Posted by undopaminergic on March 31, 2008, at 3:01:10
In reply to Nardil + Ritalin/Concerta/dexadrine = ????, posted by maoi_wowee on March 30, 2008, at 10:54:48
> I am interested in augmenting Nardil with Ritalin/Concerta or possibly dexadrine. My hope would be to increase my energy and focus while improving my mood more than Nardil does on its own.
>
> Can anyone comment on this combo or perhaps even provide links to studies that I could show my pdoc?
>
> Alternately, are there any other stimulating meds that I could add to Nardil that would work better than the ones I mentioned?
>Modafinil is the safest choice, but it is also weaker than the ones you mentioned. It might be a good start, anyway.
If modafinil doesn't do the trick, an immediate-release formulation (regular tablet) of methylphenidate - Ritalin or generic - would be a good next choice. Concerta or other long-acting formulations are not very well suited to begin with, because they can't be divided, and also because in case of adverse effects a long duration would be undesirable.
Amphetamines - Dexedrine, Adderall, and others - are more hazardous because they have much greater capacity for increasing extracellular concentrations of noradrenaline and serotonin, but that may be precisely what is needed if the other stimulants prove insufficient.
There are no problems associated with combining methylphenidate with selegiline at MAO-B selective doses in my experience, but with more extensive inhibition of both isoenzymes (MAO-A and -B) the situation may be different. In any case, care must be taken not to start with too large a dose, and to titrate slowly.
There is almost no information available without subscription. This is apparently all there is on PubMed:
Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.
http://www.ncbi.nlm.nih.gov/pubmed/15554766CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.
http://www.ncbi.nlm.nih.gov/pubmed/2056139Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
http://www.ncbi.nlm.nih.gov/pubmed/3997787Coadministration of phenelzine and methylphenidate for treatment-resistant depression.
http://www.ncbi.nlm.nih.gov/pubmed/14970373Modafinil augmentation of phenelzine for residual fatigue in dysthymia.
http://www.ncbi.nlm.nih.gov/pubmed/15337670
http://ajp.psychiatryonline.org/cgi/content/full/161/9/1716-aConcomitant use of modafinil and tranylcypromine in a patient with narcolepsy: a case report.
http://www.ncbi.nlm.nih.gov/pubmed/15341899Acute chorea and hyperthermia after concurrent use of modafinil and tranylcypromine.
http://www.ncbi.nlm.nih.gov/pubmed/17403991
poster:undopaminergic
thread:820660
URL: http://www.dr-bob.org/babble/20080330/msgs/820845.html