![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by wingedcat on February 1, 2003, at 17:44:56
I took Wellbutrin for two years with good results at first. About six months ago, the side effects (twitching, trouble sleeping) got worse while my depression came back severely. I was withdrawn and suicidal. I stopped taking Wellbutrin and started Deprenyl two weeks ago. I take 5mg a day with ~600 mg DLPA (divided doses). I am feeling a lot better, and pleasantly alert! The suicidal and guilt feelings have left. I feel more of an "I can do it" attitude. I feel sometimes transiently high but my stimulant cravings are almost gone... as opposed to a few weeks ago where all I could think about was how anxious/miserable I was and how much I wanted to take (illegal) drugs.
Best of all, I have found a psychologist who I trust enough to talk to. One I saw before didn't listen to me at all, he wanted to start me back on the Wellbutrin despite the fact that I had gotten better while off it. This new psychologist is really nice and he is okay with me taking Deprenyl.
I also had a thyroid panel done and am awaiting the results. Hypothyroidism runs in my family. In a way, I am hoping I am hypothyroid, that way I will have a "reason" for the depression, and T3 may help me improve even more. But even if that's not the case, due to the Deprenyl I feel a little better every day.
Keep trying new things, I thought just a short while ago that nothing would work for me. It's not just placebo, I've tried a few meds that either didn't work at all or made me worse.
Posted by Jacob on February 2, 2003, at 22:14:48
In reply to Having good results with Deprenyl/Selegiline! :), posted by wingedcat on February 1, 2003, at 17:44:56
Glad to hear this is working for you.
Does anyone know if the selegiline PATCH is sold anywhere? Mexico? Any comments on combining with zoloft also welcome. Thank you.
Posted by wingedcat on February 3, 2003, at 0:19:01
In reply to Deprenyl/Selegiline! :), posted by Jacob on February 2, 2003, at 22:14:48
I know that it can't be taken at the same time as SSRI's, it's caused serotonin syndrome when combined (being a MAOI). At the MAO-B dose (under 10 mg) it isn't supposed to cause serotonin syndrome, though. I'd like to be able to find the patch too! I'm hoping that it will be released soon, I've read that it should be a few months from now.
Posted by not exactly on February 3, 2003, at 1:31:54
In reply to Re: Deprenyl/Selegiline! :) » Jacob, posted by wingedcat on February 3, 2003, at 0:19:01
I participated in an evaluation trial of the patch, and it really worked very well for me. Unfortunately, it failed to get FDA approval. My understanding is that the manufacturer has abandoned it. Bummer.
- Bob
Posted by wingedcat on February 3, 2003, at 11:28:43
In reply to Re: Selegiline patch, posted by not exactly on February 3, 2003, at 1:31:54
NOOOOOOOOOOOOOOOOOOOOOOOOOOO!!!!!!!!!!!!!!!!!!
Posted by Jacob on February 3, 2003, at 12:03:09
In reply to Re: Deprenyl/Selegiline! :) » Jacob, posted by wingedcat on February 3, 2003, at 0:19:01
I propose to take 1mg( 1 drop of the liquid - sub-lingual).
I guess what I experienced last time "was" brief serotinin syndrome. I think I'll try it before taking zoloft, I'll only have the remnant of prior days dose on board.
Could this be dangerous with such a small dose?
> I know that it can't be taken at the same time as SSRI's, it's caused serotonin syndrome when combined (being a MAOI). At the MAO-B dose (under 10 mg) it isn't supposed to cause serotonin syndrome, though.
Posted by wingedcat on February 3, 2003, at 14:04:21
In reply to Re: Deprenyl/Selegiline! :), posted by Jacob on February 3, 2003, at 12:03:09
1mg Selegiline is a very low dose. I am not a doctor so when I say you shouldn't have problems I might not be right. It is an MAOI, at that level it probably only inhibits MAO-B so you should be okay. It has caused serious problems combined with SSRI's, though. I presume this was with a MAO-A dose (over 10mg) but since they don't say I can't be sure.
[Serotonin syndrome: report of a fatal case and review of the literature]
Bilbao Garay J, Mesa Plaza N, Castilla Castellano V, Dhimes Tejada P.
Servicio de Medicina Interna, Fundacion Hospital Alcorcon, Madrid, Spain.We report here the case of a patient with fluoxetine and selegiline induced serotonin syndrome, which presented as encephalopathy, generalized myoclonias, fever, stiffness and sweating, complicated with acute renal failure, rhabdomyolysis and disseminated intravascular coagulation findings. The patient died 6 days after admission. This syndrome is discussed, with an analysis of its causes, pathophysiology and therapy. A special emphasis is placed on the clinical issues and differential diagnosis with the malignant neuroleptic syndrome and other clinical entities with which it could be mistaken. General recommendations are provided to avoid this poorly characterized syndrome that, as in our patient, may have a fatal outcome.
----------
Possible serotonin syndrome arising from an interaction between nortriptyline and selegiline in a lady with parkinsonism.Hinds NP, Hillier CE, Wiles CM.
----------
Drug interactions of clinical significance with selective serotonin reuptake inhibitors.
Mitchell PB.
School of Psychiatry, University of New South Wales, Sydney, Australia. phil.mitchell@unsw.edu.auThe selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) have internationally become the accepted 'benchmark' class of antidepressants. It has become clear, however, that there are a number of clinically significant interactions between SSRIs and other medications. The most frequently described interactions are pharmacokinetic, which are far more prevalent than pharmacodynamic interactions. This article details those medications that may interact significantly with the SSRIs, and provides clinical guidelines for minimising the likelihood of such complications. The most common pharmacokinetic interactions are caused by an inhibitory effect of the SSRIs on the hepatic cytochrome P450 (CYP) metabolic system. The SSRIs differ in their potency in inhibiting a number of important CYP isoenzymes (CYP1A2, CYP2C9/10, CYP2C19, CYP2D6 and CYP3A3/4). The major outcome of concern in relation to pharmacodynamic interactions is the development of the 'serotonin syndrome'. While combination of the SSRIs with the irreversible monoamine oxidase inhibitors is the most recognised cause of this syndrome, concurrent administration with moclobemide, tryptophan or selegiline (deprenyl) may also lead to a similar outcome.
-------
Safety of selegiline (deprenyl) in the treatment of Parkinson's disease.Heinonen EH, Myllyla V.
Orion Pharma, CNS Drugs, Turku, Finland.
Selegiline (deprenyl), a selective, irreversible inhibitor of monoamine oxidase type B (MAO-B) is widely used in the treatment of Parkinson's disease. As the first MAO-B inhibitor approved for the treatment of Parkinson's disease, concerns were raised about the safety of the drug based on the adverse effect profiles of older, nonselective MAO inhibitors. Unlike the nonselective MAO inhibitors, selegiline does not significantly potentiate tyramine-induced hypertension (the 'cheese effect') at the dosages (5 to 10 mg daily) used for the treatment of Parkinson's disease. Selegiline has been well tolerated when given alone. The most frequent adverse events seen during monotherapy have been insomnia, nausea, benign cardiac arrhythmias, dizziness and headache. When combined with levodopa, selegiline can potentiate the typical adverse effects of levodopa, if the dose of levodopa is not reduced sufficiently. Thus, the most common adverse effects associated with this combination are nausea, dizziness, fatigue, constipation and insomnia. At the later stages of Parkinson's disease when fluctuations in disability occur, peak dose dyskinesias, psychiatric complications like hallucinations and insomnia, and orthostatic hypotension are further potentiated by selegiline. Mortality was recently reported to be increased when selegiline and levodopa were given together in comparison with treatment with levodopa alone, but a large meta-analysis of 5 long term studies and 4 separate studies did not support this conclusion. Selegiline seems to be generally well tolerated in combination with other drugs. However, when pethidine (meperidine) has been given to patients who are receiving selegiline therapy, severe adverse effects have been reported. Thus, the concomitant use of these drugs is not recommended. A low tyramine diet is recommended if selegiline is used together with nonselective MAO inhibitors or the selective, reversible MAO-A inhibitor, moclobemide. Several adverse effects have been reported when fluoxetine and selegiline have been used together. A recent survey revealed that the incidence of a true serotonin syndrome is, however, very low with this combination. Concomitant use of selegiline and other selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) like citalopram, which have generally less interactions than fluoxetine, seems to be well tolerated. Nevertheless, caution is advised when combining a SSRI or a tricyclic antidepressant and selegiline.
-----
Retrospective study of selegiline-antidepressant drug interactions and a review of the literature.
Ritter JL, Alexander B.
University of Washington Medical Center, Seattle 98105, USA.Selegiline is a selective monoamine oxidase inhibitor used in the treatment of Parkinson's disease. It is estimated that approximately one-half of Parkinsonian patients will develop depression requiring antidepressant drug treatment. Recently, selegiline's package insert was revised to reflect the potential risk of adverse effects when it is used in combination with selective serotonin reuptake inhibitors and tricyclic antidepressants. The objective of our study is to assess the safety of combining selegiline with antidepressants. A retrospective chart review was performed on all 28 patients with Parkinson's disease receiving selegiline and antidepressants concurrently to identify possible drug interactions. Compliance was assessed according to prescription refill records. Suspected adverse reactions with combination therapy were documented. There was a total of 40 selegiline-antidepressant drug combinations involving tricyclic antidepressants (n = 25), selective serotonin reuptake inhibitors (n = 7), trazodone (n = 5), and bupropion (n = 3). One patient receiving fluoxetine developed a reaction consistent with the serotonin syndrome; however, it was never documented as such. No other selegiline drug interactions were found. Adverse effects noted were typical of antidepressant monotherapy. Although no selegiline drug interactions were documented in our study, the concurrent administration of selegiline and selective serotonin reuptake inhibitors should be avoided because of literature-reported interactions. We believe that bupropion, tricyclic antidepressants, and trazodone are reasonable choices in combination with selegiline, although tricyclic antidepressants and trazodone may be reserved as second-line treatments.
-----
Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson's disease. Parkinson Study Group.
Richard IH, Kurlan R, Tanner C, Factor S, Hubble J, Suchowersky O, Waters C.
University of Rochester Medical Center, Department of Neurology, NY 14642-8673, USA.The manufacturer of deprenyl (selegeline; Eldepryl) (Somerset Pharmaceuticals, Tampa, FL) recently advised physicians to avoid prescribing the drug in combination with an antidepressant because of potentially serious CNS toxicity that may represent the serotonin syndrome. Manifestations of the serotonin syndrome vary but may include changes in mental status and motor and autonomic function. To better estimate the frequency of the serotonin syndrome in patients with Parkinson's disease (PD) treated with deprenyl and an antidepressant, we surveyed all investigators in the Parkinson Study Group. Based on estimates provided by the 47 investigators (75%) who responded, 4,568 patients were treated with the combination of deprenyl and an antidepressant medication. Eleven patients (0.24%) were reported to have experienced symptoms possibly consistent with the serotonin syndrome. Only two patients (0.04%) experienced symptoms considered to be serious. No deaths were reported. We also reviewed all published case reports and adverse experiences reported to the U.S. Food and Drug Administration and the manufacturer of Eldepryl. Available information indicates that serious adverse experiences resulting from the combined use of deprenyl and an antidepressant medication in patients with PD are quite rare and that the frequency of the true "serotonin syndrome" is even rarer.
Posted by jaby on February 3, 2003, at 15:25:26
In reply to Re: Deprenyl/Selegiline! :) » Jacob, posted by wingedcat on February 3, 2003, at 0:19:01
Hey wingedcat...where did yo hear that the patch would be coming out in a few months? All of the stuff I've read sounds like they've had a tough road getting the thing out, so i was surprised to hear what you mentioned.
Very curious. Many Thanks.
Posted by ZeeZee on February 3, 2003, at 16:12:17
In reply to Re: Selegiline patch, posted by not exactly on February 3, 2003, at 1:31:54
MAOI patch revisited
Posted by ZeeZee on January 19, 2003, at 10:02:11
Antidepressant by Patch May Cut Risky Side Effects
Reuters HealthBy Merritt McKinney
********Monday, December 30, 2002*************
NEW YORK (Reuters Health) - An experimental skin patch may eliminate the need for dietary restrictions in people taking a certain type of antidepressant, according to a recent study.For some people with hard-to-treat depression, antidepressants called monoamine oxidase inhibitors (MAOIs) are the most effective treatment, but the drugs can have dangerous interactions with a long list of foods.
Now, researchers report that a skin patch containing the MAOI selegiline safely and effectively treats symptoms of depression. Because this was the first study to test an MAOI patch, participants avoided certain foods, but researchers believe that the patch will eliminate the need for a special diet.
For up to 20% of people with depressive and anxiety disorders, MAOIs are the most effective therapy, according to study co-author Dr. J. Alexander Bodkin.
"Despite this, only 1% of the antidepressant prescriptions in the US are for MAOIs," Bodkin, who is at McLean Hospital in Boston, Massachusetts, told Reuters Health. According to Bodkin, this is due "in large part" to the concerns that doctors and patients have about the drugs' interactions with certain foods.
MAOIs block enzymes involved in digesting substances called tyramines, which are fermented proteins found in a variety of foods, including cheeses and soy sauce. People taking MAOIs may experience the "cheese reaction"--a rapid rise in blood pressure that occurs if they eat foods containing tyramines.
Avoiding MAOIs "is keeping full recovery away for many, many people who are suffering more than they need to," Bodkin said.
A patch containing an MAOI "offers a very elegant way of avoiding the MAOI interaction," Bodkin said. He explained that the patch, by bypassing the gut, "leaves the enzymes in the gut relatively unaffected, while targeting the medication at the brain, where it is needed."
A patch containing the MAOI selegiline effectively relieved symptoms of depression in a short-term study, Bodkin and co-author Dr. Jay D. Amsterdam, of the University of Pennsylvania in Philadelphia, report in the November issue of the American Journal of Psychiatry.
In the 6-week study, 177 adults with major depressive disorder were randomly assigned to a daily selegiline patch or a placebo patch that did not contain any medication. Patients wearing the selegiline patch experienced significantly greater improvement in symptoms than those on the placebo. In addition, side effects were no more common in the treatment group than in the placebo group, with the exception of irritation at the site of the patch.
Since this was the first clinical trial to study an MAOI patch, participants abided by a diet that restricted tyramines. However, patients were given doses of tyramine to test their response. The dose required to trigger a response was much higher than consumed in a normal diet, so the authors conclude that dietary restrictions will be "unlikely" for an MOAI patch.
********The patch is not yet available, but Bodkin said that, pending the approval of the US Food and Drug Administration, the patch could be on the market within a year.***************
Somerset Pharmaceuticals, Inc., in Tampa, Florida, provided some of the funding for the study.
SOURCE: American Journal of Psychiatry 2002;159:1869-1875
Posted by not exactly on February 3, 2003, at 18:31:15
In reply to Re: Selegiline patch » not exactly, posted by ZeeZee on February 3, 2003, at 16:12:17
Interesting. The last time I spoke to Dr. Bodkin about the selegiline patch (a couple of months ago), he was very disappointed by the FDA's rejection, and believed that Somerset had abandoned the project because it would be prohibitively expensive for them to run a new set of trials to give the FDA the positive evidence they required. I also found something on the internet stating that the patch project was cancelled - it seemed official and unambiguous - but I can't fing the reference now. Since the Reuters article you quoted is so recent, perhaps something has changed. We can hope. I will ask Dr. Bodkin about this the next time I see him.
- Bob
Posted by not exactly on February 3, 2003, at 18:58:47
In reply to Re: Selegiline patch » not exactly, posted by ZeeZee on February 3, 2003, at 16:12:17
I just re-read the Reuters article, and did a double-take. The article talks about the *first* trial of the patch, and doesn't mention any subsequent trials (or the fact that the FDA denied approval last spring). The trial I participated in (3 years ago) was the 2nd or 3rd installment (we weren't given any dietary restrictions because we were told that the safety had already been conclusively proven in previous trials). So despite the very recent date of publishing, the information that the article was based on was at least 4 years old! I would have expected Reuters to give a more timely perspective.
- Bob
Posted by ZeeZee on February 3, 2003, at 21:05:03
In reply to Re: Selegiline patch » ZeeZee, posted by not exactly on February 3, 2003, at 18:31:15
Please do ask and let us know.
Thanks
Posted by Jack Smith on February 4, 2003, at 11:54:35
In reply to Re: Selegiline patch » not exactly, posted by ZeeZee on February 3, 2003, at 21:05:03
Perhaps, Dr. Bob knows something? Do you Doc?
Posted by not exactly on February 13, 2003, at 3:55:31
In reply to Re: Selegiline patch » not exactly, posted by ZeeZee on February 3, 2003, at 21:05:03
Dr. Bodkin told me that Somerset is reapplying for FDA approval, and he expects that this time they will succeed.
- Bob
Posted by ZeeZee on February 13, 2003, at 14:58:21
In reply to Re: Selegiline patch - good news, posted by not exactly on February 13, 2003, at 3:55:31
Thanks for getting that information. I hope it proves to be more effective and have less s/e's than the AD's currently out there!
Posted by not exactly on February 13, 2003, at 21:50:39
In reply to Re: Selegiline patch - good news » not exactly, posted by ZeeZee on February 13, 2003, at 14:58:21
> I hope it proves to be more effective and have less s/e's than the AD's currently out there!
MAOIs are not for everyone. But for a significant fraction of those suffering with depression, MAOIs work better than other classes of meds (sometimes they are the *only* effective class). Based on my personal experience (as a trial subject), my reading on the web, and my discussions with Dr. Bodkin, transdermal selegiline appears to be as effective as the "classic" MAOIs (such as Parnate & Nardil). It also has a very low incidence of side effects, not just when compared to other MAOIs, but compared to virtually *any* AD. I'm very sensitive to meds and have discontinued many ADs due to intollerable side effects, but the patch was problem-free. I simply felt "well" (an unusal feeling for me). I hope it gets approved soon. It could be the best solution for many of us.
- Bob
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.