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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by m0nger on December 27, 2003, at 22:13:21
Hi,
Since I'm new here, here's some info:
38M
Diagnosed as possibly bipolar (by a general practice D.O., not a psychiatrist)
Recovering drug addict: drug of choice was opiates, primarily heroin (been clean for over 7 years), although I used other drugs at times too, cocaine , etc
Okay, here's my situation in brief, I went to my doc about meds for depression about a month ago. It was getting bad, finally decided I better go (to see a doc) before I got so bad that i might seek relief by using street drugs. I was interested in trying deprenyl/selegiline after reading about it on the 'net, but as soon as the doc heard it was MAOI, he wasn't interested in prescribing (and wouldn't listen look at the info i printed from the Internet - I guess some people are prejudiced regarding information obtainted from the Internet ).
Anyway, I was prescribed -- and am taking -- Wellbutrin XL (was started on 150mg, and increased to 300mg after about a month) and Zyprexa 2.5 mg at bedtime to help with sleep and anxiety (and i think to help prevent the triggering of a manic episode? 2.5mg daily at bedtime is a pretty low dose tho, i learned from reading up on the Internet).
I am also taking 400mg of SAM-e each day in the morning, and 50 mg of 5-HTP in the evening (neither prescribed/recommended by doctor), for about a month.
I am feeling better now on the regiment, but not really optimal, still some inability to focus and depression (milder, not extremely painful as before)
Now here is my question. Would it be safe to introduce 5-15mg a day (would start out with 5mg per day) of Selegiline/Deprenyl to that regiment? Or if nobody feels comfortable saying it's "safe", has anybody heard of such a combo having decent results for somebody?
I am going to attempt to quit smoking on New Years, too. Selegiline could possibly help with that? (the wellbutrin seems to have helped with the chain smoking that i was doing prior to starting on it)
The following site seems to suggest such a combo wouldn't be dangerous (although Zyprexa isn't mentioned), but would like to hear from others.
-snip-
"<i>Although no selegiline drug interactions were documented in our study, the concurrent administration of selegiline and selective serotonin reuptake inhibitors should be avoided because of literature-reported interactions. We believe that bupropion, tricyclic antidepressants, and trazodone are reasonable choices in combination with selegiline, although tricyclic antidepressants and trazodone may be reserved as second-line treatments.</i>"
http://www.selegiline.com/interact.htm
-end snip-
If anybody has any questions they'd like to ask about me, that would help with their providing an answer, please ask!
Thanks,
-M
Posted by m0nger on December 28, 2003, at 12:26:13
In reply to questions about medication combo, posted by m0nger on December 27, 2003, at 22:13:21
haha, sorry about the subject line, it has nothing to do with this post :-D I think maybe the previous post's subject was too generalized (and boring), so nobody read it, and that's why there's been no responses?
Anyway, I went through the archives and found some posts to my questions, including the following:-snip-
"MAOIs and Wellbutrin can be taken together, but only if you are already on an MAOI and adding Wellbutrin very slowly to it. Officially, it's not a recommended combo, but a lot of pdocs have tried it w/ no problem and it is used by many psychopharms.
However, it is probably not a good idea to add an MAOI, particularly Parnate, to your existing dose of Wellbutrin. There haven't been any studies on the safety of this as far as I know."http://www.dr-bob.org/babble/20000905/msgs/45093.html
-end snip-
Okay, i am already on Wellbutrin (not too long tho, just a little over a month now). So i would have to stop wellbutrin, then start the Selegiline, then reintroduce the Wellbutrion, if i were to follow that advice?
However, I am not interested in taking the selegiline at unselective high doses, i want to use it in the 5mg-15mg range (the lower the better, that stuff is expensive and i am getting it on my own through the mail so no insurance coverage, doc wouldn't prescribe it, had a knee jerk reaction when i told him it was MAOI, and wouldn't listen to info about it being well tolerated selective B, etc). I am primarily interested in its possible benefit as an aid to smoking abstinence, and to possibly augment anti-depressents i am already taking (Wellbutrin, SAM-e, Zyprexa(?)) along with some of the other possible "prophylactic" benefits (anti-oxident, immune system enhancment, etc). So should I be worried about introducing it into my regiment (see previous post) at a low dose range, since i have been taking Wellbutrin already? I'd really hate to stop the Wellbutrin, as i seem to be getting some benefits from it; depression is reduced, and i am not chain smoking (i tend to chain smoke when severely depressed, as well
Here's some info that was at the selegiline.com site, pertaining to smoking:
-snip-
"This preliminary study suggests that selegiline (10 mg/day) is safe for use and enhances smoking cessation rates compared with placebo in nicotine-dependent cigarette smokers."
http://www.selegiline.com/quitsmoke.html-end snip-
Any replies are welcome, even if ya don't have any answers to my concerns, at least i'll know somebody read the post!
Posted by Utopia on December 28, 2003, at 16:37:50
In reply to Massive Orgasms!, posted by m0nger on December 28, 2003, at 12:26:13
> haha, sorry about the subject line, it has nothing to do with this post :-D I think maybe the previous post's subject was too generalized (and boring), so nobody read it, and that's why there's been no responses?
>
>
> Anyway, I went through the archives and found some posts to my questions, including the following:
>
> -snip-
>
> "MAOIs and Wellbutrin can be taken together, but only if you are already on an MAOI and adding Wellbutrin very slowly to it. Officially, it's not a recommended combo, but a lot of pdocs have tried it w/ no problem and it is used by many psychopharms.
> However, it is probably not a good idea to add an MAOI, particularly Parnate, to your existing dose of Wellbutrin. There haven't been any studies on the safety of this as far as I know."
>
> http://www.dr-bob.org/babble/20000905/msgs/45093.html
>
> -end snip-
>
> Okay, i am already on Wellbutrin (not too long tho, just a little over a month now). So i would have to stop wellbutrin, then start the Selegiline, then reintroduce the Wellbutrion, if i were to follow that advice?
>
> However, I am not interested in taking the selegiline at unselective high doses, i want to use it in the 5mg-15mg range (the lower the better, that stuff is expensive and i am getting it on my own through the mail so no insurance coverage, doc wouldn't prescribe it, had a knee jerk reaction when i told him it was MAOI, and wouldn't listen to info about it being well tolerated selective B, etc). I am primarily interested in its possible benefit as an aid to smoking abstinence, and to possibly augment anti-depressents i am already taking (Wellbutrin, SAM-e, Zyprexa(?)) along with some of the other possible "prophylactic" benefits (anti-oxident, immune system enhancment, etc). So should I be worried about introducing it into my regiment (see previous post) at a low dose range, since i have been taking Wellbutrin already? I'd really hate to stop the Wellbutrin, as i seem to be getting some benefits from it; depression is reduced, and i am not chain smoking (i tend to chain smoke when severely depressed, as well
>
> Here's some info that was at the selegiline.com site, pertaining to smoking:
>
> -snip-
> "This preliminary study suggests that selegiline (10 mg/day) is safe for use and enhances smoking cessation rates compared with placebo in nicotine-dependent cigarette smokers."
> http://www.selegiline.com/quitsmoke.html
>
> -end snip-
>
> Any replies are welcome, even if ya don't have any answers to my concerns, at least i'll know somebody read the post!
> haha, sorry about the subject line, it has nothing to do with this post :-D I think maybe the previous post's subject was too generalized (and boring), so nobody read it, and that's why there's been no responses?
>
>
> Anyway, I went through the archives and found some posts to my questions, including the following:
>
> -snip-
>
> "MAOIs and Wellbutrin can be taken together, but only if you are already on an MAOI and adding Wellbutrin very slowly to it. Officially, it's not a recommended combo, but a lot of pdocs have tried it w/ no problem and it is used by many psychopharms.
> However, it is probably not a good idea to add an MAOI, particularly Parnate, to your existing dose of Wellbutrin. There haven't been any studies on the safety of this as far as I know."
>
> http://www.dr-bob.org/babble/20000905/msgs/45093.html
>
> -end snip-
>
> Okay, i am already on Wellbutrin (not too long tho, just a little over a month now). So i would have to stop wellbutrin, then start the Selegiline, then reintroduce the Wellbutrion, if i were to follow that advice?
>
> However, I am not interested in taking the selegiline at unselective high doses, i want to use it in the 5mg-15mg range (the lower the better, that stuff is expensive and i am getting it on my own through the mail so no insurance coverage, doc wouldn't prescribe it, had a knee jerk reaction when i told him it was MAOI, and wouldn't listen to info about it being well tolerated selective B, etc). I am primarily interested in its possible benefit as an aid to smoking abstinence, and to possibly augment anti-depressents i am already taking (Wellbutrin, SAM-e, Zyprexa(?)) along with some of the other possible "prophylactic" benefits (anti-oxident, immune system enhancment, etc). So should I be worried about introducing it into my regiment (see previous post) at a low dose range, since i have been taking Wellbutrin already? I'd really hate to stop the Wellbutrin, as i seem to be getting some benefits from it; depression is reduced, and i am not chain smoking (i tend to chain smoke when severely depressed, as well
>
> Here's some info that was at the selegiline.com site, pertaining to smoking:
>
> -snip-
> "This preliminary study suggests that selegiline (10 mg/day) is safe for use and enhances smoking cessation rates compared with placebo in nicotine-dependent cigarette smokers."
> http://www.selegiline.com/quitsmoke.html
>
> -end snip-
>
> Any replies are welcome, even if ya don't have any answers to my concerns, at least i'll know somebody read the post!I think you haven't had many replies because the mis-management of the meds you refer to could cause a massive vascular-cerebral crisis potentially resulting in death.
Remember that Selegiline is a MAO-A AND an MAO-B inhibitor, depending on the dose. This is usually over 40mg per day and that's when the process extends to the gut as well. It does however vary from individual to individual. Welbutrin is known to have Dopamine agonist properties (smoking cessation studies prove it - Zyban)and so does Zyprexa have Dopamine agonist properties(this is why it's a novel anti-psychotic).
So, firstly, if you go onto Selegiline without careful supervision, the resulting rush of dopamine could translate into an unsupervised hypertensive crisis and kill you.
Ex-drug users are seemingly by instinct drawn to Dopamine agonists medicines (or cigarettes because of their dopamine agonist properties)as the original drug of abuse was generally dopamine pushing, including opiates. There's no point in surviving heroin and dying of a blood pressure surge.
Secondly, although there is mention of studies that do not exclude the use of Parnate with Selegiline the risk is stll grave. The Serotonin Syndrome, which results from combining MAOI's and Serotonergic drugs is the evil master here.
It's like taking a normal engine and turbocharging it, then running it at full revs. Eventually that engine will blow because the MAOI's have removed the enzymes that mop up the neurotransmitters that feed the engine, they continue feeding it. It just carries on screaming at full tilt until "boom" - no more engine. Euphoria then death, what a way to go. You'll find that Prozac, for example, and Selegiline are a big no-no due to the risk of the Serotonin Syndrome.
Selegiline is far cleaner (the price is a good indication of it's refinement.
But what about individual response, where one might start having an MAO-A and MAO-B response at lower dosages,for example at 15mg instead of 40mg ? Without realizing the Serotonin Syndrome is a reality in this example as well.Although Welbutrin is a dopamine/adrenalin agonist, serotonin has not been excluded completely. Even Zyprexa could have Serotonergic properties. All these drugs have a smattering of all the neurochecicals with a prevalent one targetting certain sites.
It's the MAOI's that are nasty because they don't get on with the new trendies as they are still first generation.
I think you should find a physician you can work with (no knee jerk reactions!)and plod through a maize which is as potentially dangerous as what you left behind. Then see if you can introduce Selegiline slowly with his assistance.
Trust me, we are impulsives by nature and that question is always there... wouldn't that make me feel better? I've been there so I know (I also believe that a lot of the times instictually we are right) but we haven't had the training to recognize the dangers. Go cautiously.
Lastly, and I quote personally because I cannot remember the study, but St. John's Wort has been know to interfere with treatment during studies and in some cases unusual anxiety has been reported, with very little anti-depressant response being evident.Now... THAT was a long response to your message!!
Posted by dragonfly25 on December 28, 2003, at 16:39:15
In reply to Massive Orgasms!, posted by m0nger on December 28, 2003, at 12:26:13
hi mOnger
i just wanted to let you know i read your post, but i didn't have an answer for you. i am not sure about some of the drug names you mentioned. but i know ALOT about wellbutrin and quiting smoking. it worked for me. but i wasn't trying to i just started getting kind of grossed out by it and then i noticed i was sort of forcing my self to smoke. Now, when you get to about 5 cigs a day that is the hard part. i lingered there for a while and eventually quit, with the help of about 4 pieces of nicorette gum a day or less. i was a heavy smoker for awile but at the time of going on wellbutrin i was only smoking about 10 a day. the gum helped, but it is better if you can do it w/o- better success rates. i have been on wellbutrin for about 3 1/2 years know and i call it the wonder drug- it really isn't but i do like it.
i know i didn't answer your question but know you know how i quit smoking and that i read your post.
good luck quitting
dragonfly
Posted by Utopia on December 28, 2003, at 18:37:24
In reply to Re: Massive Orgasms!, posted by dragonfly25 on December 28, 2003, at 16:39:15
> hi mOnger
> i just wanted to let you know i read your post, but i didn't have an answer for you. i am not sure about some of the drug names you mentioned. but i know ALOT about wellbutrin and quiting smoking. it worked for me. but i wasn't trying to i just started getting kind of grossed out by it and then i noticed i was sort of forcing my self to smoke. Now, when you get to about 5 cigs a day that is the hard part. i lingered there for a while and eventually quit, with the help of about 4 pieces of nicorette gum a day or less. i was a heavy smoker for awile but at the time of going on wellbutrin i was only smoking about 10 a day. the gum helped, but it is better if you can do it w/o- better success rates. i have been on wellbutrin for about 3 1/2 years know and i call it the wonder drug- it really isn't but i do like it.
> i know i didn't answer your question but know you know how i quit smoking and that i read your post.
> good luck quitting
> dragonfly
I agree. My wife was on 2 zyban and came right down to about 3-4 cigs a day but couldn't dump it altogether. The doc however suggested to increase her dosage by 1/2 a tab making the dose 2 and 1/2. It's worked so far and she's been smoke free for 2 months so far.
Posted by m0nger on December 29, 2003, at 14:33:06
In reply to Re: Massive Orgasms!, posted by Utopia on December 28, 2003, at 16:37:50
Hi Utopia,
Thanks for the reply. Yeah, you've convinced me i need to proceed VERY carefully, at least :) So the main risk is hypertension? What I am thinking I'll do, is quarter the 5 mg tabs with a sharp exacto knife. Hope they are pre scored by the manufactorer, i already ordered the Jumex brand from an european supplier on Saturday. Something i wish i hadn't done, cuz i found a place in the US that sells a generic selegiline a bit cheaper. Might have required a script tho. You are right about me being impulsive!
Anyway, i will quarter them so i have 1.25 mg doses to start. Will do that for a few days and self monitor my blood pressure (and other vital signs) with one of those digital wrist gadgets they sell at drug stores. if there aren't any probs (BP and/or mental-state wise), i will go to 2.5 mg for at least a few days, and so on. I think I'll stop at 5 mg then. 15 mg a day is too risky, i think, after considering your post, as I don't want to take a chance of an individual nonselective response. 10mg is probably iffy too, so i will stay at 5 mg for awhile and see how i do, provided i work up to that without any probs. I'll keep a hypertension antidote handy too. Quiting smoking will also reduce any high blood pressure risks, obviously.
Does that sound like a good plan? I have at least a couple weeks to consider what I'll do, anyhow. long shipping time for that medication, since its coming from the UK.
And I should find another doc probably too, as you said. I like the one i see, i get the impression he cares about his patients (and not just their money/insurance plan), but he doesn't seem very open minded. Don't understand a knee jerk response regarding *ever* prescribing MAOI's, even the selective one.
Do you (or anybody else who's reading this) know of a nationwide referrel list of pdocs (what does that mean? prescription doc or psychiatric doc?) who aren't afraid to prescribe off-label on occasion?
Posted by m0nger on December 29, 2003, at 14:39:56
In reply to Re: Massive Orgasms!, posted by dragonfly25 on December 28, 2003, at 16:39:15
> hi mOnger
> i just wanted to let you know i read your post, but i didn't have an answer for you. i am not sure about some of the drug names you mentioned. but i know ALOT about wellbutrin and quiting smoking. it worked for me. but i wasn't trying to i just started getting kind of grossed out by it and then i noticed i was sort of forcing my self to smoke. Now, when you get to about 5 cigs a day that is the hard part. i lingered there for a while and eventually quit, with the help of about 4 pieces of nicorette gum a day or less. i was a heavy smoker for awile but at the time of going on wellbutrin i was only smoking about 10 a day. the gum helped, but it is better if you can do it w/o- better success rates. i have been on wellbutrin for about 3 1/2 years know and i call it the wonder drug- it really isn't but i do like it.
> i know i didn't answer your question but know you know how i quit smoking and that i read your post.
> good luck quitting
> dragonfly-------------
-------------Thanks dragonfly (for the good luck wishes). I'll need it. Only three more days! :-0
Posted by Utopia on December 29, 2003, at 14:55:32
In reply to Re: Massive Cerebral Aneurysms!, posted by m0nger on December 29, 2003, at 14:33:06
No sorry, not aware of any. I suppose losing their licence is a big consideration if you came into harm's way and it was traced back to them.
Good luck and go carefully
Posted by Dr. Bob on December 29, 2003, at 16:35:34
In reply to Massive Orgasms!, posted by m0nger on December 28, 2003, at 12:26:13
> haha, sorry about the subject line, it has nothing to do with this post
Please don't be deceptive, thanks.
Bob
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