![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by AdamCanada2 on August 15, 2009, at 11:01:15
I want to know if 2.5mg as small as it may seem would be a more ideal dose for someone with low weight and somewhat sensitive to meds?In a nutshell here is what my Selegiline Oral Tablets experience has been like for my severe depression, low mood, low drive, low motivation and Social Anxiety.
On 5mg:
Days 1-4: I felt almost no improvement and even felt a little weird. It seemed like a good kind of weird. As if I was more connected to the world.
Day 5-8: Wow what a difference. For first time in ages I felt like I was getting closer to being normal. Large boost in drive, motivation, and interests were returning! I felt like actually enjoying the summer! Getting out there, meeting girls, meeting friends, actually doing photography too. Amazing huh? I felt the urge to get out of bed every morning. Also important thing to note... I felt more intelligent. I could think more clearly. Really remarkable.
Day 9-15: Ugh huge insomnia and everything I felt during days 5-8 was lost! Back to feeling depressed and dumbed down, foggy headed.
So what gives? I also tried 7.5 mg and it feels just like days 9-15. Some minor motivation came back but I feel so idiotic. My mind feels blocked off. And my insomnia is rediculous. Frequent awakenings and never able to get more than 7 hours and often only 5.
Please help in any way you can.
Posted by Phillipa on August 15, 2009, at 11:16:49
In reply to 5mg Selegiline/Ensam too much/little?? Oral, posted by AdamCanada2 on August 15, 2009, at 11:01:15
Is this the pill? Or the patch customized? Insomnia is frequent on Emsam that I am pretty sure of. Boy what a dramatic improvement you experienced. Hoping that someone will have further insight. Love Phillipa
Posted by AdamCanada2 on August 16, 2009, at 9:17:11
In reply to Re: 5mg Selegiline/Ensam too much/little?? Oral » AdamCanada2, posted by Phillipa on August 15, 2009, at 11:16:49
I appreciate your reply Phillipa I just wish more were willing to help. I'm sorry I don't make tiny little messages with no details. I'm sorry that I forget we live in a ADHD society where anything more than a paragraph is not worth our time.
I am reaching the end of a long list of options here and I just want any Advice please.
Yes this is the pill form. Help save my miserable life.
> Is this the pill? Or the patch customized? Insomnia is frequent on Emsam that I am pretty sure of. Boy what a dramatic improvement you experienced. Hoping that someone will have further insight. Love Phillipa
Posted by SLS on August 16, 2009, at 11:50:00
In reply to Yeah ignore me. Just like the doctors., posted by AdamCanada2 on August 16, 2009, at 9:17:11
> I appreciate your reply Phillipa I just wish more were willing to help. I'm sorry I don't make tiny little messages with no details. I'm sorry that I forget we live in a ADHD society where anything more than a paragraph is not worth our time.
I don't think you are being ignored so much as I don't think people know how to respond to your post without your providing more information.
What exactly do you need to know?
- Scott
Posted by Sigismund on August 16, 2009, at 16:46:47
In reply to 5mg Selegiline/Ensam too much/little?? Oral, posted by AdamCanada2 on August 15, 2009, at 11:01:15
>I want to know if 2.5mg as small as it may seem would be a more ideal dose for someone with low weight and somewhat sensitive to meds?
Yes, that's right.
There is no point in taking a dose that gives you insomnia so you feel even worse.
Posted by Phillipa on August 16, 2009, at 20:01:06
In reply to Yeah ignore me. Just like the doctors., posted by AdamCanada2 on August 16, 2009, at 9:17:11
Adam they are here the help your're looking for that I could not provide. Could you post your meds and any other questions asked as know you will now get the help Love Phillipa
Posted by Brainbeard on August 18, 2009, at 4:12:23
In reply to 5mg Selegiline/Ensam too much/little?? Oral, posted by AdamCanada2 on August 15, 2009, at 11:01:15
At doses of 2.5mg and below, selegiline is acting more as a catecholamine (dopamine, noradrenaline) transmission booster than as a MAO-B inhibitor. (I'm sorry, I'm too lazy to give any references. If somebody kicks my *ss for it I may (gruntingly) look them up for y'all.) Many people seem to use selegiline in these low doses. Some people even use such a dose a couple of times a week instead of every day, believing it prevents dopaminergic brain aging.
My personal experience is that 2.5mg only makes me feel a little uptight without giving me much benefit - unless I combine it with tianeptine (best results with 25mg at once), in which case I get a very nice synergistic effect (both stimulating and mellowing).
So I would certainly give 2.5mg or even less a shot. It's worth trying. Don't expect it to save your life though. It's probably way too mild for that.
Posted by AdamCanada2 on August 19, 2009, at 23:00:55
In reply to Re: Yeah ignore me. Just like the doctors. » AdamCanada2, posted by SLS on August 16, 2009, at 11:50:00
Hi. I'm trying to get opinions on way me a good course of action to take. What people's views may be on my situation. I have talked a lot about my Selegiline + other med trails in previous posts with more detail but the longer I make my posts the less replies they receive.
also trying to find out other people's situations and experiences with this.
This is day 22ish or so of Selegiline. Right now i'm on 10mg (5mg twice a day, 10am and 2pm) for about 5 days this dose. And the 2nd day of current dose I began to feel a decent improvement. I started to feel like I was going to enjoy life again. That feeling diminished and now day 5 is feeling even worse than 3 and 4.
I have tried over 30 meds and my hope is not unlimited.
is lower dose.. 2.5mg a good option? Also doctor said we should try paxil 5mg (i used to take 10 mg of it with some helpful results that made life livabl). maybe combination can be good. i also take right now clonazepam 0.25mg 4 times a day, sometimes little more. Also I take Ritalin 2.5 mg 5+ times day.
I really dont know what on earth to do anymore.
> > I appreciate your reply Phillipa I just wish more were willing to help. I'm sorry I don't make tiny little messages with no details. I'm sorry that I forget we live in a ADHD society where anything more than a paragraph is not worth our time.
>
> I don't think you are being ignored so much as I don't think people know how to respond to your post without your providing more information.
>
> What exactly do you need to know?
>
>
> - Scott
Posted by Brainbeard on August 20, 2009, at 4:42:16
In reply to An Update... 3rd paragraph., posted by AdamCanada2 on August 19, 2009, at 23:00:55
> is lower dose.. 2.5mg a good option?You may be frustrated about being ignored, but you also seem to ignore my contribution and simply ask the question I tried to answer for you all over again. 'Do unto others as you have others do unto you.' ;)
Ritalin is a rather harsh drug in my opinion that can give you rebound depression, anxiety and restlessness - if you're looking for stability, I'd consider ditching it and preferably taking something less crude like a decent NRI (nortriptyline perhaps, or reboxetine).
Low dose SSRI is surely an option (may attenuate any Ritalin rebound too). I think low dose Lexapro may be a better option than Paxil (cleaner and stronger, even 2.5mg may be enough).
Just some thoughts. Ah, you're gonna ignore me anyway.. ;)
Posted by AdamCanada2 on August 20, 2009, at 10:14:33
In reply to Re: An Update... 3rd paragraph., posted by Brainbeard on August 20, 2009, at 4:42:16
i did not ignore anything. i am glad for your reply and others. i have made a note about trying 2.5 mg. and i also have been considering dropping ritalin to see how it goes and your suggestion further makes me want to attempt the withdrawl. thanks. take care
>
> > is lower dose.. 2.5mg a good option?
>
> You may be frustrated about being ignored, but you also seem to ignore my contribution and simply ask the question I tried to answer for you all over again. 'Do unto others as you have others do unto you.' ;)
>
> Ritalin is a rather harsh drug in my opinion that can give you rebound depression, anxiety and restlessness - if you're looking for stability, I'd consider ditching it and preferably taking something less crude like a decent NRI (nortriptyline perhaps, or reboxetine).
>
> Low dose SSRI is surely an option (may attenuate any Ritalin rebound too). I think low dose Lexapro may be a better option than Paxil (cleaner and stronger, even 2.5mg may be enough).
>
> Just some thoughts. Ah, you're gonna ignore me anyway.. ;)
>
>
Posted by SLS on August 20, 2009, at 10:53:25
In reply to 5mg Selegiline/Ensam too much/little?? Oral, posted by AdamCanada2 on August 15, 2009, at 11:01:15
> Please help in any way you can.
I think it will be important to have patience when trying different treatments. It is the nature of the beast that antidepressants take a minimum of 2-4 weeks to produce an improvement. It is sometimes counterproductive to watch for daily or even hourly changes. The important thing is to establish a trend. Of course, if you can't tolerate the drug, that's a good reason to abort a trial.
At the moment, I don't have any suggestions as to what direction to take your treatment. If you want, you can keep the selegiline, but add a SSRI or SNRI, and then supplement that with a drug like nortriptyline or desipramine. You could even go with a similar combination using Wellbutrin instead of a tricyclic.
What has been your history regarding the use of MAOIs?
- Scott
Posted by AdamCanada2 on August 20, 2009, at 13:55:51
In reply to Re: 5mg Selegiline/Ensam too much/little?? Oral, posted by SLS on August 20, 2009, at 10:53:25
Parnate was tremendously promising when I tried it earlier in the year. Within the first day I felt an improvement. 10-25mg seemed to help a lot but huge insomnia developed. horrendous even. sometimes only 2-3 hours of sleep but i had so much energy that even with such poor sleep i was often able to half the time be in an energized state. evenings would be quite awful from exhaustion. but the overall mood benifits, motivation, drive, enjoyment, etc were nice. 30mg parnate though ruined it. It became a reversal of effects. Insomnia turned into oversleeping and tiredness. Mind was foggy. More depressed, little drive to do anything. Returning to lower doses didn't help at that point. Something happened with the medication and even down to 10mg it had the same sleepy tired effect of dreadfulness.
Nardil I forget the dose but it didn't help a too much. It deffinetly helped to a degree. Sure life was more enjoyable than not being on an anti-depressant but it never felt like I was anywhere near normal. I didn't want to settle for merely being slightly social and somewhat able to enjoy things.
And of course this Selegiline which was a beacon of hope during days 5-8. I started to remember how beautiful life could be.
Thanks for med suggestions
> > Please help in any way you can.
>
> I think it will be important to have patience when trying different treatments. It is the nature of the beast that antidepressants take a minimum of 2-4 weeks to produce an improvement. It is sometimes counterproductive to watch for daily or even hourly changes. The important thing is to establish a trend. Of course, if you can't tolerate the drug, that's a good reason to abort a trial.
>
> At the moment, I don't have any suggestions as to what direction to take your treatment. If you want, you can keep the selegiline, but add a SSRI or SNRI, and then supplement that with a drug like nortriptyline or desipramine. You could even go with a similar combination using Wellbutrin instead of a tricyclic.
>
> What has been your history regarding the use of MAOIs?
>
>
> - Scott
Posted by SLS on August 20, 2009, at 15:38:44
In reply to My history with MAOI's » SLS, posted by AdamCanada2 on August 20, 2009, at 13:55:51
I can't know for sure, but the things you experienced immediately upon raising the dosage of Parnate from 20mg to 30mg might have been a temporary effect. At 20mg, I doubt you had any significant MAO inhibition. It is likely you were feeling the amphetamine-like effects that the Parnate molecule possesses. Once you reached 30mg, you might have had some inhibition, but not enough to produce an improvement. Instead, you found yourself in an "in-between" state that produced the fatigue and dysphoria. Most people do not respond well to Parnate until the dosage reaches the range of 40-80mg. Feeling "weird" at 30mg might have been a good sign. At 40mg, I would think that insomnia would return. I think that it is unproductive to give up on a drug because of insomnia without first trying to treat the insomnia aggressively.
- Scott
Posted by AdamCanada2 on August 20, 2009, at 15:50:38
In reply to Re: My history with MAOI's » AdamCanada2, posted by SLS on August 20, 2009, at 15:38:44
I tried countless things to help Parnate insomnia. Nothing helped and even AP's would not do the trick and instead cause much daytime sedation yet despite sedation not allow me to sleep any better.
I was on 30mg parnate for 2 weeks. The horrible depressed effect remained.
Also I do not feel it is improbable for people to have a therapeutic effect on 10-25mg of Parnate. Not all of us need mega doses. I am sensitive to meds and Paxil 10mg was the ideal dosage for me on such an SSRI while many thought it had to be higher. 20mg on that med (for 2 month I may add) put me in constant sleep. I failed a semester.
Too high a dose is not always a solution for me.
> I can't know for sure, but the things you experienced immediately upon raising the dosage of Parnate from 20mg to 30mg might have been a temporary effect. At 20mg, I doubt you had any significant MAO inhibition. It is likely you were feeling the amphetamine-like effects that the Parnate molecule possesses. Once you reached 30mg, you might have had some inhibition, but not enough to produce an improvement. Instead, you found yourself in an "in-between" state that produced the fatigue and dysphoria. Most people do not respond well to Parnate until the dosage reaches the range of 40-80mg. Feeling "weird" at 30mg might have been a good sign. At 40mg, I would think that insomnia would return. I think that it is unproductive to give up on a drug because of insomnia without first trying to treat the insomnia aggressively.
>
>
> - Scott
Posted by SLS on August 20, 2009, at 16:37:47
In reply to Re: My history with MAOI's » SLS, posted by AdamCanada2 on August 20, 2009, at 15:50:38
> I tried countless things to help Parnate insomnia.
Yes. I had to combine Halcion with Ativan to treat the total insomnia I experienced when I combined Parnate with desipramine. Fortunately, it worked.
> I was on 30mg parnate for 2 weeks. The horrible depressed effect remained.
That stinks. I have no brilliant explanations for why this happened to you.
> Also I do not feel it is improbable for people to have a therapeutic effect on 10-25mg of Parnate.
Yes, I believe it is improbably if we are talking about treating affective disorders.
> Not all of us need mega doses.
40mg is not a megadose. 140mg is.
> I am sensitive to meds and Paxil 10mg was the ideal dosage for me on such an SSRI while many thought it had to be higher. 20mg on that med (for 2 month I may add) put me in constant sleep. I failed a semester.
Did Paxil 10mg fail to keep working for you?
> Too high a dose is not always a solution for me.It would be convenient if we all responded to the same dosage of the same drug. No such luck.
Keep thinking and keep posting. I hope you are rewarded for your efforts.
- Scott
Posted by morganator on August 20, 2009, at 22:15:46
In reply to My history with MAOI's » SLS, posted by AdamCanada2 on August 20, 2009, at 13:55:51
So are you on the Emsam patch??
Posted by AdamCanada2 on August 20, 2009, at 23:08:13
In reply to Re: My history with MAOI's » AdamCanada2, posted by morganator on August 20, 2009, at 22:15:46
nt
> So are you on the Emsam patch??
Posted by AdamCanada2 on August 20, 2009, at 23:32:40
In reply to Re: My history with MAOI's » AdamCanada2, posted by SLS on August 20, 2009, at 16:37:47
the Paxil 10mg was one of the better medications out of the 30+ I have tried.
It was the proper balance for the particular med for me personally. even 12.5mg would leave me persistently sedated through the whole day and as I mentioned the 20mg would make me feel like a sleepy zombie. 10mg was enough to help me to an acceptable degree but my life would remain very stagnant and therefor even after trying other doses such as 7.5 etc I felt after the 3 years on it I really needed a change. I didn't want to settle for a life of solitude where I only want to stay at home and have difficulty relating to other people. Paxil helped my pain a lot but depression not enough.
Also another thing I remember. 10mg paxil would be consistent a lot of the time in terms of mood. some mild uplifting action. but... over time i felt as if it was losing it's effect. the 10mg no longer was helping the way it was. Which was the final factor to make my choice clear in terms of trying new medications.
> > I tried countless things to help Parnate insomnia.
>
> Yes. I had to combine Halcion with Ativan to treat the total insomnia I experienced when I combined Parnate with desipramine. Fortunately, it worked.
>
> > I was on 30mg parnate for 2 weeks. The horrible depressed effect remained.
>
> That stinks. I have no brilliant explanations for why this happened to you.
>
> > Also I do not feel it is improbable for people to have a therapeutic effect on 10-25mg of Parnate.
>
> Yes, I believe it is improbably if we are talking about treating affective disorders.
>
> > Not all of us need mega doses.
>
> 40mg is not a megadose. 140mg is.
>
> > I am sensitive to meds and Paxil 10mg was the ideal dosage for me on such an SSRI while many thought it had to be higher. 20mg on that med (for 2 month I may add) put me in constant sleep. I failed a semester.
>
> Did Paxil 10mg fail to keep working for you?
>
> > Too high a dose is not always a solution for me.
>
> It would be convenient if we all responded to the same dosage of the same drug. No such luck.
>
> Keep thinking and keep posting. I hope you are rewarded for your efforts.
>
>
> - Scott
Posted by SLS on August 21, 2009, at 6:02:53
In reply to Re: My history with MAOI's, posted by AdamCanada2 on August 20, 2009, at 23:32:40
Thanks for the explanation. I guess your odyssey must continue. I am doing better since adding a low dose of lithium - 300mg. It might be worth keeping in mind that using lithium in this manner can be an effective augmenter of a great many standard antidepressants. I am by no means in remission. There is still a long way to go. However, lithium helped get me past a stubborn sticking point. Now, I guess it is just a waiting game to see where it brings me. I want it all.
I wish you luck in your pursuits.
- Scott
Posted by FredPotter on August 23, 2009, at 20:36:33
In reply to Re: My history with MAOI's » AdamCanada2, posted by SLS on August 20, 2009, at 15:38:44
You're right Scott. I've been on Parnate for 5 weeks, gradually raising it to 50mg. I still feel weak and sleepy on it, but I can easily get insomnia as well. There have been several stages where I've thought, "That's it; it's working", only to slide into sleepiness and depression again. Despite what they say about it being quick, my experience with Nardil was a noticeable lifting of mood after 6.5 weeks but several months were required to consolidate this. I expect the same with Parnate
Posted by FredPotter on August 23, 2009, at 20:43:20
In reply to Re: My history with MAOI's » AdamCanada2, posted by SLS on August 21, 2009, at 6:02:53
I find there's an assumption floating about that you have to be stimulated to feel anxiety, whereas I can get severe anxiety and sleepiness at the same time
Posted by Phillipa on August 24, 2009, at 22:50:01
In reply to Re: My history with MAOI's, posted by FredPotter on August 23, 2009, at 20:43:20
Fred me also and not even on an maoi. Love Phillipa
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.