Posted by Ktemene on August 12, 2004, at 0:08:44
In reply to Re: Ritalin and Selegiline » Ktemene, posted by KaraS on August 9, 2004, at 5:39:15
> > > You are taking other things besides selegiline (Adderall and I'm not sure what else). How much of the antidepressant effect do you think selegiline is responsible for? Could it just be the missing piece of the puzzle and the other things you take also fill out the puzzle?
> >
> > Yes, I am taking other meds, both prescription and OTC meds. And I am doing other things that can have antidepressant effect, e.g. I exercise regularly and eat a lot of fish. So in principle I think the possibility that other factors are partly or even mainly responsible for the remission of my depression cannot be ruled out. However, I am still inclined to think that the 5 mg Selegiline I am taking is the main factor. There are two main reasons I think this. One reason is that the other prescription meds I am taking, 5-20 mg Adderall and 50-200 mg Provigil per day, are both meds that I have been taking for some time and found to have little antidepressant effect, although they are helpful for my ADD. My depression did not begin to lift until after I started taking 5 mg Selegiline per day. Of course the Adderall and Provigil might be augmenting the Selegiline so that in combination with them it has an antidepressant effect which it would not have otherwise. The reason I think this is unlikely is that my reaction to Selegiline is very similar to that of some other posters on this board, and none of them were taking Adderall, and only one of them was taking Provigil with Selegiline. There are several posters who had pretty much the same experience- here are some links to some of them:
> > elleff: http://www.dr-bob.org/babble/20040614/msgs/357474.html
> > germanium20: http://www.dr-bob.org/babble/alter/20040418/msgs/350645.html
> > Jemma: 11http://www.dr-bob.org/babble/20030525/msgs/229420.html
> >
> > To tell you the truth, I was very surprised when I had such a strong positive response to a mere 5 mg dose of Selegiline. I thought that I had no chance of any response until I reached the 45 mg dose that many docs say is the target dose for antidepressant effect. But I was wrong and 5 mg does work for me. It is a bit ironic after all these years of trying and failing to deal with my depression and after all the failed trials of all those more promising meds that I should discover that a tiny amount of a med that almost nobody has ever heard of is the one that saved me. But it did. I suppose the moral is to never stop searching because even the unlikeliest med may be the one you need. I’m sure you remember Gracie (Whiterabbit) who wrote so many great posts. In one of her last posts she describes what it is like to find the right med. She said the feeling was better than winning the jackpot: it felt like going home when you always believed there was no home to go to. She was right. Here’s the link to her post: http://www.dr-bob.org/babble/20030718/msgs/243355.html
> >
>
> Ktemene,
> You have no idea what a God send your previous post is to me right now. After failing or not tolerating so many medications and supplements for so many years now, including my current trial of Perika (SJW), I really needed to hear these good things about selegiline. I was feeling so hopeless about it all when I read your post. Selegiline is the next thing I'm planning on trying along with DLPA. I think I mentioned earlier that i have taken 5 mg. of it twice and tolerated it well. I have also tried 1000 mg. of DLPA and tolerated that well. I'm planning on trying them together once the SJW is out of my system and I'm off of the tiny amount of Effexor (<19 mg.) I'm now taking. I have some here at home now but if it works out, I will have to find a doctor to prescribe it. I will keep you posted.
>
> I had a question about Ron's (germanium20's) posting. He writes:
>
> "Side effects are very modest at my low dose (2.5mg/day). A very very modest headache & mild tremors that appear sporadically (some days not at all but if I do get them it is usually in late afternoon or early evening). These appear to be mostly due to the metabolites of selegiline rather than the selegiline itself as there are currently preporations out there that avoide the first pass metabolization where most of the metabolites come from & from what I read it is relatively free of those side-effects"
>
> Do you know what preparations of selegiline he is referring to that eliminate the first pass metabolization?
>
> Also, here's an old post by "Adam" about how the selegiline patch helped him (if you haven't already read it). Of course it's the patch and not just a small amount of selegiline like we've been discussing, but it's a good post to read and reread for so many reasons.
>
> http://www.dr-bob.org/babble/20001115/msgs/48935.html
>
> Thanks again!
> KaraHi Kara,
I am so glad my post was helpful. I certainly know what it feels like when you try a series of meds that don't work and all hope seems to be draining away. And I am sorry to be getting back to you so late-I was away for a couple of days. That post of Adam’s that you linked to is one of my all time favorite posts. It gave me a lot of hope at a time when I really didn't know where to turn. One of the great things about Adam's post is that he acknowledges how hard it is sometimes to keep trying, and that makes you believe him when he says that it really is worth it to keep trying. I wish there were a place on Psycho-Babble called "Classic Posts" to archive wonderful unforgettable posts like Adam's and Gracie's, because so many new people never get a chance to read them except by accident. (By the way I would include among the classic posts the funny ones that you and Simus reposted on the Alternative board. They were hilarious. After I read them I kept bursting into giggles for the rest of the day…and got some strange looks from my colleagues.)
Adam’s first very positive response was to the Selegiline patch, which finally received an approvable letter back in Febuary and is supposed to be available at the end of this year or in early 2005. But when he wrote the post you mention he was taking oral Selegiline and the dose (I think) was around 30 mg per day. Close to a year after he wrote that post, he went off oral Selegiline because of some odd problems he was having that he thought might have been connected to the insomnia caused by oral Selegiline. After he went off oral Selegiline and began sleeping well the odd problems he had been having did disappear. But he continued to remain depression-free and did not relapse even though he was no long taking Selegiline or any other antidepressant. Here’s a post where he briefly summarizes the whole story: http://www.dr-bob.org/babble/20011123/msgs/85472.html
Adam never really tried to deal with his Selegiline insomnia, because it did not bother him very much, until those odd problems developed. I have similar insomnia, and it does not really bother me either- it just gives me lots more time to catch up on all the work I didn’t do when I was depressed. But I am taking some advice from Adam and trying to find some meds to help with sleep because it may be some time before the patch comes out. I just thought I would mention this because you said that you had found 5 mg Selegiline somewhat activating on the couple of occasions when you tried it, and if you have the response to Selegiline that Adam and I had then you may also have some insomnia as well. Of course some people have a really positive response to Selegiline and don’t have to worry about insomnia. At any rate elleff and Jemma and Ron and some others don’t mention any problems with insomnia.But to turn to your question. I am not sure which preparations of Selegiline Ron was referring to but there are three preparations that I know of that avoid the first pass effect at least to some extent. The patch avoids the first pass effect altogether and consequently has the fewest side effects. There is also Zydis Selegiline which is a pill designed to dissolve in the mouth and allow some of the med to be absorbed directly into the bloodstream, “buccal absorbtion” as they call it. In addition there is a liquid preparation of Selegiline called Jumax I think, and that also is meant to be held in the mouth so that as much as possible can be absorbed directly into the blood stream. Unfortunately both Zydis and the liquid form are unavailable in the U.S., although they are marketed in Europe. I try to get some “buccal absorption” by opening the Selegiline cap and pouring the powder into my mouth and holding it there for a few minutes.
To my mind Selegiline is an underrated med that has lots of advantages. It is neuroprotective and even at high doses it is much less likely to cause a hypertensive crisis than Parnate and Nardil and it goes well with lots of other meds. But of course I am prejudiced because Selegiline was the med that finally put my pretty much life-long depression into remission. I really hope it works for you. I think your idea of trying Selegiline with DLPA is a good one- taking DLPA has magnified Selegiline’s effect for a lot of people. In fact I think that strategy is recommended in the Psychopharmacological Tips section of Psycho-Babble.
By the way, I found the place where I read that 5 mg Selegiline after a number of weeks builds up to the point of inhibiting almost all MAO-B. It was AndrewB. Here’s the post: http://www.dr-bob.org/babble/20010310/msgs/56574.html AndrewB has some more interesting info on low-dose Selegiline at this post: http://www.dr-bob.org/babble/20010417/msgs/60824.html
If the pdoc that you get is hesitant about prescribing Selegiline, be sure to tell him/her about the patch. A lot of pdocs have never heard of the patch, and think that Selegiline is only used for PD. But there is now a lot of literature on Selegiline as an AD because the patch is so close to being marketed.
Good luck, and keep us posted!
Ktemene
poster:Ktemene
thread:373827
URL: http://www.dr-bob.org/babble/20040811/msgs/376696.html