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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Questionmark on May 25, 2004, at 6:54:33
Please give me your thoughts and opinions people.
Okay. i am on the blessed Nardil and experiencing its tremendous benefits, but i am really starting to get sick of the anticholinergic and anorgasmic side effects. And every drug i try-- to help alleviate them, particularly the latter s.e.-- is insufficiently effective and has troublesome side effects of its own.
So a thought occurred to me the other day: What if one just took an SSRI with a low dose of selegeline (e.g., 5-15mg)? That way s/he would have all the benefits of the SSRI (assuming that the person responds well to an SSRI) in addition to the dopaminergic, apathy-preventing, motivational, procognitive, prosexual, anti-anorgasmic properties of selegeline. Also, the SSRI would hopefully help counteract/balance the emotional over-sensitivity and agitating and anxiogenic effects that selegeline might have.
Also-- well actually i was just assuming that it lacks anticholinergic effects but i really do not know, but-- since, or if, selegeline has minimal anticholinergic effects, then you would not only (hopefully) have a wonderfully effective med combination, but you would have it without the annoying hassle, discomfort, and difficulty of anticholinergic side effects. Now i know that the vast majority of pdocs would not prescribe this combination-- since they are too unfamiliar with it and therefore lack the courage to cautiously experiment with the idea, and since MAOIs and SSRIs are HIGHly contraindicated, due to the ease of developing serotonin syndrome (although at doses that only inhibit MAO-B-- if it is indeed "only"-- then this would not be a significant risk). But i wonder if it might not be an extremely worthwhile treatment.What do you think? Am i being completely naive and/or ignorant about certain factors, or is this a potentially useful treatment combination? Why or why not?
Thanks alot if you take the time to answer.
Posted by linkadge on May 25, 2004, at 8:45:44
In reply to SSRI and low-dose selegeline-- beneficial, safe?, posted by Questionmark on May 25, 2004, at 6:54:33
There is a study somewhere on www.biopsychiatry.com that shows the safe combination of selegeline and citalpram. No mention was made to the efficacy, but rather mantion was made of the pharmakokinetics and side effects.
Sounds good to me.
Linkadge
Posted by Questionmark on May 29, 2004, at 1:11:50
In reply to Re: SSRI and low-dose selegeline-- beneficial, safe?, posted by linkadge on May 25, 2004, at 8:45:44
Posted by Chairman_MAO on May 30, 2004, at 18:15:06
In reply to SSRI and low-dose selegeline-- beneficial, safe?, posted by Questionmark on May 25, 2004, at 6:54:33
I've was on celexa+remeron and then lexapro+remeron with 15mg selegiline per day back when I had a psychiatrist worth his license. It was good, but I highly doubt it was anything like taking Nardil is. The SSRI did indeed counterbalance a lot of the emotional oversensitivity/obsessiveness/paranoia that selegiline may have caused but not the agitation. It's worthy of mention that I never had the faintest indication of serotonin syndrome nor a hypertensive crisis. Also note that selegiline can be pro-sexual, but it does not do anything whatsoever to counteract SSRI sexual dysfunction.
At one point I used Celexa + selegiline + Remeron + Neurontin. That was a winner for depression, sexual function, and cognition and helpful for social anxiety, but I still doubt it's what Nardil is.
If you're on Nardil, you're on the gold standard. If I had my choice of meds for SP, though, I'd take Parnate + Klonopin. Parnate is friendlier in the side-effects department overall, but YMMV. My advice is to stick with the Nardil and work to resolve the side effects. If amantadine does not work, I suggest moving on to the new dopamine agonists; my first choice would be cabergoline. If you cannot get that, try for pramipexole or ropinirole.
By the way, thanks for your compliments; they mean a lot to me. I left this board for a while because I started working and just didn't have the energy to tend to things like this. I have a really hard time tending to multiple spheres of my life; it's a character defect which is worsened by the fact that I receive woefully inadequate psychiatric care. I hope to "keep it together" mroe this time so that I can stay on this board, move out of my house, make some real money so I can afford a real pdoc; then I could actually make it in school and become a psychopharmacologist. Aaah, to be able to actually help people with my talent [after its sufficiently nurtured by real training] instead of simply posting on this board... ;)
----
Check out this cabergoline reference. If our Cromwellian drug laws permitted the marketing of a male sexual tonic, Dostinex (cabergoline) would be it. There are sites all over the internet touting it as a sexual fountain of youth; these claims are extreme yet well-founded:
Effects of acute prolactin manipulation on sexual drive and function in males.
Kruger TH, Haake P, Haverkamp J, Kramer M, Exton MS, Saller B, Leygraf N, Hartmann U, Schedlowski M.
Department of Medical Psychology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. tillmann.krueger@web.de
The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior.Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures.***Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01).*** Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.
Posted by Questionmark on June 1, 2004, at 4:40:28
In reply to Re: SSRI and low-dose selegeline-- beneficial, safe? » Questionmark, posted by Chairman_MAO on May 30, 2004, at 18:15:06
> I've was on celexa+remeron and then lexapro+remeron with 15mg selegiline per day back when I had a psychiatrist worth his license. It was good, but I highly doubt it was anything like taking Nardil is. The SSRI did indeed counterbalance a lot of the emotional oversensitivity/obsessiveness/paranoia that selegiline may have caused but not the agitation.
That's neat & interesting (and helpful)-- i would have guessed that an SSRI would help with those things and not with the agitation (and that selegeline would cause those things)... (i think). However, i wonder how much the Remeron might have been a factor in your agitation, too. It's possible you're aware of the differences in agitation quality between Remeron and selegiline though.
> It's worthy of mention that I never had the faintest indication of serotonin syndrome nor a hypertensive crisis.
That's great. It is very helpful and important to know, too.
> Also note that selegiline can be pro-sexual, but it does not do anything whatsoever to counteract SSRI sexual dysfunction.
Wow, thAt's surprising. Freaking SSRI sexual dysfunction-- it's invincible to almost everything.
> At one point I used Celexa + selegiline + Remeron + Neurontin. That was a winner for depression, sexual function, and cognition and helpful for social anxiety, but I still doubt it's what Nardil is.
Wow. That's awesome. ... You could very well be right (& probably are) about Nardil being better than that combo. But although Nardil is outstanding for depression and social anxiety (for me and many others), it also has negative effects on my cognition and horrendous effects on my sexual gratification/reward, sexual desire, and ability to orgasm. So i'm actually curious how a drug combination like that Would compare.
> If you're on Nardil, you're on the gold standard. If I had my choice of meds for SP, though, I'd take Parnate + Klonopin. Parnate is friendlier in the side-effects department overall, but YMMV. My advice is to stick with the Nardil and work to resolve the side effects.
Yeah, i've thought for awhile now that Parnate + Klonopin might be an excellent combination (though i didn't fair too well on Parnate alone). i think they would balance each other out in a number of ways and quite nicely as well. You're right though, i should almost definitely "stick with the Nardil and work to resolve the side effects." It truly has helped me beyond words, and may very well have even saved my life. i still hate my life, and so on and so forth, to a significant extent, but i am SO much better off and in SO much less pain than i was. i have so much more hope too. i feel sincerely fortunate and grateful for being able to be on Nardil. (But enough of that).
> If amantadine does not work, I suggest moving on to the new dopamine agonists; my first choice would be cabergoline. If you cannot get that, try for pramipexole or ropinirole.
i think i will (though i'm pretty sure i'd have to settle for pramipexole or ropinirole) if i am disappointed with the amantadine. But i have read a number of anecdotes from people saying that they tried a dopamine agonist-- or at least one of the two just mentioned-- and it often worked well for about a couple months or so but then not only almost entirely pooped out, but also started causing horrible fatigue after a short time. i don't think i ever recall reading or hearing about someone who was on one of these and experienced even the slightest overall benefit for more than six months. What do you think the likelihood of experiencing poop-out and/or that debilitating fatigue would be, and in how long a time period? Do you think there is any decent way to avoid/prevent, mitigate, or extinguish this side effect and regain its beneficial effects as well? ..Or any DA agonists that do not have this side effect and be likely to continue working? Cuz it hardly seems worth it at all if all you get is 2 weeks of benefit, 3 months of beneficial effects along with terrible fatigue, and then nothing but terrible fatigue-- or something like that.
> By the way, thanks for your compliments; they mean a lot to me. I left this board for a while because I started working and just didn't have the energy to tend to things like this. I have a really hard time tending to multiple spheres of my life; it's a character defect which is worsened by the fact that I receive woefully inadequate psychiatric care.
You're welcome. Was just being honest. i'm glad they mean a lot, though. ... That's certainly a good reason (working) to leave this board for awhile. i know what you mean "having a really hard time tending to multiple spheres" of one's life. i have such a difficult freaking time with that too. i probably spend way too much time on this site actually. It's so informative, and often quite helpful, but i think it's just become something of an addiction now. Other areas of my life suffer as a result, to some extent. i want to try to continue reading and posting on this site but to limit myself much more, time wise.
> I hope to "keep it together" mroe this time so that I can stay on this board, move out of my house, make some real money so I can afford a real pdoc; then I could actually make it in school and become a psychopharmacologist. Aaah, to be able to actually help people with my talent [after its sufficiently nurtured by real training] instead of simply posting on this board... ;)
That'd be great. i hope you continue posting here. But i hope it doesn't hinder your other goals at all. Good luck with all those other things, by the way. We need psychopharmacologists like you, and you'd be a great one, as far as i can tell.
But you should have said, "Aaah, to be able to *especially* help people with my talent... even though i do help people some, even a good deal, by posting on this board." i know what you mean though. That would be great.
> Check out this cabergoline reference. If our Cromwellian drug laws permitted the marketing of a male sexual tonic, Dostinex (cabergoline) would be it. There are sites all over the internet touting it as a sexual fountain of youth; these claims are extreme yet well-founded:
>
> Effects of acute prolactin manipulation on sexual drive and function in males.
>
> Kruger TH, Haake P, Haverkamp J, Kramer M, Exton MS, Saller B, Leygraf N, Hartmann U, Schedlowski M.
>
> Department of Medical Psychology, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany. tillmann.krueger@web.de
>
> The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior.Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures.***Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01).*** Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.
Yeah, i would so love to try cabergoline. Man that'd be great.
i find it kind of interesting and humorous that this professional research study utilized "erotic film and masturbation." i'm sure it's not the only study to do something like that, but i haven't exactly come across it before.
Anyway, thanks so much for your helpful comments, again. And i'm sorry this was so long and tedious to read. i'm horribly tired.
Posted by Chairman_MAO on June 1, 2004, at 21:33:40
In reply to Re: SSRI and low-dose selegeline-- beneficial, saf » Chairman_MAO, posted by Questionmark on June 1, 2004, at 4:40:28
>
> That's neat & interesting (and helpful)-- i would have guessed that an SSRI would help with those things and not with the agitation (and that selegeline would cause those things)... (i think). However, i wonder how much the Remeron might have been a factor in your agitation, too. It's possible you're aware of the differences in agitation quality between Remeron and selegiline though.Well, I shouldn't claim that it DOESN'T help selegiline agitation, because I've never taken it while not taking an SSRI or Effexor. I suspect, however, that it may help with "meta-agitation", i.e. being upset over the fact that it is agitating, but does not cancel out the agitation altogether. Those that have taken Wellbutrin with an SSRI may know what I'm talking about.
I can tell the difference between Remeron agitation and selegiline agitation; moreover, my Remeron dose was 22.5mg, which had no discernable adrenergic effect.
>
>
> > Also note that selegiline can be pro-sexual, but it does not do anything whatsoever to counteract SSRI sexual dysfunction.
>
>
> Wow, thAt's surprising. Freaking SSRI sexual dysfunction-- it's invincible to almost everything.I had excellent results using yohimbine with or without Viagra. Supposedly viagra is contraindicated with yohimbine, but I had no problems. Yohimbine, however, is so anxiogenic that it is used as a probe in investigating panic attacks and recall of emotionally-charged memories. Remeron also worked quite well.
Oooh! I forgot to mention galantamine (Reminyl, Nivalin in Europe), a reversible cholinesterase inhibitor and nicotinic agonist. It has been used in Eastern Europe as a treatment for psychogenic impotence as well as cognitive impairment--even that from GABAnergic drugs such as benzodiazepines! I tried it when I was on Klonopin with celexa AND strattera, and it markedly improved my erections. It may worsen depression however, so proceed with caution. I believe I recommended this to someone on Nardil months ago for cognitive impairment. It could be the magic bullet instead of the dopamine agonists.
>
>
> > At one point I used Celexa + selegiline + Remeron + Neurontin. That was a winner for depression, sexual function, and cognition and helpful for social anxiety, but I still doubt it's what Nardil is.
>
>
> Wow. That's awesome. ... You could very well be right (& probably are) about Nardil being better than that combo. But although Nardil is outstanding for depression and social anxiety (for me and many others), it also has negative effects on my cognition and horrendous effects on my sexual gratification/reward, sexual desire, and ability to orgasm. So i'm actually curious how a drug combination like that Would compare.I also tried Gabitril, and it may have been better than Neurontin. Unfortunately, for all the cognitive impairment it produced at 32mg/day, I may have well been taking Nardil. Perhaps my dose was too high.
The only way you'll know if the combo is good [for you] is to try it. :(
>
>
> Yeah, i've thought for awhile now that Parnate + Klonopin might be an excellent combination (though i didn't fair too well on Parnate alone). i think they would balance each other out in a number of ways and quite nicely as well. You're right though, i should almost definitely "stick with the Nardil and work to resolve the side effects." It truly has helped me beyond words, and may very well have even saved my life. i still hate my life, and so on and so forth, to a significant extent, but i am SO much better off and in SO much less pain than i was. i have so much more hope too. i feel sincerely fortunate and grateful for being able to be on Nardil. (But enough of that).
>Learning to maximally love life, I fear, may take a lifetime--but it's a lifetime well spent. ;) I could say I "hate" my life too, but I at least like posting to psychobabble among many other things, so it's ok, heh.
>
> > If amantadine does not work, I suggest moving on to the new dopamine agonists; my first choice would be cabergoline. If you cannot get that, try for pramipexole or ropinirole.
>
>
> i think i will (though i'm pretty sure i'd have to settle for pramipexole or ropinirole) if i am disappointed with the amantadine. But i have read a number of anecdotes from people saying that they tried a dopamine agonist-- or at least one of the two just mentioned-- and it often worked well for about a couple months or so but then not only almost entirely pooped out, but also started causing horrible fatigue after a short time. i don't think i ever recall reading or hearing about someone who was on one of these and experienced even the slightest overall benefit for more than six months. What do you think the likelihood of experiencing poop-out and/or that debilitating fatigue would be, and in how long a time period? Do you think there is any decent way to avoid/prevent, mitigate, or extinguish this side effect and regain its beneficial effects as well? ..Or any DA agonists that do not have this side effect and be likely to continue working? Cuz it hardly seems worth it at all if all you get is 2 weeks of benefit, 3 months of beneficial effects along with terrible fatigue, and then nothing but terrible fatigue-- or something like that.
>I am not aware of the fatigue problem, but I am aware of the problem of my not having clinical experience to acquire such a broad spectrum of anecdotal evidence. All I can say is that the best psychiatrist I've ever had seemed to favor that approach for SSRI-induced sexual dysfunction/cognitive impairment/emotional blunting. And don't forget, if there are people for whom it poops out, there are probably people for whom it works. If I were you, I'd try it out (or galantamine, but DA agonists HELP depression).
>
> > By the way, thanks for your compliments; they mean a lot to me. I left this board for a while because I started working and just didn't have the energy to tend to things like this. I have a really hard time tending to multiple spheres of my life; it's a character defect which is worsened by the fact that I receive woefully inadequate psychiatric care.
>
>
> You're welcome. Was just being honest. i'm glad they mean a lot, though. ... That's certainly a good reason (working) to leave this board for awhile. i know what you mean "having a really hard time tending to multiple spheres" of one's life. i have such a difficult freaking time with that too. i probably spend way too much time on this site actually. It's so informative, and often quite helpful, but i think it's just become something of an addiction now. Other areas of my life suffer as a result, to some extent. i want to try to continue reading and posting on this site but to limit myself much more, time wise.I am addicted to this board as well, and have resigned to the addiction. ;) Behaviorists would say I get positive reinforcement here; they would be right.
>
>
> > I hope to "keep it together" mroe this time so that I can stay on this board, move out of my house, make some real money so I can afford a real pdoc; then I could actually make it in school and become a psychopharmacologist. Aaah, to be able to actually help people with my talent [after its sufficiently nurtured by real training] instead of simply posting on this board... ;)
>
>
> That'd be great. i hope you continue posting here. But i hope it doesn't hinder your other goals at all. Good luck with all those other things, by the way. We need psychopharmacologists like you, and you'd be a great one, as far as i can tell.
> But you should have said, "Aaah, to be able to *especially* help people with my talent... even though i do help people some, even a good deal, by posting on this board." i know what you mean though. That would be great.You're right about the rephrasing of my statement. I do not know why I am so self-deprecating; I believe it is a result of living with a lifetime of dysthymia. Hopefully the desipramine which I am trying again out of desparation will help with that. It seems to be working well after only the first does, just like last time. Hopefully this response will continue.
>
>
> Yeah, i would so love to try cabergoline. Man that'd be great.
> i find it kind of interesting and humorous that this professional research study utilized "erotic film and masturbation." i'm sure it's not the only study to do something like that, but i haven't exactly come across it before.I think that congress has prohibited the US government from funding any study into the effects of a drug on human sexuality. I do not remember why this is, but I'm almost positive it's true. Land of the free, home of the asexual (?!?)
> Anyway, thanks so much for your helpful comments, again. And i'm sorry this was so long and tedious to read. i'm horribly tired.
It was a pleasure to read. Be well!
This is the end of the thread.
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