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Re: Matze, Neal- selegiline for depression

Posted by Leighwit on April 23, 2001, at 11:36:56

In reply to Re: Matze, Neal- selegiline for depression, posted by AndrewB on April 23, 2001, at 1:03:26

Hi Andrew,

Wow. What a post. I had to print it so I could re-read it several times. I think I'll take it to my next Pdoc appointment as a basis for discussion. (There's no way I'd remember every issue/fact you addressed. I'm feeling a bit "foggy" lately.)

I was doing quite well on Wellbutrin augmented by Celexa and Aricept. The Celexa has caused major weight gain and against my doctors previous thoughts & recommendations about it, I've stopped taking Celexa this week. I wasn't sure the Celexa was the culprit for the weight gain, but after laying out an objective history, I am now sure that it is. I stopped the Aricept also, for different reasons. I'm surprised that after only a few days, I'm not feeling so great. I'll begin the Aricept again, but I know that it doesn't influence depression - it merely helps offset the side effects of the WB (which for me, are mental confusion and short term memory problems.)

I usually have a "position" put together before Pdoc appointments, but right now I'm at a loss for one. Until your post on selegiline there wasn't even anything I was particularly curious about that I hadn't tried before. I have never taken MAOIs because they're contraindicated (or so I've been advised) for Type I (insulin-dependent, juvenile-onset) diabetics. Selegiline, however, might be an exception to the rule.

Could you profile your own use of selegiline for us? What is your experience with it? What else are you taking and why? If this is somewhere else, just let me know and I'll go search again -but it didn't come up on my first search attempt.

Thanks Andrew,
LBW

> Selegiline can be quite effective for major depression, comparable to Parnate or Nardil. That is, at high dosages, selegiline acts as an MAOI inhibitor (of both MAO-A and MAO-B), like a Nardil or Parnate would. Selegiline, as an MAO-I is used at doses ranging from 20 to 60mg/day. Being in general stimulating, it is more akin to Parnate. The delivery of selegiline in a patch form is preferable, lower doses being able to be used and side effects significantly diminished. There is some controversy concerning whether you may have a compounding chemist produce selegiline in the patch form.
>
> As JohnL pointed out, Adam is a poster who has been on both the patch and (currently) the oral form for a long time. He is very knowledgeable on the subject and if you search the archive for his posts concerning selegiline you will come up with a wealth of information including information concerning compounding chemists and the patch.
>
> Now, to change the subject a bit, selegiline at doses below 15mg./day acts quite differently than it does at high doses. Specifically, it inhibits only MAO-B and not MAO-A. At dosages of 2.5mg-10mg./day people will frequently experience increased motivation, mental vigilance, sexual vigor and (as Neal has noted) increased energy.
>
> The most common side effect at these dosages is agitation or anxiety. It seems though that taking amisulpride may lessen or eliminate the possibility of this side effect.
>
> Keeping the dosage low as possible also seems to lessen the likelihood of such side effect. One study has stated that complete MAO-B inhibition can be achieved with doses of 2.5 mg. a day. My belief at this point is that there is no added benefit in using 10mg. of selegiline a day versus 5mg. If one experiences a positive effect at 5mg./day, a person should then try 2.5mg. and see if the same effect can be achieved.
>
> The reason behind this suggestion is somewhat speculative, but let me explain. Selegiline, via its MAO-B inhibition, can give one increased energy and the other effects noted above. However it also has a powerful antioxidant action by greatly increasing the action of SOD, one the body’s three major antioxidant systems. The other 2 antioxidant systems are catalase, which selegiline increases slightly, and glutathione peroxidase, which it has no action on. Antioxidants disarm free radicals in the body. These radicals if not disarmed cause cellular damage or celular death. The body’s antioxidant system becomes less effective as we age. Selegiline, probably due to its enhancement of SOD activity, is able to slow the progression of certain diseases (i.e. Alzheimer’s and Parkinson’s) and, when taken in the right dosage, may quite possibly extend one’s life span. However, the life span studies have all been done on animals. And it should be noted, for example, that while selegiline significantly increased the life span of male beagle dogs, females experienced no such effect. Ironically this has been speculated to be due to the fact that selegiline increases SOD activity in females much more so than males. Speculation is that too much SOD activity can be harmful also, creating free radicals of its own.
>
> The suggestion therefore is to 1) keep your selegiline dose to a minimum (i.e. 2.5mg./day) and 2) balance your body’s antioxidant system by increasing the gluthione peroxidase activity, which will ‘quench’ SOD produced free radicals. Specifically, take 1000mg. of the nutritional supplement N-Acetyl-Cysteine (NAC) per day. This will raise the body’s gluthione peroxidase levels. If possible, divide your NAC into 2 or 3 doses a day.
>
> Can low doses of selegiline (2.5 to 5mg.) improve mood. Yes and no. By itself selegiline is not effective against depression. Similarly, by itself the nutritional supplement L-phenylalanine is not effective against depression. However when combined together, there is significant evidence that they can be very effective in treating depression, especially dysthymia. L-phenylalanine (and D-phenylalanine) is metabolized into PEA, a natural compound in the body, with an amphetamine like structure, that is proposed to enhance mood and energy. PEA however is quickly broken down in the body into another substance by MAO-B. Therefore, an MAO-B inhibitor, namely selegiline, is required for phenylalanine supplements to be effective in raising the body’s level of PEA. Unlike manmade amphetamines, PEA’s mood enhancing and energizing effect does not diminish over time. The most common side effect of phenylalanine supplementation probably is a sense of inner tension. Again, it is my best guess, that cocommitment use of amisulpride lessens or eliminates the likelihood of such a side effect.
>
> In sum, if you are taking low dose selegiline, you may well benefit by l-phenylalanine or d-l-phenylalanine supplementation. Dosage would be approximately 1,500mg. to 6,000mg./day, taken three times a day. For example, 1,000mg. in the morning, 1,000 at noon, the last 1,000mg. in the afternoon. Take at least 30 minutes before a meal.
>
> BTW: Neal how is the amisulpride going- what symptoms has it helped you with. I am on selegiline and amisulpride also.
>
> Best wishes,
>
> AndrewB


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poster:Leighwit thread:60583
URL: http://www.dr-bob.org/babble/20010417/msgs/60854.html