Posted by Brainbeard on June 18, 2009, at 4:17:03
In reply to Re: Report of success: Selegiline: alernate MAOI, posted by Adam on March 17, 2001, at 22:24:14
> "I was once under the impression that, at 5mg/day selegiline, one should have no problem taking an SSRI concurrently, and you would still see complete or near-complete inhibition of MAO-B. I've revised my thinking (.....) It may be entirely possible (.....) to take low-dose selegiline and an SSRI concurrently, and suffer no ill effects. However, there may be real risk, which is impossible, as far as I can see, to assess beforehand, of serotonin syndrome, which, as we all know, could be deadly. (.....) Maybe I'm wrong, but, given the risks, I don't think this is a viable approach, for both health and legal reasons."
Adam, are you thinking of the risk of serotonin syndrome only, or do you have other catastrophies in mind? I ask because in my humble and uneducated opinion, serotonin syndrome is a highly overrated risk in general. Somehow, many people (medical experts included) think that they should be specifically worried about the syndrome when combining serotonergic drugs. The truth is that any strong serotonergic drug could cause serotonin syndrome all by itself. So, to be consistent, we should worry about serotonin syndrome all the time whenever somebody starts taking a strong serotonergic med (an (S)SRI, or an unselective MAOI).
It also seems that serotonin syndrome is likely to occur only in the beginning of treatment on (a) serotonergic drug(s) or when raising doses. I know blood levels of selegiline can build up, but once you've survived an (S)SRI-selegiline combo for, say, a couple of months, I guess you would be pretty safe.
Buspirone, for instance, carries a serotonin syndrome warning if combined with SSRIs. The combo is used all the time, however, and I don't know many dead people who've been on it.
All this doesn't mean the risk isn't REAL, but it does mean, I think, the risk is really SMALL. Would you agree?As a side thought, moderate to strong MAO-B inhibition might also be achieved by drinking lots of green tea. (Smoking tobacco also does some MAO-B inhibition, as does drinking coffee).
By the way, selegiline appears to have a non-MAOI mechanism, at least on lower doses, that could be described as 'turning up the volume on catecholamine nerve cell activity.' (James South, http://www.smart-drugs.net/ias-deprenylJS.htm) 2.5mg is an appropiate dose for this effect. When I combine such a dose with tianeptine, the French antidepressant, I get a great synergistic effect.
An interesting report of an individual who combined selegiline with escitalopram (Lexapro): http://www.erowid.org/experiences/exp.php?ID=67864
Another interesting report on selegiline (amongst others) in diverse combinations: http://www.erowid.org/experiences/exp.php?ID=14231
poster:Brainbeard
thread:56408
URL: http://www.dr-bob.org/babble/20090611/msgs/901714.html