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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 uncouth on May 1, 2009, at 12:06:58
hi there,
as i'm on a whole portfolio of antidepressants and etc. drugs, (milnacipran, tianeptine, nortriptyline, geodon, amantadine, memantine, agomelatine, rilutek, lithium, deplin) for my highly-treatment-resistant, suicidally-deep depression, and i'm still not seeing results (although I have only been on half these drugs for 2 weeks), I want to add yet another drug to the mix.
I have some old Emsam patches 12mg (highest dose) from a failed med trial a while back that I'd like to use to give me some Selegiline boost. What's the maximum I can take (cut the patch size down to) such that I'll be hitting only MAOB and not MAOA which would send me to the hospital given the other things I'm on.
I'm thinking that splitting the 12mg patch into 3, so each segment delivers 4mg of 24 hours, would be OK and only knock out MAOB. Since the lowest available dose of Emsam is 6mg, and I'd assume even the lowest dose of Emsam would be hitting MAOA and MAOB, I figure 4mg gives me enough of a safety room so I don't potentially give myself serotonin syndrome or worse.
I hope this post makes sense and the question I'm asking is sensible.
Love,
Al
<start vent>
P.S. and if that's not enough, I've also got Lamotrigine, Donepezil, and oral Deprenyl on order to add to my mix. F*cking sh*t I hate this illness. I figure i'm giving it a month after being on this whole portfolio of meds, and finishing up my course of ECT (i'm on shock #21 and still not fully better) and I"m either gonna get better TO THE MAX, or just decide to kill myself becuase I will have lost hope after trying essentially every psych med known to be somewhat useful.
ok <end vent>
Posted by Phillipa on May 1, 2009, at 12:21:56
In reply to Lower-dose Emsam selective for MAOb, posted by uncouth on May 1, 2009, at 12:06:58
As you know I'm not a drug expert but sounds risky to me. Have you checked with any of the others? Different site. Love Phillipa here's pulling for your recovery.
Posted by Nadezda on May 3, 2009, at 0:57:19
In reply to Lower-dose Emsam selective for MAOb, posted by uncouth on May 1, 2009, at 12:06:58
Hi.
My advice to you is NOT to take any emsam unsupervised by a pdoc who knows exactly what drugs you're taking and how much.
Taking chances with Maois is not a reasonable idea. It's much too dangerous and unpredictable-- .
Moreover, taking repeated doses of an maoi increases the effect-- so even if one day of 3 mg would be safe-- which I don't believe-- three or four days might be extremely dangerous.
Please consult with your pdoc immediately, rather than self-medicate.
Nadezda
Posted by desolationrower on May 3, 2009, at 14:47:58
In reply to Re: Lower-dose Emsam selective for MAOb, posted by Nadezda on May 3, 2009, at 0:57:19
i think the patch has much higher effect than taking orally. remember, it bypasses the gut/firt pass metabolism in liver,
-d/r
Posted by uncouth on May 3, 2009, at 16:46:41
In reply to Re: Lower-dose Emsam selective for MAOb, posted by desolationrower on May 3, 2009, at 14:47:58
so what would 4mg patch (one third of a 12mg patch) be equivalent to in terms of oral deprenyl. because i heard that you only have to worry about serotonin syndrome at MAO-A inhibiting dose of deprenyl which is minimum 10mg/day. So I was assuming it's ok to be on a SNRI plus 4mg worth of Emsam patch at the same time.
Am I wrong?
Posted by desolationrower on May 3, 2009, at 23:04:08
In reply to Re: Lower-dose Emsam selective for MAOb, posted by uncouth on May 3, 2009, at 16:46:41
i had some estimates worked out but its on my other computer. if you don't want to wait a week or two when i'm on it again, you could look at the EMSAM prescribing info and i think i looked at zelpar too (1.25mgsublingual~5mg oral i think)
-d/r
This is the end of the thread.
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