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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Vincent_QC on January 26, 2009, at 16:11:21
Hi Everyone, this is another post from me, yeah, I know, I ask a lot of questions...but I get not a lot of answer...Anyway,I have another option I want to explore and propose to my Psychiatrist if the Marplan importation in the Canada fail.
I wonder if some people on this board have try oral selegiline to treat social anxiety and depression, and if so, what is the effective dosage to have a good inhibition of the MAO-B and MAO-A?
Since I live in Canada, and the Emsam patch are expensive, I was wondering if it will worth the trail if I ask to have it in pills form, since it's very cheap here and generic version exist.
My primary problem is social anxiety with panic disorder and agoraphobia, so I was wondering if the stimulant effect of the selegiline will give to me an incresement of my anxiety and more heart problems (high blood pressure), like I experienced on the Parnate last month?
I also suffer from co-morbidities of general anxiety (mean that i'm always anxious, even when i'm alone in my house and I always have fear and have a lot of doubt about my future and things like that), depression (because the others problems are still not treated and stabilized) and anhedonia with lack of motivation, no energy (physical and mental), no interest, lack of interest in things that was before very exciting, no fun like before...everything just seem dull...
So, someone think it will be a good idea to try the selegiline, before I import some Marplan or return on the Nardil?
Thanks for any help I can recieve from all of you ;-)
Bye!
Vincent :-)
Posted by Medline on January 26, 2009, at 17:36:30
In reply to Selegiline dosage for social anxiety + Depression, posted by Vincent_QC on January 26, 2009, at 16:11:21
I use low dose Selegiline in oombination with GBL, Moclobemid...
I think the dose must exceed 10mg for inhibition of MAO-A and MAO-B. The Emsam-Patch is probably safer in regards of tyramine-induced hypertensive episodes, but I found adding low-dose Reboxetine eleminates the need for dietary restriction at least from my personal experience. I don't consider Selegiline alone a good drug for SA, but it can be combined with SSRIs/SNRIs/Benzos...
Posted by Medline on January 26, 2009, at 17:53:58
In reply to Re: Selegiline dosage for social anxiety + Depression, posted by Medline on January 26, 2009, at 17:36:30
I have to admit, when using Selegiline alone I never exceeded 5mg, therefore higher doses might work well for SA.
Posted by desolationrower on January 26, 2009, at 22:27:36
In reply to Re: Selegiline dosage for social anxiety + Depression, posted by Medline on January 26, 2009, at 17:53:58
well you can take the pills sublingually/buccally; thats what i did. its cheap and no tyramine problem. They don't taste good, although i got used to it.
I found it unhelpful for social anxiety, and not great for depression. seemed to improved energy though. it just didn't prevent negative affect. was awesome for libido. no side effects. i got up to 15mg i think, roughly about what you'd get from highest patch dose.
you still haven't tried a tca, no? i'd do that first, i think. to me, selegiline is best for someone whos just kind of old and wants a little more vim and vigour, and prevent degeneration.
-d/r
Posted by Phillipa on January 27, 2009, at 0:20:41
In reply to Re: Selegiline dosage for social anxiety + Depression, posted by desolationrower on January 26, 2009, at 22:27:36
Hey d/r I'm old so not for me? Just kidding really thought EMSAM would get less expensive and be good for Vincent with his posted intestinal problems. What do you think? Love Phillipa
Posted by Vincent_QC on January 27, 2009, at 6:54:52
In reply to Re: Selegiline dosage for social anxiety + Depression » desolationrower, posted by Phillipa on January 27, 2009, at 0:20:41
> Hey d/r I'm old so not for me? Just kidding really thought EMSAM would get less expensive and be good for Vincent with his posted intestinal problems. What do you think? Love Phillipa
Hi Everyone...Well thanks for the answer!!! I think I can say now that's alone, the Selegiline or the Emsam patch will not be a lot helpfull...maybe just as an addition drugs to another one? I will see...Emsam is too much expensive for me anyway...so the Marplan or the return on the Nardil will be a more nicer plan...
I think in the Canada, we don'T have the pills who disolve under the tongue...we have just generic pills of Selegiline...i'm still not sure...
Anyway, since my primary problem is social anxiety, I think working on one thing at the time will be a more safe way to help me...
Someone know the exact price of the Marplan pills or the Emsam patch (12mg/day)...??? I can't find the exact price of them...
That's sure, Emsam patch will look more usefull in my case, with the gastric by-pass I get a couple of years ago...That's why my PDoc talk to me about this the last time I meet him...but I have to know the price...
Thanks again!
Bye!
Vincent ;-)
Posted by JadeKelly on January 27, 2009, at 9:46:01
In reply to Re: Selegiline dosage for social anxiety + Depression » Phillipa, posted by Vincent_QC on January 27, 2009, at 6:54:52
> Hi Everyone...Well thanks for the answer!!! I think I can say now that's alone, the Selegiline or the Emsam patch will not be a lot helpfull...maybe just as an addition drugs to another one? I will see...Emsam is too much expensive for me anyway...so the Marplan or the return on the Nardil will be a more nicer plan...
>
> I think in the Canada, we don'T have the pills who disolve under the tongue...we have just generic pills of Selegiline...i'm still not sure...
>
> Anyway, since my primary problem is social anxiety, I think working on one thing at the time will be a more safe way to help me...
>
> Someone know the exact price of the Marplan pills or the Emsam patch (12mg/day)...??? I can't find the exact price of them...
>
> That's sure, Emsam patch will look more usefull in my case, with the gastric by-pass I get a couple of years ago...That's why my PDoc talk to me about this the last time I meet him...but I have to know the price...
>
> Thanks again!
>
> Bye!
>
> Vincent ;-)Hi again Vincent!
I tried the Emsam patch just before Parnate, the benefits are: at the lowest dose, no food restricts, lots of energy at first, excellent for libido, and even if you go up in dose, I think it is much more forgiving with foods and BP. Med cautions stay the same. While I don't usually suffer from SA, I found myself to be very out going on Emsam before it wore off.
The down sides are that it is extremely expensive, the only way I see to get it would be to contact the manufacturer, drug rep or your Doc and see if you can get it for free or at a reduced cost. If you need to up dose to over 12mg that gets tricky, lots of patches! (maybe you could add something at that point) The initial energy burst is the same as other MAOI's and will fade in a week or so (for me). I never took my BP or any of that. You will have to deal with some insomnia, but thats all I remember. No BP issues.If you can get the patch, I'd try it, I only could handle 1/2 6mg patch at first, so you can cut it to fit your needs and you may get some mileage out of a bunch of free samples just to see if you like it. Thats what I did. What it does beyond 9mg I don't know. It wasn't doing anything for me at 9mg so I switched to Parnate. Emsam may be great for you, or at higher doses, I just don't know.
I'm hearing Marplan is easier to take than the others, I need to finish reading the thread.
Hope you are well, I know you had some questions for me regarding my new PDoc's "Plan" for me and I will go to that sight and answer those! I'm doing exceptionally well, not 100% but getting there. I will keep taking Parnate. It hasn't been an easy road as you know, but its finally paying off! (with one augment for now).
Your friend,
~Jade ;-)
Posted by Vincent_QC on January 27, 2009, at 11:01:23
In reply to Re: Selegiline dosage for social anxiety + Depression, posted by JadeKelly on January 27, 2009, at 9:46:01
> Hi again Vincent!
>
> I tried the Emsam patch just before Parnate, the benefits are: at the lowest dose, no food restricts, lots of energy at first, excellent for libido, and even if you go up in dose, I think it is much more forgiving with foods and BP. Med cautions stay the same. While I don't usually suffer from SA, I found myself to be very out going on Emsam before it wore off.
>
>
> The down sides are that it is extremely expensive, the only way I see to get it would be to contact the manufacturer, drug rep or your Doc and see if you can get it for free or at a reduced cost. If you need to up dose to over 12mg that gets tricky, lots of patches! (maybe you could add something at that point) The initial energy burst is the same as other MAOI's and will fade in a week or so (for me). I never took my BP or any of that. You will have to deal with some insomnia, but thats all I remember. No BP issues.
>
> If you can get the patch, I'd try it, I only could handle 1/2 6mg patch at first, so you can cut it to fit your needs and you may get some mileage out of a bunch of free samples just to see if you like it. Thats what I did. What it does beyond 9mg I don't know. It wasn't doing anything for me at 9mg so I switched to Parnate. Emsam may be great for you, or at higher doses, I just don't know.
>
> I'm hearing Marplan is easier to take than the others, I need to finish reading the thread.
>
> Hope you are well, I know you had some questions for me regarding my new PDoc's "Plan" for me and I will go to that sight and answer those! I'm doing exceptionally well, not 100% but getting there. I will keep taking Parnate. It hasn't been an easy road as you know, but its finally paying off! (with one augment for now).
>
> Your friend,
>
> ~Jade ;-)
>
>Hi Jade!
Thanks for sharing with me your experience...it's very helpfull...You always have good words for me and I will always be very greatfull with you because of this!!!Did you remember the price of the patch in US $ ?... I think it's something like 14$/patch?...if it's expensive like this, I Will not be able to try it cause I don'T have private insurrance and I don'T have a job and I leave only with a small amount of money I recieve for disable people from the governement...and since I Return to live with my parents, they cut by half the amount of money I recieve each month...So my only option is to have drugs who are in the "cover" section in the list of drugs avaible in the Canada... It's why I try to know if oral selegiline will be as effective as the patch at a more high dosage, since the regular pills are cover here... I think that I read somewhere(don't remember where exactly) that oral selegiline can give the same result at high dosage...more than 30mg/day than the patch...but the diet have to be follow at this dosage but it's more forgiving for the food interraction.
I ask about the selegiline because i'm totally out of energy in these day... I can't do anything at all...I feel like I don't sleep since 2 weeks but in fact with the Seroquel (25mg, sometimes 50mg) before bed time, I Sleep more than 8 hours in a row...but I can't get energized and feel full of energy...
I had to cancel my appointment this morning with my Psychologist for my CBT because I Was not able to get up and get ready to go...She will be not happy but what I Can do??? I have NO energy and NO motivation at all. I feel like I donT live but just exist...I even don't do the exercices she give to me (exposure time in social event....we work on the shopping center, I have to go there and walk...and stay there until my anxiety return to the level it was before I enter into the shopping center...)...I don't want to lie to her and said that I do my exercices...and I don't want to loose my place for this therapy...I wait more than 1 year to have this therapy for free...so I Don'T want to loose my turn...I can cancel 2 appointments I think and after you are out...so next week I will have to kick my *ss... This morning I try so much to go...I drink a whole pot of coffee just to be able to stay awake, I take 2 pills of "Wake-up" (Caffein pills), so 200 mg...and I Was not able to move more...I Return call the office of my psychologist and leave a message on her answer machine and I Return in my bed and sleep 3 hours in a row... I wake up and I feel tired as hell...Anwyay...
I feel not really well, and I don'T write this to look like someone who want to be take in a pity...I'm just tired to feel like the way I feel now...It'S worst than when I was on the Parnate or on the Lexapro(CIpralex) + Ritalin or Wellbutrin...
I don'T know if this increase of tiredness come from the Manerix try I had last week...or it's the Parnate who leave my body slowly...but I Feel worst than usual...
For what my Psychiarist know about maoi's...he told to me that the Marplan is the more stable of the 3 that exists to treat depression. Neutral for the weight gain, neutral for the blood pressure and the more firgiving for the food interraction...also, no daytime sedation on it aparently...but since it's remove from the Canadian market since a while, he even don'T know if it was avaible at one point here, and he don't know if each time a compagny sell the drug to another one, they change the formulation, he don't know if it's effective like the good old Marplan of 1959...
To answer to d/r...No, I don't try a lot of TCA's...I ask for one the last time I meet my PDoc, Clomipramine or the other one who begin with NOR??? but he said that the NE effect will be hard for my heart, since I had a lot of blood pressure issue with the Parnate, he didn't wanted to take any chance...he said also that the weight gain is a major issue also, even if you take the one who act the more on the NE...so it's out of my options for now...
Well, another time, thanks Jade...I Really hope you find the good solution for you...maybe you don't reach the 100% stage of remission, but at least you feel better and it'S a good thing!!!!
I will keep you update of my situation...for now, I will be a little bit quiet here...since just answer to one message take me more than 30 minutes (my english level is very low, even if I live with only english speaking people for several years...)...
Take care of you ok!!! ;-)
Love!
Vincent ;-)
Posted by Phillipa on January 27, 2009, at 20:01:59
In reply to Re: Selegiline dosage for social anxiety + Depression » JadeKelly, posted by Vincent_QC on January 27, 2009, at 11:01:23
Vincent think your're speaking of TCA nortriptalline. And you're correct Emsam when first out here was like $350-500 a month. Would be so pefect for you. Could you google price of Emsam and see if it's come down? Love Phillipa
Posted by HyperFocus on January 27, 2009, at 22:22:56
In reply to Selegiline dosage for social anxiety + Depression, posted by Vincent_QC on January 26, 2009, at 16:11:21
Hey Vincent have you tried low-dose sulpiride or amisulpiride? They are very activating and may help with the dysthemia and fatigue you have. They also may have adjunct antidepressant and antianxiety effects. Also have you tried tianeptine (Stablon)? I also suffer from severe social anxiety and I seem to be responding(maybe, fingers crossed) to a combination of amitriptyline, sulpirde (50mg) and tianeptine. Search the archives for posts about sulpiride from JohnL and andrewb and others. Hope you feel better man. Social anxiety is the worse. It's like having arachnaphobia and living in a house full of spiders.
Posted by sam K on January 27, 2009, at 23:42:28
In reply to Re: Selegiline dosage for social anxiety + Depression » Vincent_QC, posted by HyperFocus on January 27, 2009, at 22:22:56
i like that "its like arachniphobia living in a house full of spiders" nice. I have social phobia too and ya its horrible. takes away life quality so bad. Being lonely and isolated isnt healthy nor is it fun.
Posted by Vincent_QC on January 28, 2009, at 9:53:30
In reply to Re: Selegiline dosage for social anxiety + Depression » Vincent_QC, posted by Phillipa on January 27, 2009, at 20:01:59
> Vincent think your're speaking of TCA nortriptalline. And you're correct Emsam when first out here was like $350-500 a month. Would be so pefect for you. Could you google price of Emsam and see if it's come down? Love Phillipa
Hi Phillipa!
I try to figure out the price of the Emsam patch, but no one seem to know it...I never found the information on google or anywhere on the web...but if it'S more than 200$ I can't try it... No job, no work, no money...For the Marplan, I never recieve an answer fron the Validus compagny...I write to them 1 week ago...I read somewhere it's something around 2 $ a pill and they come in 10mg pills only...and the dosage is 60mg /day so it's 12$ a day...I don't think I will be able to paid for this also...
So I really don't know what I will be able to do... The Nardil or the Selegiline will be the only solution I think...if the Marplan or the Emsam are not above 200$ month...
Even at 200$ month, I will have to stop smooking to be able to paid for this, I will have also to stop all my activities like going to the restaurant for a coffee and things like that... So what is more good for me??? Pay expensive drugs to feel better...or keep my money, return on drugs I qill not pay since it'S cover by public inssurance in Canada...and continue to have my regular activities...who make me less isolated and help me to keep at least a minimum level of social exposure time...
I just feel tired to think and think about this all day long...That's not my job to try to find solution for my health problems...my PDoc his paid for this...why I have to do all the work??? That's really suck...I'm the one who suffer from mental illiness and i'm the one who have to search and try to find new solutions to treat me...that's a no-sense...I mean that's not my work and i'm not paid for this... I hate the way the Pharmacital industry work and the fact that most of the PDoc are push by the Pharma comp...
Well...that's another bad day...winter snowstorm here...25cm of snow, a lot of winds...I will be stuck in the house for all the day...tomorrow also because I will not have the car of my mom to do something in the evening...
That's strange...I have a lot nausea since 3 days...I sweat a lot, especially in my face... I have NO energy, I never feel like this before, I mean I always complaint about the lack of energy and motivation but now that's so hard, I mean it's worst than ever... At the same time, I try to stop my Valium...at least to cut my dosage by half...they don't have an effect on me and I continue to take them because I fear a seizure... I have to stop smooking...I don'T know what will come next, I just feel trapped in a patern of bad anxiety and anxious situations...that make me feel a lot tired and anxious I guess...
Anyway...sorry for my bad english...this morning I don't feel the urge to correct all the mistake I do...so I hope you understand what I mean ...
You're very nice Phillipa!!! Thanks for your help and your encouragements!!! I appreciate it a lot!
Have a nice day!
Vincent ;-)
Posted by Vincent_QC on January 28, 2009, at 10:04:40
In reply to Re: Selegiline dosage for social anxiety + Depression » Vincent_QC, posted by HyperFocus on January 27, 2009, at 22:22:56
> Hey Vincent have you tried low-dose sulpiride or amisulpiride? They are very activating and may help with the dysthemia and fatigue you have. They also may have adjunct antidepressant and antianxiety effects. Also have you tried tianeptine (Stablon)? I also suffer from severe social anxiety and I seem to be responding(maybe, fingers crossed) to a combination of amitriptyline, sulpirde (50mg) and tianeptine. Search the archives for posts about sulpiride from JohnL and andrewb and others. Hope you feel better man. Social anxiety is the worse. It's like having arachnaphobia and living in a house full of spiders.
Thanks for your help! Well, no luck...no ones of the drugs you names are avaible in the Canada...!!! I just look in the list of avaible drugs and that's not there...I also google them and im rignt, not avaible in the Canada...so I guess it's an invalid option for me...
That's suck...everytime someone come with a good solution for me, I can't have the drugs cause they are not avaible in the Canada...I wonder why health Canada have less drugs choice and make them harder to enter in the Canadian market? Do they have a more high level of selection or what?
Anyway, thanks for your help... have a nice day !!! ;-)
Posted by Vincent_QC on January 28, 2009, at 10:07:35
In reply to Re: Selegiline dosage for social anxiety + Depression, posted by sam K on January 27, 2009, at 23:42:28
> i like that "its like arachniphobia living in a house full of spiders" nice. I have social phobia too and ya its horrible. takes away life quality so bad. Being lonely and isolated isnt healthy nor is it fun.
That's so right...not funny at all!!! I hate that! ... ;-)
Posted by JadeKelly on January 28, 2009, at 11:12:12
In reply to Re: Selegiline dosage for social anxiety + Depression » sam K, posted by Vincent_QC on January 28, 2009, at 10:07:35
Hey!
Sam and Vincent! Two of my favorite people on the same thread. Hope you had a Happy Birthday Vincent!
Please no more talk of spiders!!!That would get me out of the house for sure.
~Jade
This is the end of the thread.
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