MAO inhibitor, hyponatrimia

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Chrisweides
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MAO inhibitor, hyponatrimia

Post by Chrisweides »

Hello everyone,

I still have bouts of insomnia and anxiety. With a MAO inhibitor called moclobemide and HRT and therapy, I am starting to get a few hours in between that are better, Sleep is getting a little better slowly. Many nights I get around 6 hours which is less than I’d like but a lot more than waking up relentlessly after 3=4 hours like before.

However I still get those bad nights. And now I have developed some things that worry me.

First I seem to have slight hyponatrimia, which means too little sodium. It is not healthy for the brain and I don’t really know what to do about it. Eating salt doesn’t correct it and it has been only slightly under the norm so the doctor says she isn’t too worried yet. In my anxous state, I am though.

Second thing is the antidepressant itself. I feel a bit caught between a rock and a hard place. It is a MAO-A inhibitor, reversible. There are some studies that say it will improve cognition in those who have AD. Some studies I found say MAO inhibitors will raise your risk of AD in general, which is not something I want. I know depression and anxiety and insomnia are not good either, though, so treating it is better in my opinion. What do you think? Do I take medication or do I try to get rid of all brain influencing meds asap? I am specifically worried since I am to increase my dose in the hope things get better.

Also, I am getting treated in a day clinic and therefore have to eat their lunch. Three months of unhealthy food. Hm. Well three months isn’t going to hurt too much but I don’t like it.

Even before, my triglycerides were elevated even with intermittent fasting and a healthy diet which I don’t understand and which really worries me.

Just woke up again in the middle of the night worrying about these things so I thought I can ask you knowledgeable people if you have any ideas. I am glad this place exists. I have nowhere else to ask, my doctors all dismiss the future as inevitable.

Thank you
Chris
51 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!
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floramaria
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Re: MAO inhibitor, hyponatrimia

Post by floramaria »

Chrisweides wrote: Mon Sep 05, 2022 7:05 pm Hello everyone,

I still have bouts of insomnia and anxiety. With a MAO inhibitor called moclobemide and HRT and therapy, I am starting to get a few hours in between that are better, Sleep is getting a little better slowly. Many nights I get around 6 hours which is less than I’d like but a lot more than waking up relentlessly after 3=4 hours like before.

However I still get those bad nights. And now I have developed some things that worry me.

First I seem to have slight hyponatrimia, which means too little sodium. It is not healthy for the brain and I don’t really know what to do about it. Eating salt doesn’t correct it and it has been only slightly under the norm so the doctor says she isn’t too worried yet. In my anxous state, I am though.

Second thing is the antidepressant itself. I feel a bit caught between a rock and a hard place. It is a MAO-A inhibitor, reversible. There are some studies that say it will improve cognition in those who have AD. Some studies I found say MAO inhibitors will raise your risk of AD in general, which is not something I want. I know depression and anxiety and insomnia are not good either, though, so treating it is better in my opinion. What do you think? Do I take medication or do I try to get rid of all brain influencing meds asap? I am specifically worried since I am to increase my dose in the hope things get better.

Also, I am getting treated in a day clinic and therefore have to eat their lunch. Three months of unhealthy food. Hm. Well three months isn’t going to hurt too much but I don’t like it.

Even before, my triglycerides were elevated even with intermittent fasting and a healthy diet which I don’t understand and which really worries me.

Just woke up again in the middle of the night worrying about these things so I thought I can ask you knowledgeable people if you have any ideas. I am glad this place exists. I have nowhere else to ask, my doctors all dismiss the future as inevitable.

Thank you
Chris
Hi Chrisweides, I wish I had some wisdom to offer you in response to your questions, but unfortunately I don’t. Since I don’t have a medical background, I have no idea whether you are better off taking your medications or not. It sounds like the combination of the bHRT, therapy and medication are helping though. It is great that you are getting better sleep.
One thing I thought of is that maybe you could get a second opinion from another qualified medical expert. Maybe a well-Informed pharmacist could help answer some of your specific questions or you could possibly schedule a consult with another doctor. (It seems sad that your doctors all dismiss the future as inevitable.). Maybe you would be reassured by getting a second opinion. It is a lot to sort through on your own.

You already know that depression, anxiety and insomnia are definitely bad for you. So that side of the equation is known. Maybe someone who is really knowledgeable can help you understand whether the risks of the medication outweigh the benefits you are getting. It sounds from what you wrote that you have the opinion already that you are probably better off with the medication than without it.
If it is really true that in studies so far the results are conflicting, with some indicating improved cognition while others say it may contribute to AD, then you may have to choose based on less than perfect knowledge and try to make peace with that.
Sorry I can’t be more helpful!
Functional Medicine Certified Health Coach
IFM/ Bredesen Training in Reversing Cognitive Decline (March 2017)
ReCODE 2.0 Health Coach with Apollo Health
NF52
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Re: MAO inhibitor, hyponatrimia

Post by NF52 »

Chrisweides wrote: Mon Sep 05, 2022 7:05 pm Hello everyone,
...
With a MAO inhibitor called moclobemide and HRT and therapy... Many nights I get around 6 hours which is less than I’d like but a lot more than waking up relentlessly after 3=4 hours like before.

However I still get those bad nights. And now I have developed some things that worry me.

First I seem to have slight hyponatrimia, which means too little sodium...t has been only slightly under the norm so the doctor says she isn’t too worried yet.

Second thing is the antidepressant itself. I feel a bit caught between a rock and a hard place. It is a MAO-A inhibitor, reversible. There are some studies that say it will improve cognition in those who have AD...? I am specifically worried since I am to increase my dose in the hope things get better.

Also, I am getting treated in a day clinic and therefore have to eat their lunch. Three months of unhealthy food. Hm. Well three months isn’t going to hurt too much but I don’t like it.

Even before, my triglycerides were elevated even with intermittent fasting and a healthy diet which I don’t understand and which really worries me.

Just woke up again in the middle of the night worrying about these things so I thought I can ask you knowledgeable people if you have any ideas. I am glad this place exists. I have nowhere else to ask, my doctors all dismiss the future as inevitable.

Thank you
Chris
Hi again Chris,

First of all, congratulations on being both brave and proactive in seeking out therapy and medication support of MAO and HRT for the significant depression and anxiety you have been experiencing! It sounds like your day program is similar to ones provided here in the U.S. which include both individual and group therapy, medication management, some recreational and social options and, of course, a lunch you might not pick for yourself. (If my German-American mother was in charge, she would have sauerbraten with spaetzle served every day, with extra vinegar on the table!)

I know the feeling of "plan for the worst", but really think this is the time to argue back to that voice that you can "track progress" instead. You are sleeping twice as long as you were a few months ago on the 6-hour nights! Your sodium level is only "slightly" low, and you can trust your doctor that she wouldn't be ignoring it if it wee significant.
Think of temperatures, in the U.S. a perfectly normal temperature might be 98.6℉, but no doctor is going to worry if my temperature is 97.5. So "don't sweat the small stuff". Remember, you are not your mom; you have only 50% of her genes and had NONE of her lived experiences--even when you lived in the same house.

Below is the 2018 abstract from an international "gold standard" study, which is the term used for studies that have a control group that got a placebo drug, random assignment to either drug/placebo group, and "double/blind"--neither participants nor doctors know who is getting which drug. The results appear to clearly show that it is beneficial for people older than you who already have some cognitive decline. Those are folks that usually show LESS benefit from drugs, so the fact they did well seems VERY promising to me. The (P = 0.001) and (P = 0.005) in the abstract means that statistically, there is only a 0.25% chance (i.e. one-quarter of one percent chance) that these results are due to random effects. So moclobemide has a 99.75% chance of being safe and effective for depression and showing cognitive benefit in this study!.
Abstract

Background
The new reversible MAOI moclobemide was compared with placebo in the treatment of elderly patients with DSM–III diagnosis of dementia and/or of major depression.

Method
Six hundred and ninety-four elderly patients with symptoms of depression and cognitive decline entered an international, multi-centre, double blind trial in which they were randomly allocated to treatment with either moclobemide 400 mg daily or placebo for 42 days. Five hundred and eleven patients met DSM–III criteria for dementia and were also depressed (DEM+D); 183 did not meet DSM–III criteria for dementia but met the criteria for DSM–III major depressive episode and also suffered from cognitive decline (MDE+CD).

Results
Analysis of the 17 and 24-item Hamilton Depression Scale scores showed that moclobemide, compared with placebo, produced significantly greater improvement in both the demented and depressed groups (P = 0.001 both diagnostic groups). There was an improvement in cognitive function as measured by the SCAG Factor 1 in moclobemide treated patients (P = 0.005 DEM+D; P = 0.02 MDE+CD). There was no evidence of decline in cognitive function as the result of treatment... There were no significant changes in vital signs, ECG or laboratory findings in either treatment group. There were no dietary restrictions and no report of any tyramine reaction.

Conclusions
Moclobemide was shown to be a safe, well tolerated and effective antidepressant, which did not cause impairment of cognitive function in elderly patients with a DSM–III diagnosis of dementia and/or DSM–III major depression.
Moclobemide in Elderly Patients with Cognitive Decline and Depression: An International Double-blind, Placebo-controlled Trial

If I were you, I would focus on what's moving the right direction and visualize myself a year from now feeling SO much better, and swat away those pesky thoughts.
4/4 and still an optimist!
Chrisweides
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Re: MAO inhibitor, hyponatrimia

Post by Chrisweides »

Thank you both so very much for your kind and supportive answers! And for finding this study for me. I really appreciate it! The wirst part of this is really the insomnia (back at 4 hours at the moment), but it just cannot be helped, I am already doing all I can.

Best

Chris
51 years old. APO E3/4. Mother, grandmother and great grandmother had/are starting with dementia. Afflicted with anxiety disorder atm. Very eager to save brain and live a long healthy life. Grateful to you all for your knowledge and kindness!
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