Posted by Elizabeth on July 21, 1999, at 7:25:01
In reply to Re: Selegeline ? for Annie, posted by Annie on July 20, 1999, at 22:31:40
Hi Annie. About selegiline....
> Actually, I considered it, but my Pdoc seems to think that I would respond better to Parnate or Marplan at the dose I would need. The 30mg Selegiline patch has really helped many of the symptoms of my depression and the lack of side effects has been great.
I actually went up to 40mg - interestingly, with no positive effects - and I know of a couple people who've taken as much as 50. It's a little inconvenient because the highest strength pill is 5mg!
>The best improvements have been a total absence of suicidal thoughts, a much higher tolerance for stress and the fact that I am losing weight without even trying!
Do you have an appetite? I didn't - it sapped what little appetite I had at that point!
>I haven't felt this good in years. The increase in energy and motivation leveled out after a slight initial improvement. I still have to force myself to do anything or to leave the house. Social activities still feel like a penance.
For the anxiety, I'd personally suggest Marplan rather than Parnate. Selegiline, like Parnate, is a non-hydrazide MAOI and is related to amphetamine (in fact, it has amphetamine metabolites and can cause you to test positive for amphetamines on a tox screen).
>If there were a patch at a higher dose it would be a no-brainer for me, even though the diet would then be required. Remember that with transdermal delivery, lower doses are needed to reach a therapeutic level because it bypasses the liver.
Well, all drugs go through the liver eventually, but as I understand it, it bypasses first-pass metabolism.
Do you know when they're going to publish the results of this study, BTW?
>Taken orally it is unlikely 30mg would have any effect for me. I usually need to meet or exceed maximum dose to get any benefit(eg 400mg desipramine for several months before my desipramine reached the supposed therapeutic level of 180. Still didn't help though, and side effects were horrendous.
It might also just be that desipramine isn't the drug for you anyway. (BTW I think the maximum recommended therapeutic level for desipramine is 300ng/mL, but don't quote me on that.)
>My doc says that my liver must be very,very good indeed at metabolizing.) I don't know what the oral equivalent of 30mg transdermally would be,[does anyone know?] but I would probably have to go much higher.
I doubt anyone knows. It's hard to gauge the therapeutic level of an MAOI because they are metabolized pretty fast.
>There isn't much information about effects of very high doses of Selegiline, so I guess it's safer to try Parnate or Marplan for now. I am a little leery of Parnate because I experienced spontaneous hypertension in my first trial of it.
How high did your BP go? I think you're the first person I've met (other than myself) who's had this side effect from it.
>I'm not ruling it out though, if I can start low and build slowly to an effective dose.
The key I think is taking it in divided doses.
>I'd rather stay on the patch longer but it isn't possible. I'm really frightened that all the relief I've gotten is going to disappear. I don't think I could stand it.
The washout period might be hard...I'm not sure what to suggest for dealing with it, other than maybe to be sure you have benzodiazepines on hand! Best of luck to you....
> PS If anyone is aware of any studies using selegiline at higher doses, I'd appreciate if you would post the information.
Sunderland T, et al. High-dose selegiline in treatment-resistant older depressive patients. Arch Gen Psychiatry. 1994 Aug;51(8):607-15.
(Bear in mind that the elderly tend to be more sensitive to side effects than younger adults.)
poster:Elizabeth
thread:5905
URL: http://www.dr-bob.org/babble/19991001/msgs/9014.html