Posted by Adam on April 23, 2001, at 11:18:06
In reply to selegiline for depression, posted by matze on April 20, 2001, at 12:46:47
Sad to say, don't have a lot of time to post at the moment. But...
I have done very well on selegiline. I have been pretty much depression-free (at least by my standards) for about a year and a half. Prior to that, I was severely depressed, probably my whole life. It got worse as I got older, and six months before trying selegiline, I had to be hospitalized (though the reasons for that little episode are probably a bit complex).
Anyway, as others have mentioned, I first tried selegiline as a participant in a clinical trial of the Selegiline Transdermal System (SDS) for major depression. Many here, including myself, have fondly referred to the SDS as "the patch". I had a HAM-D score in the mid-to-high twenties going into the study, which went down to about six once I had a robust response. In my case, the antidepressant effect was fast, and highly efficacious. Your milage may vary, as they say.
The patch is currently not available for marketing. I hope it will be soon, but have no idea when. The date which the investigators running the trial had hoped for approval has long past, which fits my prediction that the much-anticipated time is still well in our future, if it comes at all. The benefits of the patch are many, but include more even and sustained dosing, a reduction in metabolite levels (the metabolites include the "left-hand" versions of methamphetamine and amphetamine, which are about an order of magnitude weaker than their "right-hand" isomers), and a greater blood level of the parent compound per dose, due to the avoidance of "first-pass" matabolism in the GI tract. Perhaps the most significant benefit of the patch to most users may be the lack of dietary restrictions at a dose effective for major depression in at least some patients.
I took "the patch" at 20mg/day. After the trial was over, I moved eventually to 30mg/day orally, and I'm still doing well, as I mentioned above. I do find insomnia to be more of a problem on the oral form, though I did have this difficulty also on the patch. On this dose, I have to observe drug and diet restrictions. The former I am scrupulous about, the latter...well, I cheat quite a bit, and seem to be OK, though I never go overboard - no fondue for me, though I'll sneak a slice or two of pizza (not gourmet, but the mass-produced, pseudo-imitation-rubberized-faux-mozzarella-topped variety) now and then. The fact I am on a relatively low dose (for depression) may have something to do with my ability to be all right without draconian diet restrictions. My guess is there's a little room for error when you're on an MAOI. Stay away from the forbidden drugs, though!
As I said, I'm on a relatively low dose for depression. The common dose ranges for that indication that I have seen have been 30 or 40 to 60 (or higher) mg/day, usually split into two doses, morning and afternoon, to avoid too many sleep problems.
I think many people who have done well on one MAOI might do well on selegiline, and it should be just as useful for refractory patients who have failed other first and second-line treatments as the other MAOIs, though the best drug for each person can only be found by trial and error. If one had to pick another MAOI on the market that selegiline is similar to, it might be Parnate (tranylcypromine), which also has some stimulant properties. Its generally thought that Nardil and Marplan (phenelzine and isocarboxazid) are better for those with anxiety and depression, especially the dual diagnosis of depression and social phobia, while Parnate is a better fit for those with "anergic" symptoms. All MAOIs are said to be good for those with "atypical" depressions, characterized by symptoms like mood-reactivity and severe rejection sensitivity.
The truth, of course, is that these are only broad guidelines, with no hard and fast rules for which drug is best for whom. I think selegiline is a good choice for anyone with depression, and (as I have experienced) has fairly mild side-effects at efficacious doses. However, the other MAOIs are also worth a try, if you haven't already given them a go. Some doctors prefer to use the more "tried and true" antidepressants (selegiline isn't approved as a treatment for depression, and is only used so as an "off-label" therapy - some doctors have never used it in their practice as a result), and its true that the older MAOIs have a richer history to draw from to inform your doctor's decisions.
All that said, I went through many different drugs, with little or no success, before I found selegiline. I wish someone suggested it, or another MAOI, a long time ago. I think many doctors are too reticent to use the MAOIs. They do have their hazards, but the benefits, as far as I'm concerned, far outweigh them, if they prove effective for an individual.
Best of luck to you!
> Is there anyone, who had success with selegiline for the treatment of major depression or dysthymia?
> What doses of selegiline are effective?
> Thanks for response