![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 32. Go back in thread:
Posted by sfy on October 13, 2004, at 21:30:56
In reply to Re: Selegiline Sexual Side Effects » sfy, posted by yznhymer on October 13, 2004, at 18:17:27
> sfy,
>
> Thanks for your extensive post. We've been down similar paths and share the same diagnosis. I view your assessment of the landscape pretty much the same.
>
> I hadn't really considered the option you chose... I was looking at Parnate or Cymbalta at this juncture, though I sort of felt from what I've read that the EMSAM patch may be my best option. I just couldn't afford to wait for its release.
>
> I chose to try Cymbalta first mostly because it seemed easier than trying parnate first, and I also thought there might be a better chance of no sexual side effects. Ha! I'm expecting the sexual side effects will again be a deal killer.
>
> The selegiline option you chose sounds like a good bet... hopefully a robust nardil-like response without the side effects. I'll be keeping my eyes open to see how you make out. Right now seems like you hit the sexual side effect snag. Sure hope it resolves itself.I wouldn't mind the side effects so much if I had seen any response to the selegiline. I just upped it to 10 mg. a few days ago so I'm going to give it another couple of weeks and see if anything changes.
Posted by sfy on October 13, 2004, at 21:40:05
In reply to Re: Selegiline Sexual Side Effects » sfy, posted by Larry Hoover on October 13, 2004, at 16:54:52
> > I know all about the effectiveness (or lack thereof) of low-dose selegiline. I'm taking the selegiline with DLPA (and B6) and both clinical studies and anecdotal evidence has shown that some people have gotten relief taking that combo with only 10 mg.
>
> I'm doing quite well at 5 mg. I haven't felt this good in a long time.
>
> LarI started off at 5 mg. with no result. Upped my DLPA to 1000 mg. with no change. And have now gone to 10 mg. of selegiline. I'm getting a bit discouraged because people seem to get a quick response from it.
Posted by utopizen on October 13, 2004, at 21:54:54
In reply to Re: Selegiline Sexual Side Effects » utopizen, posted by sfy on October 13, 2004, at 15:53:28
> And I can't understand preferring ECT to MAOI's. While I am not completely anti-ECT, they are generally recommended for deep, long-lasting, dark bouts of depression, not for the chronic low-level of depression and motivation that seem to be my main problems. Definitely not worth taking the risk of permanent memory loss for.
>While ECTs may produce some memory loss, MAOIs kill. I think memory loss is less of a risk than dying. I think memory is a little over-rated when we're preferring it to death. =)
(ECTs can lead to fatalities, but this is currently like 1 in 10,000 or 1 in 1,000, can't remember which, and it's mainly due to anesthesia, which is similiar to having to undergo any operation where you go under).
I encourage your success with Parnate or Nardil if they help you. I didn't know you had prior experience with it. More power to you! I just wrongly assumed you heard things solely from this board about it, but if a doc you're seeing is experienced in managing it, he'll prescribe you that med that you can take for emergency hypertensive crisis and help guide you on the proper use of it.
That said, let's not demonize drug companies. If a drug company gives a misleading statement in their NDA, that could lead to the FDA rejecting their application entirely, resulting in billion dollar loses.
I don't think Eli Lilly misleadingly claimed in the clinical trial they submitted to the FDA that a substantial number of patients reported signifigant relief within 1-2 weeks of the 60mg dose. They made it clear in this statement that full benefit from the drug came after 4-6 weeks at 60mg.
I don't think that's a dubious claim, since they had controlled trials, they were comparing this against placebo, and it's well-established that any drug targetting NE is likely to have a more rapid onset of action-- as subtle and benign as a couple of weeks seem- than SSRIs alone.
Universivally-used qualitative measurements were used to make these assessments. These weren't exactly designed by quacks. If the FDA doesn't feel design methods are at the same par as other studies they are reviewing, they can throw out the application entirely.
So there IS indeed a profit motive involved here in ensuring that information ISN'T misleading-- if it is suspected otherwise, that would cost Lilly billions in lost revenue from a drug like Cymbalta. I know it sounds crazy, that companies profit from practicing sound methods and using credible studies, but that's the reality.
Deamonizing these companies isn't constructive. If you were a doctor who worked for Lilly, and you knew you contributed to creating a drug that literally saved millions of lives and gave hopeless people the chance to find meaning in this world, would you want others dismissing you as some salaried sell-out, some Lilly lackey?
We might not find help from these drugs. But a lot do. And we need to appreciate the drug developers who invent these medicines for that reason alone. We need to appreciate that, even if we're not being helped, we're grateful someone is. That's what makes us compassionate. That's what makes us human.
I am glad that Parnate and Nardil is still available for you, and your doctor still resesearches it for you. I'm not brave enough to take it on myself, since my ADD requires me to take 60mg/day of Adderall or sometimes, when I switch, 50mg of Desoxyn/day.
So Parnate's not even an option for me anyway-- ECT would be safer than entering an amphetamine+MAOI-induced hypertensive crisis.
But I do think Cymbalta's worth a shot. I'm not telling or advising you to combine it with other meds at this time. That's up to your doc to determine. But the reality is is that by the time you've tried maximizing the dose of Cymbalta and giving it a fair shot, there will likely be reports on the field and perhaps in journals documenting the effects of augmentation therapies with Cymbalta. It's set to exceed a lot of AD's in sales, and with that comes more research into drug augmentation.
I want nothing more than for you to find relief. If Parnate or Nardil does that for you, more power to you. My only concern was that it would burden you with a dietary restriction, since I'm a nice guy and don't want to see others burdened with such things. If you're brave enough to deal with that, I admire that a lot.
But remember, I have tried every AD on the U.S. market except for Serzone at this point. And I remain convinced that Cymbalta is worth a trial for me, given its unique properties and apparent uniqueness even when compared to Effexor. Even different SSRIs can affect the same person in completely different ways in terms of response or the lackthereof.
Never think you have little hope in anything-- Cymbalta does indeed have clinical evidence of working rapdily if you take at least 60mg within the first week and try it for a couple of months.
Also, food is not the only problem with the MAOIs (when I told my Doc I was a vegan, he laughed and said, "Steve, that's not the only issue").
It means you can never take a stimulant, unless your doc is super brave and you're super experimental and frankly I can't advise that, because you just can't predict what extent of hypertensive crisis that will cause no matter what doc you see. And the drug interactions-- you mentioned several mental illnesses- what if you wanted to take something to increase your drive, like Strattera? It's unlikely you'd be given the option.
And things you and your doc aren't even beginning to worry about, but all of a sudden becomes a case report at some emergency room two years from now-- what if you get surgery, and the anesthesiologist overlooks that you're taking an MAOI? Or you get given Demerol or morphine from a paramedic on the street while you're passed out and can't talk?
Do you want to bet your life on the idea that a paramedic will decipher your med braclet, check his palm pilot for MAOI drug interactions with Dilaudid, and not inject you with anything? We're not just talking about asking the waiter at some restaurant to hold the cheese here, we're talking about issues I barely can imagine occuring that can kill you.
So yeah, if everything else failed, and I was left between Parnate and ECT, I'd say memory take a hike-- my life is more important than a few years of remembering when I felt hopeless and meaningless in this world.
God, if only dietary restrictions were the primary reason why MAOIs are avoided. One could only dream, though.
best of luck to you. I don't care how you treat yourself, I care that you are treated.
Posted by Sad Panda on October 13, 2004, at 23:02:13
In reply to Parnate, Morphine, and Trusting Joe Paramedic =), posted by utopizen on October 13, 2004, at 21:54:54
> > And I can't understand preferring ECT to MAOI's. While I am not completely anti-ECT, they are generally recommended for deep, long-lasting, dark bouts of depression, not for the chronic low-level of depression and motivation that seem to be my main problems. Definitely not worth taking the risk of permanent memory loss for.
> >
>
> While ECTs may produce some memory loss, MAOIs kill. I think memory loss is less of a risk than dying. I think memory is a little over-rated when we're preferring it to death. =)
>
> (ECTs can lead to fatalities, but this is currently like 1 in 10,000 or 1 in 1,000, can't remember which, and it's mainly due to anesthesia, which is similiar to having to undergo any operation where you go under).
>
> I encourage your success with Parnate or Nardil if they help you. I didn't know you had prior experience with it. More power to you! I just wrongly assumed you heard things solely from this board about it, but if a doc you're seeing is experienced in managing it, he'll prescribe you that med that you can take for emergency hypertensive crisis and help guide you on the proper use of it.
>
> That said, let's not demonize drug companies. If a drug company gives a misleading statement in their NDA, that could lead to the FDA rejecting their application entirely, resulting in billion dollar loses.
>
> I don't think Eli Lilly misleadingly claimed in the clinical trial they submitted to the FDA that a substantial number of patients reported signifigant relief within 1-2 weeks of the 60mg dose. They made it clear in this statement that full benefit from the drug came after 4-6 weeks at 60mg.
>
> I don't think that's a dubious claim, since they had controlled trials, they were comparing this against placebo, and it's well-established that any drug targetting NE is likely to have a more rapid onset of action-- as subtle and benign as a couple of weeks seem- than SSRIs alone.
>
> Universivally-used qualitative measurements were used to make these assessments. These weren't exactly designed by quacks. If the FDA doesn't feel design methods are at the same par as other studies they are reviewing, they can throw out the application entirely.
>
> So there IS indeed a profit motive involved here in ensuring that information ISN'T misleading-- if it is suspected otherwise, that would cost Lilly billions in lost revenue from a drug like Cymbalta. I know it sounds crazy, that companies profit from practicing sound methods and using credible studies, but that's the reality.
>
> Deamonizing these companies isn't constructive. If you were a doctor who worked for Lilly, and you knew you contributed to creating a drug that literally saved millions of lives and gave hopeless people the chance to find meaning in this world, would you want others dismissing you as some salaried sell-out, some Lilly lackey?
>
> We might not find help from these drugs. But a lot do. And we need to appreciate the drug developers who invent these medicines for that reason alone. We need to appreciate that, even if we're not being helped, we're grateful someone is. That's what makes us compassionate. That's what makes us human.
>
> I am glad that Parnate and Nardil is still available for you, and your doctor still resesearches it for you. I'm not brave enough to take it on myself, since my ADD requires me to take 60mg/day of Adderall or sometimes, when I switch, 50mg of Desoxyn/day.
>
> So Parnate's not even an option for me anyway-- ECT would be safer than entering an amphetamine+MAOI-induced hypertensive crisis.
>
> But I do think Cymbalta's worth a shot. I'm not telling or advising you to combine it with other meds at this time. That's up to your doc to determine. But the reality is is that by the time you've tried maximizing the dose of Cymbalta and giving it a fair shot, there will likely be reports on the field and perhaps in journals documenting the effects of augmentation therapies with Cymbalta. It's set to exceed a lot of AD's in sales, and with that comes more research into drug augmentation.
>
> I want nothing more than for you to find relief. If Parnate or Nardil does that for you, more power to you. My only concern was that it would burden you with a dietary restriction, since I'm a nice guy and don't want to see others burdened with such things. If you're brave enough to deal with that, I admire that a lot.
>
> But remember, I have tried every AD on the U.S. market except for Serzone at this point. And I remain convinced that Cymbalta is worth a trial for me, given its unique properties and apparent uniqueness even when compared to Effexor. Even different SSRIs can affect the same person in completely different ways in terms of response or the lackthereof.
>
> Never think you have little hope in anything-- Cymbalta does indeed have clinical evidence of working rapdily if you take at least 60mg within the first week and try it for a couple of months.
>
> Also, food is not the only problem with the MAOIs (when I told my Doc I was a vegan, he laughed and said, "Steve, that's not the only issue").
>
> It means you can never take a stimulant, unless your doc is super brave and you're super experimental and frankly I can't advise that, because you just can't predict what extent of hypertensive crisis that will cause no matter what doc you see. And the drug interactions-- you mentioned several mental illnesses- what if you wanted to take something to increase your drive, like Strattera? It's unlikely you'd be given the option.
>
> And things you and your doc aren't even beginning to worry about, but all of a sudden becomes a case report at some emergency room two years from now-- what if you get surgery, and the anesthesiologist overlooks that you're taking an MAOI? Or you get given Demerol or morphine from a paramedic on the street while you're passed out and can't talk?
>
> Do you want to bet your life on the idea that a paramedic will decipher your med braclet, check his palm pilot for MAOI drug interactions with Dilaudid, and not inject you with anything? We're not just talking about asking the waiter at some restaurant to hold the cheese here, we're talking about issues I barely can imagine occuring that can kill you.
>
> So yeah, if everything else failed, and I was left between Parnate and ECT, I'd say memory take a hike-- my life is more important than a few years of remembering when I felt hopeless and meaningless in this world.
>
> God, if only dietary restrictions were the primary reason why MAOIs are avoided. One could only dream, though.
>
> best of luck to you. I don't care how you treat yourself, I care that you are treated.
>
>You are comparing certainties to maybes. With ECT you are certainly giving yourself a little doseage of brain damage. With MAOIs you might have a hypertensive crisis or serotonin syndrome. Serotonin syndrome is just as likely to occur with SSRI's, Effexor & Cymbalta as it does with MAOIs. Also, Morphine & Dilaudid are fine to be taken with SSRI's & MAOI's. Demerol was the analgesic most likely to cause serotonin syndrome, but it takes more than one doseage & it is rarely used anymore.
Tyramine induced hypertensive crisis are a source of concern, but an antidote can be carried for this(and for SS). Amphetamines aren't totally contraindicated either, Parnate itself is an amphetamine like chemical & Selegiline which is nearly identical to Parnate does actually metabolize into methamphetamine & amphetamine. The only real problem with MAOIs is cough medicines & decongestants such as pseudoephedrine.
Cheers,
Paul.
Posted by Sad Panda on October 13, 2004, at 23:05:58
In reply to Selegiline Sexual Side Effects, posted by sfy on October 13, 2004, at 13:03:27
> Everything I've read seems to indicate that selegiline is supposed to increase libido. However, it seems to be having a paradoxical effect on me. Since I've stared the selegiline (5 mg at first and now 10 mg), my interest in sex seems to be somewhat dulled. It's also taking a bit more effort (under simulated conditions) to get an erection and climax.
>
> Has anyone else had this experience with selegiline? Does this effect point to some other approach I should try for my anhedonia/dysthymia? (Parnate is probably my next step.)
>
>I get Testosterone depots fornightly which has helped my libido enourmously & a low dose TCA fixes my anorgasmia woes that Effexor gives.
Cheers,
Paul.
Posted by Iansf on October 14, 2004, at 0:07:27
In reply to Re: Selegiline Sexual Side Effects » sfy, posted by Sad Panda on October 13, 2004, at 23:05:58
I've never heard of using a TCA to counteract anorgasmia. In fact, it was my impression tricyclics commonly cause sexual dysfunction. What one are you using, and at what dose? Does it truly work? If it does, why isn't this common knowledge among psychiatrists?
> > Everything I've read seems to indicate that selegiline is supposed to increase libido. However, it seems to be having a paradoxical effect on me. Since I've stared the selegiline (5 mg at first and now 10 mg), my interest in sex seems to be somewhat dulled. It's also taking a bit more effort (under simulated conditions) to get an erection and climax.
> >
> > Has anyone else had this experience with selegiline? Does this effect point to some other approach I should try for my anhedonia/dysthymia? (Parnate is probably my next step.)
> >
> >
>
> I get Testosterone depots fornightly which has helped my libido enourmously & a low dose TCA fixes my anorgasmia woes that Effexor gives.
>
> Cheers,
> Paul.
>
>
Posted by Sad Panda on October 14, 2004, at 7:31:59
In reply to Re: Selegiline Sexual Side Effects, posted by Iansf on October 14, 2004, at 0:07:27
> I've never heard of using a TCA to counteract anorgasmia. In fact, it was my impression tricyclics commonly cause sexual dysfunction. What one are you using, and at what dose? Does it truly work? If it does, why isn't this common knowledge among psychiatrists?
>
>I take 100mg of Amitriptyline as well as 75mg of Effexor, before this I took 125mg of Nortriptyline with 150mg of Effexor & before that I took 225mg of Effexor with 30mg of Remeron.
TCA’s taken at full antidepressant doseages can cause erectile dysfunction, but taken at lower dosages this is fairly unlikely to happen. Most TCA with the exception of Imipramine & Desipramine are good 5-HT2A antagonists. SSRI's, Effexor & probably Cymbalta cause anorgasmia by raising serotonin levels which cause adverse reactions at some serotonin receptors especially 5-HT2A. The ones that are good to combine with SSRI’s & Effexor from least sedating to most sedating are Nortriptyline, Amitriptyline, Trimipramine & Doxepin. Other AD’s that are useful are Remeron & Trazodone. Most AP’s are also 5-HT2A antagonists, Risperdal & Zyprexa at very low doseages are good, but I would put them last on the list. Other SSRI induced problems that these fix are insomnia, heat problems & anxiety. If you are taking an SSRI such as Zoloft or Lexapro or you are taking Effexor then I would recommend a trial of Nortriptyline as you might find that it has very minimal side effects as I did.
Cheers,
Paul.
Posted by utopizen on October 14, 2004, at 13:05:03
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » utopizen, posted by Sad Panda on October 13, 2004, at 23:02:13
> Tyramine induced hypertensive crisis are a source of concern, but an antidote can be carried for this(and for SS). Amphetamines aren't totally contraindicated either, Parnate itself is an amphetamine like chemical & Selegiline which is nearly identical to Parnate does actually metabolize into methamphetamine & amphetamine. The only real problem with MAOIs is cough medicines & decongestants such as pseudoephedrine.
>
> Cheers,
> Paul.
>Paul, thanks for the clarification. But my pdoc, a Harvard Professor of psychopharmacology, said MAOIs do interact with Demerol, and that's a huge risk if I were to go to the hospital in pain. I've also spoken to ER docs who use the Demerol name like it's a household name in hospitals, even assume that I'm very familiar with it because it's such a widely used drug.
Demerol is used by ER medicine a lot. And both ECT and MAOIs *are* "maybes." There is conflicting evidence that ECT contributes to memory loss, so memory loss is a maybe. And MAOI-induced hypertensive crisis is a maybe as well.
Please, I know you're ready to pull up some Medline abstracts, but I underscore the term "conflicting" evidence for a reason.
Take care, and good luck with your treatment! =)
Posted by Sad Panda on October 14, 2004, at 13:32:48
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =), posted by utopizen on October 14, 2004, at 13:05:03
> > Tyramine induced hypertensive crisis are a source of concern, but an antidote can be carried for this(and for SS). Amphetamines aren't totally contraindicated either, Parnate itself is an amphetamine like chemical & Selegiline which is nearly identical to Parnate does actually metabolize into methamphetamine & amphetamine. The only real problem with MAOIs is cough medicines & decongestants such as pseudoephedrine.
> >
> > Cheers,
> > Paul.
> >
>
> Paul, thanks for the clarification. But my pdoc, a Harvard Professor of psychopharmacology, said MAOIs do interact with Demerol, and that's a huge risk if I were to go to the hospital in pain. I've also spoken to ER docs who use the Demerol name like it's a household name in hospitals, even assume that I'm very familiar with it because it's such a widely used drug.
>
> Demerol is used by ER medicine a lot. And both ECT and MAOIs *are* "maybes." There is conflicting evidence that ECT contributes to memory loss, so memory loss is a maybe. And MAOI-induced hypertensive crisis is a maybe as well.
>
> Please, I know you're ready to pull up some Medline abstracts, but I underscore the term "conflicting" evidence for a reason.
>
> Take care, and good luck with your treatment! =)
>
>You are right, the info I have is from Australian hospitals. Demerol (called Pethidine here) was the most common way to get serotonin syndrome from MAOI's, but more than one injection is normally required. Demerol is rarely used here anymore as it is hardly any beter than codiene, but has numerous disadvantages such as a half life that is too short & neurotoxicity. I am surprised that it is still commonly used where you are.
Cheers,
Paul.
Posted by sfy on October 14, 2004, at 14:34:59
In reply to Parnate, Morphine, and Trusting Joe Paramedic =), posted by utopizen on October 13, 2004, at 21:54:54
> While ECTs may produce some memory loss, MAOIs kill. I think memory loss is less of a risk than dying. I think memory is a little over-rated when we're preferring it to death. =)
>
> (ECTs can lead to fatalities, but this is currently like 1 in 10,000 or 1 in 1,000, can't remember which, and it's mainly due to anesthesia, which is similiar to having to undergo any operation where you go under).But what are the corresponding statistics regarding deaths occurring due to the use of MAOI's? That's the only way you can make a true comparison of their relative risks.
> I encourage your success with Parnate or Nardil if they help you. I didn't know you had prior experience with it. More power to you! I just wrongly assumed you heard things solely from this board about it, but if a doc you're seeing is experienced in managing it, he'll prescribe you that med that you can take for emergency hypertensive crisis and help guide you on the proper use of it.
I'm quite familiar with the use of nifedipine having been prescribed it when I was on Nardil. But for over two years, I never even thought about reaching for those pills.
> That said, let's not demonize drug companies. If a drug company gives a misleading statement in their NDA, that could lead to the FDA rejecting their application entirely, resulting in billion dollar loses.
>
> I don't think Eli Lilly misleadingly claimed in the clinical trial they submitted to the FDA that a substantial number of patients reported signifigant relief within 1-2 weeks of the 60mg dose. They made it clear in this statement that full benefit from the drug came after 4-6 weeks at 60mg.It wasn't my intent to demonize Lilly or any other drug company. I don't necessarily doubt their data on the efficacy of Cymbalta. My main point about these findings (which may have gotten lost) is that I assume that they only measure the effectiveness of Cymbalta for Major Depressive Disorder. There are no data on its use for the treatment of Dysthymia/Anhedonia/Atypical Depression which is where I currently find myself.
Just because a med is successful at treating MDD is no evidence that it will successfully treat other forms of depression. Prozac worked wonders for me in treating my earlier MDD but did nothing more.
> I want nothing more than for you to find relief. If Parnate or Nardil does that for you, more power to you. My only concern was that it would burden you with a dietary restriction, since I'm a nice guy and don't want to see others burdened with such things. If you're brave enough to deal with that, I admire that a lot.
Having been through this before, the diet is more a minor annoyance than a burden. But I'd rather be minorly annoyed than chronically depressed.
> It means you can never take a stimulant, unless your doc is super brave and you're super experimental and frankly I can't advise that, because you just can't predict what extent of hypertensive crisis that will cause no matter what doc you see. And the drug interactions-- you mentioned several mental illnesses- what if you wanted to take something to increase your drive, like Strattera? It's unlikely you'd be given the option.
I've already been down the stimulant route to no effect so that's not an issue. And Parnate provides its own stimulating effects.
> So yeah, if everything else failed, and I was left between Parnate and ECT, I'd say memory take a hike-- my life is more important than a few years of remembering when I felt hopeless and meaningless in this world.Well, I'm not exactly feeling hopelessness and meaninglessness right now - MDD is not an issue for me. And I'm still not convinced (though open to any evidence) that ECT has been shown to be effective in treating Dysthymia.
I appreciate your concerns and your generosity in offering another side to this discussion
Posted by sfy on October 14, 2004, at 15:07:25
In reply to Re: Selegiline Sexual Side Effects » sfy, posted by Sad Panda on October 13, 2004, at 23:05:58
> I get Testosterone depots fornightly which has helped my libido enourmously & a low dose TCA fixes my anorgasmia woes that Effexor gives.
>
> Cheers,
> Paul.I'm not sure I'd want to take testosterone to counteract a drug side effect. My levels have tested well within normal range and before I started the selegiline I have no issues with low libido. I'd have to see whether TCA's are contraindicated when taking MAOI's before broaching that subject.
Posted by gromit on October 15, 2004, at 23:36:18
In reply to Re: Selegiline Sexual Side Effects » Iansf, posted by Sad Panda on October 14, 2004, at 7:31:59
> I take 100mg of Amitriptyline as well as 75mg of Effexor, before this I took 125mg of Nortriptyline with 150mg of Effexor & before that I took 225mg of Effexor with 30mg of Remeron.
>
> TCA’s taken at full antidepressant doseages can cause erectile dysfunction, but taken at lower dosages this is fairly unlikely to happen. Most TCA with the exception of Imipramine & Desipramine are good 5-HT2A antagonists. SSRI's, Effexor & probably Cymbalta cause anorgasmia by raising serotonin levels which cause adverse reactions at some serotonin receptors especially 5-HT2A. The ones that are good to combine with SSRI’s & Effexor from least sedating to most sedating are Nortriptyline, Amitriptyline, Trimipramine & Doxepin. Other AD’s that are useful are Remeron & Trazodone. Most AP’s are also 5-HT2A antagonists, Risperdal & Zyprexa at very low doseages are good, but I would put them last on the list. Other SSRI induced problems that these fix are insomnia, heat problems & anxiety. If you are taking an SSRI such as Zoloft or Lexapro or you are taking Effexor then I would recommend a trial of Nortriptyline as you might find that it has very minimal side effects as I did.Geez, I take 25mg of Elavil and I'm way tired the next day, and this hasn't gone away over time. Do you find Nortriptyline less sedating than Amitriptyline? I would really like to find something to help with the anorgasmia that doesn't knock me out the next day, I can barely stay awake as it is. My meds currently are
Lexapro 20mg
Lamictal 200mg
Buspar 30mg
Provigil 300mg
Amitrypyline 25mgThanks
Rick
Posted by pseudonym on October 16, 2004, at 13:44:41
In reply to Re: Selegiline Sexual Side Effects » sfy, posted by Larry Hoover on October 13, 2004, at 16:54:52
Let me echo Larry's comment about 5 mg. 5 mg + 250 DLPA has me feeling the best I've felt in 5+ years. My diagnosis is social anxiety, and I continue to take klonopin.
As for the 5mg/250mg DLPA, it took about a week of experimentation to arrive at the right amount, because above that for either substance, anxiety would be induced (both physical and apprehensive).
Libido? The original poster intimated libido reduction, I have experienced the exact opposite.
Posted by Sad Panda on October 16, 2004, at 23:15:29
In reply to Re: Selegiline Sexual Side Effects, posted by gromit on October 15, 2004, at 23:36:18
>
> > I take 100mg of Amitriptyline as well as 75mg of Effexor, before this I took 125mg of Nortriptyline with 150mg of Effexor & before that I took 225mg of Effexor with 30mg of Remeron.
> >
> > TCA’s taken at full antidepressant doseages can cause erectile dysfunction, but taken at lower dosages this is fairly unlikely to happen. Most TCA with the exception of Imipramine & Desipramine are good 5-HT2A antagonists. SSRI's, Effexor & probably Cymbalta cause anorgasmia by raising serotonin levels which cause adverse reactions at some serotonin receptors especially 5-HT2A. The ones that are good to combine with SSRI’s & Effexor from least sedating to most sedating are Nortriptyline, Amitriptyline, Trimipramine & Doxepin. Other AD’s that are useful are Remeron & Trazodone. Most AP’s are also 5-HT2A antagonists, Risperdal & Zyprexa at very low doseages are good, but I would put them last on the list. Other SSRI induced problems that these fix are insomnia, heat problems & anxiety. If you are taking an SSRI such as Zoloft or Lexapro or you are taking Effexor then I would recommend a trial of Nortriptyline as you might find that it has very minimal side effects as I did.
>
> Geez, I take 25mg of Elavil and I'm way tired the next day, and this hasn't gone away over time. Do you find Nortriptyline less sedating than Amitriptyline? I would really like to find something to help with the anorgasmia that doesn't knock me out the next day, I can barely stay awake as it is. My meds currently are
>
> Lexapro 20mg
> Lamictal 200mg
> Buspar 30mg
> Provigil 300mg
> Amitrypyline 25mg
>
> Thanks
> Rick
>Hi Rick,
I'd try Nortriptyline, it's at least 5 times less sedating than Amitriptyline. I wasn't sedating enough for me, probably because I took Remeron for 10 months & it is the most sedating med of all.
Cheers,
Paul.
Posted by AudreyE on October 30, 2004, at 20:37:00
In reply to Parnate, Morphine, and Trusting Joe Paramedic =), posted by utopizen on October 13, 2004, at 21:54:54
I take Parnate and wear a Medic Alert tag. I'm fairly comfortable that this will protect me in most situations, and you can't ask for 100% safety in life. I'm just glad my depression is finally responding to something after 15 years of me suffering almost non stop.
Posted by karaS on October 30, 2004, at 22:40:44
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =), posted by AudreyE on October 30, 2004, at 20:37:00
> I take Parnate and wear a Medic Alert tag. I'm fairly comfortable that this will protect me in most situations, and you can't ask for 100% safety in life. I'm just glad my depression is finally responding to something after 15 years of me suffering almost non stop.
Audrey,
How did you get the Medic Alert tag? Is it immediately obvious to anyone who sees it that you are taking Parnate (this is a good thing for paramedics but a bad thing for employers) or is it much more discreet?
Kara
Posted by King Vultan on October 31, 2004, at 10:18:49
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » AudreyE, posted by karaS on October 30, 2004, at 22:40:44
> > I take Parnate and wear a Medic Alert tag. I'm fairly comfortable that this will protect me in most situations, and you can't ask for 100% safety in life. I'm just glad my depression is finally responding to something after 15 years of me suffering almost non stop.
>
> Audrey,
>
> How did you get the Medic Alert tag? Is it immediately obvious to anyone who sees it that you are taking Parnate (this is a good thing for paramedics but a bad thing for employers) or is it much more discreet?
>
> KaraI have a bracelet I got from childsid.com, I think. They have a big selection, but I got the cheapest one in stainless steel for about $20. You can have it say whatever you want. I got mine when I went on Nardil and had it say my name and city, "I take an MAOI", and "Contact info over" on the side facing outward. The contact info is on the other side. People really can't see what it says because the letters are too small, but people who are familiar with these kinds of alerts instantly recognize that it is some kind of medical thing.
I wouldn't worry about what an employer would think. I've told a few people I work with what it's for and generally don't mind telling people; although, almost nobody really seems to notice or ask. I think the more people become aware that someone they know is taking a drug like this, the less stigma about mental illness there is likely to be.
Todd
Posted by Iansf on October 31, 2004, at 13:38:03
In reply to Re: Selegiline Sexual Side Effects » Iansf, posted by Sad Panda on October 14, 2004, at 7:31:59
> I take 100mg of Amitriptyline as well as 75mg of Effexor, before this I took 125mg of Nortriptyline with 150mg of Effexor & before that I took 225mg of Effexor with 30mg of Remeron.
>
> TCA’s taken at full antidepressant doseages can cause erectile dysfunction, but taken at lower dosages this is fairly unlikely to happen...
>
> Cheers,
> Paul.
>
I'm a bit late getting back to you on this, but according to the nortriptyline insert 100mg/d is the typical dose, yet you seem to regard 125mg/d as below clincal level. Did you mean 25mg/d, or do you consider 125mg/d to be a less than effective dose for depression? I would expect side effects to kick in at that level? Is that not so?Also since nortriptyline also acts on noradrenaline, is it good to combine it with Cymbalta? Might it cause agitation?
Thanks
John
Posted by karaS on October 31, 2004, at 14:07:12
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » karaS, posted by King Vultan on October 31, 2004, at 10:18:49
> > > I take Parnate and wear a Medic Alert tag. I'm fairly comfortable that this will protect me in most situations, and you can't ask for 100% safety in life. I'm just glad my depression is finally responding to something after 15 years of me suffering almost non stop.
> >
> > Audrey,
> >
> > How did you get the Medic Alert tag? Is it immediately obvious to anyone who sees it that you are taking Parnate (this is a good thing for paramedics but a bad thing for employers) or is it much more discreet?
> >
> > Kara
>
> I have a bracelet I got from childsid.com, I think. They have a big selection, but I got the cheapest one in stainless steel for about $20. You can have it say whatever you want. I got mine when I went on Nardil and had it say my name and city, "I take an MAOI", and "Contact info over" on the side facing outward. The contact info is on the other side. People really can't see what it says because the letters are too small, but people who are familiar with these kinds of alerts instantly recognize that it is some kind of medical thing.
> I wouldn't worry about what an employer would think. I've told a few people I work with what it's for and generally don't mind telling people; although, almost nobody really seems to notice or ask. I think the more people become aware that someone they know is taking a drug like this, the less stigma about mental illness there is likely to be.
>
> Todd
Todd,Thanks for the info. I know that most people would see one of these bracelets and recognize that it's a medical alert, I just didn't want them to know the exact nature of the alert. While I'm all for decreasing the stigma surrounding mental illness, I think it could make job hunting a lot harder than it already is. Also, I wonder if you are working in the corporate world. One of my previous employers is a big player in the financial industry. I can tell you with certainty that my acknowledgment of MAOI usage would have been a death sentence for my career.
(Of course my depression was already a death sentence for my career but that's another issue...)Kara
Posted by gardenergirl on October 31, 2004, at 15:03:24
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » King Vultan, posted by karaS on October 31, 2004, at 14:07:12
I also have a bracelet alerting medics to my MAOI use. In my case, I purchased a pewter cuff bracelet and had it engraved with the medic alert symbol, the words "Takes MAOI" on the front, and "Caution: Drug interactions" on the inside. I suppose I could have done that the other way around, but most people think it's just a bracelet. I am tempted to buy an enamel medic alert symbol to glue on, because the engraved symbol is hard to see. I'm afraid a medic wouldn't check this bracelet. I started a new job in Sept. and told two people who seem to know everything about everything (i.e. they are the "go-to" people when there is a problem) about the existence of the bracelet. This way, if something happened to me, they could tell the EMT's to check my bracelet. I didn't have to tell them what it said, just that it existed. No one asked me intrusive questions.
I think it's important to have some kind of notification. I also have a medical card in my wallet.
gg
Posted by karaS on October 31, 2004, at 16:02:13
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =), posted by gardenergirl on October 31, 2004, at 15:03:24
Posted by sfy on October 31, 2004, at 17:15:53
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » AudreyE, posted by karaS on October 30, 2004, at 22:40:44
> How did you get the Medic Alert tag? Is it immediately obvious to anyone who sees it that you are taking Parnate (this is a good thing for paramedics but a bad thing for employers) or is it much more discreet?
>
> KaraIf you get a bracelet or tag from MedicAlert itself (www.medicalert.com) it doesn't indicate what medication you are taking. Instead it tells health professionals to contact MedicAlert to get your drug information (as well as emergency contact info). This costs more than just a bracelet ($35/first year, $20 each year after that) but it might more noticeable than something else. (Plus it's supposed to have international recognition which might be an issue if you're traveling in a non-English speaking country.)
Posted by karaS on October 31, 2004, at 18:30:06
In reply to Re: Parnate, Morphine, and Trusting Joe Paramedic =) » karaS, posted by sfy on October 31, 2004, at 17:15:53
Posted by Sad Panda on November 1, 2004, at 4:17:55
In reply to Re: Selegiline Sexual Side Effects » Sad Panda, posted by Iansf on October 31, 2004, at 13:38:03
> > I take 100mg of Amitriptyline as well as 75mg of Effexor, before this I took 125mg of Nortriptyline with 150mg of Effexor & before that I took 225mg of Effexor with 30mg of Remeron.
> >
> > TCA’s taken at full antidepressant doseages can cause erectile dysfunction, but taken at lower dosages this is fairly unlikely to happen...
> >
> > Cheers,
> > Paul.
> >
> I'm a bit late getting back to you on this, but according to the nortriptyline insert 100mg/d is the typical dose, yet you seem to regard 125mg/d as below clincal level. Did you mean 25mg/d, or do you consider 125mg/d to be a less than effective dose for depression? I would expect side effects to kick in at that level? Is that not so?
>
> Also since nortriptyline also acts on noradrenaline, is it good to combine it with Cymbalta? Might it cause agitation?
>
> Thanks
>
> John
>
>Blood levels of Nortriptyline should be 50 to 150 ng/ml. In my case 125mg/day gave me a plasma level of 75 ng/ml, but it varies from person to person depending on both genetics & what other drugs you take. If you combine it with Cymbalta, you would probably use a very small dose.
Cheers,
Paul.
Posted by Marc Boucher on November 21, 2005, at 14:22:59
In reply to Selegiline Sexual Side Effects, posted by sfy on October 13, 2004, at 13:03:27
I took Deprenyl last summer in an attempt to improve a very low libido that's afflcted me for 7 years on end now. The effect DPR had was that it killed what little libido was there at the time. I'm male 33 years old btw. I've been diagnosed with Dysthymia, and ADHD by Dr. Eric Braverman in NYC last month. It seems that some people do not derive any benefits libido wise from DPR. I however felt way more focused on DPR, and my ability to concentrate while reading and composing emails was definately improved.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.