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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Mr. Scott on March 12, 2001, at 9:51:31
I have been taking Zoloft for 4 years now, and for some reason over time I have developed MORE side effects as time has passed. I had to reduce initial dosage from 100mg to 75mg and then to 50mg because of severe muscle pain that my doc thought was an extrapyramidal side effect like the side effects people often get from Antipsychotics. So he convinced me to come off of it and try selegeline which I am about to do. I am scared though.. because I know at doses where selegiline (eldepryl) doesn't require dietary restrictions (MAOI) (10mg and below) it will not reach serotonin which I FEEL is Important. For 12 years now I have been suffering from a cluster of chronic anxiety, and dysthymia or Atypical depression. I am crawling out of my skin with irritability with out the Zoloft in me. I have used most of the benzo's and SSRI's which seem although far from perfect my best bet. I am scared of this selegiline stuff (an MAOI)..
Does anyone have any advice for me either having used selegiline or having a set of symptoms similar to what I described above. My doc seems "gung ho" on MAO inhibitors, and I don't want to offend him by suggesting something else perhaps a little less drastic..But then perhaps drastic is a relative term given how "drastic" I feel right now..Thanks for any response.. Scott
Posted by Chaston on March 12, 2001, at 11:06:50
In reply to Much needed advice.., posted by Mr. Scott on March 12, 2001, at 9:51:31
In my limited experience, the MAOI dietary restrictions are not that bad, and MAOIs can work wonders for **some** people, even those who don't respond that well to SSRIs or other ADs. They are very different from SSRI's, but the effects of all these ADs are not as simple as needing more seretonin, vs. more of another neurotransmitter, (if only it were!). My experience, however, was that I felt great but got very seriously manic on an MAOI. Apparently, this is uncommon, but it does happen, so you need to be regularly monitored while you are taking any psychotropic drug. It goes to show that what works well for one person, works ill for another.
For you, an MAOI might be the perfect answer. So, if you have people around who can monitor its effects, and good communication with your P-doc, you might indeed find that it provides a great deal of relief for you, and is well worth the minor dietery restrictions. (I'm not a trained professional, though--just my opinion).
Good luck ...> I have been taking Zoloft for 4 years now, and for some reason over time I have developed MORE side effects as time has passed. I had to reduce initial dosage from 100mg to 75mg and then to 50mg because of severe muscle pain that my doc thought was an extrapyramidal side effect like the side effects people often get from Antipsychotics. So he convinced me to come off of it and try selegeline which I am about to do. I am scared though.. because I know at doses where selegiline (eldepryl) doesn't require dietary restrictions (MAOI) (10mg and below) it will not reach serotonin which I FEEL is Important. For 12 years now I have been suffering from a cluster of chronic anxiety, and dysthymia or Atypical depression. I am crawling out of my skin with irritability with out the Zoloft in me. I have used most of the benzo's and SSRI's which seem although far from perfect my best bet. I am scared of this selegiline stuff (an MAOI)..
> Does anyone have any advice for me either having used selegiline or having a set of symptoms similar to what I described above. My doc seems "gung ho" on MAO inhibitors, and I don't want to offend him by suggesting something else perhaps a little less drastic..But then perhaps drastic is a relative term given how "drastic" I feel right now..
>
> Thanks for any response.. Scott
Posted by jb on March 13, 2001, at 21:52:28
In reply to Much needed advice.., posted by Mr. Scott on March 12, 2001, at 9:51:31
Hi, Scott. I have pretty severe social phobia - making presentations in front of groups, that kind of stuff. The first meds I was prescribed were Nardil and Klonopin. This was 8 years ago: before everyone had the Internet. I was totally uninformed about what it was and what it did. Nardil worked wonders for my social phobia. It's also a powerful anti-depressant. It does tend to cause sexual dysfunction. Parnate, on the other hand, is also a non-selective MAOI (that is, it non-selectively inhibits both types fo MAO, A and B). However, it is a non-hydrazine MAOI, and Nardil is a hydrazine MAOI. They have different levels of efficacy and different side effect profiles. Parnate is more stimulating and has less of an effect on sexual function.
Selegiline, on the other hand, is mostly used at 10-15 mg/day, where it remains selective for MAO-B, thereby mostly affecting dopamine. I'm not aware of many studies of its efficacy for depression at higher dosages. I did take it at 60 mg/day, perhaps for too short of a time period, hoping it would have an effect similar to Nardil, but without Nardil's side effects. I didn't get that, but, again, perhaps my trial was too short.
Also, I wouldn't be worried about any dietary restrictions, etc. Selegiline at 15 mg/day had few, if any, I believe. While I was and continue to be on Nardil, 60 mg/day, I rarely follow the dietary restrictions. I only stay away from red wine, which causes me a slight headache. I eat pizza like crazy and drink regular or lite beer. No dark beer. I also use blue cheese dressing, etc.
Good Luck.
John B
Posted by JohnL on March 14, 2001, at 4:20:45
In reply to Much needed advice.., posted by Mr. Scott on March 12, 2001, at 9:51:31
> I have been taking Zoloft for 4 years now, and for some reason over time I have developed MORE side effects as time has passed. I had to reduce initial dosage from 100mg to 75mg and then to 50mg because of severe muscle pain that my doc thought was an extrapyramidal side effect like the side effects people often get from Antipsychotics. So he convinced me to come off of it and try selegeline which I am about to do. I am scared though.. because I know at doses where selegiline (eldepryl) doesn't require dietary restrictions (MAOI) (10mg and below) it will not reach serotonin which I FEEL is Important. For 12 years now I have been suffering from a cluster of chronic anxiety, and dysthymia or Atypical depression. I am crawling out of my skin with irritability with out the Zoloft in me. I have used most of the benzo's and SSRI's which seem although far from perfect my best bet. I am scared of this selegiline stuff (an MAOI)..
> Does anyone have any advice for me either having used selegiline or having a set of symptoms similar to what I described above. My doc seems "gung ho" on MAO inhibitors, and I don't want to offend him by suggesting something else perhaps a little less drastic..But then perhaps drastic is a relative term given how "drastic" I feel right now..
>
> Thanks for any response.. ScottScott,
With anxiety as a component of your symtoms, I think Selegiline is the wrong way to go. Selegiline is going to increase dopamine, which is not likely to help with anxiety at all. If anything, it is likely to worsen it. Of course, anything's possible and we are all different, but I have never heard of anxiety being treated with Selegiline. That's a stretch, as I see it. There are other drugs with better track records that would increase your odds of success.Again it is just my opinion, but I think your best bet will be in the antipsychotic category, with a little bit of an SSRI in the background. There is a ton of clinical research that supports this opinion, but not much evidence supporting Selegiline for your symptoms. Your doc might be gung ho on MAOIs, but if he were for example to take a look at all the clinical data on Zyprexa, he might realize treatment is available with higher odds for success and few side effects.
I am just absolutely sold on the antipsychotic category. Those meds are far superior to other categories as I see it. I have seen so many people with resistant depression, long standing dysthymia, untreatable anxiety, etc, get magical results with antipsychotics. As respected as they are, I think drugs like Zyprexa, Risperdal, or Amisulpride are highly under-rated. I think a lot of suffering could be avoided if doctors turned to these meds sooner in treatment. Obviously SSRIs are the place to start. But if results are less than desired, I feel going straight to the antipsychotic category is the best move with the highest odds for success.
In your case I could envision one of two paths to take:
1) Get back on Zoloft for a week, introduce Zyprexa into the mix, give the combination about two weeks to see what happens. You may find Zyprexa abolishes the side effects of Zoloft and cures your symptoms simultaneously. That would not surprise me. If for any reason Zyprexa turns out to be a bad choice, then try Risperdal and Amisulpride instead.
2) Choose two or three other SSRIs and try them each for about two weeks, back to back, with a one day washout inbetween. The purpose is to discover which in the group is a favorite. You want to be sure you are on the best one for you. The best one will make itself known in a two week period, either by lack of side effects and/or fairly good rapid response. Not a complete response, but enough to prove you are on the right track. Once the superior match in the group has been identified, then add to it Zyprexa, Risperdal, and Amisulpride each for about two to four weeks.No matter what you do, it looks like there will be a few months of agony, trial, and error to test out some new treatments. However, by using the above methods, you can cut do it in an organized manner with the odds stacked in your favor, and do it in less time. I hope something here is helpful to you.
When I think about drug choices in the psychiatry world, it really is like throwing the dice. You just never know what will end up working. But there are some things that seem to have more of a chance of working than others. Higher odds of success. More success stories. So when I throw the dice, I want to throw the ones that win more often than the others. With that in mind I suggest antipsychotic+SSRI combo to treat anxiety and dysthymia simultaneously with excellent results. I would not even consider the MAOI category until these other options had been totally exhausted first.
John
Posted by Mr. Scott on March 14, 2001, at 13:54:58
In reply to Re: Much needed advice.., posted by JohnL on March 14, 2001, at 4:20:45
> > I have been taking Zoloft for 4 years now, and for some reason over time I have developed MORE side effects as time has passed. I had to reduce initial dosage from 100mg to 75mg and then to 50mg because of severe muscle pain that my doc thought was an extrapyramidal side effect like the side effects people often get from Antipsychotics. So he convinced me to come off of it and try selegeline which I am about to do. I am scared though.. because I know at doses where selegiline (eldepryl) doesn't require dietary restrictions (MAOI) (10mg and below) it will not reach serotonin which I FEEL is Important. For 12 years now I have been suffering from a cluster of chronic anxiety, and dysthymia or Atypical depression. I am crawling out of my skin with irritability with out the Zoloft in me. I have used most of the benzo's and SSRI's which seem although far from perfect my best bet. I am scared of this selegiline stuff (an MAOI)..
> > Does anyone have any advice for me either having used selegiline or having a set of symptoms similar to what I described above. My doc seems "gung ho" on MAO inhibitors, and I don't want to offend him by suggesting something else perhaps a little less drastic..But then perhaps drastic is a relative term given how "drastic" I feel right now..
> >
> > Thanks for any response.. Scott
>
> Scott,
> With anxiety as a component of your symtoms, I think Selegiline is the wrong way to go. Selegiline is going to increase dopamine, which is not likely to help with anxiety at all. If anything, it is likely to worsen it. Of course, anything's possible and we are all different, but I have never heard of anxiety being treated with Selegiline. That's a stretch, as I see it. There are other drugs with better track records that would increase your odds of success.
>
> Again it is just my opinion, but I think your best bet will be in the antipsychotic category, with a little bit of an SSRI in the background. There is a ton of clinical research that supports this opinion, but not much evidence supporting Selegiline for your symptoms. Your doc might be gung ho on MAOIs, but if he were for example to take a look at all the clinical data on Zyprexa, he might realize treatment is available with higher odds for success and few side effects.
>
> I am just absolutely sold on the antipsychotic category. Those meds are far superior to other categories as I see it. I have seen so many people with resistant depression, long standing dysthymia, untreatable anxiety, etc, get magical results with antipsychotics. As respected as they are, I think drugs like Zyprexa, Risperdal, or Amisulpride are highly under-rated. I think a lot of suffering could be avoided if doctors turned to these meds sooner in treatment. Obviously SSRIs are the place to start. But if results are less than desired, I feel going straight to the antipsychotic category is the best move with the highest odds for success.
>
> In your case I could envision one of two paths to take:
> 1) Get back on Zoloft for a week, introduce Zyprexa into the mix, give the combination about two weeks to see what happens. You may find Zyprexa abolishes the side effects of Zoloft and cures your symptoms simultaneously. That would not surprise me. If for any reason Zyprexa turns out to be a bad choice, then try Risperdal and Amisulpride instead.
> 2) Choose two or three other SSRIs and try them each for about two weeks, back to back, with a one day washout inbetween. The purpose is to discover which in the group is a favorite. You want to be sure you are on the best one for you. The best one will make itself known in a two week period, either by lack of side effects and/or fairly good rapid response. Not a complete response, but enough to prove you are on the right track. Once the superior match in the group has been identified, then add to it Zyprexa, Risperdal, and Amisulpride each for about two to four weeks.
>
> No matter what you do, it looks like there will be a few months of agony, trial, and error to test out some new treatments. However, by using the above methods, you can cut do it in an organized manner with the odds stacked in your favor, and do it in less time. I hope something here is helpful to you.
>
> When I think about drug choices in the psychiatry world, it really is like throwing the dice. You just never know what will end up working. But there are some things that seem to have more of a chance of working than others. Higher odds of success. More success stories. So when I throw the dice, I want to throw the ones that win more often than the others. With that in mind I suggest antipsychotic+SSRI combo to treat anxiety and dysthymia simultaneously with excellent results. I would not even consider the MAOI category until these other options had been totally exhausted first.
> JohnI think you are right. I have certainly noticed a pointed anxiogenic reaction from the selegeline. Obviously I'll bounce these ideas off of my doc, but how quickly do you think a switch back to Zoloft could be made after taking Selegiline 5mg for a few days? It sounds like you may have had some relevant experience. Also why did you ditch the selegiline?
Rich
Posted by JohnL on March 16, 2001, at 4:52:57
In reply to Re: Much needed advice.., posted by Mr. Scott on March 14, 2001, at 13:54:58
> I think you are right. I have certainly noticed a pointed anxiogenic reaction from the selegeline. Obviously I'll bounce these ideas off of my doc, but how quickly do you think a switch back to Zoloft could be made after taking Selegiline 5mg for a few days? It sounds like you may have had some relevant experience. Also why did you ditch the selegiline?
>
> RichI ditched Selegiline because it created anxiety, did not help my depression, and caused impotence. Funny, it is supposedly favorable for sex. Not for me.
If you wanted to go back on Zoloft or any other SSRI, you could do so right away though doses would have to be tiny for the first week. There have been clinical studies where Selegiline was combined with SSRIs and adverse reactions were few. It can be done. But if done, it should be done cautiously with tiny doses to start with. After a week the Selegiline should be mostly gone and then you could increase SSRI doses. Besides, 5mg Selegiline isn't very much. It probably had little if any effect on serotonin.
John
Posted by Mr. Scott on March 16, 2001, at 16:27:02
In reply to Re: Much needed advice..Mr Scott, posted by JohnL on March 16, 2001, at 4:52:57
>
>
> > I think you are right. I have certainly noticed a pointed anxiogenic reaction from the selegeline. Obviously I'll bounce these ideas off of my doc, but how quickly do you think a switch back to Zoloft could be made after taking Selegiline 5mg for a few days? It sounds like you may have had some relevant experience. Also why did you ditch the selegiline?
> >
> > Rich
>
> I ditched Selegiline because it created anxiety, did not help my depression, and caused impotence. Funny, it is supposedly favorable for sex. Not for me.
>
> If you wanted to go back on Zoloft or any other SSRI, you could do so right away though doses would have to be tiny for the first week. There have been clinical studies where Selegiline was combined with SSRIs and adverse reactions were few. It can be done. But if done, it should be done cautiously with tiny doses to start with. After a week the Selegiline should be mostly gone and then you could increase SSRI doses. Besides, 5mg Selegiline isn't very much. It probably had little if any effect on serotonin.
> John
John,
You and I sound way too much alike in our responses to selegiline. I have noticed a detrimental effect on my sexual performance (not Drive but function), increased anxiety. And I'm only at 10 MGs now. I'm throwing in the towel. If you would, because of response similarities to selegiline tell me what HAS worked for you if anything It would be much appreciated. Again, my problem is depression & anxiety and is mixed in a way that it is often difficult to say which comes first.
Scott
Posted by Mr. Scott on March 16, 2001, at 16:30:43
In reply to Re: Much needed advice..Mr Scott, posted by Mr. Scott on March 16, 2001, at 16:27:02
> >
> >
> > > I think you are right. I have certainly noticed a pointed anxiogenic reaction from the selegeline. Obviously I'll bounce these ideas off of my doc, but how quickly do you think a switch back to Zoloft could be made after taking Selegiline 5mg for a few days? It sounds like you may have had some relevant experience. Also why did you ditch the selegiline?
> > >
> > > Rich
> >
> > I ditched Selegiline because it created anxiety, did not help my depression, and caused impotence. Funny, it is supposedly favorable for sex. Not for me.
> >
> > If you wanted to go back on Zoloft or any other SSRI, you could do so right away though doses would have to be tiny for the first week. There have been clinical studies where Selegiline was combined with SSRIs and adverse reactions were few. It can be done. But if done, it should be done cautiously with tiny doses to start with. After a week the Selegiline should be mostly gone and then you could increase SSRI doses. Besides, 5mg Selegiline isn't very much. It probably had little if any effect on serotonin.
> > John
>
>
> John,
> You and I sound way too much alike in our responses to selegiline. I have noticed a detrimental effect on my sexual performance (not Drive but function), increased anxiety. And I'm only at 10 MGs now. I'm throwing in the towel. If you would, because of response similarities to selegiline tell me what HAS worked for you if anything It would be much appreciated. Again, my problem is depression & anxiety and is mixed in a way that it is often difficult to say which comes first.
> ScottI saw your recommendations above by the way and plan to investigate them.. Just wanted to know if your recommendations are from your own experiences. Antipsychotics for Anxiety and depression and all. I do know someone taking Seroquel for Anxiety.. I'll check with her too.
Posted by JohnL on March 18, 2001, at 3:43:53
In reply to Re: Much needed advice..Mr Scott, posted by Mr. Scott on March 16, 2001, at 16:27:02
>
> John,
> You and I sound way too much alike in our responses to selegiline. I have noticed a detrimental effect on my sexual performance (not Drive but function), increased anxiety. And I'm only at 10 MGs now. I'm throwing in the towel. If you would, because of response similarities to selegiline tell me what HAS worked for you if anything It would be much appreciated. Again, my problem is depression & anxiety and is mixed in a way that it is often difficult to say which comes first.
> Scott
Hi again Scott. What has worked for me? Several things. Prozac, Zyprexa, Amisulpride, Adrafinil. Any combination of two of these works for me. Currently my favorite is 20mgProzac+5mgZyprexa+300mgAdrafinil. I experience 99% total recovery with this combination.
John
Posted by Mr. Scott on March 18, 2001, at 20:37:38
In reply to Re: Much needed advice..Mr Scott, posted by JohnL on March 18, 2001, at 3:43:53
>
> >
> > John,
> > You and I sound way too much alike in our responses to selegiline. I have noticed a detrimental effect on my sexual performance (not Drive but function), increased anxiety. And I'm only at 10 MGs now. I'm throwing in the towel. If you would, because of response similarities to selegiline tell me what HAS worked for you if anything It would be much appreciated. Again, my problem is depression & anxiety and is mixed in a way that it is often difficult to say which comes first.
> > Scott
>
>
> Hi again Scott. What has worked for me? Several things. Prozac, Zyprexa, Amisulpride, Adrafinil. Any combination of two of these works for me. Currently my favorite is 20mgProzac+5mgZyprexa+300mgAdrafinil. I experience 99% total recovery with this combination.
> JohnAny thoughts on Seroquel? I tried Seroquel (1 25mg tablet) and was impressed except for the Zombie like side effects and increased hunger. What should I expect side-effect wise on the Zyprexa? Have you gained any weight from it, or is this offset by the adrafinil (which I ordered today).
This is the end of the thread.
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