![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Judy on May 2, 2000, at 15:12:22
This is my second attempt at this message. The first disappeared in the registration process.
First some background: I'm MAOI responder – specifically Nardil. It completely banishes my depression/anxiety/anhedonia. Unfortunately the side effects (severe edema, for one) make it impossible for me to take it anymore. I also responded relatively well to Marplan but the side effects were even more pronounced.
I was switched to oral Selegeline, which had no side effects whatsoever; but it was only slightly beneficial in the beginning. By the time I had titrated up to 60 mg per day, I was as depressed as ever. My doctor wouldn’t increase the dosage further or augment because he was uncomfortable with Selegeline’s lack of track record as an AD at high doses.
I washed out Selegeline for two weeks and started Parnate at 10 mg a day. By the second day, I was in hypomanic heaven! That lasted for two weeks and pooped out, and I began titrating up by 10 mg every couple of weeks, with relative few side effects, until I got to 60 mg/day, where I am now. Never, since that first two-week period, has Parnate touched my anhedonia again.
My point (finally!). I’ve taken MAOI’s at least a half dozen times in the past, and each time I quit, I experience almost exactly four-weeks of lingering benefits afterwards. It just seems too coincidental to me that I felt so great for the first two weeks on Parnate. Is it possible that I was reacting to the combination of Parnate and the small amount of Selegeline remaining in my system? I meekly posed this question to my doctor and he pooh-poohed it, saying my brain had been robbed of Selegeline and it pounced on Parnate as soon as it was introduced. (Excuse the layman’s language – he was a bit more technical than that.) That seems too much of a coincidence to me – two weeks of goodness, then nothing?
Now I’m obsessed by the fact that I might have a side-effect-free cure for my depression sitting right in my medicine cabinet. My question is: What would be the risks of my trying a small amount (5 – 10 mg) of Selegeline with Parnate? (Besides my doctor throwing me out on my keester for self-medicating and never seeing me again?). It even seems to me I might be able to get away with a much lower daily dose of Parnate if my theory is correct.
I realize I’m asking a 'taboo' question here but I’m a bit desperate. In the past 16 years, I’ve run the gamut of AD’s and nothing works for me but MAOI’s. I'd appreciate any comments except "What are you, crazy?!?"
Judy
Posted by Adam on May 3, 2000, at 0:28:23
In reply to Parnate+Selegeline Temptation, posted by Judy on May 2, 2000, at 15:12:22
Hey, Judy,
The conventional wisdom is that such a strategy is HIGHLY contraindicated. In rare cases, people have had extremely bad reactions to combinations of MAOIs.
There have also been reports, in rare cases, of people having adverse reactions to combinations of low-dose selegiline and SSRIs. A review of these reports I read concluded that few if any of these were actual cases of serotonin syndrome, but that caution was still warranted.
Still further have been reports of hypertensive episodes on the normal 5mg b.i.d. regimen of selegiline plus either tyramine-rich foods or sympathomimetic drugs. Again, though rare, Somerset Pharmaceuticals have revised their literature to advise avoiding such combinations while on selegiline.
My personal, very non-MD oppinion is that low dose selegiline, in the 10mg/day range is already high enough to cause some inhibition of MAO-A, and in some individuals, this inhibition may be significant. Some papers have been published showing that complete inhibition of MAO-B can be achieved with doses as small as 2.5 mg b.i.d., and that 10mg/day is more than necessary to achieve therapeutic levels for Parkinson's disease.
Again, in my very, very unprofessional oppinion, doses of selegiline that are truly MAO-B specific (below 10mg/day, in all likelihood) should be relatively safe in combination with antidepressants, including non-selective MAOIs. However, I doubt very much any physician will feel comfortable risking such a combo., and to be good patients, we should listen to them, as frustrating as it is. I think your doctor may be right about at least one thing, though: It's not the combination that made you feel well. Selegiline, taken orally, has a half life of something like 6-8 hours. If you waited two weeks before starting Parnate, there would be negligible amounts of selegiline left in your system. Also, MAO levels would have returned to nearly baseline in the mean time. Even the amphetamine and methamphetamine metabolites,which have longer half-lives, would be essentially gone. In my experience, I have also had periods of uncanny euthymia during and immediately following a taper from an antidepressant I found not worth the side-effects. This was especially true of Remeron (mirtazapine). Here's my theory: The drug is having an effect on your mood, though not a robust one. However, it's hard to focus on that when side effects are making you feel so badly. As the side effects disappear, upon tapering off of a medication, you feel some of the mood elevating effects without feeling the adverse ones, not to mention a sense of relief at being drug-free for a change. Unfortunately, it doesn't last; relapse inevitably occurs. That may, in a loose sense, be what's up with you and Nardil/Marplan.
Now, you didn't have bad side-effects with selegiline, but you did feel euphoric shortly after taking Parnate. I have another theory: Parnate and selegiline have many similarities in chemical structure. The former is essentially amphetamine with a modified side chain, and the latter is metabolized into amphetamines. Both thus have some stimulant properties, as well as some other effects on the sympathetic nervous system. Parnate is actually one of the few antidepressants with abuse potential, in all likelihood because it's a stimulant. People who stop taking stimulants after prolonged use can and usually do get depressed, and, as expected, they perk right up again with the next fix, as long as that vicious cycle can last. You may have experienced something roughtly similar, and as soon as you were tolerized to the stimulant effects, Parnate's deficits as an antidepressant were soon recognized.
There might be some solutions to this problem. One would be to augment Parnate with lithium. Lithium, as well as Nardil and Marplan, have the ability (among other things) to potentiate the action of GABA (through a variety of complex, not always well-understood mechanisms), a property selegiline and Parnate certainly do not have. I think whatever "GABAnergic" effects the hydrazine MAOIs and lithium have, it defenitely benefits some people with depression, as well as some other problems related to anxiety. In a very crude sense, lithium might both augment and mitigate beneficially Parnate's action. There are, however, side effects with lithium augmentation to be reckoned with, too. It may still be worth a try, though.
You might also, since you seem to have responed so well mood-wise to initial treatment with Parnate, benefit from augmentation with a stimulant like dextroamphetamine or methylphenidate. This seems paradoxical to me, somehow, given your good response to Nardil and Marplan, though. I call this impression an "intuition", which, having no clinical expertise whatsoever, probably isn't worth much, though.
At any rate, given your good response to some MAOIs in the past, there's hope for Parnate still, either at higher doses, or augmented with something. It appears lithium is particularly good for some at giving Parnate the kick in the pants it needs to be effective. I seem to remember Elizabeth mentioning that she did well for a while on Nardil, but it pooped out, and then, after a lackluster initial response to Parnate, had a very robust response to the addition of lithium (perhaps she might comment, and/or correct me on things I have said above). You fit the first part of this picture. Perhaps you will fit the second.
Hope this is helpful.
> This is my second attempt at this message. The first disappeared in the registration process.
>
> First some background: I'm MAOI responder – specifically Nardil. It completely banishes my depression/anxiety/anhedonia. Unfortunately the side effects (severe edema, for one) make it impossible for me to take it anymore. I also responded relatively well to Marplan but the side effects were even more pronounced.
>
> I was switched to oral Selegeline, which had no side effects whatsoever; but it was only slightly beneficial in the beginning. By the time I had titrated up to 60 mg per day, I was as depressed as ever. My doctor wouldn’t increase the dosage further or augment because he was uncomfortable with Selegeline’s lack of track record as an AD at high doses.
>
> I washed out Selegeline for two weeks and started Parnate at 10 mg a day. By the second day, I was in hypomanic heaven! That lasted for two weeks and pooped out, and I began titrating up by 10 mg every couple of weeks, with relative few side effects, until I got to 60 mg/day, where I am now. Never, since that first two-week period, has Parnate touched my anhedonia again.
>
> My point (finally!). I’ve taken MAOI’s at least a half dozen times in the past, and each time I quit, I experience almost exactly four-weeks of lingering benefits afterwards. It just seems too coincidental to me that I felt so great for the first two weeks on Parnate. Is it possible that I was reacting to the combination of Parnate and the small amount of Selegeline remaining in my system? I meekly posed this question to my doctor and he pooh-poohed it, saying my brain had been robbed of Selegeline and it pounced on Parnate as soon as it was introduced. (Excuse the layman’s language – he was a bit more technical than that.) That seems too much of a coincidence to me – two weeks of goodness, then nothing?
>
> Now I’m obsessed by the fact that I might have a side-effect-free cure for my depression sitting right in my medicine cabinet. My question is: What would be the risks of my trying a small amount (5 – 10 mg) of Selegeline with Parnate? (Besides my doctor throwing me out on my keester for self-medicating and never seeing me again?). It even seems to me I might be able to get away with a much lower daily dose of Parnate if my theory is correct.
>
> I realize I’m asking a 'taboo' question here but I’m a bit desperate. In the past 16 years, I’ve run the gamut of AD’s and nothing works for me but MAOI’s. I'd appreciate any comments except "What are you, crazy?!?"
>
> Judy
Posted by Ant-Rock on May 3, 2000, at 7:36:37
In reply to Parnate+Selegeline Temptation, posted by Judy on May 2, 2000, at 15:12:22
Hi Judy,
I do know of a doctor in the Georgia area who treats many refractory patients successfully with the parnate/deprenyl combo. A woman I corresponded with did very well on 40mg Parnate, 30mg Deprenyl. I believe there was even a study being done using these meds, but this was going back a few years. The Dr. I spoke of is part of a research oriented program who treats many patients with new and non-traditional protocals.
Please do not discount the info in Adams post, as he is certainly more knowledgable regarding meds than myself.
I just thought I'd let you (or anyone) know that this combo is, though probably rarely, being used.
One question Judy,I think you mentioned Nardil being better for your anhedonia than Parnate. Could you please elaborate on the benefits of nardil vs parnate that you experienced. I had a good energizing effect from parnate, but it didn't improve my anhedonia, which has really been a problem for me. Maybe nardil would work better? I didn't realize these two drugs could have different AD properties.
Thanks Judy,Anthony
Posted by Adam on May 3, 2000, at 10:39:22
In reply to Re: Parnate+Another Opinion, posted by Ant-Rock on May 3, 2000, at 7:36:37
Ant,
Wow, that's news to me. I have, in the past, wondered about low-dose selegiline/tranylcypromine combinations, but 30mg is hardly a low dose of selegiline. Do you have the name of this doctor? I'm very curious to read about his methods, if there is anything to read.
At any rate, serious adverse reactions to MAOI combinations are, as they say, rare. However, if my memory serves me, when there is an adverse reaction, it can be anywhere from unpleasant to fatal.
I'm also suprised at the idea of a selegiline/tranylcypromine combo at non-specific doses for simple conceptual reasons, and wonder what the rationale is.
I still think Judy's experiences are unlikely to be related to a therapeutic combination of selegiline and Parnate. Again, as I said, if she waited two weeks after stopping selegiline to start Parnate, there should have been essentially no selegiline in her system, and MAO levels should have been approaching normal.
Judy, just as an aside, I don't want to, with my discussion of lithium and its effects on the GABA system, minimize the primary rationale for lithium augmentation of antidepressants, which is the potentiation of serotonergic neurotransmission (though, for instance, the effects of lithium on second messenger systems involved in some serotonin signalling puts an interesting spin on this). The Parnate lithium combo. seems to be especially common, though lithium and Nardil are certainly also used successfully, and this is presumed to be a serotonin-related effect. What I find intriguing about the lithium/Parnate combo. is that, while lithium seems to mediate positive GABAergic effects, GABAergic effects can be antagonized by dopamine, and of particular interest is the dopamine D2 receptor in this feedback system. It is worth noting that Parnate is thought to have strong effects on D2. These two drugs have an intriguing pas de deux.
> Hi Judy,
> I do know of a doctor in the Georgia area who treats many refractory patients successfully with the parnate/deprenyl combo. A woman I corresponded with did very well on 40mg Parnate, 30mg Deprenyl. I believe there was even a study being done using these meds, but this was going back a few years. The Dr. I spoke of is part of a research oriented program who treats many patients with new and non-traditional protocals.
> Please do not discount the info in Adams post, as he is certainly more knowledgable regarding meds than myself.
> I just thought I'd let you (or anyone) know that this combo is, though probably rarely, being used.
> One question Judy,I think you mentioned Nardil being better for your anhedonia than Parnate. Could you please elaborate on the benefits of nardil vs parnate that you experienced. I had a good energizing effect from parnate, but it didn't improve my anhedonia, which has really been a problem for me. Maybe nardil would work better? I didn't realize these two drugs could have different AD properties.
> Thanks Judy,
>
> Anthony
Posted by AntRock on May 3, 2000, at 16:04:59
In reply to Re: Parnate+Another Opinion, posted by Adam on May 3, 2000, at 10:39:22
> Ant,
>
> Wow, that's news to me. I have, in the past, wondered about low-dose selegiline/tranylcypromine combinations, but 30mg is hardly a low dose of selegiline. Do you have the name of this doctor? I'm very curious to read about his methods, if there is anything to read.
>
> At any rate, serious adverse reactions to MAOI combinations are, as they say, rare. However, if my memory serves me, when there is an adverse reaction, it can be anywhere from unpleasant to fatal.
>
> I'm also suprised at the idea of a selegiline/tranylcypromine combo at non-specific doses for simple conceptual reasons, and wonder what the rationale is.
>
> I still think Judy's experiences are unlikely to be related to a therapeutic combination of selegiline and Parnate. Again, as I said, if she waited two weeks after stopping selegiline to start Parnate, there should have been essentially no selegiline in her system, and MAO levels should have been approaching normal.
>
> Judy, just as an aside, I don't want to, with my discussion of lithium and its effects on the GABA system, minimize the primary rationale for lithium augmentation of antidepressants, which is the potentiation of serotonergic neurotransmission (though, for instance, the effects of lithium on second messenger systems involved in some serotonin signalling puts an interesting spin on this). The Parnate lithium combo. seems to be especially common, though lithium and Nardil are certainly also used successfully, and this is presumed to be a serotonin-related effect. What I find intriguing about the lithium/Parnate combo. is that, while lithium seems to mediate positive GABAergic effects, GABAergic effects can be antagonized by dopamine, and of particular interest is the dopamine D2 receptor in this feedback system. It is worth noting that Parnate is thought to have strong effects on D2. These two drugs have an intriguing pas de deux.
>
>
Hi Adam,
The Dr.s name is Dr. James Mcknight. I don't know if he as any articles published, but he is out of Georgia. The woman I corresponded with was a patient of his, and she wanted to try deprenyl after reading about the patch trials. She wanted to get off the parnate because of weight gain, but was hesitant because it worked really well for her. So she slowly added deprenyl(oral) to the parnate and had very good success with the combo. She eventually wanted to get off the parnate altogether and just try the deprenyl alone, but I'm not sure she ever did. Anyway her Dr. used this combo with several of his other refractive patients with good results.
I still have the Dr.s phone # if you would like it, just let me know.
Are you still on the parnate Adam?, how is it working? As good as the patch?
I was on & off parnate a couple of times in the last few years. Helped with energy/cognition, but not anhedonia.(Would Lithium help?) I never had problems w/food reactions, and I tested a few of them(cautiosly). I think to much is made out of the whole tyramine diet. It is very easy to abide by the few definite restrictions one needs to follow.
Anyway, I always enjoy reading your posts, even if some parts are over my head.
Take Care,Anthony
Posted by SLS on May 3, 2000, at 16:19:48
In reply to Re: Parnate+Another Opinion, posted by Ant-Rock on May 3, 2000, at 7:36:37
> Hi Judy,
> I do know of a doctor in the Georgia area who treats many refractory patients successfully with the parnate/deprenyl combo. A woman I corresponded with did very well on 40mg Parnate, 30mg Deprenyl. I believe there was even a study being done using these meds, but this was going back a few years. The Dr. I spoke of is part of a research oriented program who treats many patients with new and non-traditional protocals.Thanks for the info.
Would it be inappropriate for you to mention this doctor's name or the research program he is affiliated with? I would be interested in this sort of treatment alternative.
> One question Judy,I think you mentioned Nardil being better for your anhedonia than Parnate.
This has also been my experience.
> Could you please elaborate on the benefits of nardil vs parnate that you experienced. I had a good energizing effect from parnate, but it didn't improve my anhedonia, which has really been a problem for me. Maybe nardil would work better? I didn't realize these two drugs could have different AD properties.
Nardil seems to be used more often than Parnate for anxiety disorders, social phobia, and OCD. Parnate is usually preferred to Nardil for bipolar depression. There are differences, but no hard rules.
- Scott
Posted by Rick on May 3, 2000, at 19:19:50
In reply to Re: Parnate+Another Opinion, posted by SLS on May 3, 2000, at 16:19:48
During the four days I was weaning off of Nardil, my pdoc started me on 5 mg Selegiline. He said patients are "really not supposed to" take them concurrently, but that it should be OK.
Well, the first morning I took Selegiline with the Nardil, I happened to check my blood pressure about 45 mins later, and it was 210/120! I felt just fine, although there was a strange cold sensation on my crown. 30 minutes later I was down to 140/90, and after another 30 minutes I was at 90/50. (One of the reasons I stopped Nardil is that it converted me from mildly hypertensive to hypotensive!).
I thought this must be a fluke, but the next morning was a replay of what happened the day before. I cut off the Nardil immeiately at that point, with no problems.
My pdoc, who has been an MAOI proponent for over twenty years, said he had never heard of such a thing. Maybe this WAS a rare reaction, but I thought I should share it with you.
Rick
Posted by Judy on May 3, 2000, at 20:49:24
In reply to Re: Parnate+Selegeline Temptation, posted by Adam on May 3, 2000, at 0:28:23
Hey Adam
Thanks for coming our of lurkdom to respond. And thanks for not completely burstng my bubble. I realize how highly contraindicated combining two MAOI's is. After two readings of your message, I'm still not sure I'm ready to ignore my gut feeling that I'm on to something here, particularly after reading Anthony's message.
Let me try to explain a bit more. I've many times experienced that 'honeymoon' that occurs with the lessening of side effects while the AD effect is still in place when you quit a drug. But it usually lasts for a day or so when you say to yourself, "Geez, maybe I made a mistake, I feel pretty good on this stuff." What I felt for at least two weeks was exactly what you wrote about when you started the patch. That galloping joy that you can't really harness but it's wonderful anyway. You don't sleep, but you don't need it; you'll talk about anything at a million miles an hour to anyone, even strangers in the street. That lasted a day or two and then I settled into a blissful state of focus, motivation and energy that enabled me to paint my 13' high kitchen ceiling and then feel pleasure and accomplishment when it was done. (Just like I would have felt on Nardil, might I add). This was NOT lessening of side effects - I didn't have any with Selegiline!
You mentioned the similarities in structure of Parnate and Selegiline. At low doses of both, wouldn't that tend to work in my favor? What exactly might be the physical risks in combining the two? Hypertension? I had notable postural hypertension with Nadil, but not with these two; however, that's not to say that combining them wouldn't cause it. If they are stimulants, it wasn't obvious physically - in fact Parnate tends to make me 'nod' unless I space out the dosage correctly; again, who knows about combining the two? What else? I keep thinking of all the elderly Parkinson's patients who take Selegiline and imagine all the other medication they're probably pumping into themselves...
I have taken lithium alone before. It was a horrendous experience - made me suicidally sedated; but I did consider trying it with Parnate (perhaps I had that in mind from one of Elizabeth's old threads) before I got this bee in my bonnet.
Right now 60 mg of Parnate is allowing me to cope but I'm so, so tired of the anhedonia. I have two daughters graduating this year and I would love to stand there and cry tears of joy and feel their accomplishments at the ceremonies. I know I'll cry - but it won't be the same. In fact, I'll make a deal with you - if you'll call the doctor Anthony mentioned and he even touches on the positive, I'll gladly be the guinea pig!
Judy
Posted by Judy on May 3, 2000, at 21:37:39
In reply to Re: Parnate+Another Opinion, posted by Ant-Rock on May 3, 2000, at 7:36:37
Anthony
Thanks so much for that info. If you read my message to Adam, you'll see I've offered to be the guinea pig if he'll call the doctor you mentioned and talk the psychopharm-speak that I can't.
As for the differences between Nardil and Parnate, they are to me (YMMV of course) two completely different drugs. Nardil had many more side effects - edema, bigtime difficulty at urinating, constipation and out-of-control weight gain. Parnate doesn't cause any of those, although it has increased my appetite and cravings and I've gained weight because I keep cramming food, particularly chocolate, in my mouth!
Both drugs cause me restless sleep (I take Xanax at bedtime only so I can fall asleep. Both drugs cause almost immediate inorgasmia.
If you can deal with any or all of the above, I can't recommend Nardil highly enough for your anhedonia. It works quickly - within the first week I feel it kicking in; and upon reaching 45 mg/day, I felt better than I've ever felt in my life (mentally - physically it was awful enough to have to give it up). I felt great all the time. I couldn't wait to get up in the morning and accomplish something. Nothing bothered me. It was wonderful - that's why I can't let this Parnate/Selegiline thing go without looking into it.
Parnate is totally different for me. Once Nardil was in my system, I remained stable all the time. Parnate seems to let me know when it's time for my next dose. Reminds me of Xanax or Ritalin with a quick in/quick out effect. If I don't take my noon dose, I find myself becoming very tired and cranky - and as soon as I take the Parnate, I'm relatively normal again. But the anhedonia is always there - always. At least at 60 mg/day. What was your dose?
Again, I can't imagine Nardil not working for your anhedonia if your depression responded to Parnate. Like I said - there are a couple of concessions you might have to make - like having a waistline and a sexlife - but it might be worth a try. Some people don't have those side effects at all.
If I didn't touch on something, let me know; and thanks for your information.
Judy
Posted by Judy on May 3, 2000, at 22:06:55
In reply to Re: Parnate+Selegilne: WARNING!, posted by Rick on May 3, 2000, at 19:19:50
Whoa Rick! That sounds uncomfortably familiar to me. I was having trouble with Parnate dosages because I'd get dangerously tired in the afternoon when I had to make a 50-mile commute home.
My doctor recommended that I try taking two pills in the morning and four in the late afternoon hoping the sleepiness would hold off until bedtime. The first afternoon, I took four and then drove home without problem. Just as I got home (about an hour later) I got the creepiest cold crawly feeling in my scalp. It lasted for a long time. My first fear was an allergic reaction - I never even gave BP a thought. I waited a day and tried the four at a time again. Same thing. I ended up going back to two, two and two and I've not had any problems.
Thanks Rick, for that valuable information. What did you do when you found your BP at 90/50 by the way, just wait it out? Did you have any other symptoms besides the cold creepy crown?
Judy
> During the four days I was weaning off of Nardil, my pdoc started me on 5 mg Selegiline. He said patients are "really not supposed to" take them concurrently, but that it should be OK.
>
> Well, the first morning I took Selegiline with the Nardil, I happened to check my blood pressure about 45 mins later, and it was 210/120! I felt just fine, although there was a strange cold sensation on my crown. 30 minutes later I was down to 140/90, and after another 30 minutes I was at 90/50. (One of the reasons I stopped Nardil is that it converted me from mildly hypertensive to hypotensive!).
>
> I thought this must be a fluke, but the next morning was a replay of what happened the day before. I cut off the Nardil immeiately at that point, with no problems.
>
> My pdoc, who has been an MAOI proponent for over twenty years, said he had never heard of such a thing. Maybe this WAS a rare reaction, but I thought I should share it with you.
>
> Rick
Posted by Rick on May 3, 2000, at 23:00:07
In reply to Re: Parnate+Selegilne: WARNING!, posted by Judy on May 3, 2000, at 22:06:55
Judy -
I just waited it out. Hypotension is not dangerous if it's not extreme. But it did make me feel kind of weak and tired, similar to what you described. Other than that and the creepy cold crown (which sounds like it may have been shorter-lived and less bothersome than yours), I had no symptoms from the low BP. What was really more alarming and potentially damaging were those severely high readings when the Nardil and Selegiline were combined, but fortunately they went down rapidly.
There must have been many times when my BP was briefly way too low on Nardil, because I had fleeting blackouts and fell down about six or seven times. And this WASN'T always orthostatic (i.e., just after standing up); once I just suddenly blacked out momentarily and fell to the floor in the busy restroom at my client's office.
By the way, I also felt a gentle, productive and confidence-building euphoria in weeks two and three of Nardil, but then it pooped out and gave me nothing but side effects. There was one day during that "good" two week period that really ended up worrying me, however: For 24 hours, it felt like I was in a dream and could not get out. Even though I didn't have an ounce of social phobia (my reason for trying Nardil) or cognitive impairment during those 24 hours, I was starting to wonder if I'd ever get back into the real world! Since I've never used "street" drugs, I don't know whether that was similar to the kind of high some of them can give.
Rick
Posted by Adam on May 5, 2000, at 0:46:46
In reply to Re: Parnate+Selegeline - Adam, posted by Judy on May 3, 2000, at 20:49:24
>
> You mentioned the similarities in structure of Parnate and Selegiline. At low doses of both, wouldn't that tend to work in my favor?Not necessarily. Augmentation strategies usually try to exploit differences in drug action to yield a beneficial effect from the combination. Of course, Parnate and Selegiline are not the same, just similar in some ways. But inhibition of MAO-B on 60mg of Parnate should be fairly complete. I don't think adding a very low dose of selegiline would enhance that effect much, but if it did, it probably wouldn't be dangerous. However, selegiline and Parnate do all kinds of things besides inhibit MAO. There could be benefits, and risks. Again, I'm not saying such an augmentation strategy couln't work. The truth is, I have no idea. What I'm saying is it seems highly unlikely that selegiline contributed to your experience when initiating Parnate, for the simple fact that there was essentially no selegiline in your system when you began Parnate.
>What exactly might be the physical risks in combining the two? Hypertension? I had notable postural hypertension with Nadil...
Hypertension could be a risk, as well as serotonin syndrome. One thing to ask: What enzymes are responsible for metabolizing Parnate and selegiline? If both are substrates of, say, the same member of the cytochrome P450 family, then the effective dose of one or the other could be dramatically increased. That could be quite dangerous.
Conversely, hypotension (I assume you meant postural or orthostatic HYPOtension above) could also be a risk. This seems to be a fairly common side effect of selegiline at low doses, and it can also be a side effect of other MAOIs, as you know from your experience. In fact, dangerous hypotension has been implicated as a possible explanation for a disturbing phenomenon: in some clinical surveys, it was noted that mortality _increased_ on average for people taking selegiline+levodopa vs. levodopa alone, quite the opposite effect one would hope for. How reliable this observation is, I don't know, but it's something to think about. Especially for the elderly, severe hypotension can be deadly, and it certainly can lead to fainting spells and accidents for anyone.
>
> I have taken lithium alone before. It was a horrendous experience - made me suicidally sedated; but I did consider trying it with Parnate (perhaps I had that in mind from one of Elizabeth's old threads) before I got this bee in my bonnet.
>I wish she were around so she could advise you. She's way more up on this stuff than I am. I believe lithium, when used to augment an antidepressant, is administered at lower doses than one would if, say, they were using it to treat bipolar illness. However, I don't know what dose you were taking, so it's hard then to say if it would be a good thing for you or not.
>
>I'll make a deal with you - if you'll call the doctor Anthony mentioned and he even touches on the positive, I'll gladly be the guinea pig!
>I feel like a bit of a hypocrite, since I have cast aspersions at pdocs before for sometimes behaving like everything the PDR says is
holy writ. However, what Ant described actually made me squirm. Maybe only 1 in 50,000 people would die if you gave them Prozac and Parnate together, but I wouldn't want to try it, and I suspect the odds are worse. I am taking 30mg/day of selegiline right now alone, and have already had one hypertensive episode: I goofed up and ate some bad chicken. Put my b.p. through the roof (UNpleasant). That means inhibition of MAO-A is near complete, or high enough to worry about, at any rate. ANY dose of Parnate worth taking plus 30mg/day selegiline sounds dangerous to me. I wouldn't mess with something like this unless I had no other options. 5mg/day is one thing, but 30mg/day is just out there, IMO.
This is the end of the thread.
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