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Re: Sublingual Selegiline - more questions hok

Posted by not exactly on March 16, 2003, at 8:13:08

In reply to Re: Sublingual Selegiline - more questions not exactly, posted by hok on March 15, 2003, at 22:17:35

HK,

Thanks for the thorough & enlightening answers to my questions. I'll try to give equally thorough (and hopefully somewhat enlightening) answers to your questions.

> 1) How long ago was the trial that you were in?

3 years ago (Dec. 1999 - Mar. 2000).

> 2) Was it an open-label trial or was it being tested against something else?

Open label. All participants started with real selegiline patches; after 3 months, 50% (double-blind random selection) were switched to identical-looking placebo patches. (I unfortunately ended up in the placebo group.)

> 3) Could you give us a brief description of your depressive symptoms (e.g., melancholic, atypical)?

Typical "atypical": mood reactive, poor self-esteem, introverted, low motivation, poor focus/concentration, no long-term goals, anhedonia, hypersomnia. Comorbid ADD, SP, GAD, SAD, OCD, CFS, Asperger's Syndrome.

> 4) Can you provide a subjective rating for the selegiline patch in terms of an antidepressant? In other words, can you compare its efficacy to anything you've been on before?

The best results I ever had from an antidepressant was my very first treatment - Pramipexole (for 1 month in another pre-approval drug study). Complete remission and a fabulous experience (but not manic) - let's call that a 10. Next best was Wellbutrin + Ritalin; I'd give that a 9. Selegiline patch was at least an 8. Wellbutrin by itself, Ritalin by itself, and oral Selegiline were all about 6. Desipramine was a 3, Effexor 2, Paxil 0 (no depression but no motivation either), Amitriptyline -1 (felt poisoned), Remeron -2 (felt VERY poisoned), Prozac -10 (nearly-homicidal agression).

> 5) What were the side effects?

The only significant side effect was local irritation. My skin was red after I removed the patch. Each day, I'd apply a new patch to a different location (as directed), and the redness disappeared after about 3 days. So on any given day, I'd have one patch, one red blotch, and one pink blotch. The irritation was never severe enough to cause pain or itching, and the doctors & nurses that monitored my progress during the study said that the effect was "typical" and "harmless". BTW, this also provided me with confirming evidence that I had been switched to placebo - the phoney patches did not cause redness.

There may have been other temporary side effects at first, but they were so mild and brief that I don't even remember what they were.

> 6) Was there any issues with being able to tolerate the high dose in patch form (e.g., overstimulation/ increased side effects)? This is more of a personal question because I'm concerned I won't even be able to handle 30 mg in patch form if I can only tolerate 5-10 sublingually. Any thoughts?

The 30 mg patch seemed less "speedy" to me than 15 mg/day oral selegiline.

> 7) How much of the oral form have you been taking? My experience with the oral tablets was like taking poison, causing the irritablity of Wellbutrin-like effects times ten.

I never tried more than 20 mg/day, and eventually settled on 15 mg/day as "optimal". More than 15 caused excessive "speedy" side effects and worried me about the possibility of "death by cheese". Less than 15 was unreliable and made me feel almost bipolar - unpredictable and severe mood swings.

Wellbutrin, BTW, never made me irritable. It DID make me feel motivated, and for the first week even DRIVEN. But long term it dulled my emotions - the addition of a bit of Ritalin fixed that problem.

But I'm certainly not immune to drug-induced irritability. Meds that have made me feel irritable include Desipramine (+), Sudafed (++), and Prozac (+++++).

> 8) What is your current treatment?

Right now I'm taking Buspar + Klonopin. This has been very effective for my SP and GAD (no surprise), but it also turns out to be (for me, at least) an excellent antidepressant! I've only been on this combo for 2 weeks, and I'm not sure if the benefit has reached a plateau yet, but I'd give it an 8 so far. It's plausible that it could be improved by dose adjustment or augmentation. In fact, selegiline is one of the meds that I was thinking might enhance the effect.

> Any other knowledge on the subject would be much appreciated?

I've got lots more stories and opinions. Suggest a topic and I'll babble some more... :-)

> Why not just buy the sublingual form next time to try it out?

1. I assume the sublingual form is not available as a generic, and therefore would be much more expensive. Since I'm currently unemployed, this is a concern.
2. I still have some oral selegiline left from my last prescription, so I was hoping to be able to use it to test the sublingual route and see how well it worked before I tried to convince my pdoc to prescribe it.

- Bob


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