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phenelzine + methylphenidate info » streetsk8er794

Posted by azalea on October 15, 2008, at 11:06:12

In reply to Nardil and the f-its..., posted by streetsk8er794 on October 14, 2008, at 22:04:44

Daytrana is a transdermal formulation of methylphenidate. There is a letter to the editor describing oral methylphenidate in combination with phenelzine (Nardil). I've pasted the text below.
I hope this provides some useful information. Keep in mind the case below was in-patient with careful monitoring. Your pdoc may or may not be comfortable utilizing a similar combination.

Coadministration of phenelzine and methylphenidate for treatment-resistant depression
Ann Pharmacother. 2004 Mar;38(3):508. Epub 2004 Jan 23.
Shelton Clauson A, Elliott ES, Watson BD, Treacy J.

TO THE EDITOR: Several strategies have been used in attempts to manage treatment-resistant depression. Some strategies include lithium augmentation, liothyronine, and lamotrigine. A combination that has shown efficacy is a monoamine oxidase inhibitor (MAOI) with a psychostimulant. When combined with an MAOI, which inhibits neuroamine catabolism, psychostimulants have been associated with severe toxicity including hypertensive crisis and intracranial hemorrhage, severe hyperthermia, seizures, other central effects, and death.

We report a case where combination therapy with phenelzine and methylphenidate were used effectively and safely.

Case Report. A 31-year-old white woman was admitted to an inpatient mental health unit secondary to suicidal ideations. Her depression symptoms upon admission included hopelessness, insomnia, reduced appetite, reduced concentration and energy, psychomotor slowing, and frequent crying spells. Her recurrent depression had not substantially responded to >50 electroconvulsive therapy treatments (initially with good success in 1996) or methylphenidate augmentation of a novel antidepressant. However, the methylphenidate had aided her concentration at that time. The depression also had not responded to monotherapy trials of paroxetine, sertraline, fluoxetine, venlafaxine, bupropion, and mirtazapine. Axis I diagnoses were major depression, recurrent, severe, as well as attention deficit disorder.

On hospital day 1, the patient started phenelzine 15 mg/day. On day 4, the phenelzine dose was increased to 15 mg twice daily. On days 5 through 8, methylphenidate 10 mg/day was initiated and increased by adding 2.5 mg at noon daily. On day 6, since the blood pressure (measured 4 times daily) remained within normal limits, phenelzine was increased to 15 mg 3 times daily. The patient's blood pressure remained normal throughout hospitalization. She reported an episode of dizziness that was transient and did not return. On day 9, the patient reported improvement in mood and was discharged on day 10 due to her financial concerns. Her discharge medications were phenelzine 15 mg 3 times daily and methylphenidate 10 mg in the morning and 7.5 mg at noon. Several months after she was discharged, her outpatient therapist reported that the woman was doing well on this combination and had finished her college degree.

Discussion. There are several case reports that show efficacy and safety when combining an MAOI with a psychostimulant. Sovner1 reported using tranylcypromine and dextroamphetamine in a patient with treatment-resistant depression. Another report described 32 patients with refractory depression treated with a combination of a psychostimulant (pemoline or dextroamphetamine) and an MAOI.2 Of these patients, 78% experienced at least 6 months of symptom remission and 31% maintained that level.

Due to the potential for serious drug interactions, the combination of an MAOI and a psychostimulant should not be initiated without attempting other, more traditional combinations first and considering patient-specific risk factors.

Footnotes
We dedicate this report to the late Dr. Pio Albert Pol, the treating psychiatrist in this case. His sincere kindness and unwavering commitment to his patients go unparalleled.

> Hello all.
>
> I started taking stims to help with my ADHD, and of course they helped emmensely. But, they made my OCD unbearable.
> I've tried Nardil in the past, so my doc decided to lower my stim dose to 5 mg dex, three times a day; and titrate me up on Nardil. Also I take .5 mg klonopin twice a day. So far, I've been on Nardil for 2 weeks at 30 mg, and I feel it working already. Only, problem is, Im getting a big case of the "f-its."
>
> If something needs to get done, I put it off, which is why I started the stims in the 1st place. So its like I'm back at square one.
>
> My doc says we can increase the dex to 10 mg, three times a day, but to be honest, dex cause me to break out severely, and I hate the crash at the end of the day.
> I would like to try Daytrana (since it basically lasts till you take the damn thing off! I know, I was on it), but the only documented stims I've seen taken with Nardil is Dexedrine.
>
> Would daytrana be a viable alternative to the dex? And what would 10 mg dex, three times a day be equivalent to in daytrana dosage?
>
> Please, I really need your help guys. I went from being top salesman at my job, to being one of the worst now that I can't think straight due to lack of stimulation.


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poster:azalea thread:857502
URL: http://www.dr-bob.org/babble/20081006/msgs/857554.html