Posted by azalea on October 19, 2008, at 12:11:55
In reply to Parnate PLUS Selegiline - comments please, posted by uncouth on October 19, 2008, at 9:11:12
Have you considered increasing your dose of Parnate before augmenting with selegiline? Maximum recommended dose is 60mg/day for Parnate.
There are reports of using higher than recommended doses of Parnate for treatment-resistant depression. I've included an abstract below . . .
Pharmacopsychiatry. 1989 Jan;22(1):21-5.
High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
> Hello,
> I'm on 40mg of parnate, which has been moderately effective in reducing my depressive symptoms, but extremely effective in cutting out the suicidal thinking. I'm also taking 5mg abilify.
>
> I was wondering what the pros and cons are to adding a low-dose of selegiline to the mix. I was on emsam 9mg/12mg in the past, and found it to be way too activating and anxiety inducing, but similar to parnate in it's effectiveness...just a bit harsher.
>
> I'm extremely impressed with selegiline's neuroprotective abilities, independent of it's MAO-B action, and I was thinking about adding 2.5mg of oral (pill form, not liquid form) of selegiline daily to the mix, for neuroprotection and added "help" for my dopaminergic neurons.
>
> I'd also expect that the low dose of selegiline would shift some of the parnate's action more to MAO-A (e.g., if selegiline is helping out with MAO-B, then more parnate can work on MAO-A than otherwise).
>
> Is this a safe mix? Has anyone tried it before? Are there any general issues about combining MAOIs, even at low doses, that could be problematic?
>
> Are there any selegiline experts out there that can speak to whether a low dose like 2.5mg will even have any neuroprotective/neurogenesis effects at all? (e.g., is it even worth it).
>
> I should note my sleep has been bad on abilify + parnate, but i'm hopin such a low dose of selegiline won't add to the sleep issues, but provide me with more energy during the day, while I work on the sleep issues independently.
>
> Thanks for all the comments. I'm going to try this unless someone specifically says "DANGER!"
poster:azalea
thread:858218
URL: http://www.dr-bob.org/babble/20081016/msgs/858228.html