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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 Economist on March 13, 2010, at 17:32:17
Does Adderall work on the same dopamine receptors as EMSAM/Selegiline? Whenever I take Adderall it does not produce any significant changes in my motivation, anhedonia, or flat mood. I was just prescribed EMSAM and I imagine that if Adderall gives me no motivational effect, neither will EMSAM, since both are said to work on dopamine. Am I just wasting my time trying EMSAM?
Posted by ed_uk2010 on March 13, 2010, at 18:05:07
In reply to EMSAM/Selegiline vs. Adderall?, posted by Economist on March 13, 2010, at 17:32:17
Adderall and Emsam have different mechanisms of action ie. they do not work in the same way. Because of this, I do not think that your response to Adderall can predict your response to Emsam.
Posted by Economist on March 13, 2010, at 18:14:45
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 13, 2010, at 18:05:07
> Adderall and Emsam have different mechanisms of action ie. they do not work in the same way. Because of this, I do not think that your response to Adderall can predict your response to Emsam.
I thought Adderall and EMSAM both cause more dopamine to hang around the synapse?
Posted by ed_uk2010 on March 13, 2010, at 18:51:43
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 13, 2010, at 18:14:45
>I thought Adderall and EMSAM both cause more dopamine to hang around the synapse?
Indeed, but the brain is a bit more complicated than that ;)
They both affect dopamine neurotransmission but in different ways. They also affect other neurotransmitters as well. They are really very different medications.
Posted by Economist on March 13, 2010, at 19:20:58
In reply to Re: EMSAM/Selegiline vs. Adderall?, posted by ed_uk2010 on March 13, 2010, at 18:51:43
So what does Adderall do with dopamine, and what does EMSAM do?
Posted by Phillipa on March 13, 2010, at 19:31:12
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 13, 2010, at 19:20:58
Emsam is basically a patch form of the drug classification MAOI but at lower doses no dietary restrictions. I'd google it for further clarification. Adderal is basically a stimulant for add and adhd. Another google might clarify this also. Phillipa
Posted by ed_uk2010 on March 14, 2010, at 6:47:22
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 13, 2010, at 19:20:58
>So what does Adderall do with dopamine, and what does EMSAM do?
As an MAO inhibitor, selegiline (Emsam) prevents the breakdown of neurotransmitters such as dopamine, serotonin and NE inside the neuron. It also blocks the breakdown of neuromodulators such as phenylethylamine. There are no MAO enzymes in the synapse.
Emsam increases the stores of monoamine neurotransmitters which are available for release into the synapse. It does not directly release them.
Amphetamine (Adderall) acts as a psycho-stimulant. It acts predominantly on dopamine and NE but serotonin is also affected. Amphetamine is believed to block the re-uptake of dopamine into the pre-synaptic neuron, thus increasing synaptic concentrations. It also forces larger amounts of dopamine to be released into the synapse, unlike MAOIs.
It is quite probable that MAOIs and stimulants effect dopamine neurotransmission in different parts of the brain. Amphetamines are often very reinforcing and have a high potential for misuse. MAOIs have a very low potential for misuse. This is because they have a different mechanism of action to the stimulants. The reinforcing properties of amphetamine have been linked to an increase in dopamine in the mesolimbic system.
Posted by Economist on March 14, 2010, at 17:09:19
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 14, 2010, at 6:47:22
Do you think if someone is suffering from anhedonia and low motivation, Adderall should do a better job at alleviating the problem than EMSAM?
Posted by ed_uk2010 on March 14, 2010, at 17:26:38
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 14, 2010, at 17:09:19
> Do you think if someone is suffering from anhedonia and low motivation, Adderall should do a better job at alleviating the problem than EMSAM?
Amphetamines in general often produce an initial motivating effect, which is not always sustained in the long run. Not everyone benefits, as you are well aware. Emsam may have some efficacy in relieving anhedonia and low motivation associated with depression. Response to Emsam seems to be quite variable.
Do you have a diagnosis and are you on any regular medication?
Posted by Economist on March 14, 2010, at 19:49:02
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 14, 2010, at 17:26:38
I don't really have a diagnosis, however in 2008 I experienced a psychotic episode (psychosis NOS, not triggered by drugs or stress) and since recovering I was no longer able to experience emotions and lost interest in everything.
Posted by ed_uk2010 on March 15, 2010, at 14:53:26
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 14, 2010, at 19:49:02
> I don't really have a diagnosis, however in 2008 I experienced a psychotic episode (psychosis NOS, not triggered by drugs or stress) and since recovering I was no longer able to experience emotions and lost interest in everything.
Regarding the psychosis, were hallucinations and delusions prominent? Also, are you taking any medication at the moment? (or recently). Have you had any benefit from any medications so far?
Posted by Economist on March 15, 2010, at 21:51:58
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 15, 2010, at 14:53:26
Delusions were prominent (people reading my mind, cops following me, god talking to me through the television). I was given 3 mg Risperdal, and after about a month stopped taking meds entirely, except for several antidepressants for the anhedonia. None of them made a difference. I was even given ECT.
Now I am on the third day of EMSAM at the 6 mg patch. No changes and I don't expect any. My doctor said if I had a dopamine deficiency, Adderall should have taken care of it and it didn't.
Posted by ed_uk2010 on March 18, 2010, at 14:44:48
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 15, 2010, at 21:51:58
> Delusions were prominent (people reading my mind, cops following me, god talking to me through the television). I was given 3 mg Risperdal, and after about a month stopped taking meds entirely, except for several antidepressants for the anhedonia. None of them made a difference. I was even given ECT.
>
> Now I am on the third day of EMSAM at the 6 mg patch. No changes and I don't expect any. My doctor said if I had a dopamine deficiency, Adderall should have taken care of it and it didn't.Negative symptoms following psychosis are not usually relieved by antidepressants. Stimulants such as Adderall could cause a relapse into psychosis, and should be avoided.
In some cases, negative symptoms can be relieved by low doses of atypical antipsychotics. Amisulpride at an initial dose of 50mg/day could be useful, although it is not available in all countries.
Posted by Economist on March 19, 2010, at 18:00:03
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 18, 2010, at 14:44:48
Tried amisulpride 50 mg (got it from the Philippines), no difference. Tried several antipsychotics with no difference.
Posted by ed_uk2010 on March 20, 2010, at 10:49:27
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 19, 2010, at 18:00:03
> Tried amisulpride 50 mg (got it from the Philippines), no difference. Tried several antipsychotics with no difference.
Which ones have you tried so far?
Posted by ed_uk2010 on March 20, 2010, at 10:49:45
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 19, 2010, at 18:00:03
> Tried amisulpride 50 mg (got it from the Philippines), no difference. Tried several antipsychotics with no difference.
Which APs have you tried so far?
Posted by Economist on March 20, 2010, at 15:26:59
In reply to Re: EMSAM/Selegiline vs. Adderall?, posted by ed_uk2010 on March 20, 2010, at 10:49:27
Abilify, Risperdal, Zyprexa. I was also on Cymbalta augmented with Lithium.
Posted by ed_uk2010 on March 20, 2010, at 15:39:02
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 20, 2010, at 15:26:59
> Abilify, Risperdal, Zyprexa. I was also on Cymbalta augmented with Lithium.
Have you ever taken mirtazapine (Remeron)?
Although mirtazapine is often quite sedating, there is (limited) evidence that it may improve negative symptoms associated with psychotic illness. It's frequently used in combination with antipsychotics.
Posted by Economist on March 20, 2010, at 15:51:46
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 20, 2010, at 15:39:02
I've read so many studies that said "medication X improves negative symptoms" and have subsequently tried them. It's always like taking a sugar pill. I'm interested in the MAOIs because it seems to have helped a number of people who went many years without relief from other medications.
Posted by ed_uk2010 on March 20, 2010, at 16:29:52
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 20, 2010, at 15:51:46
>I'm interested in the MAOIs because it seems to have helped a number of people who went many years without relief from other medications.
That's true. Most people take MAOIs for severe depression or anxiety though. I've not known anyone to take an MAOI for post-psychotic negative symptoms. I wouldn't know what to expect.
I still not convinced about Emsam. Phenelzine (Nardil) and tranylcypromine (Parnate) are still the 'real' MAOIs in my opinion.
Posted by Economist on March 20, 2010, at 16:31:46
In reply to Re: EMSAM/Selegiline vs. Adderall? » Economist, posted by ed_uk2010 on March 20, 2010, at 16:29:52
Right, I don't have depression, but since anhedonia is also a symptom of depression there's a chance that something that treats depression can also treat negative symptoms.
Posted by ed_uk2010 on March 21, 2010, at 14:48:13
In reply to Re: EMSAM/Selegiline vs. Adderall? » ed_uk2010, posted by Economist on March 20, 2010, at 16:31:46
> Right, I don't have depression, but since anhedonia is also a symptom of depression there's a chance that something that treats depression can also treat negative symptoms.
Hopefully. Your doctor will want to monitor for the return of psychotic symptoms during treatment with antidepressants.
This is the end of the thread.
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