Treatment resistant depression in Scottsdale: Michael Yasinski MD discusses why he uses MAO-l’s when few other psychiatrists in the country do
Treatment resistant depression is one of the most common problems I see and I have seen a disappointing trend in the psychiatric community be unwilling to utilize potent tools in the fight against treatment resistant depression for a variety of reasons. One of the most potent tools to treat severe depression is utilizing an MAO-I (Monoamine oxidase inhibitor). MAO A and MAO B are enzymes in our brain which metabolize neurotransmitters involved in depression. MAO A helps break down dopamine, norepinephrine and serotonin and MAO B breaks down dopamine.
In addition, MAO-I drugs act to modify other circuits, gene regulation and receptor expression involved in treatment resistant depression which goes above and beyond its effect on the 3 well-known neurotransmitters serotonin, norepinephrine and dopamine. I have utilized MAO-I’s extensively over the past 3 years and have seen tremendous results in people who have had no response or minimal response to other typical antidepressants.
The MAO-I that I find most effective is Parnate for severe treatment resistant depression. Parnate is inhibits both MAO-A and MAO-B which provides a potent ant-depressant response in the brain. Parnate is particularly useful for atypical depression which includes people who are finding they are sleeping excessively, have low energy and are finding it impossible to garner joy or pleasure out of activities they historically have. Apathy, or lack of feeling pleasure/emotion is often eliminated and people find they feel joy, regain their personality and are able to feel emotion again.
Why don’t more psychiatrists use MAO-I’s? for treatment resistant depression if they work so well? Frankly, modern psychiatrists are no longer trained in using these medicines. Older psychiatrists are often fearful about legal ramifications due the climate of medicine in general. The climate of modern medicine rarely allows for adequate time spent with patients and while MAO-I medications are perfectly safe when used by an experienced psychiatrists, they come with specific restrictions which a patient needs to understand and comply with. Many psychiatrists due to not get to know their patients well enough to establish the necessary rapport to build this trusting relationship.
The main concern is some dietary restrictions which from years of prescribing these medications for treatment resistant depression, I have not seen a single problem with the dozens of patients I have treated. MAO-I can interact with tyramine, which is a compound found in some foods and if ingested in large amounts while on an MAO-I can cause a hypertensive reaction that can be dangerous. If the diet is followed and an understanding of the types of foods to avoid is followed, it has few restrictions in reality. Here is a link from mayo clinic on the MAO-I diet
If you are struggling with treatment resistant depression and want someone with experience in the most potent tools available please call me and I am happy to discuss the many options.