![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by Judy on December 18, 1999, at 14:19:35
I've been taking Selegiline since the first week in November. I titrated up to 60 mg/day and have been there for almost three weeks. For the past several days, I've begun experiencing terrible sleep problems. I fall asleep easily enough at bedtime (with the help of 1 mg Xanax) but I seem to awaken an hour or so later and then I'm aware of every passing hour on my digital clock for the rest of the night. What little sleep I do get is of the doze-type during which I dream that I'm at work or at home trying to solve impossible tasks. (The next day, I'm not sure whether I actually finished a project at work or if I just dreamed it - they're that realistic). Unlike taking Nardil, when I only slept a few hours a night but didn't miss the extra sleep at all, I'm exhausted. This onset of sleep disturbance makes me wonder if I've hit "therapeutic" dose and that things are as good as they're going to get.
I have no other bad side effects at 60 mg/day of Selegiline - a moot point if it's not an effective AD for me, I suppose. My depression HAS been lifted from "black" to "blue" (some days are better than others and I seem to be prone to crying jags lately); and I'm not feeling any relief from anxiety without the help of .5 mg of Xanax with each dose of Selegiline. BUT, there ARE some benefits. My cognitive functions are vastly improved; my sexual response is fantastic (Adam - if you're reading this - it IS magical!) although there is not much of a libido boost to compliment the mechanical improvement; and interestingly, my skin (which had become dry and basically old looking over the past year of failures on four other AD's) looks like it's regenerating! Perhaps there IS something to the rumor of Selegiline's anti-aging/free-radical roundup properties.
My questions are these: After three weeks at 60 mg/day, is this as good as it's going to get? Given the new sleep problems, increasing my dosage doesn't seem like it would be helpful (and I don't think there's any literature recommending doses above 60 mg). I feel like I'm right on the edge of something good, but it just doesn't seem to be kicking in. Is more time needed at 60 mg for me to see something more beneficial? Is there something I could augment with that would effect a kick-in or at least a bit more mood elevation?
Any advice would be greatly appreciated. I'm at the bottom of the AD barrel here. There's nothing left that I haven't tried. I'm feeling terribly desperate!
Judy
Posted by Noa on December 18, 1999, at 14:34:12
In reply to Selegiline Expertise Needed Again, posted by Judy on December 18, 1999, at 14:19:35
Judy,
Sorry, I have no selegeline info for you but wanted to just acknowledge your post, because I have had my share of desperation, discouragement with med problems. I liked your use of Black vs. Blue to describe the intensity of your depressive mood. I hope you hear from the selegeline folks soon.
Posted by jamie on December 19, 1999, at 2:45:44
In reply to Selegiline Expertise Needed Again, posted by Judy on December 18, 1999, at 14:19:35
Sorry Judy, I'm no expert. But I remember other people here that have taken selegiline reported a fairly long lag period. Something like 5 weeks or so. I read that somewhere too. If you can, you might want to stay with the 60mg for another full 2 or 3 weeks. If you go that long with no improvement, then I would say you gave it a solid trial. The highest dose I've heard about is 80mg.
Only the experts or the brave would augment the maoi. That's tricky business and potentially dangerous or deadly. I bet if we asked your question in a survey of pdocs lithium would come up as the top choice. Probably a few would suggest adding a small amount of a tca (but not clomipramine). That would help with sleep too. I guess wellbutrin might be possible, but then sleep would be even worse. I think I remember reading that 80mg was the maximum dose of selegiline used in depression. Maybe even a touch of pindolol might do the trick. But anything you do is potentially very scary if done without extreme caution. Your situation certainly warrants ECT treatment, if you haven't done that already.
There's nothing left you haven't tried? I don't know. I don't think an entire lifetime is long enough to try everything. What have you tried? Maybe if you give us a history of your diagnosis, treatment, doses, reasons for discontinuing, etc, we might be able to come up with some ideas. Can you share with us your history? I bet some good ideas will come up. jamie
Posted by Adam on December 19, 1999, at 3:40:20
In reply to Selegiline Expertise Needed Again, posted by Judy on December 18, 1999, at 14:19:35
Hey, Judy,
It's now 2:50 AM where I am. As usual, I'm wide awake. I just got home from a holiday party and I would still be
spinning those dradels now if all my friends weren't ready to collapse from exaustion. I am so awake right now.
I'm not even tired. It's definitely incredible how much selegiline has obliterated any semblance of a normal sleep
pattern that I used to have. The biggest problem I have is boredom. I'd play my guitar or a CD, but my roomates
are both in bed. It's interesting to hear about your dreams. I seem to be barely dreaming at all, and before, while
on Remeron (which is very sedating) I had dreams of the kind of realism you are describing: so vivid you can't tell
what is the dream and what isn't. I used to hit the bed so hard on that drug I could feel the wave of sleep washing
over me, and would start to dream in that twilight realm between sleep and wakefulness. It was amazing. I dearly
miss those vivid dreams, they were often so pleasurable, and I miss a deep, long sleep. I do not miss depression,
though. A this point, the insomnia is more than an equitable trade for the despair that preceeded it.I can definitely understand, though, that if you are not feeling much of a response that this insomnia could be a
waking nightmare of sorts. If you are going from black to blue, that could be a good sign. You are, at least, maybe,
a partial responder, which could mean that a) you will contiune to improve, or b) you have a good chance of responding
to an augmentation strategy such as the addition of low-dose lithium. Non-responders to MAOI treatment are less
likely to achieve a full response from lithium augmentation. Also, three weeks is a little late at a full therapeutic
dose to not see the desired change, but it is not unheard of that the response to oral selegiline or any other MAOI
could take six weeks or even longer. I would say that if you are no better at six weeks, you might try increasing the
dose (never heard of a dose over 60mg, though!) or try lithium.As for the Xanax, you might try Ambien instead. It has a favoralbe side-effect profile (esp. in the area of impact
on cognative functioning) than Xanax or other benzodiazepines, and thus you might be able to play with dose more without
serious problems. Another augmentation strategy that may also have some beneficial effects on sleep might be the
combination of selegiline with valproate (Depakote), which has been shown to be both effective for insomnia at high
doses, as well as and adjuvant for antidepressants. I'm not certain of any specific drug interactions with selegiline
and valproate; the primary risk of valproate treatment seems to be hepatotoxicity, but its interaction with cytochrome
p450 enzymes is relatively minor. For some Benadryl is a helpful sleep aid and has relatively few side effects at
doses sufficient to help with sleep, though its sedating effects appear to wear off over time with some people.
> I've been taking Selegiline since the first week in November. I titrated up to 60 mg/day and have been there for almost three weeks. For the past several days, I've begun experiencing terrible sleep problems. I fall asleep easily enough at bedtime (with the help of 1 mg Xanax) but I seem to awaken an hour or so later and then I'm aware of every passing hour on my digital clock for the rest of the night. What little sleep I do get is of the doze-type during which I dream that I'm at work or at home trying to solve impossible tasks. (The next day, I'm not sure whether I actually finished a project at work or if I just dreamed it - they're that realistic). Unlike taking Nardil, when I only slept a few hours a night but didn't miss the extra sleep at all, I'm exhausted. This onset of sleep disturbance makes me wonder if I've hit "therapeutic" dose and that things are as good as they're going to get.
>
> I have no other bad side effects at 60 mg/day of Selegiline - a moot point if it's not an effective AD for me, I suppose. My depression HAS been lifted from "black" to "blue" (some days are better than others and I seem to be prone to crying jags lately); and I'm not feeling any relief from anxiety without the help of .5 mg of Xanax with each dose of Selegiline. BUT, there ARE some benefits. My cognitive functions are vastly improved; my sexual response is fantastic (Adam - if you're reading this - it IS magical!) although there is not much of a libido boost to compliment the mechanical improvement; and interestingly, my skin (which had become dry and basically old looking over the past year of failures on four other AD's) looks like it's regenerating! Perhaps there IS something to the rumor of Selegiline's anti-aging/free-radical roundup properties.
>
> My questions are these: After three weeks at 60 mg/day, is this as good as it's going to get? Given the new sleep problems, increasing my dosage doesn't seem like it would be helpful (and I don't think there's any literature recommending doses above 60 mg). I feel like I'm right on the edge of something good, but it just doesn't seem to be kicking in. Is more time needed at 60 mg for me to see something more beneficial? Is there something I could augment with that would effect a kick-in or at least a bit more mood elevation?
>
> Any advice would be greatly appreciated. I'm at the bottom of the AD barrel here. There's nothing left that I haven't tried. I'm feeling terribly desperate!
>
> Judy
Posted by Adam on December 19, 1999, at 3:52:35
In reply to Re: Selegiline Expertise Needed Again, posted by Adam on December 19, 1999, at 3:40:20
Just as a note, I forgot to mention that Depakote can CAUSE depression in some people, though
it has been shown to be helpful in others. FYI. It was a possibility given to me by a doctor
and so I thought I would pass it along.
Posted by Judy on December 19, 1999, at 12:48:02
In reply to Re: Selegiline Expertise Needed Again, posted by jamie on December 19, 1999, at 2:45:44
Jeez you guys! Look at the times you're posting! And I'm moaning about MY sleep problems!!!
>Can you share with us your history? I bet some good ideas will come up.
Let me start by telling you that I AM an MAOI responder. I could be the 'poster child' for Nardil. I've taken it five times over the past 15 years and I am the best possible person I could ever be when taking it. Unfortunately, the side effects (severe edema, almost complete shutdown of my entire excretory system) have eliminated it from my list of possibilities. I've lost my 'safety net'! It's also probably unfortunate that Nardil is the yardstick by which I measure all other AD's because I don't think I will ever find another that provides the robust, wonderful hypomanic benefits that Nardil does.
>I think I remember reading that 80mg was the maximum dose of selegiline used in depression
I've never seen 80 mentioned before - but I wonder what 80 would do to my nightmarish sleep if it's bad at 60 mg.
>Only the experts or the brave would augment the maoi.
You're right! My Pdoc is self-admittedly not one of the brave. He would augment with lithium, however. He also admits that he's not sophisticated enough to recommend drug cocktails and would prefer that I see a big-time psychopharm in Boston for that.
>If you are going from black to blue, that could be a good sign. You are, at least, maybe,
a partial responder, which could mean that a) you will contiune to improve, or b) you have a good chance of responding to an augmentation strategy such as the addition of low-dose lithium. Non-responders to MAOI treatment are less likely to achieve a full response from lithium augmentation.
>If you can, you might want to stay with the 60mg for another full 2 or 3 weeksThis is the unknown that bothers me...am I a responder to Selegiline, obviously a completely different drug than Nardil? Nardil showed benefit within the first two weeks - is it possible that Selegiline could possibly kick-in after so much longer? Or is from 'black' to 'blue' as good as it's ever going to get? With or without augmentation? Tough questions to answer when a drug has little or no track record.
>I seem to be barely dreaming at all. A this point, the insomnia is more than an equitable trade for the despair that preceeded it
Not dreaming, for me, is a sign that an MAOI is working. I too missed dreaming when I took Nardil; but like you, I felt the insomnia and lack of dreams were well worth it for the relief it provided. My hellish nights right now are making me very concerned about Selegiline's effectiveness.>Maybe if you give us a history of your diagnosis, treatment, doses, reasons for discontinuing, etc.
My Dx is, and I quote, "Major Depression at worst; Severe Dysthymia my best"
TCA's tried: Imiprimine, Desiprimine - very little AD benefit, big weight gain, severe sweating.
SSRI's: Tried all but Celexa. No AD benefit. Every one made me too fatigued to function. No amount of time made them tolerable.
Effexor: Little AD benefit, too enervating
Effexor SR: A disaster (for 6 weeks at 150 mg). No AD benefit. Tremors, muscle weakness. Flu-like symptoms.
Klonapin: Fatigue. No benefit.
Welbutrin: Way too enervating! Felt like a 'nervous breakdown' Couldn't give it a decent trial.
Lithium (alone): Fatigue bordering on Coma
Serzone: Worse fatigue than Lithium (if possible), with aggression and hostility from out of the blue. If I'd had the physical strength, I would have thrown myself in front of a bus to put an end to the way it made me feel!
Marplan: AD benefit (nothing like Nardil though). Slower kick-in than Nardil. Worse edema.
Parnate: Too enervating. Very short trial.
ECT & Rememon: Both have been offered. I feel as if ECT is only a temporary measure with no medicinal backup. Remeron - after my debacle with Serzone, the thought of taking it scares the heck out of me (Can I believe that it becomes enervating at high doses?)
There are more that don't come to mind right now - I wish I'd written them all down over the years. Combining any of the above really makes me skittish - like trying to make a 'right' with two 'wrong's' I do wonder if Parnate might be worth another shot if I augmented it with something (what?) to counteract the aggitation it causes.
One other question. I am scheduled to have a thyroid function test done right after the holidays. I'm also wondering whether diminishing Estrogen (I'm guessing menopause isn't too far away) might be the cause of drugs that I've taken before acting differently now (i.e. Effexor was a relatively benign drug several years ago - SR almost did me in a few months ago. And the increased edema with Nardil recently? - it was never that bad before).
Thanks for your responses and anything else you might be able to add. Judy
Posted by Noa on December 19, 1999, at 14:26:01
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Judy on December 19, 1999, at 12:48:02
Getting Thyroid checked is a good idea. It is quite common that depression is not responsive to treatment because of hypothyroid.
Posted by Noa on December 19, 1999, at 14:27:51
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Judy on December 19, 1999, at 12:48:02
BTW, I have been having trouble loading babble, too. In fact, I have tried to no avail, several times, to respond to your post about it.
Posted by Adam on December 20, 1999, at 2:41:45
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Judy on December 19, 1999, at 12:48:02
Hey, Judy,
Perhaps what a big-time psychopharm. could do for you is help you find a way to
tolerate Nardil. It seems like edema and constipation (if I'm reading your post
correctly) out to be treatable. I have had such a good response to selegiline
(for depression, at least) that I often have to restrain myself from telling everyone
and anyone who hasn't responded to five or six "first-line" antidepressant trials
to run out and get some. As you stated yourself, the lag in response is a bit
dissapointing, given the frequent rapidity of a robust MAOI response. I can only
hope that sticking it out or an augmentation strategy will help you with selegiline.
Take care and let us know how its going.
> Jeez you guys! Look at the times you're posting! And I'm moaning about MY sleep problems!!!
>
> >Can you share with us your history? I bet some good ideas will come up.
>
> Let me start by telling you that I AM an MAOI responder. I could be the 'poster child' for Nardil. I've taken it five times over the past 15 years and I am the best possible person I could ever be when taking it. Unfortunately, the side effects (severe edema, almost complete shutdown of my entire excretory system) have eliminated it from my list of possibilities. I've lost my 'safety net'! It's also probably unfortunate that Nardil is the yardstick by which I measure all other AD's because I don't think I will ever find another that provides the robust, wonderful hypomanic benefits that Nardil does.
>
> >I think I remember reading that 80mg was the maximum dose of selegiline used in depression
>
> I've never seen 80 mentioned before - but I wonder what 80 would do to my nightmarish sleep if it's bad at 60 mg.
>
> >Only the experts or the brave would augment the maoi.
>
> You're right! My Pdoc is self-admittedly not one of the brave. He would augment with lithium, however. He also admits that he's not sophisticated enough to recommend drug cocktails and would prefer that I see a big-time psychopharm in Boston for that.
>
> >If you are going from black to blue, that could be a good sign. You are, at least, maybe,
> a partial responder, which could mean that a) you will contiune to improve, or b) you have a good chance of responding to an augmentation strategy such as the addition of low-dose lithium. Non-responders to MAOI treatment are less likely to achieve a full response from lithium augmentation.
> >If you can, you might want to stay with the 60mg for another full 2 or 3 weeks
>
> This is the unknown that bothers me...am I a responder to Selegiline, obviously a completely different drug than Nardil? Nardil showed benefit within the first two weeks - is it possible that Selegiline could possibly kick-in after so much longer? Or is from 'black' to 'blue' as good as it's ever going to get? With or without augmentation? Tough questions to answer when a drug has little or no track record.
>
> >I seem to be barely dreaming at all. A this point, the insomnia is more than an equitable trade for the despair that preceeded it
>
> Not dreaming, for me, is a sign that an MAOI is working. I too missed dreaming when I took Nardil; but like you, I felt the insomnia and lack of dreams were well worth it for the relief it provided. My hellish nights right now are making me very concerned about Selegiline's effectiveness.
>
> >Maybe if you give us a history of your diagnosis, treatment, doses, reasons for discontinuing, etc.
>
> My Dx is, and I quote, "Major Depression at worst; Severe Dysthymia my best"
>
> TCA's tried: Imiprimine, Desiprimine - very little AD benefit, big weight gain, severe sweating.
>
> SSRI's: Tried all but Celexa. No AD benefit. Every one made me too fatigued to function. No amount of time made them tolerable.
>
> Effexor: Little AD benefit, too enervating
>
> Effexor SR: A disaster (for 6 weeks at 150 mg). No AD benefit. Tremors, muscle weakness. Flu-like symptoms.
>
> Klonapin: Fatigue. No benefit.
>
> Welbutrin: Way too enervating! Felt like a 'nervous breakdown' Couldn't give it a decent trial.
>
> Lithium (alone): Fatigue bordering on Coma
>
> Serzone: Worse fatigue than Lithium (if possible), with aggression and hostility from out of the blue. If I'd had the physical strength, I would have thrown myself in front of a bus to put an end to the way it made me feel!
>
> Marplan: AD benefit (nothing like Nardil though). Slower kick-in than Nardil. Worse edema.
>
> Parnate: Too enervating. Very short trial.
>
> ECT & Rememon: Both have been offered. I feel as if ECT is only a temporary measure with no medicinal backup. Remeron - after my debacle with Serzone, the thought of taking it scares the heck out of me (Can I believe that it becomes enervating at high doses?)
>
> There are more that don't come to mind right now - I wish I'd written them all down over the years. Combining any of the above really makes me skittish - like trying to make a 'right' with two 'wrong's' I do wonder if Parnate might be worth another shot if I augmented it with something (what?) to counteract the aggitation it causes.
>
> One other question. I am scheduled to have a thyroid function test done right after the holidays. I'm also wondering whether diminishing Estrogen (I'm guessing menopause isn't too far away) might be the cause of drugs that I've taken before acting differently now (i.e. Effexor was a relatively benign drug several years ago - SR almost did me in a few months ago. And the increased edema with Nardil recently? - it was never that bad before).
>
> Thanks for your responses and anything else you might be able to add. Judy
>
>
>
>
>
>
Posted by Adam on December 20, 1999, at 2:53:09
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Judy on December 19, 1999, at 12:48:02
Just as an aside, I experienced a severe worsening of my illness while on Serzone, and read
with interest and distrubance that you found it difficult to deal with. I got so bad I
wound up in the hospital. I was a mess, a "death please take me now" kind of violently
relentless despair. I have so often wondered if Serzone precipitated this episode, or if
it was just a coincidence.Having said that, I tried Remeron, and did not experience anything as troubling. Nearly
irresistalbe somnolence was the primary side effect, and yes, strange as it seems, this
did get a bit better as I raised the dose (up to 45mg/day). I never got too much of an
antidepressant response out of it, and it always left me feeling very tired. But compared
to the first couple of weeks in the end it was relatively tolerable. The first day I
took it I wanted to crawl on the floor from my bed to the bathroom rather than walk. It
was unreal.> Jeez you guys! Look at the times you're posting! And I'm moaning about MY sleep problems!!!
>
> >Can you share with us your history? I bet some good ideas will come up.
>
> Let me start by telling you that I AM an MAOI responder. I could be the 'poster child' for Nardil. I've taken it five times over the past 15 years and I am the best possible person I could ever be when taking it. Unfortunately, the side effects (severe edema, almost complete shutdown of my entire excretory system) have eliminated it from my list of possibilities. I've lost my 'safety net'! It's also probably unfortunate that Nardil is the yardstick by which I measure all other AD's because I don't think I will ever find another that provides the robust, wonderful hypomanic benefits that Nardil does.
>
> >I think I remember reading that 80mg was the maximum dose of selegiline used in depression
>
> I've never seen 80 mentioned before - but I wonder what 80 would do to my nightmarish sleep if it's bad at 60 mg.
>
> >Only the experts or the brave would augment the maoi.
>
> You're right! My Pdoc is self-admittedly not one of the brave. He would augment with lithium, however. He also admits that he's not sophisticated enough to recommend drug cocktails and would prefer that I see a big-time psychopharm in Boston for that.
>
> >If you are going from black to blue, that could be a good sign. You are, at least, maybe,
> a partial responder, which could mean that a) you will contiune to improve, or b) you have a good chance of responding to an augmentation strategy such as the addition of low-dose lithium. Non-responders to MAOI treatment are less likely to achieve a full response from lithium augmentation.
> >If you can, you might want to stay with the 60mg for another full 2 or 3 weeks
>
> This is the unknown that bothers me...am I a responder to Selegiline, obviously a completely different drug than Nardil? Nardil showed benefit within the first two weeks - is it possible that Selegiline could possibly kick-in after so much longer? Or is from 'black' to 'blue' as good as it's ever going to get? With or without augmentation? Tough questions to answer when a drug has little or no track record.
>
> >I seem to be barely dreaming at all. A this point, the insomnia is more than an equitable trade for the despair that preceeded it
>
> Not dreaming, for me, is a sign that an MAOI is working. I too missed dreaming when I took Nardil; but like you, I felt the insomnia and lack of dreams were well worth it for the relief it provided. My hellish nights right now are making me very concerned about Selegiline's effectiveness.
>
> >Maybe if you give us a history of your diagnosis, treatment, doses, reasons for discontinuing, etc.
>
> My Dx is, and I quote, "Major Depression at worst; Severe Dysthymia my best"
>
> TCA's tried: Imiprimine, Desiprimine - very little AD benefit, big weight gain, severe sweating.
>
> SSRI's: Tried all but Celexa. No AD benefit. Every one made me too fatigued to function. No amount of time made them tolerable.
>
> Effexor: Little AD benefit, too enervating
>
> Effexor SR: A disaster (for 6 weeks at 150 mg). No AD benefit. Tremors, muscle weakness. Flu-like symptoms.
>
> Klonapin: Fatigue. No benefit.
>
> Welbutrin: Way too enervating! Felt like a 'nervous breakdown' Couldn't give it a decent trial.
>
> Lithium (alone): Fatigue bordering on Coma
>
> Serzone: Worse fatigue than Lithium (if possible), with aggression and hostility from out of the blue. If I'd had the physical strength, I would have thrown myself in front of a bus to put an end to the way it made me feel!
>
> Marplan: AD benefit (nothing like Nardil though). Slower kick-in than Nardil. Worse edema.
>
> Parnate: Too enervating. Very short trial.
>
> ECT & Rememon: Both have been offered. I feel as if ECT is only a temporary measure with no medicinal backup. Remeron - after my debacle with Serzone, the thought of taking it scares the heck out of me (Can I believe that it becomes enervating at high doses?)
>
> There are more that don't come to mind right now - I wish I'd written them all down over the years. Combining any of the above really makes me skittish - like trying to make a 'right' with two 'wrong's' I do wonder if Parnate might be worth another shot if I augmented it with something (what?) to counteract the aggitation it causes.
>
> One other question. I am scheduled to have a thyroid function test done right after the holidays. I'm also wondering whether diminishing Estrogen (I'm guessing menopause isn't too far away) might be the cause of drugs that I've taken before acting differently now (i.e. Effexor was a relatively benign drug several years ago - SR almost did me in a few months ago. And the increased edema with Nardil recently? - it was never that bad before).
>
> Thanks for your responses and anything else you might be able to add. Judy
>
>
>
>
>
>
Posted by David Mitrtzer on December 20, 1999, at 9:44:19
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Adam on December 20, 1999, at 2:53:09
How about Pindolol as a potentiator for Selegiline? Anyone tried it, or have any thoughts?
Posted by Judy on December 20, 1999, at 18:44:41
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Adam on December 20, 1999, at 2:53:09
Adam - I would bet the farm that Serzone played a part in what led up to your hospitalization. I have dubbed it "the most dangerous drug I've ever taken." Every morning I would sleep through the alarm clock radio set at full volume. My husband then started to call home when it was time for me to get up, get my daughter on the phone and tell her to wake me. A couple of frightening times, my brain was awake enough to know that she was at my bedside, but I was, for a minue or so, unable to respond or even move my body. It was just like coming out of anesthesia! In little better than that condition, I would then drive 40 miles to work - over the Sagamore Bridge and down the Cape.
Besides the near fugue state I was in, I started to become overly-angry and hostile (at the time I thought it was just my fatigue). I actually told the boss's wife where to go one morning! (Believe me, I'd thought it many times, but *never* would have verbalized it!) It wasn't until after I stopped taking Serzone that I read somewhere that it can cause feelings of agression and hostility.
For some, Serzone may be a blessing; but I couldn't possibly recommend it to anyone! I'm wondering if our particular brain chemical makeup responds favorably to MAOI's, but strikes back at Serzone. (BTW, I have the same urge to push Nardil on treatment-resistant people that you do with Selegiline.)
As for Remeron - I am plain scared to death of any drug that makes me feel sedated. Too much like depression (or Serzone!). Besides, most of us don't have the luxury of being able to sleep out the early stages of a sedating drug. Do I sound like I'm making excuses for not trying everything in my power to get well? I hope not. I'm just truly afraid I can't deal with one more trial and nasty failure.
I guess an appointment with the big-time psychopharm is in order. Thanks so much for all your suggestions. Judy
> Just as an aside, I experienced a severe worsening of my illness while on Serzone, and read
> with interest and distrubance that you found it difficult to deal with. I got so bad I
> wound up in the hospital. I was a mess, a "death please take me now" kind of violently
> relentless despair. I have so often wondered if Serzone precipitated this episode, or if
> it was just a coincidence.
>
> Having said that, I tried Remeron, and did not experience anything as troubling. Nearly
> irresistalbe somnolence was the primary side effect, and yes, strange as it seems, this
> did get a bit better as I raised the dose (up to 45mg/day). I never got too much of an
> antidepressant response out of it, and it always left me feeling very tired. But compared
> to the first couple of weeks in the end it was relatively tolerable. The first day I
> took it I wanted to crawl on the floor from my bed to the bathroom rather than walk. It
> was unreal.
Posted by JohnL on December 21, 1999, at 2:18:35
In reply to Re: Selegiline Expertise Needed Again(Long/Boring), posted by Adam on December 20, 1999, at 2:41:45
Adam, couple questions for you. Your experiences on serzone and remeron mirror mine almost exactly, which makes me wonder if I might have a high likelihood of responding to selegiline as you have. First, didn't you say selegiline boosts libido and desire? Is it still that way? Second, at any point did you have any male difficulties in sex? I was reading about selegiline side effects and one of them listed is 'sexual dysfunction'. I thought, huh? Better ask Adam bout that...Thanks. JohnL
Posted by Adam on December 21, 1999, at 8:30:45
In reply to Re: Selegiline Expertise Needed Again-Adam, posted by Judy on December 20, 1999, at 18:44:41
Judy,
Thanks for your response. It sure is strange how one person's cure is another person's curse.
I wish you the best of luck with this. I wish everybody the best of luck with this. Nothing would make me happier if we all could find something that can be tolerated and helpful at the same time. Take care of yourself.
> Adam - I would bet the farm that Serzone played a part in what led up to your hospitalization. I have dubbed it "the most dangerous drug I've ever taken." Every morning I would sleep through the alarm clock radio set at full volume. My husband then started to call home when it was time for me to get up, get my daughter on the phone and tell her to wake me. A couple of frightening times, my brain was awake enough to know that she was at my bedside, but I was, for a minue or so, unable to respond or even move my body. It was just like coming out of anesthesia! In little better than that condition, I would then drive 40 miles to work - over the Sagamore Bridge and down the Cape.
>
> Besides the near fugue state I was in, I started to become overly-angry and hostile (at the time I thought it was just my fatigue). I actually told the boss's wife where to go one morning! (Believe me, I'd thought it many times, but *never* would have verbalized it!) It wasn't until after I stopped taking Serzone that I read somewhere that it can cause feelings of agression and hostility.
>
> For some, Serzone may be a blessing; but I couldn't possibly recommend it to anyone! I'm wondering if our particular brain chemical makeup responds favorably to MAOI's, but strikes back at Serzone. (BTW, I have the same urge to push Nardil on treatment-resistant people that you do with Selegiline.)
>
> As for Remeron - I am plain scared to death of any drug that makes me feel sedated. Too much like depression (or Serzone!). Besides, most of us don't have the luxury of being able to sleep out the early stages of a sedating drug. Do I sound like I'm making excuses for not trying everything in my power to get well? I hope not. I'm just truly afraid I can't deal with one more trial and nasty failure.
>
>
Posted by Adam on December 21, 1999, at 8:51:38
In reply to Re: Selegiline Expertise Needed Again - -Adam, posted by JohnL on December 21, 1999, at 2:18:35
JohnL
It doesn't suprise me at all that sexual dysfunction is a side effect of selegiline. Different people respond differently, that's perhaps the only axiom I could trust, in regards to meds, and based on the stories I have read here. Perhaps the similarities in our responses to other drugs might be predictive, but I wouldn't count on that. Also, I'm currently taking selegiline in such a different manner (transdermally vs. orally) than most people here will be able too. Transdermal delivery changes the pharmicokinetics of selegiline quite a bit. I am, myself, scared sh#tless about what will happen in three months when the study I am in is over and I have to give up the patch. But this much I can say it true about me now: Sex is NOT a problem. I, um, just got more evidence of that last night (I am, as they say, a little giddy at the moment). Does it _enhance_? It sure doesn't hurt. I have spent so many previous years trying to deal with sexual dysfunction that it's hard to know anymore what my "normal" level of functioning is. I pretty much have to look back to my early twenties for that (I'm about 2.5 months shy of 30). I would say I am at that level now, but...(oh, what the hell), I have not experienced an almost ravenous sexual hunger like this in a LONG time. Actually, there's no "almost" about it. I would say performance is as good as ever (and I'm older now), and desire is, hooahh...words can hardly describe. If there is a problem, it might be that my stamina is a bit adversely affected. I'm hoping with a little concentration to deal with that. It's not a big concern, I don't think. We'll see.
>
> Adam, couple questions for you. Your experiences on serzone and remeron mirror mine almost exactly, which makes me wonder if I might have a high likelihood of responding to selegiline as you have. First, didn't you say selegiline boosts libido and desire? Is it still that way? Second, at any point did you have any male difficulties in sex? I was reading about selegiline side effects and one of them listed is 'sexual dysfunction'. I thought, huh? Better ask Adam bout that...Thanks. JohnL
Posted by Adam on December 21, 1999, at 11:33:43
In reply to Re: Selegiline Augmentation, posted by David Mitrtzer on December 20, 1999, at 9:44:19
That definitely seems like a good idea, for depression at least. I've read that pindolol (like other beta-blockers) can cause sleep disturbances. I've had such a hard time with insomnia lately with selegiline alone I find the thought of such a combination a bit scary, but it seems worth trying, at least. What I'm not altogether clear on, based on what I've read in abstracts, is if pindolol really has an additive benefit as an augmentation, or if it just hastens response. Any thoughts on this?
Posted by Rick on December 21, 1999, at 15:06:11
In reply to Re: Selegiline Expertise Needed Again - -JohnL, posted by Adam on December 21, 1999, at 8:51:38
JohnL-
I'm back to taking a small amount (10 mg -- no food restrictions!) of Selegiline orally with my 2.0 mg Klonopin and 5 mg. Pindolol. And, my sexual reaction sounds just like what Adam is seeing with the patch. Unbelievable sexual desire and "sensations", but maybe actually a tad less stamina (but that could very well be from one of the other meds, or the combo, rather than the Selegiline itself).
Once again, everyone's prone to different side effects. For example, look at how many meds list BOTH hypertension and hypotension as possible side effects.
Rick
----
> JohnL
>
> It doesn't suprise me at all that sexual dysfunction is a side effect of selegiline. Different people respond differently, that's perhaps the only axiom I could trust, in regards to meds, and based on the stories I have read here. Perhaps the similarities in our responses to other drugs might be predictive, but I wouldn't count on that. Also, I'm currently taking selegiline in such a different manner (transdermally vs. orally) than most people here will be able too. Transdermal delivery changes the pharmicokinetics of selegiline quite a bit. I am, myself, scared sh#tless about what will happen in three months when the study I am in is over and I have to give up the patch. But this much I can say it true about me now: Sex is NOT a problem. I, um, just got more evidence of that last night (I am, as they say, a little giddy at the moment). Does it _enhance_? It sure doesn't hurt. I have spent so many previous years trying to deal with sexual dysfunction that it's hard to know anymore what my "normal" level of functioning is. I pretty much have to look back to my early twenties for that (I'm about 2.5 months shy of 30). I would say I am at that level now, but...(oh, what the hell), I have not experienced an almost ravenous sexual hunger like this in a LONG time. Actually, there's no "almost" about it. I would say performance is as good as ever (and I'm older now), and desire is, hooahh...words can hardly describe. If there is a problem, it might be that my stamina is a bit adversely affected. I'm hoping with a little concentration to deal with that. It's not a big concern, I don't think. We'll see.
> >
> > Adam, couple questions for you. Your experiences on serzone and remeron mirror mine almost exactly, which makes me wonder if I might have a high likelihood of responding to selegiline as you have. First, didn't you say selegiline boosts libido and desire? Is it still that way? Second, at any point did you have any male difficulties in sex? I was reading about selegiline side effects and one of them listed is 'sexual dysfunction'. I thought, huh? Better ask Adam bout that...Thanks. JohnL
Posted by Davis Mirtzer on December 21, 1999, at 15:16:39
In reply to Re: Selegiline Augmentation, posted by Adam on December 21, 1999, at 11:33:43
Adam, I can't answer the latter question, but the only sleep disturbance Pindolol (prescribed for high blood pressure) seems to give me is relentlessly weird dreams. I've heard the sleep-disturbance warnings too, but at 5 mg/day I actually get to sleep quicker and wake up much less during the night since starting Pindolol.
I haven't taken Selegiline; I'm just doing research and weighing options.
DM
> That definitely seems like a good idea, for depression at least. I've read that pindolol (like other beta-blockers) can cause sleep disturbances. I've had such a hard time with insomnia lately with selegiline alone I find the thought of such a combination a bit scary, but it seems worth trying, at least. What I'm not altogether clear on, based on what I've read in abstracts, is if pindolol really has an additive benefit as an augmentation, or if it just hastens response. Any thoughts on this?
Posted by Adam on December 21, 1999, at 16:47:23
In reply to Re: Selegiline Augmentation, posted by Davis Mirtzer on December 21, 1999, at 15:16:39
Yeah, the biggest things I see are nightmares and insomnia. Is 5mg/day considered a low dose? 10mg/day seems to be the norm.
> Adam, I can't answer the latter question, but the only sleep disturbance Pindolol (prescribed for high blood pressure) seems to give me is relentlessly weird dreams. I've heard the sleep-disturbance warnings too, but at 5 mg/day I actually get to sleep quicker and wake up much less during the night since starting Pindolol.
>
> I haven't taken Selegiline; I'm just doing research and weighing options.
>
> DM
>
> > That definitely seems like a good idea, for depression at least. I've read that pindolol (like other beta-blockers) can cause sleep disturbances. I've had such a hard time with insomnia lately with selegiline alone I find the thought of such a combination a bit scary, but it seems worth trying, at least. What I'm not altogether clear on, based on what I've read in abstracts, is if pindolol really has an additive benefit as an augmentation, or if it just hastens response. Any thoughts on this?
Posted by David Mirtzer on December 21, 1999, at 23:40:26
In reply to Re: Selegiline Augmentation, posted by Adam on December 21, 1999, at 16:47:23
Well, as I said I'm actually taking it for hypertension, and the recommended STARTING dose is 10 mg. But oddly enough 5 mg seem to do the trick for me, all taken in the morning (and Pindolol's not even extended-release like many other beta blockers).
In research I've done on Pindolol used as an augmenting agent for antidepressants, I usually see things like, "2.5 mg tid, although some patients may require 5.0 mg tid for adequate response". My pdoc says Selegiline itself lowers blood pressure in many people, so you'd have to be careful to monitor BP when taking Pindolol aong with it.
BTW, my "weird dreams" with Pindolol aren't so much "nightmares" as they are incomprehensible and/or "uncomfortale", although I've heard about people having nightmares when on beta blokers.
-----
> Yeah, the biggest things I see are nightmares and insomnia. Is 5mg/day considered a low dose? 10mg/day seems to be the norm.
>
> > Adam, I can't answer the latter question, but the only sleep disturbance Pindolol (prescribed for high blood pressure) seems to give me is relentlessly weird dreams. I've heard the sleep-disturbance warnings too, but at 5 mg/day I actually get to sleep quicker and wake up much less during the night since starting Pindolol.
> >
> > I haven't taken Selegiline; I'm just doing research and weighing options.
> >
> > DM
> >
> > > That definitely seems like a good idea, for depression at least. I've read that pindolol (like other beta-blockers) can cause sleep disturbances. I've had such a hard time with insomnia lately with selegiline alone I find the thought of such a combination a bit scary, but it seems worth trying, at least. What I'm not altogether clear on, based on what I've read in abstracts, is if pindolol really has an additive benefit as an augmentation, or if it just hastens response. Any thoughts on this?
Posted by Zeke on December 25, 1999, at 23:53:27
In reply to Selegiline Expertise Needed Again, posted by Judy on December 18, 1999, at 14:19:35
I would think if you are in the Boston area that seeing a psychpharm there is a fantastic idea.
As for sleep, Xanax definetly interferes with REM sleep, and I believe Selegiline may also. What about trying a little Melatonin (0.3mg) at bedtime in place of the Xanax (so long as seasonal affective disorder isn't part of your depression). Melatonin should help with the sleep without blocking REM. (Not sure though of any interactions with Selegiline -- anyone have any ideas?)
Re Pindolol: it blocks serotonin autoreceptors and theoretically only AUGMENTS other meds that effect serotonin. Supposedly when SSRIs (for example) increase synaptic serotonin, the autoreceptors sense this and consequently cause a reduction in serotonin production (and probably other effects) and this comprimises the antidepressant effect. But the pindolol blocks this and the SSRI doesn't cause negative feedback. I keep saying 'theoretically' because this doesn't explain the delayed response to ADs or the effect ADs have on neurogenesis. So Pindolol (and the SSRIs etc) may likely not be completely described by these explanations. Its curious to me that Pindolol is being tried with Selegiline, as it does not directly effect serotonin but dopamine and phenethylamine which are 'downstream' from serotonin.
Lastly, you mentioned estrogen and that is worth considering. I recently was reading an Australian webpage where it referred to estrogen as an adjucnt in depression. I guess they consider estrogen like docs in the states consider lithium and pindolol etc. Also estrogen does have antidepressant effects in itself and this is receiving more and more documentation in the medical literature. (Interestingly, both Selegiline and estrogen have been shown beneficial in Alzheimer's and in terms of both memory and mood. And like Selegiline, estrogen has a neuroprotective effect, and receptors for estrogen definitely exist in the brain.) The only relative concern is edema which may occur from the estrogen. But then again, the edema produced in you from Nardil may not occur with estrogen (or occur to any significant degree). I think estrogen is certainly worth considering. (BTW do a medline search on estrogen and affective disorder if you want to know more. There is more.)
Posted by Judy on December 26, 1999, at 10:59:00
In reply to Judy -- Selegiline, Pindolol, Melatonin & Estrogen, posted by Zeke on December 25, 1999, at 23:53:27
Thanks, Zeke! I will do a medline search on estrogen. I have a 'gut' feeling that estrogen, or lessening amounts of it, may be playing a significant part in the changing personna of my depression and the reason why previously used AD's affect me differently now. (Or perhaps my aging synapses and receptors are just rolling over and dying at a faster rate!)
Melatonin? Is that indicated with MAOI's? Not sure if anyone knows what is/isn't indicated with Selegiline at high doses. Another medline search maybe. Besides the sleep problems, I DO need Xanax (or something) for the anxiety that Selegiline isn't touching - or may even be exascerbating.
Great explanation of Pindolol's mechanism. I too wondered why it would be of benefit with Selegiline. In general, I've always wondered why it is that SSRI's just DO NOT work for me. They make me so fatigued that I wouldn't notice any benefit if it were there. Is it possible that Seratonin just isn't my problem brain chemical, or is there another mechanism of SSRI's that pushes my 'coma' button? Is it possible that Pindolol might lessen my SSRI- induced fatigue?
I'll do those web searches when I have a quiet moment today. If I find anything promising (or confusing), I hope you'll be here to run them by. Thanks again. Judy
Posted by Rick on December 26, 1999, at 18:31:55
In reply to Re: Judy -- Selegiline, Pindolol, Melatonin & Estrogen, posted by Judy on December 26, 1999, at 10:59:00
While Selegiline was designed as a dopamine-enhancing agent, the attached monograph section suggests that Selegiline's long-lasting metabolites *may* help discourage serotonin re-uptake. Thus, it is not necessarily illogical to think that the serotonergic beta blocker Pindolol could potentiate Selegiline, as it purportedly does for SSRI's and other AD's.
While I also feel that Selegiline is neutral-to-negative for anxiety (that's why I keep my dose very low -- all I use it for now is a little mental activation and alertness, which 5 mg does seem to provide), low-dose Pindolol itself sure seems to supply a mildly calming effect that nicely builds on my Klonopin's benefits. For all I know, I could get that same effect from various other beta blockers; but since Pindolol is the only one with serotonergic effects, I'm not so sure.
One thing I am fairly sure about is that Pindolol is not a good candidate to help with the fatigue. Indeed, just like other beta blockers, it causes fatigue in many people. This side-effect is especially prevalent for the cardio non-selective BB's, which include Pidolol and Propronolol (Inderal) among others. For me, anything above 5 mg starts to cause a little sleepiness, especially when taken at night. I haven't needed anything for sleep since taking Klonopin (even though I rarely take it after 6 p.m.). Back when I was taking an occasional Xanax at bedtime, I really felt groggy the next day. In fact, if you don't mind weird dreams and your blood pressure isn't too low, bedtime Pindolol might be a gentler sleep-inducer with fewer downside effects and some possible anti-anxiety benefits.
ATTACHMENT (from Selegiline monograph):
It is important to be aware that selegiline may have pharmacological effects unrelated to MAO B inhibition. As noted above, there is some evidence that it may increase dopaminergic activity by other mechanisms, including interfering with dopamine re-uptake at the synapse. Effects resulting from selegiline administration may also be mediated through its metabolites. Two of its three principal metabolites, amphetamine and methamphetamine, have pharmacological actions of their own; they interfere with neuronal uptake and enhance release of several neurotransmitters (e.g., norepinephrine, dopamine, serotonin). However, the extent to which these metabolites contribute to the effects of selegiline are unknown.
**********************************************
> Thanks, Zeke! I will do a medline search on
estrogen. I have a 'gut' feeling that estrogen,
or lessening amounts of it, may be playing a
significant part in the changing personna of my
depression and the reason why previously used AD's affect me differently now. (Or perhaps my aging
synapses and receptors are just rolling over and
dying at a faster rate!)
>
> Melatonin? Is that indicated with MAOI's? Not
sure if anyone knows what is/isn't indicated with
Selegiline at high doses. Another medline search maybe. Besides the sleep problems, I DO need
Xanax (or something) for the anxiety that
Selegiline isn't touching - or may even be
exascerbating.
>
> Great explanation of Pindolol's mechanism. I
too wondered why it would be of benefit with
Selegiline. In general, I've always wondered why
it is that SSRI's just DO NOT work for me. They
make me so fatigued that I wouldn't notice any
benefit if it were there. Is it possible that
Seratonin just isn't my problem brain chemical, or
is there another mechanism of SSRI's that pushes
my 'coma' button? Is it possible that Pindolol
might lessen my SSRI- induced fatigue?
>
> I'll do those web searches when I have a quiet
moment today. If I find anything promising (or
confusing), I hope you'll be here to run them by.
Thanks again. Judy
Posted by Zeke on December 27, 1999, at 11:46:31
In reply to To Judy and Zeke re: Selegiline and Pindolol, posted by Rick on December 26, 1999, at 18:31:55
> One thing I am fairly sure about is that Pindolol is not a good candidate to help with the fatigue.
That's a good point (the anti-anxiety effect of pindolol and the other beta-blockers). However, the doses of pindolol used with antidepressants are typically lower than those used for hypertension and the anergia is logically much less also.
> ATTACHMENT (from Selegiline monograph):
> It is important to be aware that selegiline may have pharmacological effects unrelated to MAO B inhibition. As noted above, there is some evidence that it may increase dopaminergic activity by other mechanisms, including interfering with dopamine re-uptake at the synapse. Effects resulting from selegiline administration may also be mediated through its metabolites. Two of its three principal metabolites, amphetamine and methamphetamine, have pharmacological actions of their own; they interfere with neuronal uptake and enhance release of several neurotransmitters (e.g., norepinephrine, dopamine, serotonin). However, the extent to which these metabolites contribute to the effects of selegiline are unknown.A fraction of selegiline is metabolized to to amphetamines and these are levo-methamphetamine and levo-amphetamine, which effect norepinephrine but not dopamine (at least not to any significant degree). Theoretically, this is why the dextroamphetamines are 4 to 6 times stronger than levoamphetamines. Also note that the government allows levo-methamphetamine (aka l-desoxyephedrine) to be sold over the counter in Vicks Inhalers. (Look at the active ingredient listed the nest time you visit your local drug store.) Re serotonin, methamphetamine but not amphetamine has some effect in itself. I'm not sure of how the levo isomer effects serotonin compared to the dextro.
Still, enhancing dopamine processes might reasonably effect serotonin even without imediate interaction of the two drugs.
An additional note about estrogen is that it reportedly increases serotonin by virtue of decreasing production of MAO (MAO-A?). Affective disorders and anxiety in persons with estrogen (and/or testosterone) deficiency is thought to be due to excess MAO which 'mops up' too much serotonin. Estrogen also seems related to Nerve Growth Factor and depressed persons tend to exhibit shrunken hippocampal structures.
Re melatonin, I though you (Judy) might try it at bedtime in place of Xanax -- to allow more REM. I'd think you could continue Xanax at other times. (Just a thought...)
Posted by anita on January 1, 2000, at 16:50:38
In reply to Re: Judy -- Selegiline, Pindolol, Melatonin & Estrogen, posted by Judy on December 26, 1999, at 10:59:00
Hi Judy,
I've always had low estrogen and have suspected it may be a factor in depression. All I've read about estrogen seems to indicate that this could be the case. However, when I was on nardil, the only AD that actually seemed to have a significant effect, my estrogen levels got a little lower and my testosterone level was sky-high.
I'm only in my early 30s, so I think for me I've just had low estrogen all my life (late puberty, painful and irregular and usu. 30+ day periods). I think I felt better when I was taking birth control pills years ago, but then again that was a better time of my life.
Anybody know of any studies on estrogen and the sleep cycle?
anita
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