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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by smith562 on April 7, 2005, at 16:27:14
Hey Everyone,
I have a history of panic disorder and depression with a family history of BP II. Thus far nardil has provided me the best relief, but the 30lbs weight gain, insomnia and sexual dysfunction were hard to tolerate. I have tried to recreate nardil with zoloft (serotonin), klonopin (GABA), wellbutrin (Norepi/Dopamine) and low dose lithium (augmentor) with some sucess.
Wellbutrin seem to aggreviate my anxiety too much. Was wondering if anyone has tried selegiline .... more specifically seligiline (more dopamine then wellbutrin to help my apathy/social phobia) low dose with an SSRI?
Thanks!!!!!
Sincerely,
Smith
Posted by WeeWilly on April 7, 2005, at 18:03:20
In reply to Making a better Nardil with Selegiline?, posted by smith562 on April 7, 2005, at 16:27:14
Have you considered trying Parnate? It usually does not cause weight gain.Best wishes
Posted by smith562 on April 7, 2005, at 20:55:22
In reply to Why not Parnate?, posted by WeeWilly on April 7, 2005, at 18:03:20
Hey WW,
Unforunately, parnate was much too activating and anxiogenic for me. I gave a 10 week trial to parnate 2 years ago .... spent whole summer anxious and inside my apartment.
Thanks for the response! Hope you are well.
Smith
Posted by ixus on April 8, 2005, at 4:27:51
In reply to Re: Why not Parnate? » WeeWilly, posted by smith562 on April 7, 2005, at 20:55:22
> Hey WW,
>
> Unforunately, parnate was much too activating and anxiogenic for me. I gave a 10 week trial to parnate 2 years ago .... spent whole summer anxious and inside my apartment.
>
> Thanks for the response! Hope you are well.
>
> SmithSelegiline is more activating and anxiogenic than tranylcypromine.
/ixus
Posted by smith562 on April 8, 2005, at 5:51:58
In reply to Re: Why not Parnate? » smith562, posted by ixus on April 8, 2005, at 4:27:51
> Selegiline is more activating and anxiogenic than tranylcypromine.
> /ixus
I know they are both non-hydrazine MAOIs and can be anxiogenic for some ... selegiline does metabolize to amphetamines. The problem with parnate was that I would never add an SSRI and risk serontonin syndrome/death. The data with selegiline at 10mg or below suggest it is fairly safe (thousands of parkinson's patients get selegiline and an ssri every year), although no guarentees.I am hoping low dose zoloft and klonopin will offset any anxiety induced by selegilne. Hopefully someone out there has maybe tried this and can give me feedback.
Thanks Ixus! Hope you are well. Please keep the post coming!
Smith
Posted by ixus on April 8, 2005, at 6:29:26
In reply to Re: Never parnate with an SSRI » ixus, posted by smith562 on April 8, 2005, at 5:51:58
> > Selegiline is more activating and anxiogenic than tranylcypromine.
> > /ixus
>
> I know they are both non-hydrazine MAOIs and can be anxiogenic for some ... selegiline does metabolize to amphetamines. The problem with parnate was that I would never add an SSRI and risk serontonin syndrome/death. The data with selegiline at 10mg or below suggest it is fairly safe (thousands of parkinson's patients get selegiline and an ssri every year), although no guarentees.
>
> I am hoping low dose zoloft and klonopin will offset any anxiety induced by selegilne. Hopefully someone out there has maybe tried this and can give me feedback.
>
> Thanks Ixus! Hope you are well. Please keep
> the post coming!
Hi Smith,
why not to use tranlycypromine + benzo only? Have you tried that combo? I know that tranylcypromine + clonazepam does not work well for me (tranylcypromine seems to potentiate depression induced by clonazepam).
I have a good success with tranylcypromine 30 + clorazepate 20 mg (similar to diazepam). However in order to get rid of benzo I will try phenelzine.
I tried selegiline in a high dose (60 mg). I doubt whether you will see any effect at 10 mg.
Safety is always a concern, I would not go on 1+ serotonergic drugs (though as you noticed 10 mg of selegiline should not have any influence on serotonin).Could you describe your feelings of phenelzine? What was the dose?
/ixus
Posted by Ted_Brossnan on April 8, 2005, at 10:08:43
In reply to Making a better Nardil with Selegiline?, posted by smith562 on April 7, 2005, at 16:27:14
I have tried it. Selegiline was activating and made my anxiety worse. Have not been on it for very log time, not sure if the anxiety gets better. But it was way too anxiogenic at all doses, 5, 10, 15, 25, and 30mg.
The problem with it is that it acts probably as a reuptake inhibitor of dopamine (like wellbuitrin) and it gets metabolized into l-amphetamine and l-methamphetamine.
Posted by KaraS on April 8, 2005, at 22:56:50
In reply to Making a better Nardil with Selegiline?, posted by smith562 on April 7, 2005, at 16:27:14
> Hey Everyone,
>
> I have a history of panic disorder and depression with a family history of BP II. Thus far nardil has provided me the best relief, but the 30lbs weight gain, insomnia and sexual dysfunction were hard to tolerate. I have tried to recreate nardil with zoloft (serotonin), klonopin (GABA), wellbutrin (Norepi/Dopamine) and low dose lithium (augmentor) with some sucess.
>
> Wellbutrin seem to aggreviate my anxiety too much. Was wondering if anyone has tried selegiline .... more specifically seligiline (more dopamine then wellbutrin to help my apathy/social phobia) low dose with an SSRI?
>
> Thanks!!!!!
>
> Sincerely,
>
> Smith
Hi,
I've also been interested in using low dose selegiline (5-10 mg.) along with DLPA plus something to take care of my anxiety. I'd prefer not to get started on long-term benzo usage. I'd rather use an SSRI or low dose of a sedating TCA (am currently on 25 mg. of doxepin) or Remeron in conjunction with the selegiline + DLPA. I know of one Babbler who takes 60 mg. of Remeron along with s + D and does very well on it. I didn't know that many with Parkinsons are treated with low dose selegiline along wtih an SSRI. Now I feel better about trying that combo. (Theoretically I figured it was probably safe but was still just a bit scared of combining them.)K
Posted by smith562 on April 9, 2005, at 7:20:01
In reply to Re: Never parnate with an SSRI » ixus, posted by smith562 on April 8, 2005, at 5:51:58
To Everyone,
I am extremely sorry to everyone following this post. Although I have heard of some patients getting selegiline and an SSRI for Parkinsons, the offical literature is that an SSRI and selegiline are *contraindicated*. Apparently there has been several case reports of serontonin syndrome with the combo of selegiline and SSRI or TCAs.
Once again, I am very sorry for posting misinformation. I am going to speak to more neurologists regarding this matter. I am going ask Dr Bob to consider removing/modifing the post.
Smith
> I know they are both non-hydrazine MAOIs and can be anxiogenic for some ... selegiline does metabolize to amphetamines. The problem with parnate was that I would never add an SSRI and risk serontonin syndrome/death. The data with selegiline at 10mg or below suggest it is fairly safe (thousands of parkinson's patients get selegiline and an ssri every year), although no guarentees.
>
> I am hoping low dose zoloft and klonopin will offset any anxiety induced by selegilne. Hopefully someone out there has maybe tried this and can give me feedback.
>
> Thanks Ixus! Hope you are well. Please keep the post coming!
>
> Smith
>
Posted by smith562 on April 9, 2005, at 7:32:05
In reply to Re: Apologize to everyone *Serontonin Syndrome*, posted by smith562 on April 9, 2005, at 7:20:01
Posted by ed_uk on April 9, 2005, at 12:24:43
In reply to Re: Apologize to everyone *Serontonin Syndrome*, posted by smith562 on April 9, 2005, at 7:20:01
Hi!
>Although I have heard of some patients getting selegiline and an SSRI for Parkinsons, the offical literature is that an SSRI and selegiline are *contraindicated*. Apparently there has been several case reports of serontonin syndrome with the combo of selegiline and SSRI or TCAs.
True, they are 'officially' contra-indicated. There have been reports of *very* serious interactions. Nevertheless, many people have successfully used the combination without problems.
Ed.
Posted by KaraS on April 9, 2005, at 17:51:08
In reply to Re: Apologize to everyone *Serontonin Syndrome*, posted by smith562 on April 9, 2005, at 7:20:01
> To Everyone,
>
> I am extremely sorry to everyone following this post. Although I have heard of some patients getting selegiline and an SSRI for Parkinsons, the offical literature is that an SSRI and selegiline are *contraindicated*. Apparently there has been several case reports of serontonin syndrome with the combo of selegiline and SSRI or TCAs.
>
> Once again, I am very sorry for posting misinformation. I am going to speak to more neurologists regarding this matter. I am going ask Dr Bob to consider removing/modifing the post.
>
> Smith
Yes, they are officially contraindicated but I think the issue is whether that is valid when the dose of selegiline is very low and MAO-B specific.K
Posted by Ted_Brossnan on April 9, 2005, at 18:27:35
In reply to Re: Apologize to everyone *Serontonin Syndrome* » smith562, posted by KaraS on April 9, 2005, at 17:51:08
I have taken in the past Lexapro (Escitalopram - Cipralex) along with 10mg Selegiline, nothing bad happened. In fact in the Cipralex leaflet in Norway, Sweden and Denmark it's mentioned that such a combo is not contraindicated if the selegiline is at 10 mark or less.
So SSRI's and low dose selegiline is fine.
Posted by ed_uk on April 9, 2005, at 19:46:56
In reply to Re: Apologize to everyone *Serontonin Syndrome* » KaraS, posted by Ted_Brossnan on April 9, 2005, at 18:27:35
Hi Teodor!
>So SSRI's and low dose selegiline is fine.
For you, and for most people it's ok.... but some people have suffered life-threatening reactions after taking that combination.
Regards,
Ed.
Posted by KaraS on April 9, 2005, at 22:19:59
In reply to Re: Apologize to everyone *Serontonin Syndrome* » Ted_Brossnan, posted by ed_uk on April 9, 2005, at 19:46:56
> Hi Teodor!
>
> >So SSRI's and low dose selegiline is fine.
>
> For you, and for most people it's ok.... but some people have suffered life-threatening reactions after taking that combination.
>
> Regards,
> Ed.
Thanks, Ted, for your input. I know that there are others out there who have used combos like this successfully.Ed, those who have suffered life-threatening reactions, was it due to poor liver function or not breaking the meds down properly or is the reason just not known?
K
Posted by smith562 on April 10, 2005, at 7:29:00
In reply to Re: *Serontonin Syndrome* - Ted and Ed, posted by KaraS on April 9, 2005, at 22:19:59
Hey Everyone,
I performed a pubmed search (www.ncbi.nlm.nih.gov/entrez/query.fcgi?) on "Serotonin Syndrome Selegiline" and obtained
ten articles. Two articles were case reports concerning an interaction between prozac and selegiline and pamelor and selegiline ... the dose of selegiline were not mentioned. Another article was a chart review which reported 40 incidences of selegiline and an antidepressant were adminstered. One patient who took prozac and selegiline had symtoms consistant with serotonin syndrome. The last article look at 4,568 patients who took the combo ... it stated 11 patient had the reaction and that 2 were "serious" reactions. The authors stated "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 ed_uk on April 10, 2005, at 8:09:07
In reply to Re: *Serontonin Syndrome* - Ted and Ed, posted by KaraS on April 9, 2005, at 22:19:59
Hi Kara,
>Ed, those who have suffered life-threatening reactions, was it due to poor liver function or not breaking the meds down properly or is the reason just not known?
I don't think the reason was known. I can only guess that some people do get significant inhibition of MAO-A at low doses. Due to the differences in drug metabolism between individuals, some people probably get unusually high serum concentrations from 10mg doses.
Ed xx
Posted by KaraS on April 10, 2005, at 17:42:01
In reply to Re: *Serotonin Syndrome* - Ted and Ed and Kara, posted by smith562 on April 10, 2005, at 7:29:00
> Hey Everyone,
>
> I performed a pubmed search (www.ncbi.nlm.nih.gov/entrez/query.fcgi?) on "Serotonin Syndrome Selegiline" and obtained
> ten articles. Two articles were case reports concerning an interaction between prozac and selegiline and pamelor and selegiline ... the dose of selegiline were not mentioned. Another article was a chart review which reported 40 incidences of selegiline and an antidepressant were adminstered. One patient who took prozac and selegiline had symtoms consistant with serotonin syndrome. The last article look at 4,568 patients who took the combo ... it stated 11 patient had the reaction and that 2 were "serious" reactions. The authors stated "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."
Thanks for the info - but without giving us the dosage of selegiline involved, it still leaves us with too many questions.K
Posted by KaraS on April 10, 2005, at 17:59:45
In reply to Re: *Serontonin Syndrome* - Ted and Ed » KaraS, posted by ed_uk on April 10, 2005, at 8:09:07
> Hi Kara,
>
> >Ed, those who have suffered life-threatening reactions, was it due to poor liver function or not breaking the meds down properly or is the reason just not known?
>
> I don't think the reason was known. I can only guess that some people do get significant inhibition of MAO-A at low doses. Due to the differences in drug metabolism between individuals, some people probably get unusually high serum concentrations from 10mg doses.
>
> Ed xx
I hate grey area. I guess it's a risk to try them together but not a huge risk. I wouldn't go above 5 mg. and with only a fairly low level of an SSRI or TCA. (Actually, I bet that trimipramine would probably be the safest as it is considered one of the safest TCAs to combine with other MAOIs.) And then just watch very carefully for signs of serotonin syndrome. Make sense?K
Posted by ed_uk on April 11, 2005, at 9:49:01
In reply to Re: *Serontonin Syndrome* - Ted and Ed » ed_uk, posted by KaraS on April 10, 2005, at 17:59:45
Hi Kara!
>I guess it's a risk to try them together but not a huge risk.
I agree. It would be important to start with a very low dose of selegiline and to increase very gradually, you could break a selegiline tablet into little pieces. If there were any signs of the SS at a low dose you would know not to increase.
I wouldn't recommend taking selegiline with a high dose of........
....any SSRI, Effexor, clomipramine, imipramine or Cymbalta. If at all possible, it would be safest to avoid combining selegiline with any of these drugs.
>And then just watch very carefully for signs of serotonin syndrome. Make sense?
Yes, it would be important to know the symptoms of the SS so that you could identify them quickly and easily. The SS comes in many varieties, it can be mild, moderate, severe or life-threatening.... depending partly on the degree to which serotonin levels have been elevated.
Mild SS-like symptoms are common in people treated with SSRIs alone..... for example: excessive sweating, exaggerated reflexes, tremor, diarrhea, muscle tension, agitation, jaw clenching etc.
If you start with a very low dose of selegiline and increase very gradually, you should be able to spot the symptoms of SS in their mild form- this would tell you not to increase the dose any further.
If you were on an SSRI, Effexor, clomipramine, imipramine or Cymbalta, it would make sense to drastically lower the dose before adding selegiline. You could then cautiously increase the dose again (if necessary) while carefully watching for symptoms.
>Actually, I bet that trimipramine would probably be the safest as it is considered one of the safest TCAs to combine with MAOIs.
Yes, I can't imagine the SS occuring with trimipramine + low-dose of selgiline.
I don't think you're on an SSRI at the moment are you? I thought you were just taking 25mg doxepin and nothing else? Doxepin would probably be a lot safer than an SSRI but you would still need to be very cautious. Serious reactions seem to be very rare but they do occur!
Ed xx
Posted by KaraS on April 11, 2005, at 22:43:46
In reply to Serotonin syndrome » KaraS, posted by ed_uk on April 11, 2005, at 9:49:01
Thanks Ed. I'm only on the doxepin right now but I was thinking that I might be on an SSRI in the future.
K
This is the end of the thread.
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