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Dr. Bob is Robert Hsiung, MD,
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Posted by Ame Sans Vie on October 6, 2004, at 14:40:19
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by Optimist on October 6, 2004, at 9:42:42
> Congratulations on your success! It seems like your meds are more on the stimulant side of things, combined with some benzos.
Thanks! :-)
Yeah, it wasn't till fairly recently I realized the unfathomable advantages of catecholaminergic enhancement in my disorders -- hence my meds being "more on the stimulant side of things".
> Have you tried wellbutrin in the past, and if you have how does it compare to the selegiline?
My experience with Wellbutrin (actually Zyban, but they're both bupropion HCl) is limited, but I can say that the short time (two months) I spent taking Zyban was quite comparable to my recent trial of desipramine (Norpramin). Zyban is equivalent to 150mg Wellbutrin SR, if I recall correctly. It gave me the same bad dry mouth as desipramine and, also like desipramine, raised my blood pressure a bit. Neither of them, however, increased my anxiety levels. In all fairness though, I was taking 8mg/day Klonopin, 400mg/day Ultram (tramadol -- an atypical narcotic analgesic with properties similar to Effexor), and various hypnotics at different times (i.e., Halcion [triazolam], Restoril [temazepam], Ambien [zolpidem], Somnote [chloral hydrate], Placidyl [ethchlorvynol], Nembutal [pentobarbital]) at the same time as the Zyban; during my desipramine trial (300mg/day for two months) I was additionally taking between 8-12mg/day Klonopin, a bit of Xanax XR here and there, 60-90mg/day Adderall, barbiturate hypnotics (Seconal [secobarbital], and Tuinal [secobarbital 50%/amobarbital 50%]), and either 60-120mg Delsym (dextromethorphan polistirex) or 60-120mg Dexalone (dextromethorphan HBr). I'm pretty convinced that the similarities I found between these two meds are strongly linked to their relatively potent norepinephrine reuptake effects, though I know some would blame the desipramine dry mouth on anticholinergia, I never experienced this adverse effect on more powerful anticholinergics such as Elavil (amitriptyline) or Flexeril (cyclobenzaprine). I believe Wellbutrin/Zyban has about half the affinity for the dopamine transporter as for the norepinephrine transporter, but someone please correct me if I'm wrong.
As for the effects on my mental condition, 150mg bupropion HCl didn't help a bit, and I wouldn't dare increase the dose due to a lack of desire to be prescribed artificial saliva. Libido and sexual function were slightly enhanced, but that effect is ten-fold with selegiline HCl... for myself, anyway. :-D
> I was asking my pdoc about trying selegiline a year ago but she wasn't too hot on the idea. I'm currently taking wellbutrin 300mg per day, plus 5mg of Adderall XR twice a day. It seems to be working well, but the selegiline has always intrigued me.
Yeah, selegiline had intrigued me for quite some time before I finally decided to take the plunge with oral Eldepryl, seeing as how EmSam (the transdermal selegiline patch) doesn't seem to be appearing on the horizon anytime terribly soon.
By the way, I feel it quite important to note that I take my Eldepryl in a rather odd, but quite effective way: I always take it with food, as the literature asserts that this increases drug absorption three- to four-fold, however, I take 2.5mg of each dose sublingually, swallowing the remainder. I began taking it this way three weeks ago when my psychiatrist recommended it at my one-week checkup (we're being cautious and making sure to meet at least biweekly due to the combination of the MAO inhibitor and amphetamines) and the effect increased dramatically. I also open up my capsules of DLPA and simply swallow the crystalline powder inside, which seems to provide a more pronounced effect.
Any more questions, feel perfectly free to ask away! I've tried nearly every traditional psych med as well as a bunch of off-the-wall stuff, so if you're curious about other dopaminergics (e.g., Mirapex [pramipexole], Symmetrel [amantadine], Sinemet [levodopa/carbidopa]) or any other drug/alternative therapies, I can provide you with my experiences and personal opinions.
Glad to hear you're doing well on your current combo, though! :-) Mind if I ask how long it took you to arrive at your current plan? Just curious.
All the best to you,
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Colleen D. on October 6, 2004, at 15:03:45
In reply to One month on selegiline now and loving it!!, posted by Ame Sans Vie on October 6, 2004, at 3:45:11
heads up regarding this med's ability to reduce the cravings for cigarettes. I really, really want to quit but no med has helped me yet.
Wishing you continued success,
Colleen
PPD, GAD and OCD
Posted by Ame Sans Vie on October 6, 2004, at 15:16:09
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by SLS on October 6, 2004, at 11:21:25
> Hi Michael.
Hi Scott, glad to see you. :-)
> All I can say is COOL!
lol, my sentiments *exactly*!
> My first question is whether or not you ever tried Parnate.
No, that's one of five *approved* antidepressants I haven't tried (tranylcypromine, isocarboxazid, amoxapine, trimipramine, duloxetine)... six if you count that I've never given a therapeutic dose of trazodone a try. I've been curious about Parnate, and it was actually next on my list were Eldepryl to fail, but I just couldn't bear the thought of parting with my Adderall that helps so much. Though my doctors wouldn't mind a cautious implementation of a psychostimulant and non-selective MAO inhibitor concurrently, Medicaid would never allow me to fill the prescriptions. It was a battle to get them to cover Eldepryl while it was on file that I also took amphetamines. I had to print out a good thirty pages of information on the safety of judicious use of MAO inhibitors with amphetamines, bring them into Walgreens, and basically argue my way with the pharmacist for a good thirty minutes into getting the Eldepryl which it was, "against [his] better judgment to do." He finally did after I showed him an abstract that asserted methamphetamine, when administered along with selegiline, had fewer cardiac effects than when dosed alone. Oh well... at least it means the pharmacy's actually on its toes, lol.
> My second question is whether there is any bipolarity to your condition, and how you would describe the type and severity of your depression.
There may be a mild element of cyclothymia to my affective disorders, but all my doctors (as well as I) tend to feel that my symptomology and history (I used to cut in my teen years a bit) is more consistent with borderline personality disorder. That's still open to debate, though. But thank you for reminding me -- I need to do some more research on the subject. Just for the sake of knowing, I mean... whatever it is, it's already treated. My mood swings were marked by a *very* short fuse -- I would be in an excellent mood, then the littlest thing would cause me to blow up, though this has diminished since adolescence. Until age sixteen or so, this was typically accompanied by violent temper tantrums, destroying things around the house, and usually cutting (generally with a piece of glass I'd retrieve after smashing a hanging picture frame on my head), After that phase of my life ended (thank goodness), my violent rage in response to certain stimuli was replaced by extreme irritability, restlessness, and alienation. My friendships throughout gradeschool (until my problems caused me to drop out to homeschool myself in 1998, 10th grade) were never stable and and intimate relationships were impossible. I was extremely possessive and needy, and any friends I would make quickly grew tired of my mood fluctuations and moved on. But I'm rambling... sorry, lol.
As far as the severity of my depression is concerned, though it was never an official diagnosis, I feel that the "chronic low-grade depression" definition of dysthymia suits (well... suit*ed* <g>) me perfectly. Any setbacks in my treatment, or any area of my life for that matter, and I would spiral into a lengthy episode of atypical major depression. I'd say that over the past ten years, dysthymia (with prominent atypical features) has accounted for about 70% of my life, episodes of MDD about 20%, and euthymia or some form of what I can only describe as brief episodes of "giddiness" the other 10% (hypomania?).
> Thanks
No problemo -- sorry I'm getting so detailed in my posts today, but I'm so damned excited! lol
Take care,
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by JayDee on October 6, 2004, at 15:38:57
In reply to Parnate / bipolarity » SLS, posted by Ame Sans Vie on October 6, 2004, at 15:16:09
> No, that's one of five *approved* antidepressants I haven't tried (tranylcypromine, isocarboxazid, amoxapine, trimipramine, duloxetine)... six if you count that I've never given a therapeutic dose of trazodone a try. I've been curious about Parnate, and it was actually next on my list were Eldepryl to fail, but I just couldn't bear the thought of parting with my Adderall that helps so much. Though my doctors wouldn't mind a cautious implementation of a psychostimulant and non-selective MAO inhibitor concurrently, Medicaid would never allow me to fill the prescriptions. It was a battle to get them to cover Eldepryl while it was on file that I also took amphetamines. I had to print out a good thirty pages of information on the safety of judicious use of MAO inhibitors with amphetamines, bring them into Walgreens, and basically argue my way with the pharmacist for a good thirty minutes into getting the Eldepryl which it was, "against [his] better judgment to do." He finally did after I showed him an abstract that asserted methamphetamine, when administered along with selegiline, had fewer cardiac effects than when dosed alone. Oh well... at least it means the pharmacy's actually on its toes, lol.I wonder if the Pharmacist even realized that methamphetamine and amphetamine are actually both METABOLTIES of selegiline. To say adding more stimulants to it would be so dangerous would kinda be oxymoron... Congrats on beating him at wits! ;)
Posted by Ame Sans Vie on October 6, 2004, at 15:40:11
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by alesta on October 6, 2004, at 11:45:04
> hi, ame,:)
>
> good to see you again! :) glad your still popping in..Hi there, alesta -- and likewise! I just figured I needed a forced hiatus from the board to prevent myself from prematurely posting about my exciting response to selegiline, lol. I'm definitely still here.
> i have also heard very favorable things about selegiline for depression, but also that it can increase anxiety, and should perhaps be avoided by the anxiety-prone..perhaps your high dosages of 2 benzos counteracts this? have you noticed any increased anxiety?
I'll look into this a bit further and get back to you later tonight regarding the occurrence of anxiety-provocation as a selegiline adverse effect... I'm tempted to say that it is probably not likely to cause or increase anxiety levels as it's primary method of action is, as far as we know, inihibition of MAO-B. In the clinically important sense, monoamine oxidase type B seems predominantly to degrade "excess" beta-phenylethylamine [PEA]; blocking this enzyme alone doesn't really decrease the degradation of dopamine all that much, if memory serves me correctly. MAO-A is actually perfectly capable of not just degrading serotonin, norepinephrine, and other trace amines as is widely held to be gospel, but also will destroy dopamine. Now, PEA being *SO* closely related to amphetamine suggests that increased levels could be anxiety provoking, but I would guess this might happen only in very susceptible individuals.
However, it *is* quite possible that in addition to MAO-B blockade, selegiline exerts its many effects through mild reversible MAO-A inhibition (even at low doses), dopamine reuptake inhibition, so-called "catecholamine enhancement activity"... there are many theories. Despite the very small amounts produced through its metabolism, it may even be possible that selegiline's active metabolites levoamphetamine (the same l-amphetamine that comprises 25% of Adderall) and levomethamphetamine (available over-the-counter in Vick's Inhalers, though spelt "levmetamfetamine", presumably to avoid stigma) lend their monoamine reuptake inhibiting, monoamine releasing, and MAO inhibiting properties to the resultant effects as well.
All the technical jargon aside, I can personally say that, even if I miss a dose (or more) of my benzos, the selegiline/DLPA combo seems to offer a "balancing" effect that my brain so desperately needs and appears to me to be somewhat adaptogenic. That said, I would never miss more than one full day of my Klonopin/Xanax XR! :-)
> awesome anti-smoking info! that's really fantastic! thanks for sharing that.
You're very welcome. :-)
I think there are some clinical trials that are being conducted (*have* been conducted?) investigating this very approach to smoking cessation. I came across them while searching http://www.clinicaltrials.gov and http://www.centerwatch.com upon realization that selegiline had eliminated my cravings. Good thing too, because TX Medicaid's formulary changed this week, dropping the only other smoking-cessation therapy that's ever worked for me (Nicotrol Inhaler), and $150 for a week's supply of that stuff is enough to make you say, "Eh, cigarettes aren't so bad after all," lol.
> take care,
> amy ;)Likewise -- all the best,
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Ame Sans Vie on October 6, 2004, at 15:42:57
In reply to Re: One month on selegiline now and loving it!!, posted by JayDee on October 6, 2004, at 12:42:36
> Hi Ame Sans Vie
>
> I'm looking for a good pdoc in the Houston area, could you give me any reccs? do you mind if I email you?
>
> thanks alot,
> JonSure you can e-mail -- I am in Beaumont, though... I do know most of the psychiatrists in the Golden Triangle Area however. My current pdoc is in Nederland. Write me at: his_infernal_majesty23@netzero.com
Hope to hear from you soon,
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Ame Sans Vie on October 6, 2004, at 15:50:18
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by sfy on October 6, 2004, at 13:05:18
> How long did it take you to see results from the selegiline? I just started it about 10 days ago and haven't noticed anything. I'm taking 5 mg. once a day with DLPA but will bump it up next week - I was just waiting for the side effects (buzzy headache, slight nausea) to fade.
I didn't experience any side effects starting right at 10mg -- guess I got lucky! But I would definitely say you're on the right track bumping up the dose once you can tolerate the drug.
Just a few questions:
1. What brand of DLPA do you take?
1a. Is it capsules, tablets, or powder?
2. How do you take the selegiline and DLPA in regard to scheduling around meals? This is *very* important to success with this combination.
3. Do you take any vitamin supplements? Some are practically essential to allow DLPA to "do its thing" (e.g., vitamin C, vitamin B6 [its coenzymated form, pyridoxal-5-phosphate, aka P5P, is *vastly* preferable to the usual pyridoxine HCl]).If you can get back to me with this info, I may have some suggestions for you to really help get the most out of selegiline.
Oh, and to answer your original question, though the smoking-cessation effects were evident immediately, mental effects weren't noticeable to me until day eight. This was when I began to experiment with sublingual usage and made other adjustments.
Hope to hear from you soon,
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Dr. Bob on October 6, 2004, at 16:15:08
In reply to Selegiline onset latency » sfy, posted by Ame Sans Vie on October 6, 2004, at 15:50:18
> 1. What brand of DLPA do you take? ...
Sorry to interrupt, but I'd like to redirect follow-ups regarding DLPA to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20040928/msgs/399707.html
Thanks,
Bob
Posted by Ame Sans Vie on October 6, 2004, at 16:28:24
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by tendency on October 6, 2004, at 14:11:55
> Damn! that's alot of adderall. Why do you take it with dextromethorphan?
lol, yes, it's a bit above the FDA's recommended maximum daily dose for dextroamphetamine (1mg/kg). I take it with a solution of Alka-Seltzer Gold. I use this because it contains no aspirin, and it effervesces in water to form primarily sodium citrate and potassium citrate, both of which raise the pH (i.e., decrease acidity/make more alkaline) of the gastrointestinal contents and the urine. Amphetamines, as the prescribing information for Adderall/Adderall XR, Dexedrine/Dexedrine Spansule/DextroStat, Desoxyn, and Didrex will inform you, are absorbed more readily into the system when the stomach contents are alkaline, and are both more slowly excreted *and* reabsorbed into the bloodstream when urine is alkaline. So to make each dose of Adderall I take reach its full potential, I use the alkalinizers which increase the effects by 150-175% (YMMV) and increase the duration of effect from approximately four to closer to six hours. I take my dose every six hours, and that includes a dose right before bed as (believe it or not) it improves my sleep quality drastically where Halcion, Restoril, Ambien, Sonata, Placidyl, Nembutal, Tuinal, Seconal, Somnote, and Equanil have all failed miserably. Sorry, I just felt compelled to explain all that junk I'm sure you could care less about, lol -- now I'll answer your actual question.
Many drugs which block certain subtypes of receptors in the brain known as N-methyl-D-aspartate (NMDA) receptors have been shown to prevent development of tolerance to drugs for which this is a known problem. Dextromethorphan (DXM) is one such drug. Many drugs that achieve this ultimate goal in the brain are illicitly abused dissociative anesthetics (i.e., phencyclidine [PCP; angel dust] and ketamine [Ketalar; Ketaset; Special K]). DXM is available over-the-counter and also extensively abused, but at low NMDA-antagonist doses it has been shown to prevent tolerance (and even *reverse* tolerance in critically ill patients) to narcotic analgesics. There's a product in the works called MorphiDex that combines morphine and DXM and has been shown to allow chronic pain patients to remain at a stable dose in the majority of cases. There's another in the works using oxycodone instead of morphine, though the name eludes me at the moment.
I'm not aware of any specific studies involving the effects of DXM therapy on amphetamine or other psychostimulant tolerance (though there very well may be some), but based on anecdotal evidence and upon being given the greenlight by my psychiatrist, I began taking OTC Delsym (dextromethorphan polistirex), an extended release form of DXM lasting eight hours per dose. It's worked beautifully for me, and several other stimulant-treated patients in my psychiatrist's practice now that I've brought it to his attention, and I wouldn't go without it.
Recently, a product called "Dexalone" became available which is available in 10- and 30-packs of 30mg DXM HBr capsules and I've switched to that because a) I'm pre-diabetic, and the Delsym is a sugary syrup, and b) Delsym tastes like *ss, lol. Only problem -- you'll likely only find Dexalone in non-chain pharmacies, as the large-chains don't like to stock it because of the increasing awareness of DXM's abuse potential. Occasionally they carry it behind the counter, though.
Other NMDA-blockers are available which are worth a shot, but I'm not going to try them -- why rock the boat? Magnesium is one that's easily obtainable. Namenda (memantine -- for Alzheimer's disease) and Symmetrel (amantadine -- for Parkinson's disease), both Rx only, are also very good NMDA-antagonists, though Symmetrel also increases dopaminergic action through unknown mechanisms and so may cause more undesirable side effects.
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Ame Sans Vie on October 6, 2004, at 16:30:26
In reply to Thanks so much for the... » Ame Sans Vie, posted by Colleen D. on October 6, 2004, at 15:03:45
> heads up regarding this med's ability to reduce the cravings for cigarettes. I really, really want to quit but no med has helped me yet.
What all have you tried, if you don't mind me asking... and as long as you don't mind suggestions from a layperson. :-)
> Wishing you continued success,
> Colleen
> PPD, GAD and OCDThank you very much. :-)
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Ame Sans Vie on October 6, 2004, at 16:33:16
In reply to Re: Parnate / bipolarity, posted by JayDee on October 6, 2004, at 15:38:57
> I wonder if the Pharmacist even realized that methamphetamine and amphetamine are actually both METABOLTIES of selegiline. To say adding more stimulants to it would be so dangerous would kinda be oxymoron... Congrats on beating him at wits! ;)
lol, yup, it's always fun teaching someone with a Pharm.D, M.D., *whatever* a thing or two!! :-D
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
Posted by Ame Sans Vie on October 6, 2004, at 16:34:59
In reply to Re: Anyone take more than 4mg of Klonopin daily? » tendency, posted by Ame Sans Vie on October 6, 2004, at 16:28:24
Posted by tendency on October 6, 2004, at 17:49:26
In reply to Re: Anyone take more than 4mg of Klonopin daily? » tendency, posted by Ame Sans Vie on October 6, 2004, at 16:28:24
> So to make each dose of Adderall I take reach its full potential, I use the alkalinizers which increase the effects by 150-175% (YMMV) and increase the duration of effect from approximately four to closer to six hours.
wow, cool. I didn't realize that. I take 20mg/day in morning and I seem to be needing a boost now, think I'll try the alkaseltzer.
>
> Many drugs which block certain subtypes of receptors in the brain known as N-methyl-D-aspartate (NMDA) receptors have been shown to prevent development of tolerance to drugs for which this is a known problem.wow, doubly cool. I do seem to be developing a tolerance so this is good to know, I'll look into it.
One other interesting thing I've noticed: I used to have horrible side effects from adderall both those entirely ceased when my lamictal dose hit 200mg. Unfortunately, at that dose the lamictal seems to have blunted the effectiveness (knoced it out totally). Anyone else seen this?
Posted by Colleen D. on October 6, 2004, at 18:07:22
In reply to Re: Anyone take more than 4mg of Klonopin daily? » Colleen D., posted by Ame Sans Vie on October 6, 2004, at 16:30:26
> What all have you tried, if you don't mind me asking... and as long as you don't mind suggestions from a layperson. :-)
Zyban, Nicorette Gum, Nicotine Patch, and Cold Turkey a number of times with no meds. I also did one of those group things. I think my OCD has something to do with my difficulty quitting; yep, I'm gonna blame it on my chemical imbalance! :-)
Colleen
Posted by utopizen on October 6, 2004, at 18:57:18
In reply to Re: One month on selegiline now and loving it!! » Ame Sans Vie, posted by alesta on October 6, 2004, at 11:45:04
um, ah, gosh, not that I'm judging you on your benzo regimen, nor would I defend the use of barbituates in place of benzos, but gosh, I wonder with such an extreme dose of benzos whether you'd simply be better off seeing if a low dose of Amytal or some other barbituate might help?
Posted by utopizen on October 6, 2004, at 19:05:34
In reply to Re: Anyone take more than 4mg of Klonopin daily? » tendency, posted by Ame Sans Vie on October 6, 2004, at 16:28:24
>I take my dose every six hours, and that includes a dose right before bed as (believe it or not) it improves my sleep quality drastically where Halcion, Restoril, Ambien, Sonata, Placidyl, Nembutal, Tuinal, Seconal, Somnote, and Equanil have all failed miserably.
>Okay, are you referring to your subjective quality of sleep, or is this something that has been confirmed with a sleep study?
Unless a sleep study, with some comprehensive wires coming off your head, confirms that you're entering a much deeper sleep on amphetamines, then, uh, maybe the fact that you know what drug you're taking is altering the subjective result.
I know you want to feel you're correct. I am not trying to correct you. But as my current pdoc said-- with a very concerned look that seemed to recgonize a lot of the profound pain I've experienced through having talked with my former doc- "you don't have to be your own psychopharmacologist, steve!"
I know, everyone on this board is going to say I'm wrong for thinking it's healthy to obsess over our condition and meds on this board, but if you people think this is fun or helpful in anyway, why are you still on it?
Frankly I think this board merely encourages a lot of the obsessive thought tendancies I have. But again, this IS MY HUMBLE OPINION, and YOU ARE ALLOWED TO DISAGEE WITH ME, and I MAY VERY WELL BE WRONG. I'm just talking to myself here, and please let me do this, please. I don't mean to "correct" or discourage anyone's views here.
Posted by Jasmineneroli on October 6, 2004, at 23:46:46
In reply to One month on selegiline now and loving it!!, posted by Ame Sans Vie on October 6, 2004, at 3:45:11
Hello Michael:
Please read my post to the BRC thread above "Re: 4mg Klonopin", because I addressed a query to you :). Thanks.
I forgot to add that my daughter also has a lot of aches and pains, especially at night. She sometimes has to get up and sit in a chair.
I remember well, your issues with tremendous pain, so I do value your opinion greatly. Thanks.
JasBTW....In the past, I quite often quietly wondered if you were Borderline Pers. Dis. I know a lot about this disorder because I have been closely associated with 2 people with that dx. So if you have any questions for me on that, I'd be happy to talk. :)
Posted by cache-monkey on October 6, 2004, at 23:54:39
In reply to One month on selegiline now and loving it!!, posted by Ame Sans Vie on October 6, 2004, at 3:45:11
Michael,
Congrats on the success with selegiline! I'm very glad it's working for you. I actually met with my pdoc today to see about starting it and he agreed.
I'm wondering, though, about the DL-Phenylalanine. This is the chocolate-happy amino acid, right? I seem to remember reading somewhere (here maybe) that this acts synsergistically with the selegiline. What has been your experience with this? Did you start the DLPA along with the selegiline, or before or after or what?
I guess I'm wondering if the DLPA has made a significant difference for you. Please let me know when you have the chance.
Thanks,
cache-monkey<< Hi everyone, I haven't posted in a while because I wanted to give my latest medication addition -- selegiline HCl -- a chance to work. Truth be told, I could have written a glowing review three weeks ago, but I didn't want to be premature. Here's is med schedule as it is now (and as I'm confident that it's going to remain!!):
>
> Klonopin (Roche brand): 4mg three times daily
> Xanax XR (Pfizer brand): 3mg three times daily
> Adderall (Shire brand): 30mg four times daily (each dose with 30mg Dexalone brand dextromethorphan)
> Eldepryl (Somerset brand): 5mg twice daily with meals
> DL-Phenylalanine (Solaray brand): 500mg twice daily on an empty stomach with sublingual B12/B6/folic acid, pyridoxal-5-phosphate, and Ester-C
>
> I'll write more if anyone has any questions/comments, but for now I'll just say that a) selegiline is *the* best stop-smoking therapy I've tried (though I never expected it to have that effect when I began taking it) -- I haven't had a tinge of a craving since day 1!!, and b) the antidepressant/prosocial/motivational effects are *phenomenal*!
~Michael
SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
>>
Posted by karaS on October 6, 2004, at 23:57:21
In reply to One month on selegiline now and loving it!!, posted by Ame Sans Vie on October 6, 2004, at 3:45:11
> Hi everyone, I haven't posted in a while because I wanted to give my latest medication addition -- selegiline HCl -- a chance to work. Truth be told, I could have written a glowing review three weeks ago, but I didn't want to be premature. Here's is med schedule as it is now (and as I'm confident that it's going to remain!!):
>
> Klonopin (Roche brand): 4mg three times daily
> Xanax XR (Pfizer brand): 3mg three times daily
> Adderall (Shire brand): 30mg four times daily (each dose with 30mg Dexalone brand dextromethorphan)
> Eldepryl (Somerset brand): 5mg twice daily with meals
> DL-Phenylalanine (Solaray brand): 500mg twice daily on an empty stomach with sublingual B12/B6/folic acid, pyridoxal-5-phosphate, and Ester-C
>
> I'll write more if anyone has any questions/comments, but for now I'll just say that a) selegiline is *the* best stop-smoking therapy I've tried (though I never expected it to have that effect when I began taking it) -- I haven't had a tinge of a craving since day 1!!, and b) the antidepressant/prosocial/motivational effects are *phenomenal*!
>
> ~Michael
> SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPDHi Michael,
I'm so jealous! I've been intrigued by selegiline for quite a while now. My depression is atypical with profound apathy and lethargy. My plan was to try activating antidepressants and stimulants. Unfortunately my reaction to stimulating (dopaminergic) medications and supplements has been very discouraging. They all put me to sleep. (After doing a bit of research I figured out that the likely cause is hypersensitive dopamine autoreceptors. After reaching this conclusion, I have't been able to think about much else.)At any rate, when I tried selegiline pills alone I was sleepy but then 7-8 hours later when I wanted to go to sleep I felt some activation start. I have tried it once with DLPA and I did get some stimulation from the PEA. Would that eventually lead to an antidepressant effect? Because of my situation, I had figured that selegiline was probably not an option for me until I read your post. Now I'm thinking that maybe I should give it more of a chance. Even if the dopaminergic side would be a bust for me, maybe the PEA will overcompensate. Do you have any insight or opinion on this? Also, have you tried the selegiline pills at all? I wonder if the liquid really is that much better. I have wondered what was fact versus what was hype due to the political story behind the liquid vs. the pills.
Thanks,
Kara
Posted by alesta on October 7, 2004, at 0:42:16
In reply to Selegiline HCl and anxiety » alesta, posted by Ame Sans Vie on October 6, 2004, at 15:40:11
salut michael, :)
<I'm definitely still here.
good. we'd miss you if you left!
> All the technical jargon aside, I can personally say that, even if I miss a dose (or more) of my benzos, the selegiline/DLPA combo seems to offer a "balancing" effect that my brain so desperately needs and appears to me to be somewhat adaptogenic. That said, I would never miss more than one full day of my Klonopin/Xanax XR! :-)
woah, dr. ame! intense information overload, dude..:-) with your interest and knowledge in medicine, perhaps you should go to medical school and become a psychiatrist..although that is a hel* of a lot of work...:-)
glad you are having such success with seleg! you sound wonderful! (or maybe you're just happy to see me; just kidding! i'm not a narcissist.;))
take care,
amy
Posted by JayDee on October 7, 2004, at 3:11:44
In reply to E-Mail » JayDee, posted by Ame Sans Vie on October 6, 2004, at 15:42:57
Email sent. *Phew!* thanks.
sorry again for the screwed up formatting.
Posted by jujube on October 7, 2004, at 15:26:37
In reply to Selegiline onset latency » sfy, posted by Ame Sans Vie on October 6, 2004, at 15:50:18
Could you please tell me which natural supplements (including vitamins/minerals) would be best to take for GAD with comorbid depression/adhedonia. My anxiety has gone through the roof after my first Depo Provera shot (like nothing I've ever experienced before and it's making me crazy). I am currently taking Celexa 30 mg and thinking of going to 40 mg. I tried L-Tyrosine, but think I over did it and became extremely agitated (don't want to go there again). I am planning on added Gaba-Plus (which is a blend of Gaba and niacinimide) as well as B-Complex (100 mg two or 3 times a day)and magnesium (250 mg three times a day). I want to try Rhodolia as well, but have heard mixed reviews about it and have some concern about combining it with an AD (although my doctor did not have a problem with it and I know others have done this). Anything you can tell me would be greatly appreciated. Thanks so much.
Tamara
> > How long did it take you to see results from the selegiline? I just started it about 10 days ago and haven't noticed anything. I'm taking 5 mg. once a day with DLPA but will bump it up next week - I was just waiting for the side effects (buzzy headache, slight nausea) to fade.
>
> I didn't experience any side effects starting right at 10mg -- guess I got lucky! But I would definitely say you're on the right track bumping up the dose once you can tolerate the drug.
>
> Just a few questions:
>
> 1. What brand of DLPA do you take?
> 1a. Is it capsules, tablets, or powder?
> 2. How do you take the selegiline and DLPA in regard to scheduling around meals? This is *very* important to success with this combination.
> 3. Do you take any vitamin supplements? Some are practically essential to allow DLPA to "do its thing" (e.g., vitamin C, vitamin B6 [its coenzymated form, pyridoxal-5-phosphate, aka P5P, is *vastly* preferable to the usual pyridoxine HCl]).
>
> If you can get back to me with this info, I may have some suggestions for you to really help get the most out of selegiline.
>
> Oh, and to answer your original question, though the smoking-cessation effects were evident immediately, mental effects weren't noticeable to me until day eight. This was when I began to experiment with sublingual usage and made other adjustments.
>
> Hope to hear from you soon,
>
> ~Michael
> SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
>
>
Posted by sfy on October 7, 2004, at 17:36:45
In reply to Redirect: DLPA, posted by Dr. Bob on October 6, 2004, at 16:15:08
> > 1. What brand of DLPA do you take? ...
>
> Sorry to interrupt, but I'd like to redirect follow-ups regarding DLPA to Psycho-Babble Alternative. Here's a link:
>
> http://www.dr-bob.org/babble/alter/20040928/msgs/399707.html
>
> Thanks,
>
> BobJust wondering what are the criteria for a redirect? This post also involves the use of selegiline and there's even been at least one mainstream published result on the combo: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6425455
I'm just concerned that the redirect caused a loss of reply. Thanks!
Posted by Optimist on October 8, 2004, at 10:09:57
In reply to Selegiline vs. Wellbutrin -- my perspective » Optimist, posted by Ame Sans Vie on October 6, 2004, at 14:40:19
> > Congratulations on your success! It seems like your meds are more on the stimulant side of things, combined with some benzos.
>
> Thanks! :-)
>
> Yeah, it wasn't till fairly recently I realized the unfathomable advantages of catecholaminergic enhancement in my disorders -- hence my meds being "more on the stimulant side of things".
>
> > Have you tried wellbutrin in the past, and if you have how does it compare to the selegiline?
>
> My experience with Wellbutrin (actually Zyban, but they're both bupropion HCl) is limited, but I can say that the short time (two months) I spent taking Zyban was quite comparable to my recent trial of desipramine (Norpramin). Zyban is equivalent to 150mg Wellbutrin SR, if I recall correctly. It gave me the same bad dry mouth as desipramine and, also like desipramine, raised my blood pressure a bit. Neither of them, however, increased my anxiety levels. In all fairness though, I was taking 8mg/day Klonopin, 400mg/day Ultram (tramadol -- an atypical narcotic analgesic with properties similar to Effexor), and various hypnotics at different times (i.e., Halcion [triazolam], Restoril [temazepam], Ambien [zolpidem], Somnote [chloral hydrate], Placidyl [ethchlorvynol], Nembutal [pentobarbital]) at the same time as the Zyban; during my desipramine trial (300mg/day for two months) I was additionally taking between 8-12mg/day Klonopin, a bit of Xanax XR here and there, 60-90mg/day Adderall, barbiturate hypnotics (Seconal [secobarbital], and Tuinal [secobarbital 50%/amobarbital 50%]), and either 60-120mg Delsym (dextromethorphan polistirex) or 60-120mg Dexalone (dextromethorphan HBr). I'm pretty convinced that the similarities I found between these two meds are strongly linked to their relatively potent norepinephrine reuptake effects, though I know some would blame the desipramine dry mouth on anticholinergia, I never experienced this adverse effect on more powerful anticholinergics such as Elavil (amitriptyline) or Flexeril (cyclobenzaprine). I believe Wellbutrin/Zyban has about half the affinity for the dopamine transporter as for the norepinephrine transporter, but someone please correct me if I'm wrong.
>
> As for the effects on my mental condition, 150mg bupropion HCl didn't help a bit, and I wouldn't dare increase the dose due to a lack of desire to be prescribed artificial saliva. Libido and sexual function were slightly enhanced, but that effect is ten-fold with selegiline HCl... for myself, anyway. :-D
>
> > I was asking my pdoc about trying selegiline a year ago but she wasn't too hot on the idea. I'm currently taking wellbutrin 300mg per day, plus 5mg of Adderall XR twice a day. It seems to be working well, but the selegiline has always intrigued me.
>
> Yeah, selegiline had intrigued me for quite some time before I finally decided to take the plunge with oral Eldepryl, seeing as how EmSam (the transdermal selegiline patch) doesn't seem to be appearing on the horizon anytime terribly soon.
>
> By the way, I feel it quite important to note that I take my Eldepryl in a rather odd, but quite effective way: I always take it with food, as the literature asserts that this increases drug absorption three- to four-fold, however, I take 2.5mg of each dose sublingually, swallowing the remainder. I began taking it this way three weeks ago when my psychiatrist recommended it at my one-week checkup (we're being cautious and making sure to meet at least biweekly due to the combination of the MAO inhibitor and amphetamines) and the effect increased dramatically. I also open up my capsules of DLPA and simply swallow the crystalline powder inside, which seems to provide a more pronounced effect.
>
> Any more questions, feel perfectly free to ask away! I've tried nearly every traditional psych med as well as a bunch of off-the-wall stuff, so if you're curious about other dopaminergics (e.g., Mirapex [pramipexole], Symmetrel [amantadine], Sinemet [levodopa/carbidopa]) or any other drug/alternative therapies, I can provide you with my experiences and personal opinions.
>
> Glad to hear you're doing well on your current combo, though! :-) Mind if I ask how long it took you to arrive at your current plan? Just curious.
>
> All the best to you,
>
> ~Michael
> SAD, GAD, PD, OCD, agoraphobia, dysthymia, MDD, ADD, AvPD
>
Hi Michael, I forgot to reply on how long it took me to arrive at my current plan. I haven't been on antidepressants very long. I tried effexor for to 2 weeks, 3 years ago, but couldn't handle the sexual side effects and apathy at the beginning. I think I was at a point where I thought those types of side effects weren't worth the trouble of being on an antidepressant. I may have been in a bit of denial as well. I tend to feel a more of an apathetic depression as well, and it seemed the effexor was compounding those effects although I know I didn't give it enough time to give a proper evaluation anyways.A year ago, I was in a rough state of mind, and decided to get a psychiatrist. She put me on moclobemide (Manerix), in July and I was ramped up to 1200mg quite quickly. Even at that high a dose I didn't experience any side effects. Zilch. Which I thought was a little funny. Gradually I tended to feel better, but I usually tend to feel better in September/October anyways so it was a tough call whether it was the AD that was working or seasonal pattern to my depression. In the beginning of nov. the floor came out from under me, so my pdoc decided to switch me to wellbutrin 300mg. She added lamictal in dec. at 100mg. I added some St. John's Wort at the end of Feb and shortly after started feeling much better. I also bought a light box at that time.
In the beginning of march I took myself off the lamictal and wellbutrin on my own. The lamictal was making me feel like a zombie. I felt like there was a continual fog in my head, and since I was in university at the time I decided that I couldn't handle that side effect anymore. My depression started to lift quite remarkably at that time but in march/april it usually tends to lift anyways. Again part of a seasonal pattern I think. I'm still trying to figure out if it's really there. I tend to get depressed in the winter and summer for 8 months of the year, and feel better during spring and fall for 4 months of the year. I went off the SJW at the beginning of spring as well.
So in July again of this year I had been having problems with depression again. It had been creeping up for a couple months, so I decided to go back on the St. John's Wort and Wellbutrin. I started feeling much better shortly afterwards.
The last week my pdoc put me on the Adderall, since I was complaining of some loss of motivation/energy which I had been having problems for continuously. I also have been unemployed for 4 months and was started to get desperate to get my life going in the right direction. Even though my depression had abated I felt like I needed an extra kick in the pants to get things started.
I have experimented with 5-HTP and tyrosine as well the last couple months. I've used it more for PRN type situations (as needed) to give me a little extra effects from time to time. Since I've been paying everything out of pocket it gets expensive though so I haven't explored that avenue as much as I've liked.
I know this was a little long, but that's generally the overview of my AD experimentation. It hasn't been very long. I find it a bit therapeutic telling about myself as I think it gives me more perspective about myself and my own inner workings. We'll see this november if my improvement is from my AD combo or whether it is the seasonal pattern. I'm crossing my fingers.
Brian
Posted by Dr. Bob on October 8, 2004, at 18:18:58
In reply to Re: Redirect: DLPA » Dr. Bob, posted by sfy on October 7, 2004, at 17:36:45
> Just wondering what are the criteria for a redirect?
I replied, but over at Psycho-Babble Administration. Here's a link:
http://www.dr-bob.org/babble/admin/20040927/msgs/400538.html
Thanks,
Bob
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