![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Larry Hoover on April 24, 2005, at 13:09:04
In reply to Who prescribes selegeline, posted by linkadge on April 24, 2005, at 12:12:57
> Why are some doctors more familliar with the usage of alternative drug therapies such as selegeline ?
>
> My doctor wondered what on earth I was asking about a parkinson's med for, as I didn't have parkinsons.
>
> LinkadgeThe CPS (the Canadian drug bible) only lists selegiline for Parkinson's disease....that is absolutely correct.
I was able to get a prescription from my doctor because it is clear that nothing else seemed to help, or was tolerated by my med-sensitive body. I brought him an argument, that low-dose selegiline was virtually risk-free, and that the specific MAO-B activity worked outside the catecholamine activities of typical antidepressants.
My doctor is giving me about 2/3 of the drugs I suggest to him.....he's come to realize that we have to think outside the box, for me. Lar is outside the box, and if a rationale for a drug trial can be supported, a drug trial is what I get. A small prescription, and a follow-up visit.
If you have a rapport with your doctor, if you can bring evidence of both the rationale and the safe management of a drug trial, and combine that with your obvious treatment-resistance.....maybe you can move into the realm of collaborative treatment.
My doctor is old-school, wait-and-see......at the hospital, they call him "Wait-and-see Whatley", he's so well-known for not prescribing meds unless absolutely necessary. But, I got through that, because we ran out of conservative wait-and-see options. Ane, because he knows I manage these drug experiments with great care.
That's what works for me.
Lar
Posted by emme on April 24, 2005, at 13:24:53
In reply to Who prescribes selegeline, posted by linkadge on April 24, 2005, at 12:12:57
Mine suggested it. She thinks way outside the box. She had said there was literature supporting the use of L-phenylalanine with selegiline for treatment of depression. Here's a couple of references in case you want to present info to your doctor:**********************************
Rapid treatment of depression with selegiline-phenylalanine combination.
J Clin Psychiatry. 1991 Mar;52(3):137.
(There was no abstract on Pubmed with this reference)
****************************************
J Neural Transm. 1984;59(1):81-7. Related Articles, LinksL-deprenyl plus L-phenylalanine in the treatment of depression.
Birkmayer W, Riederer P, Linauer W, Knoll J.
The antidepressive efficacy of 1-deprenyl (5-10 mg daily) plus 1-phenylalanine (250 mg/day) has been evaluated in 155 unipolar depressed patients. Both oral and intravenous administration showed beneficial effects in 90% of outpatients and 80.5% of inpatients. It is concluded that this combined treatment has a potent antidepressive action based on the accumulation of 1-phenylethylamine in the brain.
em
Posted by linkadge on April 24, 2005, at 14:43:40
In reply to Re: Who prescribes selegeline » linkadge, posted by Larry Hoover on April 24, 2005, at 13:09:04
I know about some of the literature available.
I suppose, Larry, that you have been subjected to the Paxil, and Zyprexa combination?.I'm not sure If I am as med sensitive as you, or it is simply the fact that I do my research and the thought of taking paxil and zyprexa again gives my psychosomatic symptoms!!
Anyhow, you may have read my post on the Alternative. I did some research on MAO-B inhibiting herbs. I found fo-ti, which some suggest is the most potent MAO-B inhibiting herb available.
I took it with some DL Phenylalanine. It gave me an almost immediate AD effect that I havn't felt in years. Something I had to jog for HOURS to get. I'm proabably trying to get the PEA boost that exercise gives.
But now I'm even more depressed, since I know that taking this herb is not terrably reliable, and I don't want to be on the rollercoaster that varying potency can present.
The fact is, in many doctor's eyes, I'm not old enough to be treatment resistant. Plus, I already told my doctor that the clomipramine was working because quite frankly I felt embarrased to complain one more time.
I don't know, maybe I'll start smoking or something.
Linkadge
Posted by KaraS on April 24, 2005, at 18:13:34
In reply to Who prescribes selegeline, posted by linkadge on April 24, 2005, at 12:12:57
> Why are some doctors more familliar with the usage of alternative drug therapies such as selegeline ?
>
> My doctor wondered what on earth I was asking about a parkinson's med for, as I didn't have parkinsons.
>
> Linkadge
If/when the selegiline patch comes out, you will be vindicated. I know that's probably little help to you now but maybe your doctor will remember that you were ahead of the game for suggesting it now and have more respect for your input.Kara
Posted by Phillipa on April 24, 2005, at 18:28:02
In reply to Re: Who prescribes selegeline » linkadge, posted by KaraS on April 24, 2005, at 18:13:34
How can someone be too young to be med resistant? Fondly, Phillipa
Posted by linkadge on April 24, 2005, at 18:49:46
In reply to Re: Who prescribes selegeline, posted by Phillipa on April 24, 2005, at 18:28:02
They think of med resistant people as these crochety old people who've been on everything since Nardil. The doctors almost laugh at me cause they just assume I havn't been on the medications long enough.
Linkadge
Posted by Phillipa on April 24, 2005, at 18:53:06
In reply to Re: Who prescribes selegeline, posted by linkadge on April 24, 2005, at 18:49:46
That's not fair! Especially since you know so much about them. Fondly, Phillipa
Posted by Declan on April 24, 2005, at 23:39:19
In reply to Re: Who prescribes selegeline » linkadge, posted by Phillipa on April 24, 2005, at 18:53:06
I dunno where you live and what your regulations are, but in Australia it is permissable to import 3 months supply of either selegeline or liquid Deprenyl which I've taken for years, currently 1 or 2 mg/day plus 250mg DLPA, so I don't need a script. Rhodiola is a herb with a pro-dopamine type effect, which I liked a lot, especially with Deprenyl, but even if I took it first thing I couldn't sleep well, so I stopped it.
Declan
Posted by sl on April 26, 2005, at 18:10:13
In reply to Re: Who prescribes selegeline » Larry Hoover, posted by linkadge on April 24, 2005, at 14:43:40
> But now I'm even more depressed, since I know that taking this herb is not terrably reliable, and I don't want to be on the rollercoaster that varying potency can present.
Well, it seems like it should be possible to find a brand that has a pretty consistent potency. You may have to shop around, or even order it from China, but it should be possible.
The thing I'd worry about is that anything that takes effect that quick may not last...after a week or two, you may not feel as good anymore.
Posted by linkadge on April 26, 2005, at 18:48:00
In reply to Re: Who prescribes selegeline, posted by sl on April 26, 2005, at 18:10:13
This is true. Some of the studies done on Selegeline and DLPA found a sustained antidepressant effect after several months. They too also found a very rapid onset of action.
My depression has always been acompanied by an inability to concentrate. The SSRI's make this much worse.
I suppose only time will tell.
Linkadge
Posted by sl on April 26, 2005, at 20:43:00
In reply to Re: Who prescribes selegeline, posted by linkadge on April 26, 2005, at 18:48:00
I am somewhat confused, are we talking about fo-ti or selegeline?? I was talking about fo-ti....
but the only info I can find on it is as a tonic to restore vigor and hair color to people who don't have it.
Posted by Declan on April 27, 2005, at 0:08:11
In reply to Re: Who prescribes selegeline, posted by sl on April 26, 2005, at 20:43:00
Hi Linkadge, could you see a practitioner of traditional chinese medicine? They should have the good stuff and know about combinations.
Declan
Posted by linkadge on April 27, 2005, at 8:23:48
In reply to Re: Who prescribes selegeline, posted by linkadge on April 26, 2005, at 18:48:00
Well I am looking to try selegeline, but currently I am taking fo-ti which is supposed to be a fairly potent MAO-B inhibitior.
Linkadge
Posted by Declan on April 27, 2005, at 17:08:28
In reply to Re: Who prescribes selegeline, posted by linkadge on April 27, 2005, at 8:23:48
Hey Linkadge,
"Polygonum decreases levels of lipid peroxides in senile quails, and was more effective than Vitamin E in human tests. The life-span of senile quails was prolonged." In spite of the MAO-B thing it is used for "neurasthenia especially with insomnia". You found it a noticeable effect. How did your sleep go with it? I liked the effect of Rhodiola with deprenyl but I couldn't sleep properly.
Declan
Posted by Elroy on April 27, 2005, at 20:10:58
In reply to Who prescribes selegeline, posted by linkadge on April 24, 2005, at 12:12:57
If you search The Web, you will find some VG studies involving the use of selegiline for depression (as well as being an excellent life-extension compound). And very safe. Of course, we're talking LOW DOSE (10mg or less, possibly up to 15 mg but not any more) of selegiline.
Here's some general links of selegiline (deprenyl):
http://qualitycounts.com/fpdeprenyl.html
http://www.selegiline.com/refs/
http://www.smart-drugs.com/ias-Info/ias-deprenyl.htm
QUOTE: "L-deprenyl is what good pharmaceuticals are all about. First it is exceptionally safe, second it protects and enhances mental function, mood and even libido, thirdly, it may even extend life. Imagine a safe agent that enhances both the quality and length of life." - Julian Whitaker M.D. - Health and Healing Newsletter, Whitaker Wellness Institute, Newport Beach, California.... Also: Mendlewicz and Youdim reported a marked improvement in 14 patients with unipolar or bipolar depression who received selegiline hydrochloride 5 mg three times daily for 40 days compared with 13 patients given placebo. (1) Similarly, Birkmayer et al. reported benefit in an uncontrolled study in 102 outpatients and 53 inpatients with unipolar depression who received selegiline hydrochloride 5 to 10 mg daily in association with phenylalanine 250 mg daily- about 70% of these patients, in whom conventional antidepressants were not effective, were reported as having complete remission. END QUOTEhttp://smart-drugs.net/ias-deprenylJS.htm
QUOTE: In 1978 Mendelwicz and Youdim treated 14 depressed patients with 5 mg deprenyl plus 300 mg 5-HTP 3 times daily for 32 days. (1) Deprenyl potentiated the antidepressant effect of 5-HTP in 10/14 patients. 5-HTP enhances brain serotonin metabolism, which is frequently a problem in depression (37), while deprenyl enhances dopamine/noradrenalin activity. Under-activity of brain dopamine, noradrenalin and serotonin neural systems are the most frequently cited biochemical causes of depression (18,19,37), so deprenyl plus 5-HTP would seem a natural antidepressant combination. ALSO: In 1991 H. Sabelli reported successful results treating 6 of 10 drug-resistant major depressive disorder patients. (9) Sabelli used 5 mg deprenyl daily, 100 mg vitamin B6 daily, and 1-3 grams phenylalanine twice daily as treatment. 6 of 10 patients viewed their depressive episodes terminated within 2-3 days! Global Assessment Scale scores confirmed the patients’ subjective experiences. Vitamin B6 activates the enzyme that converts phenylalanine to PEA, so the combination of low-dose deprenyl, B6, and phenylalanine is a bio-logical way to enhance both PEA and catecholamine brain function, and thus to diminish depression. END QUOTEhttp://www.selegiline.com/pea.html
http://www.selegiline.com/depplus.html
http://www.restoreunity.org/improving_deprenyl.htm
My personal favorite:
http://www.dr-bob.org/babble/20041211/msgs/430276.htmlSo you might want to consider printing out some of these and having an "informative chat" with your doc and see if you can't tactfully bring him around for a trial venture???
X
X
X
X> Why are some doctors more familliar with the usage of alternative drug therapies such as selegeline ?
>
> My doctor wondered what on earth I was asking about a parkinson's med for, as I didn't have parkinsons.
>
> Linkadge
Posted by linkadge on April 27, 2005, at 20:57:18
In reply to Re: Who prescribes selegeline » linkadge, posted by Elroy on April 27, 2005, at 20:10:58
I find fo-ti kind of activating. It certainly brightens up my vision (as do other dopaminergics). It seems very calming at first, but I have a hard time staying asleep on it. Kind of like if I drink coffee before bed.
Anyhow, I don't even know if I can muster up the courage to bug my doctor again. Somtimes I just wish things would work properly in this world without such a hastle.
Anyhow thanks for the information.
Linkadge
Posted by linkadge on April 27, 2005, at 21:03:30
In reply to Re: Who prescribes selegeline, posted by linkadge on April 27, 2005, at 20:57:18
Thats all I can say. I give up.
Linkadge
Posted by Phillipa on April 27, 2005, at 21:24:57
In reply to Re: Who prescribes selegeline, posted by linkadge on April 27, 2005, at 20:57:18
Amen! Or if they come up with a way to know without a doubt what meds will work for you. fondly, Phillipa
Posted by sl on April 27, 2005, at 23:47:20
In reply to Re: Who prescribes selegeline, posted by linkadge on April 27, 2005, at 20:57:18
> I find fo-ti kind of activating. It certainly brightens up my vision (as do other dopaminergics). It seems very calming at first, but I have a hard time staying asleep on it. Kind of like if I drink coffee before bed.
Actually, the herbalist I talked to said it was probably the dl-phelylalinine you said you took with it that had the most effect, he'd never heard of fo-ti being taken for antidepressent effects at all.
But he said if you did want to take it for that, get the powdered herb itself and capsule it yourself, and that should give you a pretty consistent quality.> Anyhow, I don't even know if I can muster up the courage to bug my doctor again. Somtimes I just wish things would work properly in this world without such a hastle.
Well, but that's the depression talking.
It's a nasty catch 22, the depression steals your motivation to look for a better solution to the depression, y'know?
Keep trying!!! There's bound to be a combo out there somewhere! :)Luck,
sl
Posted by linkadge on April 28, 2005, at 9:07:58
In reply to Re: Who prescribes selegeline, posted by sl on April 27, 2005, at 23:47:20
I didn't pick fo-ti cause it was listed as an antidepressant, I just did some extensive searching for herbs with MAO-B inhibitory activity.
Fo-Ti came at the top of the list. In a few studies inhibtion of 80% was noted.
I think this herb is primarily used these days for anti-aging. Which is funny, since the MAO-B inhibitor selegeline is also used for anti-aging.
I have tried the two separately, thinking along the same lines as you have. There is a clear cut difference.
DLPA alone raises my heart rate for perhaps 1/2 hour. If I take 2-3 grams of fo-ti beforehand, then the effect lasts all day.
The fo-ti itself also seems to give me better muscle co-ordination. When I play the piano, my jaw is always clenched tight. After the fo-ti Its like I have controll of how I want each of my muscles to behave.
Regards,
Linkadge
Posted by medhed on April 28, 2005, at 10:49:09
In reply to Re: Who prescribes selegeline, posted by linkadge on April 28, 2005, at 9:07:58
I can't wait to try Deprenyl/DLPA mix. Will I have to go off Welbutrin? If so, how long after discontinuing WelB. can I start MAOB? I'm hoping my pdoc will know but she really doesn't seem to know much, hence my lurking around trying to do my own research.
Here is my idea of a regiem:
Lexapro 10mg., I'm taking that now with no side effects, not sure of AD efficacy yet, just started taking it 5 days ago.
Deprenyl 5-10mg.
DLPA 250mg-300mg.
Lyrica or some kind of calming agent.
Lunesta start off at 3mg.How's it sound? My goal is low side effects, relief from depression, ADD, OCD, PTSD, and sleep disorder...can't fall asleep but when I do I can sleep up to 18 hrs. sometimes (really debilatating)
your experience and help is needed.
thanx.
P.S. Could Provigil be tolerated or is it even indicated?
Oh yeah, Welbutrin withdrawl, is there such a thing? I've been taking it for many years and I never tryed to stop it before.
Posted by linkadge on April 28, 2005, at 11:58:29
In reply to Re: Who prescribes selegeline » linkadge, posted by medhed on April 28, 2005, at 10:49:09
Sounds like a good idea. I would be cautious about the introduction of Selegeline. It could very well interact with wellbutrin, so allow a few days of wellbutrin absence.
Other than this there should be no interaction. Perhaps be aware of the symtpoms of serotonin syndrome. Selegeline midly inhibits MAO-A which can interact with SSRI's (but shouldn't at these doses).
Good Luck
Linkadge
Posted by linkadge on April 28, 2005, at 12:01:02
In reply to Re: Who prescribes selegeline » linkadge, posted by medhed on April 28, 2005, at 10:49:09
You can get withdrawl from any medication. Symptoms of wellbutrin withdrawl would generally be apathy, lethargy, and general low energy.
I would not mix a stimulant with selegeline, but I don't know if it is stricty contraindicated.
If you're not getting enough boost from selegeline, just take a higher dose.
Linkadge
Posted by Aurora Borealis on April 28, 2005, at 16:52:57
In reply to Re: Who prescribes selegeline, posted by linkadge on April 28, 2005, at 12:01:02
Posted by medhed on April 28, 2005, at 17:26:18
In reply to Re: Who prescribes selegeline, posted by linkadge on April 28, 2005, at 12:01:02
> You can get withdrawl from any medication. Symptoms of wellbutrin withdrawl would generally be apathy, lethargy, and general low energy.
>
> I would not mix a stimulant with selegeline, but I don't know if it is stricty contraindicated.
> If you're not getting enough boost from selegeline, just take a higher dose.
>
>
> Linkadge
>my thoughts too. no need for 2 dopamine type drugs.
thankyou very much.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.