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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by jaclinhyde on May 29, 2011, at 18:39:48
For anyone interested in using Ritalin/methylphenidate or buproprion with an MAOI here is some info provided to me by Dr. Gillman who practically wrote the book on MAOI's in my opinion....
Regarding Wellbutrin and MAOI's...
"Thanks for your good question. I suppose it is only dealt with rather obliquely in my material. It (Wellbutrin) is a very weak reuptake inhibitor and probably works via other mechanisms to produce fairly small changes. It certainly does not have any significant serotonergic activity and there are no reports of it causing any kind of serotonergic overstimulation or serotonin toxicity when mixed with drugs like tranylcypromine.
In view of the above I not infrequently gave tranylcypromine and bupropion together and never had any problems. However, co-administration was usually terminated by cessation of the bupropion because it simply added little to the overall effect, except a fairly large hole in people's wallets across."
Dr Ken Gillman
ken.psychotropical@gmail.com and kg@matilda.net.au__________________________________________
Methylphenidate and MAOI's......
"Methylphenidate and MAOIs have been in use together for 40 years, so it would be surprising if someone had not ingested the combination by now: death, or morbidity, from such an event has not been reported (whereas it has with amphetamine). Methylphenidate is most widely used as a treatment for attention-deficit hyperactivity disorder (ADH) in children. It has been supposed to have serotonergic effects; if that is so it would be predicted to be at high risk of precipitating serotonin toxicity if combined with MAOIs. There are no definite case reports indicating serotonin toxicity with methylphenidate in combination with MAOIs, or other serotonergic drugs (see above). (1-4)
Also, as with mirtazapine and amitriptyline, methylphenidate does not produce serotonergic side effects, or signs of serotonergic toxicity in over-dose or if combined with MAOIs (see Markowitz). E.g.the Sherman case was not serotonin toxicity, but blood pressure elevation. (5-12)
These observations of serotonergic side effects, and signs of serotonergic toxicity in over-dose or if combined with MAOIs, have been proposed as a measure of a drugs clinically significant serotonergic effect in humans. If these effects are not produced clinically significant serotonergic effects are unlikely. (13-16)
Methylphenidate also appears safe in combination with MAOIs; see Feinbergs recent and helpful review of MAOIs and CNS stimulants.(17-20)
This is in keeping with its negligible 5-HT transporter affinity (>10,000 nmol) and apparent inability to raise brain serotonin levels. Unfortunately Rothmans data does not include methylphenidate so there is no releaser potency data. If methylphenidate acts as a releaser in humans then it would be predicted that its effect would be lessened by selective serotonin reuptake inhibitors (SSRIs)s (5-7, 21).
New references (5, 22-26).References
1.Malhotra, S and Santosh, PJ, An open clinical trial of buspirone in children with attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry, 1998. 37(4): p. 364-71.
2.Popper, CW, Antidepressants in the treatment of attention-deficit/hyperactivity disorder. J. Clin. Psychiatry, 1997. 58 Suppl 14: p. 14-29; discussion 30-1.
3.Gainetdinov, RR, Wetsel, WC, Jones, SR, Levin, ED, et al., Role of serotonin in the paradoxical calming effect of psychostimulants on hyperactivity. Science, 1999. 283(5400): p. 397-401.
4.Kafka, MP and Hennen, J, Psychostimulant augmentation during treatment with selective serotonin reuptake inhibitors in men with paraphilias and paraphilia-related disorders: a case series. J. Clin. Psychiatry, 2000. 61(9): p. 664-70.
5.Bymaster, FP, Katner, JS, Nelson, DL, Hemrick-Luecke, SK, et al., Atomoxetine increases extracellular levels of norepinephrine and dopamine in prefrontal cortex of rat: a potential mechanism for efficacy in attention deficit/hyperactivity disorder. Neuropsychopharmacology, 2002. 27(5): p. 699-711.
6.Kuczenski, R and Segal, DS, Effects of methylphenidate on extracellular dopamine, serotonin, and norepinephrine: comparison with amphetamine. J. Neurochem., 1997. 68(5): p. 2032-7.
7.Volkow, ND, Gatley, SJ, Fowler, JS, Wang, GJ, et al., Serotonin and the therapeutic effects of ritalin. Science, 2000. 288(5463): p. 11.
8.Kooij, JJ, Burger, H, Boonstra, AM, Van der Linden, PD, et al., Efficacy and safety of methylphenidate in 45 adults with attention-deficit/hyperactivity disorder. A randomized placebo-controlled double-blind cross-over trial. Psychol. Med., 2004. 34(6): p. 973-82.
9.Klein-Schwartz, W and McGrath, J, Poison centers' experience with methylphenidate abuse in pre-teens and adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 2003. 42(3): p. 288-94.
10.Klein-Schwartz, W, Pediatric methylphenidate exposures: 7-year experience of poison centers in the United States. Clin. Pediatr. (Phila). 2003. 42(2): p. 159-64.
11.Klein-Schwartz, W, Abuse and toxicity of methylphenidate. Curr. Opin. Pediatr., 2002. 14(2): p. 219-23.
12.Sherman, M, Hauser, GC, and Glover, BH, Toxic Reactions to Tranylcypromine. Am. J. Psychiatry, 1964. 120: p. 1019-21.
13.Gillman, PK, Reply to associate professor Norman. Aust. N. Z. J. Psychiatry, 2004. 38(4): p. 269.
14.Gillman, PK, Mirtazapine: not a dual action antidepressant? Aust. N. Z. J. Psychiatry, 2004. 38(4): p. 266-7.
15.Gillman, PK, Mirtazapine: unable to induce serotonin toxicity? Clin. Neuropharmacol., 2003. 26: p. 288-289.
16.Gillman, PK, Amitriptyline: dual-action antidepressant? J. Clin. Psychiatry, 2003. 64: p. 1391.
17.Shelton Clauson, A, Elliott, ES, Watson, BD, and Treacy, J, Coadministration of phenelzine and methylphenidate for treatment-resistant depression. Ann. Pharmacother., 2004. 38(3): p. 508.
18.Feinberg, SS, Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication. J. Clin. Psychiatry, 2004. 65(11): p. 1520-4.
19.Feighner, JP, Herbstein, J, and Damlouji, N, Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression. J. Clin. Psychiatry, 1985. 46(6): p. 206-9.
20.Myronuk, LD, Weiss, M, and Cotter, L, Combined treatment with moclobemide and methylphenidate for comorbid major depression and adult attention-deficit/hyperactivity disorder. J. Clin. Psychopharmacol., 1996. 16(6): p. 468-9.
21.Roth, B, Kroeze, W, Patel, S, and Lopez, E, The Multiplicity of Serotonin Receptors: Uselessly diverse molecules or an embarrasment of riches? The Neuroscientist, 2000. 6: p. 252-262.
22.Williard, RL, Middaugh, LD, Zhu, HJ, and Patrick, KS, Methylphenidate and its ethanol transesterification metabolite ethylphenidate: brain disposition, monoamine transporters and motor activity. Behav. Pharmacol., 2007. 18(1): p. 39-51.
23.Davies, HM, Hopper, DW, Hansen, T, Liu, Q, et al., Synthesis of methylphenidate analogues and their binding affinities at dopamine and serotonin transport sites. Bioorg. Med. Chem. Lett., 2004. 14(7): p. 1799-802.
24.Fleckenstein, AE, Gibb, JW, and Hanson, GR, Differential effects of stimulants on monoaminergic transporters: pharmacological consequences and implications for neurotoxicity. Eur. J. Pharmacol., 2000. 406(1): p. 1-13.
25.Markowitz, JS and Patrick, KS, Differential pharmacokinetics and pharmacodynamics of methylphenidate enantiomers: does chirality matter? J. Clin. Psychopharmacol., 2008. 28(3 Suppl 2): p. S54-61.
26.Schweri, MM, Deutsch, HM, Massey, AT, and Holtzman, SG, Biochemical and behavioral characterization of novel methylphenidate analogs. J. Pharmacol. Exp. Ther., 2002. 301(2): p. 527-35."
Posted by floatingbridge on May 29, 2011, at 20:52:15
In reply to Dr. Gillmans Helpful Info re MAOI, posted by jaclinhyde on May 29, 2011, at 18:39:48
Thanks for this. I wrote Dr. Gillman and he answered in lightning speed. Now to convince my doctor!
What a great find--thankyou.
fb
Posted by jaclinhyde on May 30, 2011, at 1:32:52
In reply to Re: Dr. Gillmans Helpful Info re MAOI » jaclinhyde, posted by floatingbridge on May 29, 2011, at 20:52:15
> Thanks for this. I wrote Dr. Gillman and he answered in lightning speed. Now to convince my doctor!
>
> What a great find--thankyou.
>
> fbYou are very welcome! Yes, he answered me incredibly fast as well. It is nice to know that there are still professionals out there who really take an interest in others. I printed out the info he sent so I can show it to my doctor. Hopefully he will listen!
Terri
Posted by floatingbridge on May 30, 2011, at 1:43:56
In reply to Re: Dr. Gillmans Helpful Info re MAOI, posted by jaclinhyde on May 30, 2011, at 1:32:52
Good luck!...to us !
Posted by bleauberry on May 30, 2011, at 19:17:06
In reply to Dr. Gillmans Helpful Info re MAOI, posted by jaclinhyde on May 29, 2011, at 18:39:48
I like reading Gillman's stuff. He sort of takes the science studies, dissects them, and combines it with his own clinical observations to come up with some good stuff.
Posted by jaclinhyde on May 30, 2011, at 19:39:43
In reply to Re: Dr. Gillmans Helpful Info re MAOI, posted by bleauberry on May 30, 2011, at 19:17:06
> I like reading Gillman's stuff. He sort of takes the science studies, dissects them, and combines it with his own clinical observations to come up with some good stuff.
Yeah, he is very knowledgeable and insightful. I wish he didn't live "down under" :-)
Terri
Posted by Conundrum on June 4, 2011, at 12:06:34
In reply to Re: Dr. Gillmans Helpful Info re MAOI, posted by bleauberry on May 30, 2011, at 19:17:06
> I like reading Gillman's stuff. He sort of takes the science studies, dissects them, and combines it with his own clinical observations to come up with some good stuff.
I agree. I find Stahl's books too focused on drug mechanisms and not based on what actually works. I'd rather hear stories about patients jumping out of chairs saying this worked than this hits this receptor and causes the relesase of chemical 'x', while inhibitnig the release of chemical 'y'. I've tried going down that route and the brain is way to complicated to try to figure what will work. It is a lot of educated guesses but mostly trial and error. Unfortunate.
Posted by desolationrower on June 11, 2011, at 13:17:08
In reply to Re: Dr. Gillmans Helpful Info re MAOI, posted by Conundrum on June 4, 2011, at 12:06:34
> > I like reading Gillman's stuff. He sort of takes the science studies, dissects them, and combines it with his own clinical observations to come up with some good stuff.
>
> I agree. I find Stahl's books too focused on drug mechanisms and not based on what actually works. I'd rather hear stories about patients jumping out of chairs saying this worked than this hits this receptor and causes the relesase of chemical 'x', while inhibitnig the release of chemical 'y'. I've tried going down that route and the brain is way to complicated to try to figure what will work. It is a lot of educated guesses but mostly trial and error. Unfortunate.I think the problem with Stahl is he has the idea that all the research from the last decade tells us important things abotu how these drugs work, but that researach from the upcoming decade will not tell us anything of note about them.
-d/r
[oh and i didn't have gillman's site bookmarked, but was kind of feeling like there was a site i'd like to link to. thanks for the link.]
Posted by Conundrum on June 12, 2011, at 11:30:29
In reply to Re: Dr. Gillmans Helpful Info re MAOI, posted by desolationrower on June 11, 2011, at 13:17:08
> > > I like reading Gillman's stuff. He sort of takes the science studies, dissects them, and combines it with his own clinical observations to come up with some good stuff.
> >
> > I agree. I find Stahl's books too focused on drug mechanisms and not based on what actually works. I'd rather hear stories about patients jumping out of chairs saying this worked than this hits this receptor and causes the relesase of chemical 'x', while inhibitnig the release of chemical 'y'. I've tried going down that route and the brain is way to complicated to try to figure what will work. It is a lot of educated guesses but mostly trial and error. Unfortunate.
>
> I think the problem with Stahl is he has the idea that all the research from the last decade tells us important things abotu how these drugs work, but that researach from the upcoming decade will not tell us anything of note about them.
>
> -d/r
>
> [oh and i didn't have gillman's site bookmarked, but was kind of feeling like there was a site i'd like to link to. thanks for the link.]For me personally, I've tried 3 of his heroic combos and none have helped. Well I'm still on the third, but nothing is happening.
This is the end of the thread.
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