From: SCHOLAR@MEENA.CC.UREGINA.CA
Newsgroups: sci.med
Subject: Help, hypotension is messing up my MAOI trial!
Date: 20 Aug 92 06:00:00 GMT


 
I'm on a trial of Parnate (an MAO inhibitor), having tried norpramine, doxipine
and Prozac without success. While Parnate feels more promising than any of the
others, the hypotension is debilitating.  Its not just when I first stand up,
I'm dizzy and light headed just sitting or standing, and sometimes I almost
faint when I've been standing or even walking for a while (almost faint that
is, because I lie down in time to avoid fainting).
     Anyway, drinking tonnes of water (with salt) and lowering my dose allowed
me to survive the last few days, but if this weren't summer vacation I'd be
dead, besides how can I work if get weak every time I bend over and have to
move like an eighty year old to keep from fainting?
     So this morning I sat down with my copy of the PDR and looked to see if
there was anything I could take with an MAOI that would help.  The only thing
that looked safe to me was the antidiuretic desmopressin [DDAVP], a long
lasting analog vasopressin without most of the pressor action.  I got rather
excited because I'm under the impression that vasopressin (and its analogs) are
the only nootropics with anything like proven action, and with my memory the
way it is these days, I need all the help I can get to make through my next
year of engineering classes.
     I walked down to the library to see what I could find on vasopressin and
on treating the side effects of MAOIs.  Here's what I found:
 
     ... more troubling side effect is orthostatic hypotension ... In its
     milder forms this condition is easily controlled by adding salt to food
     ... fludrocortisone acetate, a mineralocorticoid, may effectively maintain
     blood pressure... .1 mg one to three times daily.  In refractory cases ...
     methylphenidate HCL [Ritalin] or dextroamphetamine [Dexedrine] (2.5 mg per
     day to start) can be added safely and are highly effective...
 
     Fludrocortisone isn't in my (out of date) PDR. I've had bad experience
with Prednisone before (infections took over my face and gums), does
Fludrocortisone have the same sort of immunosuppressive effect at .3 mg?
     Neither Ritalin nor Dexedrin are available in Canada.  I wonder whether
pseudophenedrine could substitute?  I've always gotten unpleasant side effects
from Sudaphed though (anxiety, irritability, dysphoria, poor memory and finally
burn out after taking it for a whole summer).
     Is my DDAVP idea sound?
     My Dad thinks that if I build up my dose slowly enough, my body will
eventually learn to compensate for the hypotensive side effect, is this true?
How long could that take - I'm not particularly patient at this point.
     Don't send me any mail between Aug. 28 and Sept. 1, I might miss the
letter when the university cleans off its hard disks.  Anyway, sorry this is so
long and I hope my light-headedness hasn't affected my writing too badly.
 
                 Joshua Scholar (scholar@meena.cc.uregina.ca)

P.S. I did find an article with some clinical evidence that vassopressin can
     be useful for depression in some cases, but no studies.
Newsgroups: sci.med