium, or bumpity-bump? I’ve read of people not particularly caring for this aspect - though others don't seem to mind. For myself, I must profess - there’s nothing like that looooong, smooooooth anti-depressant action. The MAOI gondola ride is a couple days getting to the peak - and a slow, perfectly comfortable decent down the other side. In considering a stimulant, the up/down is something I wonder about.


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Just a note: The MAOI "peak" dissolves from underneath somewhat quickly. That is, tolerance is definitely a factor. Push the dosage into the maximum recommended range and it’s efficacy is superlative. For a time. Stay in that range for a few days, and you’ll notice it’s usefullness beginning to wane. The longer you crank the dosage knob to ‘high’, the less bang you get for your buck. From my experience, in a week or two you’ll be feeling closer to baseline again, while still taking the same higher dose. Dang! Some kind of re-regulation is going on in the neurochemical department - like, the cell managers are all talking to each other saying “Dudes! This clown is trying to outsmart us. Decrease levels of x! Slow the production of y! Inhibit the action of z!”.

Realizing that I was dealing with a sophisticated inhibitory feedback-mechanism designed to keep things on the level - and that I couldn’t keep infinately raising the dose - I essentially said “Relax guys, it’s cool. See? I’ve tapered my dose downwards towards the barest of maintenance levels.”

But... heh heh... for times when my anxiety is barking like a bulldog and I want to put a muzzle on it (moving into a new job, for example), or when the road of life is just plain ol’ rough ‘n’ ugly - I bump up the meds. And it works. However, for at least 90% of the time, I’m on a minimal “keep it in my system” dose. At maintenance levels, it still seems to provide me with a degree of buffer against undue anxiety and the darker shades of gloom - and - it doesn’t mess with my sleep. (On higher doses of Nardil, getting to sleep can be a real problem - and there’s nothing like sleep deprivation to put some extra bone in my bonehead. Hello Spaceboy!)

I’ve read in these forums re: Strattera - “Worked great! Um... for a short time. Darn!” Since Strattera is anti-depressant-like in it’s action, I’ve wondered if the above technique would work. As in, re-regulation of neurochemicals is likely to occur, diminishing efficacy in the process - so perhaps figure out a dosing technique to work with it rather than against it. These things ain't perfect, you know, and when it comes to meds, shoot... I’ll settle for part-time efficacy over zero efficacy anyday.


It sorta makes me think of that old Stones song - you know, the one that goes: "You can't always get what you waa-aant... but if you fiddle with your dose, you just might find, you get what you need."

Hehe.

I found on Aurorix it was pretty constant in it's effects on my mood. A higher dose did make me feel better when I needed it, but I mostly kept to a lower dose as well and that was sufficient. I have only been on dex for two weeks but this is my observation so far: I get more vague than before I was on it if I don't take my tablet on time - can't stay tuned to a conversation and forget stuff. I also get tired when I am coming down and I can't motivate myself to do much especially if I have not been sleeping much anyway (bc of going out or whatever - not because of the dex). There is not too much effect on my mood on the come down (even though I am withdrawing off my antidepressant) and if I do feel flat (twice in 2 weeks) I have found a multivitamin has done the job.... A doctor I saw who was also trained as a naturopath told me to take a lot of vitamin B and C when I thought I was getting depressed once and it did actually work for a while - but ultimately the very stressful relationship I was in at the time won over and I got depressed. Though still, vitamins do seem to have an impact on me. I've read you need more C when stressed and of course the effects of vitamin B on stress are well known. Apparently your body uses more of them when you are stressed. I guess amphetamine would put some stress on your body or just the change of meds or whatever....

Spoonbits, this is very helpful to read. Thank you for posting your experiences.

It sounds like we have very similiar problems - I am also depressed, with social anxiety and inattentive ADHD. (What a lovely combination - I'll let you guess how full my social calendar is.)

What I don't understand is this - if taking a stimulant produces better focus by increasing the amount of either dopamine (methlyphenidate) or norepinephrine (dex) in your brain, then why wouldn't an MAOI affect one in the same way, in that taking it would also presumably result in more dopamine/norepinephrine in your brain? :confused:

It sounds like we have very similiar problems - I am also depressed, with social anxiety and inattentive ADHD. (What a lovely combination - I'll let you guess how full my social calendar is.) Hey Allison,
I'm glad you've gotten something from my posts. I figured there had to other people out there similar to me, and I've had good luck using medication to treat a couple of my less than optimal brain functions - so I figured I put it out there. Besides, I've never had the opportunity to say things like "The MAOIs rock!" before. It's just not a topic you'll frequently find discussed, and, man, I've long had an itch to say "The MAOIs rock!"


I don’t know what your experience of social anxiety is like - how limiting you feel it to be. If you’re interested, www.socialfear.com (http://www.socialfear.com/) is a website worth checking out. It’s a small site, but it provides a good overview of medication treatments for social anxiety. The site author also extolls the virtues of Nardil, (as do I) based upon his personal experience with it.

Social anxiety and depression often work in tandem, creating a vicious cycle which can make life very uncomfortable. The degree of discomfort depends, to a fair extent, on how “buffered” you are. A decent enough family life and social life will buffer you from worst case scenarios. Even if your experience of it, however, is relatively mild, it can still wreak havoc in areas like career advancement and relationships. We’re highly social animals, you know, and if you can’t swim well through the social medium, your opportunities are likely to be limited accordingly.

In my case, the dynamic duo of social anxiety and depression turned into a vicious cycle spinning overtime. Things got out of control when, for reasons of ambition, I struck out on my own and moved to a much larger city (NYC). (My family/social “buffer” disappeared when I moved.) I didn’t even realize entirely what was going on, but within my first year I found myself feeling quite isolated. Isolation, of course, is a fabulous environment for the cultivation of depressed moods. And depressed moods, in turn, not only increase anxiety (social and otherwise), but reduce motivation and interest in social activity altogether.

And - I might point out - they don’t put people in solitary confinement for no reason. Social interaction is like food for the emotional being. Don’t get enough of it, and things start getting... a bit weird. Weird and desperate. My desperation to pull myself out of isolation put a tremendous amount pressure on my social interactions. The result was fantastically high levels of self-consciousness - I'd freeze up around people in a big way. It was a bit like being caught in a sand-pit trap, struggling to get out seemed only to hasten my decline down the slope. Awaiting my arrival at bottom, of course, were big pincers and poisonous things.

I hung on in New York with a white knuckled grip for as long as I could. After a number of years of grisly endurance, however, I finally conceded defeat and bailed. I just couldn’t break the cycle. So I moved back to my city of origin where I had family and friends. This eased things a bit, and life appeared to get better - but then... it got worse again (feelings of isolation and downward trends) - then it would become a bit better... but invariably things would take a turn for the worse, and I’d find myself heading, once again, towards one of the lower hells. And every time I started going down, it would put the fear of god in me - cuz I never had the sense of being to put brakes on my slide.

Eventually, man, that was it. I’d had it. Life sucked and nothing I did seemed to help it. I had very few friends, and the one’s I did have, I didn’t see too often. Unable to take much more of it - I finally investigated medication treatment. Thank god.

After a couple SSRIs and some desperate research, I discovered Nardil (as described in above posts). I landed a prescription and, since it seemed like something of a last chance, crossed my fingers. Lo and freakin’ behold - after six weeks of worry and wonder - it took hold. And when it took hold... it vaporized my depression/social anxiety combo like a scrap ship around the perimeter of a south pacific nuclear test site.

With an old, irreversible MAOI like Nardil, lemmee tell you, there ain’t no half-steppin’ and no messin’ around. You won’t find yourself asking questions like “Gee... is it working yet?”. No ma’am. When Nardil kicks in - you know it. Nardil is p.o.t.e.n.t. And the best part of it’s potency is that - hot diggity dog! You can finally be yourself around other people.

I will add, however, that Nardil is not perfect. It’s a boost. And, hopefully, the boost it gives will find one flowing into a better scene. Cuz, believe me, there’s nothing like a more extended social circuit to alleviate anxiety and quell depression. That’s what you’re ultimately seeking. Increase your social circle, solidify friendships, establish a sense of belonging - and you’ll have found the world’s best anti-depressant. That’s been my experience.

I’ve kept Nardil around for 9 years because it continues to serve as buffer, boost, and brake. On really low maintenance doses it provides a bit of a buffer. When I need a boost, I boost it. And it most definitely will put the brakes on a more precipitous decline. This last aspect is actually one of it’s nicer anxiety reducing effects. Just knowing that it’s available and that it works, helps keep a lid on worry.

As for this: What I don't understand is this - if taking a stimulant produces better focus by increasing the amount of either dopamine (methlyphenidate) or norepinephrine (dex) in your brain, then why wouldn't an MAOI affect one in the same way, in that taking it would also presumably result in more dopamine/norepinephrine in your brain? I don’t know what to say about this either. I'm just describing my experience - and it's not something I've corroborated with other folks - cuz I've never met other folks on Nardil. On higher doses I’ve definitely noticed increased motivation - fer sure. But I still feel scattery and distracted. You know, sorta here, there, and... oh, say, look at this!

Part of the reason may lie in the difficulty higher doses can cause with sleeping. Lack of sleep doesn’t help with ADD anything.

Hi!
Ive recently been doing some research on Deprenyl (Selegiline). Its a relitavely new irreversible selective MAO-B Inhibitor, and as such, has no dietry restrictions unless the dose is sufficiently high to inhibit MAO-A. Selegiline increases dopamine and phenythylamine levels in the CNS/brain. (MAO-A is the one that raises levels of serotonin and norepinephrine.) It can raise norepinephrine levels indirectly as well. Now im not entirely sure about this part but selegiline is partly metabolized to 'inactive' stereoisomers of methamphetamine which can cause you to fail tests - but - since it has the effect of energising you, improving concentration, cognitive processes, etc. I do wonder if they are at least partly active. It also improves memory, purports to extend life (aged rats lives were lengthened by 20% in a study), protect against mental illness in the future (e.g. parkinsons, alzhiemers), and increases libido as a sexual stimulant/aphrodisiac (in men) significantly (not like amphetamine!). For women, apparently sexual desire is not so stimulated.

Ive been wondering about this drug for a couple of days now and it seems to me to be almost perfect for my ADD/Social anxiety. From what ive researched, there doesnt seem to be any physical withdrawel (is that the case with all MAOI's? I'm asking b/c I havent found any info on that - and other antidepressants have bad withdrawals from stopping suddenly), and it seems much safer and good for the body than amphetamine. Theres one thing that could be seen as an advantage or a disadvantage - the irreversibility of it. Heres a quote from wikipedia:
Reversibility

The early MAOIs inhibited monoamine oxidase irreversibly. When they react with monoamine oxidase, they permanently deactivate it, and the enzyme cannot function until it has been replaced by the body, which can take about two weeks. A few newer MAOIs, notably moclobemide (http://en.wikipedia.org/wiki/Moclobemide), are reversible, meaning that they can inhibit the enzyme for a time, but eventually detach, allowing the enzyme to function once more. Im also trying to find the answer to the question of whether it builds up in the body over long term treatment and as a consequence starts to inhibit MAO-A as well (that was hinted somewhere as I was researching). This could be disasterous to me (although not necessarily of course as spoonbits explained) as I eat alot of the foods not allowed on an MAOI diet.


As for those drugs which are supposed to not be used with MAOIs, the reason for that is that they are vastly potentiated. Hence, as spoonbits mentioned, adding stimulants very cautiously will not produce a hypertensive reaction. Theoretically it is perfectly possible to combine an MAOI with any drug it interacts with - the dose will just be far lower to produce the same effect. For example, if you were on say 5mg selegeline per day, you might be able to add 5mg dexedrine to the combination and it would be as powerful as if you took 20mg dexedrine on its own and would be more long lasting (of course, I dont know the right dosages - the ratio will most likely be different for everyone). In any case, if you start out with tiny amounts of the drug your not supposed to combine, you may well find you can take these drugs with no adverse effects.

Often theres a very real danger when someone on an MAOI takes recreational drugs - due to the reason described above. LSD or magic mushrooms for example are phenethylamines. Due to MAO-B being inhibited and therefore not removing phenethylamines nearly as fast, the user would need to take much less to achieve a more powerful and long lasting experience. The same goes for many other phenethylamines (such as research chems like 2C-B, 2C-T-7) and I assume, all the tryptamines (DMT is a tryptamine). MDMA, of course, also is potentiated. I really doubt cannabis is potentiated though.. no research done on that one - anyone know for sure? GHB definately is - I read a report about someone who took selegiline and their normal dose of GHB and the GHB didnt wear off for a full 12 hours (dangerous situation).

If you have heard of the drug DMT, you may know that it has to be taken with an MAOI to work. Now my curious self dreamed up this question: If DMT is potentiated by an MAOI, and DMT is also secreted by the pinneal gland (I read somewhere that it happens during sleep when you dream but I don't know if its true), I would have thought you'd get much more intense dreams - does spoonbits or anyone else on an MAOI experience really vivid dreams because of their MAOI?

As to the availability of Selegiline, I have found several reliable internet stores where it can be ordered quite cheaply as a nootropic - and its not against the law, so its very tempting to give it a go.
Any comments are welcome - i'd love some feedback/answers!!
Thanks,
Alex

Coming from a treatment resistant depression/anxiety background i can say without a doubt the most effective and potent non maoi/non benzo cocktail i've ever experianced is effexor/remeron. I would imagine its far to intense for most people but if you're allready onto MAOIs and need to find a good replacement this would be your best bet. Benzos of course dont hurt either.

The only thing i really worried about with this combo is serotonin syndrome. You would need to educate yourself and probably try to get some anti serotogenic drugs from your doctor incase the problem were to ever come up. Theres a cheap anti histamine who's name escapes me pericidan(sp?) maybe, that works well i've heard.

If anyone is curious about the MAOIs and their effectiveness in terms of ADD, my experience might be of interest.


Thanks for sharing your experience Spoonbits. I'm on the other side of the fence from you, taking Adderall/Cymbalta/Klonopin to help make me a productive (if much less creative) drone. I'm still kinda depressed, I still have many of the same social phobia problems, but at least I can get work done... In my view it's a terrible trade because I feel the Adderall taking it's toll on my body and I walk through life productive but on an emotional flatline. (except when I crash at night... then I cry for an hour or so. lol.)

I was wondering, every doctor has told me that "Nardil will make you very fat." Has this been your experience having taken it for nine years? What about the other side-effects, such as loss of libido? It seems every PDoc I talk with would rather give me an Rx for crack cocaine than for Nardil or Parnate. I don't get it.

Just how bad is the increase in ADD syptoms when you're at your effective dose of Nardil? Are you more inattentive or hyperactive?

Sometimes I think that I may not be ADD at all, or it may not be my primary problem, and that the grinding of the atypical depression and social phobia had just led me to a place where I don't even try to concentrate because I know I'll feel like an inferior peice of garbage no matter what I do. I'm not sure what the solution is, because if I were to try Nardil and not be able to work due to distraction, then I'd be a happy, outgoing homeless person. Right now I'm a mostly miserable shut-in who has a job.

I know that there has to be some solution to this... and I really don't think the solution is a new dosage of the PStims (tried them all) or a hot new SSRI or SNRI (tried them all). There has got to be something... I just don't know where to turn next and I'm afraid of turning into a whale overnight by taking Nardil.

(sorry for the rant, but I'm rather frustrated right now!):( /:mad: