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Re: Selegiline » RobertDavid

Posted by Tomatheus on December 27, 2005, at 0:23:50

In reply to Re: Selegiline » Tomatheus, posted by RobertDavid on December 24, 2005, at 13:42:31

RobertDavid,

I'm sorry for taking so long to respond to your post. My responses to various sections of your post are below.

> Wow, a plethora of info to ponder in your post! I'm not sure that the scientists that make these drugs have the answers to some of your hypothisis, but it's very interesting.

Thanks for the kind words. I too am uncertain as to whether whether the scientists that make MAOIs actually have the evidence to either support or confirm my hypothesis. I would like to point out that even though I've already put some time into thinking about the relationship between the efficacy of MAOIs and the consistency of MAO-A and MAO-B inhibition, I've only scratched the tip of the iceberg, so to speak, in terms of the amount of research that has actually been done regarding the relationship between serum concentrations of various meds and the efficacy of these meds. I intend to keep doing more research (probably a lot more) for a variety of purposes. So, hopefully some of my future posts about the relationship between the consistency of MAO inhibition and the efficacy of MAOIs will be less speculative and more fact-based.

> Because I have had so many poor responses to anti depressants and other meds to treat my SAD/GAD with mild depression I too am skeptical of EMSAM. But, I'm done with "30 day trials" of other meds until it comes out. My last trial was with Remeron and it was about the worst so far.

I'm sorry to hear that. :(

> My doctor has always thought that if he only had once shot, one try to prescribe a med for me (even before trying all the others) it would have been Nardil.

Wow! Finally a doctor who thinks on the same wavelength as I do. Nothing against my pdoc (I do think that he's highly intelligent and willing to think "outside the box" a little more than most psychiatrists), but I never thought I'd actually hear of a doctor saying that he should have just prescribed a patient Nardil to begin with. It shows that your doctor is interested actually finding the med that's the best fit for a patient from the very beginning and that he (?) is sympathetic to the painful frustration of the trial-and-error process of psychiatric treatment that we have to endure as treatment-resistant patients.

> All I'm hoping for with EMSAM is some help with mild depression, cognitive clarity, brighten my mood, and additional anxiety relief (in reading that it looks like a lot to ask for).

It may sound like you're asking for a lot, but I don't think that it's unreasonable or even unrealistic to have the goal of getting some relief from your most bothersome symptoms. You deserve better than the inadequate responses that you've received from most meds, and I do think that it's possible that you can do better -- or at least will be able to do better at some point. Now, whether or not any of the meds that are currently available (or soon to become available, in Emsam's case) will do the trick is another question. But even if you don't get the response you're looking for from Emsam or Nardil (and I'm not saying that you won't), it's always possible that the best med for you will be the next one to be developed. And also, please be aware that if you do end up taking Nardil at some point, many long-term Nardil users in the U.S. (are you in the U.S.?) consider the current Nardil formulation to be inferior to an older formulation that was used until the fall of 2003. If you don't respond favorably to the current Nardil formulation, it's always possible that you might respond better to the older formulation if it ever becomes available again (and that's a possibility that I would not rule out). So, I guess the point that I'm trying to make is that the possibility of achieving remission will always be there, even if you end up exhausting all of your current options.

> Though I can't wait to try it and it seems as promising as anything that's out there, I too am skeptical. I've just had my hopes up too many times. Hopefully it will be a breakthrough med.

I hope you're right. It looks like you've got the right combination of skepticism and optimism.

> Perhaps other meds will work better via a patch delivery. We'll see.......

That is actually something that I considered but never got around to saying when I read your post about making your own Emsam. If we could actually figure out a good way to make our own transdermal meds, then I guess those options will become available, even if no drug company ever wants to pursue them. So, if it's true that MAOIs could become more effective by using a delivery system that allows for a more consistent inhibition of the MAO enzymes, maybe we should consider making our own Nardil, or even our own moclobemide. Of course, the scenario I'm describing is not the most desirable one and should not be attempted by just anybody (personally, I wouldn't feel comfortable making my own meds), but it's something to think about if all else fails.

Tomatheus


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