![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 96. This is the beginning of the thread.
Posted by Brandon on May 10, 1999, at 23:07:11
Has anyone heard of selegiline for depression. I have heard that it can be helpful.
Posted by Andrew on May 11, 1999, at 11:24:00
In reply to Selegiline for depression?, posted by Brandon on May 10, 1999, at 23:07:11
> Has anyone heard of selegiline for depression. I have heard that it can be helpful.
It didn't help me. I took 10mg./day combined with phenylalanine. I think there is some more info. on this med. in the tips section of the website. It made me feel a bit racey at times.
Posted by Judy on May 11, 1999, at 11:41:20
In reply to Selegiline for depression?, posted by Brandon on May 10, 1999, at 23:07:11
> Has anyone heard of selegiline for depression. I have heard that it can be helpful.
Yes. I've taken selegiline (Eldepryl) on two different occasions for depression. It lightened my depression somewhat, but wasn't helpful at all for anxiety. I had to take Xanax at the same time to control that.
Selegiline is an MAOI-Type B, but at the usual low doses it is prescribed, you don't have to follow an MAOI diet. You DO have to make sure you don't mix SSRI's with it though.
It might work for you and you could probably experiment with higher doses if you received some relief at the original does. Good luck!
Posted by Elizabeth on May 11, 1999, at 15:36:47
In reply to Re: Selegiline for depression?, posted by Judy on May 11, 1999, at 11:41:20
Low-dose selegiline (deprenyl) is sometimes mildly helpful in depression, but higher doses are more likely to work - "low doses" meaning doses at which it selectively inhibits MAO type B (under 20mg or so - typical doses for Parkinson's disease, its official indication, are 5-10mg), "high doses" being those at which there's significant MAO-A inhibition as well. Note that at the higher doses, you do need to observe the MAOI diet. Also, do *not* take selegiline - even at low doses - with an SSRI, Demerol, dextromethorphan, etc.
I tried taking it at up to 40mg. It didn't do much, if anything, for me (though Nardil and Parnate have worked), but not a lot is known about the effective dose range, and it's possible that I needed to go higher.
It's metabolized into l-amphetamine and l-methamphetamine, and I tested positive for amphetamines at one point while I was taking it. Watch out for that.
Research on selegiline for depression has been going on for a little while. A particularly interesting thing about this is the route of administration: they're using a transdermal patch, which for obvious reasons eliminates the potential for food-drug interactions. I hear that it's been successful so far.
Posted by Judy on May 11, 1999, at 18:11:50
In reply to Re: Selegiline for depression?, posted by Elizabeth on May 11, 1999, at 15:36:47
Has anyone taken Moclobemide (Manerix or Aurorix) with any success? I've read that the Type A's tend to deal more with mood elevation and (do I dare even suggest) "happiness."
Does anyone else out there blow out their birthday candles or see the first star in the evening sky and wish for "happy" like I do?
I was excited when I read about Moclobemide but had my bubble burst when my doctor wouldn't allow it because it's not approved in the US by the FDA.
Posted by JD on May 12, 1999, at 6:21:39
In reply to Re: Selegiline for depression?, posted by Elizabeth on May 11, 1999, at 15:36:47
I tried adding small doses of seligiline to my regimen once and found it VERY activating-- surprised myself by going for a ten-mile run a few hours after the first dose! More energizing than mood-lifting in my case, and ultimately discontinued for this reason (insomnia, etc.). Your mileage may vary of course... it's probably a reasonably useful med for certain people.
Posted by Jaime on May 12, 1999, at 8:06:38
In reply to Re: What about Moclobemide - an MAOI Type A?, posted by Judy on May 11, 1999, at 18:11:50
I am a mexican and right now the only MOI available is the AUROREX.(Here is very cheap) The social security give to all the depressed with atipical. For me works fine for about 10 years and then I switch to nardil.
> Has anyone taken Moclobemide (Manerix or Aurorix) with any success? I've read that the Type A's tend to deal more with mood elevation and (do I dare even suggest) "happiness."
>
> Does anyone else out there blow out their birthday candles or see the first star in the evening sky and wish for "happy" like I do?
>
> I was excited when I read about Moclobemide but had my bubble burst when my doctor wouldn't allow it because it's not approved in the US by the FDA.
Posted by Chris A. on May 16, 1999, at 5:14:03
In reply to Selegiline for depression?, posted by Brandon on May 10, 1999, at 23:07:11
Yes, selegiline was helpful to me, but at doses of 50 mg. divided or 24 hours, which is ten times the dose typically given to parkinson's patients. There are some side effects and an MAOI diet must be adhered to at any dose above 20 mg./day. It is the only AD I am willing to revisit if needed.
It was helpful in pulling me out of a severe bipolar depression.Best,
Chris
Posted by Annie on May 16, 1999, at 6:19:25
In reply to Re: Selegiline for depression?, posted by Chris A. on May 16, 1999, at 5:14:03
The transdermal Selegiline patch being tested now for depression does not require the MAOI diet. Just don't eat the patch!
> Yes, selegiline was helpful to me, but at doses of 50 mg. divided or 24 hours, which is ten times the dose typically given to parkinson's patients. There are some side effects and an MAOI diet must be adhered to at any dose above 20 mg./day. It is the only AD I am willing to revisit if needed.
> It was helpful in pulling me out of a severe bipolar depression.
>
> Best,
>
> Chris
Posted by David K. on July 3, 1999, at 8:22:45
In reply to Re: Selegiline for depression?, posted by Annie on May 16, 1999, at 6:19:25
I'm a subject in a double blind study on this very thing. I've been wearing the patch for 3 weeks now, and have noticed little change. Either the med. is ineffective with me, or I've been taking the placebo.
> The transdermal Selegiline patch being tested now for depression does not require the MAOI diet. Just don't eat the patch!
>
> > Yes, selegiline was helpful to me, but at doses of 50 mg. divided or 24 hours, which is ten times the dose typically given to parkinson's patients. There are some side effects and an MAOI diet must be adhered to at any dose above 20 mg./day. It is the only AD I am willing to revisit if needed.
> > It was helpful in pulling me out of a severe bipolar depression.
> >
> > Best,
> >
> > Chris
Posted by Annie on July 3, 1999, at 8:45:01
In reply to Re: Selegiline for depression?, posted by David K. on July 3, 1999, at 8:22:45
David, in the double blind study, I also had little relief. I then went into the study using a 30mg selegiline patch. The hype says relief in a week or so. After a month I still felt no improvement but stuck it out. Between week 5 and 6 I started to notice more energy. I am now on week 9. My cognitive abilities are now improving and my ability to handle stress. My mood and abilty to enjoy life do not seem improved, but the suicidal thoughts are gone. I have tried most ADs and combos in the last 6 years with little lasting improvement. I feel a little stronger all the time and am cautiously hopeful.
> I'm a subject in a double blind study on this very thing. I've been wearing the patch for 3 weeks now, and have noticed little change. Either the med. is ineffective with me, or I've been taking the placebo.
>
>
> > The transdermal Selegiline patch being tested now for depression does not require the MAOI diet. Just don't eat the patch!
> >
> > > Yes, selegiline was helpful to me, but at doses of 50 mg. divided or 24 hours, which is ten times the dose typically given to parkinson's patients. There are some side effects and an MAOI diet must be adhered to at any dose above 20 mg./day. It is the only AD I am willing to revisit if needed.
> > > It was helpful in pulling me out of a severe bipolar depression.
> > >
> > > Best,
> > >
> > > Chris
Posted by Judy on July 3, 1999, at 11:58:23
In reply to Re: Selegiline for depression?, posted by Annie on July 3, 1999, at 8:45:01
Annie,
Wanted to let you know that after five weeks on Nardil and two bales of Alfafa later, I had to take your advice and throw in the towel on Nardil before my innards *blew*! It wouldn't have been a pretty sight!
I'll finish my washout this coming Friday and start Marplan. I have a feeling it will turn out to be Nardil with just a different name; but I'll try anything in the hopes of hitting paydirt with some med or another.
My questions about Selegiline: I took it (Eldepryl) and found that, like you, I didn't see any benefits for the first 5 - 6 weeks. Many weeks later, I still was not achieving the relief I sought and gave up on it. Maybe I should have requested an increased dose (was only taking 15 mg per day orally)?
At 30 mg, do you have to follow the MAOI diet since Selegiline is a Type B? How's your weight? Sex? Excretory system problems? Do you still feel you're heading towards more relief, slowly but surely?
Should Marplan turn out to be another lemon, I might try revisiting Selegiline at higher doses. What's the diff between the patch and the pills?
Thanks for any info you can give me, and also thanks for laughing with me about my Nardil side-effects a couple of weeks ago. Made me feel a little better to find a fellow ex-sufferer who could also see the humor in that nasty situation!
Judy
----------------------->David, in the double blind study, I also had little relief. I then went into the study using a 30mg
>selegiline patch. The hype says relief in a week or so. After a month I still felt no improvement but
>stuck it out. Between week 5 and 6 I started to notice more energy. I am now on week 9. My
>cognitive abilities are now improving and my ability to handle stress. My mood and abilty to enjoy life
>do not seem improved, but the suicidal thoughts are gone. I have tried most ADs and combos in the
>last 6 years with little lasting improvement. I feel a little stronger all the time and am cautiously
>hopeful.
Posted by Annie on July 3, 1999, at 21:54:00
In reply to Re: Nardil Follow-up to Annie + Selegiline ?'s, posted by Judy on July 3, 1999, at 11:58:23
Judy,
Sorry the Nardil treatment crapped out. (couldn't resist) The selegiline patch is only available in research studies right now. Using a 30mg selegiline transdermal patch, the MAOI diet is not necessary. I think taken orally, the diet would be needed at that dose. Marplan is, I think, the better choice until the patch is available by prescription. The side effects the first few weeks were minimal and even when they kicked in at week 6, they are not intolerable. I had gained lots of weight on prior meds but I am finding it possible to lose some on selegiline. The sexual interest is there but it is more difficult to achieve orgasm. Not as bad as some ADs, but still a problem, alas. Yes there are some 'excretory system problems', but they are manageable. You won't need as many bales of alfalfa! And I don't get that bloated swollen feeling with Selegiline. There is some urinary frequency, but that seems to be improving.
I am hopeful of more improvement but when the study is over, Marplan is also my choice. I think I would have to go higher than 30mg of selegiline anyway and the research pdoc said that the MAOI diet would probably be necessary at any higher dose.
Good luck with the Marplan. Did you have any problem finding a pharmacy that could get it? Keep us posted with your progress. Annie
> Annie,
>
> Wanted to let you know that after five weeks on Nardil and two bales of Alfafa later, I had to take your advice and throw in the towel on Nardil before my innards *blew*! It wouldn't have been a pretty sight!
>
> I'll finish my washout this coming Friday and start Marplan. I have a feeling it will turn out to be Nardil with just a different name; but I'll try anything in the hopes of hitting paydirt with some med or another.
>
> My questions about Selegiline: I took it (Eldepryl) and found that, like you, I didn't see any benefits for the first 5 - 6 weeks. Many weeks later, I still was not achieving the relief I sought and gave up on it. Maybe I should have requested an increased dose (was only taking 15 mg per day orally)?
>
> At 30 mg, do you have to follow the MAOI diet since Selegiline is a Type B? How's your weight? Sex? Excretory system problems? Do you still feel you're heading towards more relief, slowly but surely?
>
> Should Marplan turn out to be another lemon, I might try revisiting Selegiline at higher doses. What's the diff between the patch and the pills?
>
> Thanks for any info you can give me, and also thanks for laughing with me about my Nardil side-effects a couple of weeks ago. Made me feel a little better to find a fellow ex-sufferer who could also see the humor in that nasty situation!
>
> Judy
> -----------------------
>
> >David, in the double blind study, I also had little relief. I then went into the study using a 30mg
> >selegiline patch. The hype says relief in a week or so. After a month I still felt no improvement but
> >stuck it out. Between week 5 and 6 I started to notice more energy. I am now on week 9. My
> >cognitive abilities are now improving and my ability to handle stress. My mood and abilty to enjoy life
> >do not seem improved, but the suicidal thoughts are gone. I have tried most ADs and combos in the
> >last 6 years with little lasting improvement. I feel a little stronger all the time and am cautiously
> >hopeful.
Posted by Judy on July 4, 1999, at 19:31:02
In reply to Re: Answers to Judy's Selegiline ?'s, posted by Annie on July 3, 1999, at 21:54:00
Hi Annie,
Thanks for the poop (not as good as yours, but you have to bear in mind I'm washing-out right now) on Selegiline! Seriously, I appreciate your advice, info and sense of humor - made me LOL.
I called my pharmacy and they don't stock Marplan because nobody's asked for it yet; but they said if I bring in a script (or the doctor calls one in), they can have it for me by the next day. So I start this Friday. Since it's supposed to be fast acting (like Nardil), I should have some preliminary findings in a couple of weeks. I'll post 'em in case anybody's interested.
Again, thanks, Annie!
Judy
(P.S. I wrote a longer version of this response earlier and swear to God I saw it posted (hallucinations, now?). Anyway, if you see an extra response floating around somewhere, it's my first one)
-------------------------
> Judy,
> Sorry the Nardil treatment crapped out. (couldn't resist) The selegiline patch is only available in research studies right now. Using a 30mg selegiline transdermal patch, the MAOI diet is not necessary. I think taken orally, the diet would be needed at that dose. Marplan is, I think, the better choice until the patch is available by prescription. The side effects the first few weeks were minimal and even when they kicked in at week 6, they are not intolerable. I had gained lots of weight on prior meds but I am finding it possible to lose some on selegiline. The sexual interest is there but it is more difficult to achieve orgasm. Not as bad as some ADs, but still a problem, alas. Yes there are some 'excretory system problems', but they are manageable. You won't need as many bales of alfalfa! And I don't get that bloated swollen feeling with Selegiline. There is some urinary frequency, but that seems to be improving.
> I am hopeful of more improvement but when the study is over, Marplan is also my choice. I think I would have to go higher than 30mg of selegiline anyway and the research pdoc said that the MAOI diet would probably be necessary at any higher dose.
> Good luck with the Marplan. Did you have any problem finding a pharmacy that could get it? Keep us posted with your progress. Annie
>
>
> > Annie,
> >
> > Wanted to let you know that after five weeks on Nardil and two bales of Alfafa later, I had to take your advice and throw in the towel on Nardil before my innards *blew*! It wouldn't have been a pretty sight!
> >
> > I'll finish my washout this coming Friday and start Marplan. I have a feeling it will turn out to be Nardil with just a different name; but I'll try anything in the hopes of hitting paydirt with some med or another.
> >
> > My questions about Selegiline: I took it (Eldepryl) and found that, like you, I didn't see any benefits for the first 5 - 6 weeks. Many weeks later, I still was not achieving the relief I sought and gave up on it. Maybe I should have requested an increased dose (was only taking 15 mg per day orally)?
> >
> > At 30 mg, do you have to follow the MAOI diet since Selegiline is a Type B? How's your weight? Sex? Excretory system problems? Do you still feel you're heading towards more relief, slowly but surely?
> >
> > Should Marplan turn out to be another lemon, I might try revisiting Selegiline at higher doses. What's the diff between the patch and the pills?
> >
> > Thanks for any info you can give me, and also thanks for laughing with me about my Nardil side-effects a couple of weeks ago. Made me feel a little better to find a fellow ex-sufferer who could also see the humor in that nasty situation!
> >
> > Judy
> > -----------------------
> >
> > >David, in the double blind study, I also had little relief. I then went into the study using a 30mg
> > >selegiline patch. The hype says relief in a week or so. After a month I still felt no improvement but
> > >stuck it out. Between week 5 and 6 I started to notice more energy. I am now on week 9. My
> > >cognitive abilities are now improving and my ability to handle stress. My mood and abilty to enjoy life
> > >do not seem improved, but the suicidal thoughts are gone. I have tried most ADs and combos in the
> > >last 6 years with little lasting improvement. I feel a little stronger all the time and am cautiously
> > >hopeful.
Posted by Elizabeth on July 4, 1999, at 23:08:01
In reply to Re: Answers to Judy's Selegiline ?'s, posted by Annie on July 3, 1999, at 21:54:00
> The selegiline patch is only available in research studies right now. Using a 30mg selegiline transdermal patch, the MAOI diet is not necessary.
This is true; when the MAOI bypasses the GI tract, you don't have to worry about interactions with food. You *do*, however, still need to avoid drugs that can interact with MAOIs.
I've taken selegiline in pills, up to I think 40mg. It caused some pretty bad insomnia and anxiety, and didn't seem to help much with the mood thing. My appetite actually got worse. No sex problems, but then I don't seem to get those.
At high (20mg+, I believe) doses, you do need to observe the diet if taking it orally because it is no longer a selective inhibitor of MAO-B - at these doses it inhibits MAO-A irreversibly as well.
You ladies will have to tell us all how the Marplan thing goes. I'm still having concentration problems, and I'd really much rather be able to take just an antidepressant and skip the lithium, as I'm getting an unpleasant side effect from it. (Acne! And here I thought that my skin had finally cleared up!)
Posted by Judy on July 5, 1999, at 9:34:29
In reply to Re: Answers to Judy's Selegiline ?'s, posted by Elizabeth on July 4, 1999, at 23:08:01
I'm not sure I understand why the MAOI bypassing the GI tract avoids the tyramine problem. The MAOI is still very much in your system. Does it actually have to interact with the tyramine *in* the GI tract to cause trouble?
Elizabeth, please take this with the humor I intend it: If I read once more about your not having sex problems with all these different meds, I'm may freak and track you down and slap you silly out of my envy and frustration!!!! (Did I read in one of your posts that you're in the Boston area? I'm on the South Shore - about 20 miles south, so I might just be able to find you!) How the heck to you pull that off?!?!?! Of course, with all the other side effects you're suffering, it's probably not the magical experience for you that I'm imagining.
Thanks for the further info on Selegiline. Gives me something to think about for the future. In the meantime, I'll post my experience with Marplan as soon as I "feel" anything - good or bad.
Judy
--------------------------> > The selegiline patch is only available in research studies right now. Using a 30mg selegiline transdermal patch, the MAOI diet is not necessary.
>
> This is true; when the MAOI bypasses the GI tract, you don't have to worry about interactions with food. You *do*, however, still need to avoid drugs that can interact with MAOIs.
>
> I've taken selegiline in pills, up to I think 40mg. It caused some pretty bad insomnia and anxiety, and didn't seem to help much with the mood thing. My appetite actually got worse. No sex problems, but then I don't seem to get those.
>
> At high (20mg+, I believe) doses, you do need to observe the diet if taking it orally because it is no longer a selective inhibitor of MAO-B - at these doses it inhibits MAO-A irreversibly as well.
>
> You ladies will have to tell us all how the Marplan thing goes. I'm still having concentration problems, and I'd really much rather be able to take just an antidepressant and skip the lithium, as I'm getting an unpleasant side effect from it. (Acne! And here I thought that my skin had finally cleared up!)
Posted by Elizabeth on July 7, 1999, at 22:26:05
In reply to One More "?" About Selegiline , posted by Judy on July 5, 1999, at 9:34:29
> I'm not sure I understand why the MAOI bypassing the GI tract avoids the tyramine problem. The MAOI is still very much in your system. Does it actually have to interact with the tyramine *in* the GI tract to cause trouble?
Well, here's the thing, if the MAOI doesn't get into the upper GI tract, then there will still be MAO living there peacefully. Thus, oral tyramine doesn't have a chance to get into the blood, and thereby the brain, because it is metabolized normally.
With drug-drug interactions it's generally a more complicated matter, as the drugs in question aren't metabolized by MAO as such, but rather, they have pharmacodynamic interactions in the CNS. (Although transdermal MAOIs would presumably have no potentiating effect on oral dimethyltryptamine and derivatives - this is normally considered a beneficial interaction, though.)
> Elizabeth, please take this with the humor I intend it: If I read once more about your not having sex problems with all these different meds, I'm may freak and track you down and slap you silly out of my envy and frustration!!!! (Did I read in one of your posts that you're in the Boston area? I'm on the South Shore - about 20 miles south, so I might just be able to find you!) How the heck to you pull that off?!?!?! Of course, with all the other side effects you're suffering, it's probably not the magical experience for you that I'm imagining.
I wouldn't call it "magical," no! Anyway, I'm not yet in my sexual prime, so to speak, so don't think that sexual bliss comes easily to me even unmedicated! (Was that more information than you needed? :-) I do feel for people who get this disheartening side effect; unlike some other side effects, it's very difficult to deal with, although some pharmacologic add-ons seem to work some of the time (yohimbine, bupropion, sildenafil, etc.). There's also the old "slip some Prozac in your partner's coffee so it takes him forever too" trick. Not that I'm suggesting such a thing. ;-)
Posted by Judy on July 19, 1999, at 20:08:38
In reply to Re: Answers to Judy's Selegiline ?'s, posted by Annie on July 3, 1999, at 21:54:00
Annie,
Just a quick question that's been bothering me. When you complete the patch study, why aren't you considering taking Selegeline orally? I KNOW there must be a good reason - just curious as to what it is.
Judy
> Judy,
> Sorry the Nardil treatment crapped out. (couldn't resist) The selegiline patch is only available in research studies right now. Using a 30mg selegiline transdermal patch, the MAOI diet is not necessary. I think taken orally, the diet would be needed at that dose. Marplan is, I think, the better choice until the patch is available by prescription. The side effects the first few weeks were minimal and even when they kicked in at week 6, they are not intolerable. I had gained lots of weight on prior meds but I am finding it possible to lose some on selegiline. The sexual interest is there but it is more difficult to achieve orgasm. Not as bad as some ADs, but still a problem, alas. Yes there are some 'excretory system problems', but they are manageable. You won't need as many bales of alfalfa! And I don't get that bloated swollen feeling with Selegiline. There is some urinary frequency, but that seems to be improving.
> I am hopeful of more improvement but when the study is over, Marplan is also my choice. I think I would have to go higher than 30mg of selegiline anyway and the research pdoc said that the MAOI diet would probably be necessary at any higher dose.
> Good luck with the Marplan. Did you have any problem finding a pharmacy that could get it? Keep us posted with your progress. Annie
>
Posted by Brandon on July 19, 1999, at 20:55:14
In reply to Re: Selegeline ? for Annie, posted by Judy on July 19, 1999, at 20:08:38
Hey everyone,
It's been about two months since I last posted my question about selegiline, I finally convinced my psydoc to let me try it...so far the results have been outstanding! I'm only taking 20mg a day and I definitely feel much better than I ever did. My level of concentration is way up and my mood is pretty darn good, and the best part is there is no pesky sexual side effects...my libido is actually enhanced! I just wanted to say thanks for all the info and was wondering if anyone here had tried the liquid form. I've heard that it is superior in it's lack of side effects, any info would be appreciated.
Thanks,
Brandon
Posted by Annie on July 20, 1999, at 22:31:40
In reply to Re: Selegeline ? for Annie, posted by Judy on July 19, 1999, at 20:08:38
> Annie,
>
> Just a quick question that's been bothering me. When you complete the patch study, why aren't you considering taking Selegeline orally? I KNOW there must be a good reason - just curious as to what it is.
>
> JudyJudy,
Actually, I considered it, but my Pdoc seems to think that I would respond better to Parnate or Marplan at the dose I would need. The 30mg Selegiline patch has really helped many of the symptoms of my depression and the lack of side effects has been great. The best improvements have been a total absence of suicidal thoughts, a much higher tolerance for stress and the fact that I am losing weight without even trying! I haven't felt this good in years. The increase in energy and motivation leveled out after a slight initial improvement. I still have to force myself to do anything or to leave the house. Social activities still feel like a penance. If there were a patch at a higher dose it would be a no-brainer for me, even though the diet would then be required. Remember that with transdermal delivery, lower doses are needed to reach a therapeutic level because it bypasses the liver. Taken orally it is unlikely 30mg would have any effect for me. I usually need to meet or exceed maximum dose to get any benefit(eg 400mg desipramine for several months before my desipramine reached the supposed therapeutic level of 180. Still didn't help though, and side effects were horrendous. My doc says that my liver must be very,very good indeed at metabolizing.) I don't know what the oral equivalent of 30mg transdermally would be,[does anyone know?] but I would probably have to go much higher. There isn't much information about effects of very high doses of Selegiline, so I guess it's safer to try Parnate or Marplan for now. I am a little leery of Parnate because I experienced spontaneous hypertension in my first trial of it. I'm not ruling it out though, if I can start low and build slowly to an effective dose. I'd rather stay on the patch longer but it isn't possible. I'm really frightened that all the relief I've gotten is going to disappear. I don't think I could stand it.Hope the Marplan is going well for you.
Annie
PS If anyone is aware of any studies using selegiline at higher doses, I'd appreciate if you would post the information.
Posted by Elizabeth on July 21, 1999, at 7:25:01
In reply to Re: Selegeline ? for Annie, posted by Annie on July 20, 1999, at 22:31:40
Hi Annie. About selegiline....
> Actually, I considered it, but my Pdoc seems to think that I would respond better to Parnate or Marplan at the dose I would need. The 30mg Selegiline patch has really helped many of the symptoms of my depression and the lack of side effects has been great.
I actually went up to 40mg - interestingly, with no positive effects - and I know of a couple people who've taken as much as 50. It's a little inconvenient because the highest strength pill is 5mg!
>The best improvements have been a total absence of suicidal thoughts, a much higher tolerance for stress and the fact that I am losing weight without even trying!
Do you have an appetite? I didn't - it sapped what little appetite I had at that point!
>I haven't felt this good in years. The increase in energy and motivation leveled out after a slight initial improvement. I still have to force myself to do anything or to leave the house. Social activities still feel like a penance.
For the anxiety, I'd personally suggest Marplan rather than Parnate. Selegiline, like Parnate, is a non-hydrazide MAOI and is related to amphetamine (in fact, it has amphetamine metabolites and can cause you to test positive for amphetamines on a tox screen).
>If there were a patch at a higher dose it would be a no-brainer for me, even though the diet would then be required. Remember that with transdermal delivery, lower doses are needed to reach a therapeutic level because it bypasses the liver.
Well, all drugs go through the liver eventually, but as I understand it, it bypasses first-pass metabolism.
Do you know when they're going to publish the results of this study, BTW?
>Taken orally it is unlikely 30mg would have any effect for me. I usually need to meet or exceed maximum dose to get any benefit(eg 400mg desipramine for several months before my desipramine reached the supposed therapeutic level of 180. Still didn't help though, and side effects were horrendous.
It might also just be that desipramine isn't the drug for you anyway. (BTW I think the maximum recommended therapeutic level for desipramine is 300ng/mL, but don't quote me on that.)
>My doc says that my liver must be very,very good indeed at metabolizing.) I don't know what the oral equivalent of 30mg transdermally would be,[does anyone know?] but I would probably have to go much higher.
I doubt anyone knows. It's hard to gauge the therapeutic level of an MAOI because they are metabolized pretty fast.
>There isn't much information about effects of very high doses of Selegiline, so I guess it's safer to try Parnate or Marplan for now. I am a little leery of Parnate because I experienced spontaneous hypertension in my first trial of it.
How high did your BP go? I think you're the first person I've met (other than myself) who's had this side effect from it.
>I'm not ruling it out though, if I can start low and build slowly to an effective dose.
The key I think is taking it in divided doses.
>I'd rather stay on the patch longer but it isn't possible. I'm really frightened that all the relief I've gotten is going to disappear. I don't think I could stand it.
The washout period might be hard...I'm not sure what to suggest for dealing with it, other than maybe to be sure you have benzodiazepines on hand! Best of luck to you....
> PS If anyone is aware of any studies using selegiline at higher doses, I'd appreciate if you would post the information.
Sunderland T, et al. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry. 1994 Aug;51(8):607-15.
(Bear in mind that the elderly tend to be more sensitive to side effects than younger adults.)
Posted by Annie on July 21, 1999, at 13:55:57
In reply to Re: Selegeline ? for Annie, posted by Elizabeth on July 21, 1999, at 7:25:01
Elizabeth, Thank you for the study info. I'm not certain that the tested 60mg taken orally would be sufficient for me since I am a "super- metabolizer", but I'll copy it for my Pdoc and see what he says.
Yes, I do have an appetite on selegiline and I am eating normally. In my case, the loss of weight is greatly appreciated.
I never considered the lack of motivation and isolating features of my depression as related to anxiety. Interesting thought. Possible. I thought I could use a little amphetamine action to get myself going.
The selegiline study is still on-going in many parts of the country, so it may be quite a while before the final results are published. If I see any preliminary data, I will let you know. I know I saw one article published but it more Rah- Rah hype than scientific data.
I know the hard way that Desipramine was not the drug for me, I used that example because TCA levels can me measured and to illustrate the high dose I needed to get to therapeutic level. I have had many trials of SSRIs et al at high doses with similar (non)results.
Regarding the spontaneous hypertension, after only 3 days on Parnate at minimum dose, my BP went from 127/73 to 200/102.
I usually don't experience withdrawal symptoms during washout periods, but thanks for the advice. I'll have some Xanax ready just in case.
Annie
> Hi Annie. About selegiline....
>
> > Actually, I considered it, but my Pdoc seems to think that I would respond better to Parnate or Marplan at the dose I would need. The 30mg Selegiline patch has really helped many of the symptoms of my depression and the lack of side effects has been great.
>
> I actually went up to 40mg - interestingly, with no positive effects - and I know of a couple people who've taken as much as 50. It's a little inconvenient because the highest strength pill is 5mg!
>
> >The best improvements have been a total absence of suicidal thoughts, a much higher tolerance for stress and the fact that I am losing weight without even trying!
>
> Do you have an appetite? I didn't - it sapped what little appetite I had at that point!
>
> >I haven't felt this good in years. The increase in energy and motivation leveled out after a slight initial improvement. I still have to force myself to do anything or to leave the house. Social activities still feel like a penance.
>
> For the anxiety, I'd personally suggest Marplan rather than Parnate. Selegiline, like Parnate, is a non-hydrazide MAOI and is related to amphetamine (in fact, it has amphetamine metabolites and can cause you to test positive for amphetamines on a tox screen).
>
> >If there were a patch at a higher dose it would be a no-brainer for me, even though the diet would then be required. Remember that with transdermal delivery, lower doses are needed to reach a therapeutic level because it bypasses the liver.
>
> Well, all drugs go through the liver eventually, but as I understand it, it bypasses first-pass metabolism.
>
> Do you know when they're going to publish the results of this study, BTW?
>
> >Taken orally it is unlikely 30mg would have any effect for me. I usually need to meet or exceed maximum dose to get any benefit(eg 400mg desipramine for several months before my desipramine reached the supposed therapeutic level of 180. Still didn't help though, and side effects were horrendous.
>
> It might also just be that desipramine isn't the drug for you anyway. (BTW I think the maximum recommended therapeutic level for desipramine is 300ng/mL, but don't quote me on that.)
>
> >My doc says that my liver must be very,very good indeed at metabolizing.) I don't know what the oral equivalent of 30mg transdermally would be,[does anyone know?] but I would probably have to go much higher.
>
> I doubt anyone knows. It's hard to gauge the therapeutic level of an MAOI because they are metabolized pretty fast.
>
> >There isn't much information about effects of very high doses of Selegiline, so I guess it's safer to try Parnate or Marplan for now. I am a little leery of Parnate because I experienced spontaneous hypertension in my first trial of it.
>
> How high did your BP go? I think you're the first person I've met (other than myself) who's had this side effect from it.
>
> >I'm not ruling it out though, if I can start low and build slowly to an effective dose.
>
> The key I think is taking it in divided doses.
>
> >I'd rather stay on the patch longer but it isn't possible. I'm really frightened that all the relief I've gotten is going to disappear. I don't think I could stand it.
>
> The washout period might be hard...I'm not sure what to suggest for dealing with it, other than maybe to be sure you have benzodiazepines on hand! Best of luck to you....
>
> > PS If anyone is aware of any studies using selegiline at higher doses, I'd appreciate if you would post the information.
>
> Sunderland T, et al. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry. 1994 Aug;51(8):607-15.
>
> (Bear in mind that the elderly tend to be more sensitive to side effects than younger adults.)
Posted by Elizabeth on July 21, 1999, at 23:49:39
In reply to Re: Answer to Elizabeth, posted by Annie on July 21, 1999, at 13:55:57
> Elizabeth, Thank you for the study info. I'm not certain that the tested 60mg taken orally would be sufficient for me since I am a "super- metabolizer", but I'll copy it for my Pdoc and see what he says.
Maybe it's just some general fast-metabolizer thing, but different drugs are metabolized through different pathways, so the high dose of desipramine you needed wouldn't necessarily mean you'd also need a high dose of selegiline (30mg isn't that high for depression).
> Yes, I do have an appetite on selegiline and I am eating normally. In my case, the loss of weight is greatly appreciated.
Cool!
> I never considered the lack of motivation and isolating features of my depression as related to anxiety. Interesting thought. Possible. I thought I could use a little amphetamine action to get myself going.
Well, sometimes anxiety makes people feel kind of "dead," easily fatigued, sluggish, etc., and I could see it sapping motivation as well.
> The selegiline study is still on-going in many parts of the country, so it may be quite a while before the final results are published. If I see any preliminary data, I will let you know. I know I saw one article published but it more Rah- Rah hype than scientific data.
Actually I know a fellow who was conducting the study at McLean, here in Boston - perhaps I'll enquire (I don't even know if it's still going on).
> I know the hard way that Desipramine was not the drug for me, I used that example because TCA levels can me measured and to illustrate the high dose I needed to get to therapeutic level. I have had many trials of SSRIs et al at high doses with similar (non)results.
Well, that might just mean that SSRIs don't work for you. Actually there have been attempts to come up with recommended serum levels for fluoxetine and norfluoxetine at least.
> Regarding the spontaneous hypertension, after only 3 days on Parnate at minimum dose, my BP went from 127/73 to 200/102.
Mine increased by about the same amount, only I had a much lower (~100/60) baseline BP so it didn't get as high (180/100?).
> I usually don't experience withdrawal symptoms during washout periods, but thanks for the advice. I'll have some Xanax ready just in case.
MAOIs can have pretty rough withdrawal symptoms - don't play fast and loose with them! There's also just the difficulty of no longer being on an antidepressant, though for just two weeks that shouldn't matter too much.
Posted by nancy on July 22, 1999, at 17:07:12
In reply to Re: One More "?" About Selegiline , posted by Elizabeth on July 7, 1999, at 22:26:05
LOL, LOL, LOL...You two are cracking me up!
You wouldn't hunt down and kill someone, who is still multiorgasmic and loving it, would you???
:) ;) :)
> > Elizabeth, please take this with the humor I intend it: If I read once more about your not having sex problems with all these different meds, I'm may freak and track you down and slap you silly out of my envy and frustration!!!! (Did I read in one of your posts that you're in the Boston area? I'm on the South Shore - about 20 miles south, so I might just be able to find you!) How the heck to you pull that off?!?!?! Of course, with all the other side effects you're suffering, it's probably not the magical experience for you that I'm imagining.
>
> I wouldn't call it "magical," no! Anyway, I'm not yet in my sexual prime, so to speak, so don't think that sexual bliss comes easily to me even unmedicated! (Was that more information than you needed? :-) I do feel for people who get this disheartening side effect; unlike some other side effects, it's very difficult to deal with, although some pharmacologic add-ons seem to work some of the time (yohimbine, bupropion, sildenafil, etc.). There's also the old "slip some Prozac in your partner's coffee so it takes him forever too" trick. Not that I'm suggesting such a thing. ;-)
Posted by Brandon on July 22, 1999, at 18:34:27
In reply to Re:Judy and Elizabeth : ), posted by nancy on July 22, 1999, at 17:07:12
Hi Elizabeth,
I just wanted to know how you knew wether you were taking the actual med or a placebo in the selegiline patch study. Is it still ongoing and if so is it still possible to register,
thanks
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