Posted by Ron Hill on September 17, 2007, at 5:27:37
In reply to Emsam - no energy?!, posted by SheilaC on September 16, 2007, at 14:12:36
Sheila,
Have you considered adding phenylethylamine (PEA) to oral Selegiline? It has a very good chance of working. Read the following studies. You don’t hear much about PEA because there is not a drug company behind it. Expect remission within hours or a couple of days after taking the PEA with an MAOI-B (oral Selegiline).
The full text of the first article (Link #1) is available to you for free, but you have to fill out the free registration form to the site. Scroll down to the bottom of the page that comes up when you click on link #1, and click on the link Register for Access .
http://bjsm.bmj.com/cgi/content/full/35/5/342 Link #1
When you click on Link #2 or Link #3, you will be allowed to gain access to the respective abstracts, but not the full text. So to get the full texts for Link #2 and Link #3, we have to go through a back door.
Here is the back door method: Pull up Link #1 (on the site you registered for a minute ago). At the bottom of the full text article of Link #1, you will find a List of References. The articles for Link #2 and Link #3 are both in the List of References. Further, each respective reference contains a free access hot link to the full text.
Click on the full text link in the List of Reference. On the page that comes up, click on Full Text (PDF). On the following page, click Begin Manual Download. After a few seconds the PDF full text version of the article will come on your screen.
http://neuro.psychiatryonline.org/cgi/reprint/8/2/168?ijkey=06afc814a30be5cffbc9b86f37b3a7fbad19ed59 Link #2http://neuro.psychiatryonline.org/cgi/reprint/7/1/6?ijkey=94ca859a0c27403d6bef7c0ae1f4a947723f845f Link #3
http://www.smart-drugs.net/ias-depression-JamesSouth-page2.htm
Every study I've read on the topic keeps the Selegiline dosage in the range where it is a selective MAOI-B. The studies use either 5 or 10 mg/day of oral Selegiline. Having said that, however, I have also read studies in which PEA has been used to augment Nardil. Obviously, Nardil is not a selective MAOI-B.
Look at Table 2; on page one, of the Emsam Prescribing Information Document. Here is the link:Table 2 shows that 10 mg of oral Selegiline produces a mean AUC of 4.5 (ng)(hr)/mL of Selegiline plasma concentration. On the other hand, a 6 mg Emsam patch supplies 46.2 (ng)(hr)/mL of Selegiline plasma concentration over a 24 hour period. My point is that the 6 mg patch is a non-selective MAOI-A and MAOI-B. But, I'm sure you knew that already. The metabolites are thought by some to play a small role as well, but I am going to ignore that issue in this cursorily discussion.
If it were me, I'd dump the expensive patch, have my pdoc write a script for 10 mg/day of oral Selegiline and add the recommended 10 to 60 mg/day of PEA, where the PEA dosage is determined by what works best for the patient.
But, it's not me; it’s you. And, you will decide what is best for yourself. If you did decide to go this route, you might experience some withdrawal symptoms coming off of the Emsam patch cold turkey because the MAOI-A is playing a large role in the antidepressant effect of Emsam. To minimize the withdrawal, you might consider taking 50 or 60 mg/day of oral Selegiline, starting the day after you remove your patch. And then titrate the oral dosage down to 10 mg. But, to be safe, follow the MAOI diet while you are titrating down.
It would probably be okay to add PEA to a 6 mg patch of Emsam, but I would need to do some research to be sure that it is safe. DO NOT IMPLEMENT MY HUNCH BY ADDING PEA TO YOUR PATCH! I’ve not read any research on this combination. It seems logical to me that it would be okay given that it is okay to use with Nardil.
However, it’s one thing for me to carefully implement my own hunches. But, it would kill me if you got hurt trying out what I think should work. Instead, either stop the patch and add 10 mg of oral Selegiline with 10 to 60 mg of PEA, or conduct some research to convince yourself if it is safe or not to add PEA to a 6 mg Emsam patch. Rule #1: Nobody gets hurt.
If you have questions, just ask.
-- Ron
Bipolar II with ultra rapid cycling (15 day cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil----------------------------------------------------------------
> The first week or two on 6mg. Emsam patch, I felt great - lots of energy. Now, after 3 weeks, I feel tired and depressed. I tried upping my dose to 9mg. and so far no difference. I don't understand. I thought it was supposed to be amphetamine-like.
>
> What should I do? I need some energy. Right now I am dragging and drinking way too much caffine.
poster:Ron Hill
thread:783251
URL: http://www.dr-bob.org/babble/20070911/msgs/783425.html