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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SalArmy4me on July 8, 2001, at 23:36:53
Anyone done really well on this drug at over 10 mg for non-Parkinsons', non-elderly, melancholic depression?
Posted by Lorraine on July 9, 2001, at 12:14:01
In reply to Selegiline (L-deprenyl) stories, posted by SalArmy4me on July 8, 2001, at 23:36:53
> Anyone done really well on this drug at over 10 mg for non-Parkinsons', non-elderly, melancholic depression?
I can't tolerate more than 5 mg a day and I think that Andrew said that at this level it blocks all of the MAO that it targets. (I can't remember if it's A or B.)
Posted by Elizabeth on July 9, 2001, at 21:49:22
In reply to Selegiline (L-deprenyl) stories, posted by SalArmy4me on July 8, 2001, at 23:36:53
> Anyone done really well on this drug at over 10 mg for non-Parkinsons', non-elderly, melancholic depression?
I'm a little confused. You have bipolar II disorder, right? Can you describe your depressions?
I had a hard time tolerating selegiline for early-onset melancholic depression (I was 21 years old at the time). I did give it enough time to work, but I may not have been taking a high enough dose.
-elizabeth
Posted by SalArmy4me on July 9, 2001, at 22:21:51
In reply to Re: Selegiline (L-deprenyl) stories » SalArmy4me, posted by Elizabeth on July 9, 2001, at 21:49:22
How much did you take? I hear 30-40 mg is supposed to be an antidepressant dose.
Posted by SalArmy4me on July 10, 2001, at 0:47:54
In reply to Selegiline (L-deprenyl) stories, posted by SalArmy4me on July 8, 2001, at 23:36:53
Year Book of Psychiatry & Applied Mental Health
© Mosby-Year Book Inc. 1996. All Rights Reserved.
Volume 1996(10) Annual 1996 pp 472-473
High-Dose Selegiline in Treatment-Resistant Older Depressive Patients:Background.-As many as one third of elderly patients with depression are considered refractory to treatment. Because elderly patients tend to be sensitive to the cardiovascular and anticholinergic effects of traditional tricyclic agents, the monoamine oxidase inhibitors may be useful for those with treatment-resistant depression. The effect of high-dose selegiline in a group of elderly patients with treatment-resistant depression was investigated.
Methods.-Sixteen patients (mean age, 65.6 years) were enrolled in the double-blind, randomized, crossover study. Placebo was compared with 3 weeks of selegiline at 60 mg/day. Repeated lumbar punctures were performed in 10 patients for CSF analysis of monoamine metabolites.
Findings.-Hamilton Depression Rating Scale, Global Depression, and Brief Psychiatric Rating Scale scores were significantly improved with selegiline treatment. Subjective behavioral measures, however, showed no significant improvements. Cerebrospinal fluid assessment demonstrated a significant decline in 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid levels. Systolic blood pressure declined significantly on standing. However, these changes were not associated with clinical side effects.
Conclusions.-High-dose selegiline appears to be an effective therapy for treatment-resistant depression in elderly patients. Although selegiline may have tyramine interactions, it has other advantages that merit further research.
*Commentary: The epidemiologic data are clear that depression and suicidal behavior occur at high rates in the elderly. It is also well documented that many of the side effects associated with traditional tricyclics prohibit their application in this population. Consequently, monoamine oxidase (MAO) inhibitors are often used by clinicians to treat the elderly depressed patient. Sunderland and colleagues in the NIMH intramural program examined the efficacy of high-dose selegiline (formerly known as L-deprenyl) in treatment-resistant older depressed patients. Of interest is the robust clinical improvement in depression with a daily dose of 60 mg of selegiline in only a 3-week clinical trial. This is a good response in a relatively short period and suggests an unusually rapid onset of action. As the authors note, a high dose of selegiline is no longer selective for MAO-B, and thus mechanism-of-action questions are raised by this study. The issue was addressed with a demonstration of significant decreases in noradrenergic as well as serotonergic metabolites. Further studies of mechanism are clearly needed.-A. Breier, M.D.
Posted by Elizabeth on July 11, 2001, at 1:27:13
In reply to Re: Selegiline (L-deprenyl) stories, posted by SalArmy4me on July 9, 2001, at 22:21:51
> How much did you take? I hear 30-40 mg is supposed to be an antidepressant dose.
Up to 40 mg. The effective dose varies from person to person, though. Anyway, I just felt worse on it (much like Wellbutrin).
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:34:43
In reply to Re: Selegiline (L-deprenyl) stories, posted by SalArmy4me on July 9, 2001, at 22:21:51
> How much did you take? I hear 30-40 mg is supposed to be an antidepressant dose.
At least, I *think* it was 40. It was definitely at least 30, but I've heard that some people need up to 60. I just couldn't tolerate it well enough to increase it that much (and I've tolerated a *lot* of side effects).
-elizabeth
This is the end of the thread.
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