![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by willyee on April 3, 2006, at 11:54:16
I think simply said a lot of maoi users and dont take this the wrong way please but might be a bit cocky,i know i was definatly.
Reason is you simply cant truly respect the guidelines unless u have been though a full interaction,i personaly dont believe u can at all.
You might feel u do,but when and hopefully not u have one,it becomes a different ball game.When u know u are there and cant turn back the clock but instead go forward either getting better or worse and in ER,you start a new appreciation for the drug interactions.
Posted by Maxime on April 3, 2006, at 13:31:37
In reply to Maois and interactions, posted by willyee on April 3, 2006, at 11:54:16
Well when I first started taking Parnate I tried to eat some of the foods in small amount to see if I would have a reaction. Turns out I have a high tolerance for tyramine. The only two things that I have to stay away from is soy sauce and red wine.
Guess I'm lucky.
Maxime
> I think simply said a lot of maoi users and dont take this the wrong way please but might be a bit cocky,i know i was definatly.
>
> Reason is you simply cant truly respect the guidelines unless u have been though a full interaction,i personaly dont believe u can at all.
>
> You might feel u do,but when and hopefully not u have one,it becomes a different ball game.When u know u are there and cant turn back the clock but instead go forward either getting better or worse and in ER,you start a new appreciation for the drug interactions.
Posted by TylerJ on April 3, 2006, at 14:01:52
In reply to Re: Maois and interactions, posted by Maxime on April 3, 2006, at 13:31:37
I've yet to have a reaction..but I'm pretty darn careful about what I eat, etc. I have two wonderful young boys ages 7 and 4, and a great wife, I don't want to leave them without a husband and Daddy. On the flip side, the risks are worth it to me, because my life sucks and I'm not much of a Daddy/husband when I'm severly depressed.
Tyler
Posted by Phillipa on April 3, 2006, at 18:31:48
In reply to Re: Maois and interactions » Maxime, posted by TylerJ on April 3, 2006, at 14:01:52
But it won't matter on the patch will it? Love Phillipa
Posted by TylerJ on April 3, 2006, at 18:48:18
In reply to Re: Maois and interactions » TylerJ, posted by Phillipa on April 3, 2006, at 18:31:48
> But it won't matter on the patch will it? Love Phillipa
Seems to be a much safer way to deliver the medicine, huh? If and when I need to, this will be the next drug I try. I'm hoping of course that Parnate will last for many, many years. But you never know with these *CRAZY DRUGS*, do you?
Tyler
Posted by Phillipa on April 3, 2006, at 21:13:54
In reply to Re: Maois and interactions » Phillipa, posted by TylerJ on April 3, 2006, at 18:48:18
I thought they were the same MAOI's. See I know nothing about them. So what is the difference in the patch ingredients? Love Phillipa
Posted by TylerJ on April 4, 2006, at 9:58:39
In reply to Re: Maois and interactions » TylerJ, posted by Phillipa on April 3, 2006, at 21:13:54
> I thought they were the same MAOI's. See I know nothing about them. So what is the difference in the patch ingredients? Love Phillipa
*The Patch* EMSAM is an MAOI, it's just a different drug,(just like prozac and zoloft are different drugs, but both ssri's) it's different than Nardil and Parnate, but it is still in the MAOI class of drugs. Of course it's delivered via a patch on your skin, instead of taken by mouth as in pills. Experts believe because it doesn't go into the gut, there will be less side effects and less chance of a hypertensive crisis. The patch should have a much less restrictd diet than the other maoi's. :}Tyler
Posted by CEK on April 4, 2006, at 10:49:44
In reply to Re: Maois and interactions » Phillipa, posted by TylerJ on April 4, 2006, at 9:58:39
What are the restrictions on MAOIs? I've never taken any before but many have suggested them to me. SSRIs don't work for me.
Posted by Caedmon on April 4, 2006, at 17:03:43
In reply to Re: Maois and interactions » TylerJ, posted by CEK on April 4, 2006, at 10:49:44
No one, IMHO, should be on an MAOI without an emergency antihypertensive (chlopromazine or nifedipine).
The EMSAM patch will not require dietary changes at the two lower doses, but it will at the two higher doses. Depends on how much you need. Just anecdotally it seems selegiline doesn't have as good a reputation as the other irreversible MAOIs, but that could be totally wrong. I'm hoping the patch will renew an interest in MAOIs.
- C
Posted by Phillipa on April 4, 2006, at 19:05:25
In reply to Re: Maois and interactions » Phillipa, posted by TylerJ on April 4, 2006, at 9:58:39
Tyler will it relieve extreme axiety and the depression that results because your anxiety is so high you stay home, afraid of people, can't concentrate and can you cut it in half like Ed asked in another Thread so you could see if it would be okay for you? And how may docs will actually use this med and will the drug companies push it like they do the SSRI's SSNRI's the so called wonder drugs. that don't work for me and after l0 years I ought to know what works for me. My fear of them only developed after the horrible sides effects I got form them. I was always so relieved when they took me off them that I felt better. Love Phillipa
Posted by TylerJ on April 5, 2006, at 10:37:05
In reply to Re: Maois and interactions » TylerJ, posted by Phillipa on April 4, 2006, at 19:05:25
> Tyler will it relieve extreme axiety and the depression that results because your anxiety is so high you stay home, afraid of people, can't concentrate and can you cut it in half like Ed asked in another Thread so you could see if it would be okay for you? And how may docs will actually use this med and will the drug companies push it like they do the SSRI's SSNRI's the so called wonder drugs. that don't work for me and after l0 years I ought to know what works for me. My fear of them only developed after the horrible sides effects I got form them. I was always so relieved when they took me off them that I felt better. Love Phillipa
That's what they're hoping for Jan. Hopfully, it'll be an effective MAOI without all of the annoying side effects..at least without some of them. As far as cutting the Patch up, honestly, I haven't heard if this is possible yet. But I'm sure they're going to come in different sizes/dosages. This just might be the right MAOI for you Jan. If it works as well as nardil and Parnate without the side effects,WOW,that would be great!
Love, Tyler
Posted by JaclinHyde on April 6, 2006, at 16:42:53
In reply to Re: Maois and interactions » Phillipa, posted by TylerJ on April 5, 2006, at 10:37:05
The thing with Emsam is that it has always been around as L-Deprenyl (Selegeline) but has never or rarely been used as an anti-d because you have to use the higher dose and therefore it becomes just like Nardil or Parnate with the cheese effect (don't you hate that term?) The patch seems to bring on the same problem. But again it has some might protective and health boosting properties.
Better living through chemistry.
Here is a great article on selegeline..."..... Selegiline, also known as l-deprenyl, is an irreversible and (relatively) selective MAO-B inhibitor. Meta-analysis of published clinical trials confirms it offers a cheap, safe and effective symptomatic treatment of early Parkinson's disease. Selegiline may also be neuroprotective and act as an antidepressant.
The enzyme monoamine oxidase has two main forms, type A and type B. They are coded by separate genes. MAO may be inhibited with agents that act reversibly or irreversibly; and selectively or unselectively. These categories are not absolute. MAO type-A preferentially deaminates serotonin and noradrenaline, and also non-selectively dopamine. Type B metabolises dopamine, phenylethylamine (the chocolate amphetamine) and various trace amines.
At dosages up to around 10 mg or so daily, selegiline retains its selectivity for the type-B MAO iso-enzyme; but it is also a weak reversible inhibitor of the type-A MAO iso-enzyme. In contrast to unselective and irreversible MAO inhibitors such as tranylcypromine (Parnate) and phenelzine (Nardil), both of which strongly potentiate the catecholamine-releasing effect of tyramine, selegiline inhibits it. This ensures that low-dosage selegiline does not induce the hypertensive "cheese effect". A regimen of 2 x 5 mg daily of selegiline daily irreversibly inhibits over 90% of MAO-B in the basal ganglia, the location of over 80% of dopamine in the human brain. This level of MAO-B inhibition leads to a 40%-70% increase in synaptic dopamine.Selegiline has immune-system-boosting and anti-neurodegenerative effects. Its use increases the level of tyrosine hydroxylase, growth hormone, cerebral nitric oxide and the production of key interleukins. Selegiline offers protection against DNA damage and oxidative stress by hydroxyl and peroxyl radical trapping; and against excitotoxic damage from glutamate. In addition, selegiline stimulates the release of superoxide dismutase (SOD). SOD is a key enzyme which helps to quench the production of damaging free-radicals. Potentially, selegiline may prevent or reverse iron-induced memory impairment. The deposition of excess iron in the brain is implicated several neurodegenerative diseases.
Selegiline protects the mitochondria via its effects on mitochondrial membrane permeability: it directly interacts with the pore-forming structures. Mitochondria are the energy powerhouses of the eukaryotic cell where oxygen respiration occurs. If the mitochondrial theory of aging is correct, then the root cause of aging is damage to mitochondrial DNA by free radical leakage from adjacent respiratory proteins. Alas selegiline itself is not an elixir of eternal youth. But its current "off-label" use by life-extensionists prefigures the longevity-enhancing mitochondrial medicine of decades to come.
Taken consistently in low doses, selegiline tends to extend the life-expectancy of rats by some 20%; enhances drive, libido and endurance; and independently improves cognitive performance in Alzheimer's patients and in some healthy normals. Its protective role against age-related memory decline derives at least in part from its protection of hippocampal neurons in the aging brain. Aging drug-free rats have poorer spatial memories and fewer hippocampal neurons than their counterparts on selegiline. Selegiline is already used successfully to treat canine cognitive dysfunction syndrome (CDS) in dogs.
Selegiline retards the metabolism not just of dopamine but also of phenylethylamine, a trace amine also found in chocolate and released when we're in love.
Selegiline protects the brain's dopamine cells from oxidative stress. The brain has only about 30-40 thousand dopaminergic neurons in all. We tend to lose perhaps 13% a decade in adult life. An eventual 70%-80% loss leads to the dopamine-deficiency disorder Parkinson's disease, frequently foreshadowed by depression. Selegiline in pill form was approved by the FDA as an adjunct in the treatment of Parkinson's disease in 1989.
Administered at low doses, selegiline is neuroprotective against possible damage to the serotonergic fine axon terminals caused by overconsumption of the popular drug MDMA (Ecstasy). Several competing theories exist that purport to explain MDMA-induced neurotoxicity. One theory blames the deamination by MAO-B of excessive dopamine taken up by the membrane-bound transporter into the depleted serotonin terminals. This abnormal uptake follows MDMA-induced reversal of the serotonin reuptake pump. In the absence of MAO-B inhibition, deamination by MAO-B of excess dopamine taken up into the serotonergic axon terminals is liable to generate a glut of toxic free radicals. These highly reactive compounds cause membrane lipid peroxidation and consequent fine terminal degeneration. Selegiline prevents such serotonergic damage, in theory at any rate.On the other hand, co-administering unselective selegiline dosages or unselective irreversible MAOIs like tranylcypromine (Parnate) or phenelzine (Nardil) with MDMA is potentially lethal.
Taken at MAO-B-selective dosages, selegiline is typically less effective as a mood-brightener than other dopaminergics such as amineptine (Survector) - though occasionally spectacular remission of depressive symptoms may occur even with minimal MAO-A inhibition. Taken at unselective dosages of 20mg a day or more, selegiline is typically an effective, well-tolerated antidepressant. Selegiline at higher dosages may also be useful for "atypical" depressive symptoms of overeating, oversleeping, and hypersensitivity to rejection. An unselective dosage regimen would normally call for an MAOI diet (no cheese, red wine, fava beans, salami, etc).
However, the gastrointestinal tract can be bypassed. Selegiline can be delivered via a one-a-day transdermal patch. In December 2004, pharmaceutical firms Bristol-Myers Squibb and Somerset Pharmaceuticals announced they had entered into an agreement to distribute and commercialize EMSAM - the first transdermal treatment for major depression. Wrangling over labelling issues delayed the product launch. But in February 2006, the FDA granted EMSAM a product license for the treatment of major depressive disorder in adults. EMSAM's pharmacokinetic and pharmacodynamic properties promote the inhibition of MAO-A and MAO-B in the CNS while avoiding significant inhibition of intestinal and liver MAO-A enzyme.
Three different strengths of EMSAM patch are currently marketed: 20mg/20cm2, 30mg/30cm2, and 40mg/40cm2. The three patch sizes deliver daily doses of selegiline averaging 6mg, 9mg and 12mg respectively. Use of the lowest dosage EMSAM 6 mg/24 hour patch calls for no dietary modification. At this dosage range, MAO-A in the digestive tract is preserved at levels adequate to break down tyramine, while MAO in the brain is inhibited at levels adequate to induce an antidepressant effect. A restricted "MAOI diet" is prudently advised for the higher dosage EMSAM 9 mg/24 hr patch and the 12 mg/24 hr patch to avoid any risk of hypertensive crisis.
Other prescribing indications for selegiline are in prospect. In November 2004, Yale University researchers launched a study of selegiline for smokers who want to quit tobacco."
JH ~ The research hog
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.