Posted by Chairman_MAO on May 30, 2004, at 18:15:06
In reply to SSRI and low-dose selegeline-- beneficial, safe?, posted by Questionmark on May 25, 2004, at 6:54:33
I've was on celexa+remeron and then lexapro+remeron with 15mg selegiline per day back when I had a psychiatrist worth his license. It was good, but I highly doubt it was anything like taking Nardil is. The SSRI did indeed counterbalance a lot of the emotional oversensitivity/obsessiveness/paranoia that selegiline may have caused but not the agitation. It's worthy of mention that I never had the faintest indication of serotonin syndrome nor a hypertensive crisis. Also note that selegiline can be pro-sexual, but it does not do anything whatsoever to counteract SSRI sexual dysfunction.
At one point I used Celexa + selegiline + Remeron + Neurontin. That was a winner for depression, sexual function, and cognition and helpful for social anxiety, but I still doubt it's what Nardil is.
If you're on Nardil, you're on the gold standard. If I had my choice of meds for SP, though, I'd take Parnate + Klonopin. Parnate is friendlier in the side-effects department overall, but YMMV. My advice is to stick with the Nardil and work to resolve the side effects. If amantadine does not work, I suggest moving on to the new dopamine agonists; my first choice would be cabergoline. If you cannot get that, try for pramipexole or ropinirole.
By the way, thanks for your compliments; they mean a lot to me. I left this board for a while because I started working and just didn't have the energy to tend to things like this. I have a really hard time tending to multiple spheres of my life; it's a character defect which is worsened by the fact that I receive woefully inadequate psychiatric care. I hope to "keep it together" mroe this time so that I can stay on this board, move out of my house, make some real money so I can afford a real pdoc; then I could actually make it in school and become a psychopharmacologist. Aaah, to be able to actually help people with my talent [after its sufficiently nurtured by real training] instead of simply posting on this board... ;)
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Check out this cabergoline reference. If our Cromwellian drug laws permitted the marketing of a male sexual tonic, Dostinex (cabergoline) would be it. There are sites all over the internet touting it as a sexual fountain of youth; these claims are extreme yet well-founded:
Effects of acute prolactin manipulation on sexual drive and function in males.
Kruger TH, Haake P, Haverkamp J, Kramer M, Exton MS, Saller B, Leygraf N, Hartmann U, Schedlowski M.
Department of Medical Psychology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. tillmann.krueger@web.de
The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior.Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures.***Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01).*** Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.
poster:Chairman_MAO
thread:350354
URL: http://www.dr-bob.org/babble/20040527/msgs/352192.html