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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Avenarius on August 27, 2011, at 13:33:47
40 mg of selegiline is doing the job. No longer depressed and I've got very little anxiety.
Now I have to figure out how to deal with the side effects. I feel very sleepy/tired all day. My eyelids are drooping, actually my whole face is drooping. How do MAOI users deal with this?
I think I'll have to supplement with an appropriate stimulant. There's research and anecdotal support for this combo in spite of general rule against it. (see links)
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
http://www.ncbi.nlm.nih.gov/pubmed/3997787
Posted by bleauberry on August 27, 2011, at 15:50:53
In reply to MAOI Working!... But..., posted by Avenarius on August 27, 2011, at 13:33:47
I do terrible on dex but ritalin does good. With someone else it could be the opposite. One way or the other it has appeared to me the majority of people like one of them but not the other. So I guess you'll have to try one at a time. The hard thing about either of them for me is when they wear off. Even with extended release it isn't comfortable during the transition period when they wear off. I think that gives me more trouble than most though.
I would bet if you could somehow ride it out for 6 months the majority of those side effects would be minimal or gone. I'm not thinking of the body needing time to get used to the med, though that will probably happen, I'm thinking of the longterm resetting and readjustments that are going on in the adrenal/cortisol/adrenaline axis and the increased serotonin at that dose. As receptor sensitivities change, adrenal glands adjust, receptor densities change, and genes take on new coding...they will seek to return to their original instruction except they will need to figure out how to do that with all the extra neurotransmitters floating around. That takes times, more than a few weeks and more than a couple months. Some similar examples that come to mind were some people in a long term Milnacipran trial where their benefits didn't really begin to show up until 6 months and then got real good by 9 months as the side effects became less and less of a problem the whole while too.
I remember some nardil users here over the years that said their troublesome side effects were no longer a problem at 6 months to a year.
But what do I know. Just thinking out loud.
Here's an idea. Take a ritalin or dex just one day every 3 or 4 days. Yeah you'll be dragging on the off days, but you can look forward to that good day. And just use that strategy to allow a few months to go by before doing anything else.
Or on the other hand you might find both are uncomfortable with anxiety stuff, or maybe even make you more tired instead of stimulated. Could happen. I've seen it.
Anyway.
Posted by floatingbridge on August 28, 2011, at 9:27:06
In reply to MAOI Working!... But..., posted by Avenarius on August 27, 2011, at 13:33:47
Did they mention the stin? Instead of Dexedrine, could vvynase be used? Ritalin I have heard of too. Maybe others will weigh in.
Posted by Avenarius on August 28, 2011, at 10:21:11
In reply to Re: MAOI Working!... But..., posted by bleauberry on August 27, 2011, at 15:50:53
Thanks for the advice. I probably will try to ride it out for 6 months. I like the strategy of taking a stimulant every few days, that might help.
I have to find a way to deal with the insomnia as well. Sucks being tired yet still unable to sleep. 1 mg klonopin works, ambien works. Low dose trazodone might be a better longterm option.
Posted by floatingbridge on August 28, 2011, at 11:12:18
In reply to Re: MAOI Working!... But..., posted by Avenarius on August 28, 2011, at 10:21:11
> Thanks for the advice. I probably will try to ride it out for 6 months. I like the strategy of taking a stimulant every few days, that might help.
>
> I have to find a way to deal with the insomnia as well. Sucks being tired yet still unable to sleep. 1 mg klonopin works, ambien works. Low dose trazodone might be a better longterm option.You're welcome. Klonopin helps you sleep? I've been having a wicked time sleeping, now failingn Tenazapam. Klonopin, eh? Why trazodone? Does, itmprovide better quality sleep?
Posted by Avenarius on August 29, 2011, at 9:01:15
In reply to Re: MAOI Working!... But... » Avenarius, posted by floatingbridge on August 28, 2011, at 11:12:18
My understanding is that trazodone, at low doses, is widely prescribed for sleep because you don't get acclimated to it so you needn't keep increasing the dose, and it's relatively harmless over the long term.
Posted by jedi on August 31, 2011, at 1:35:09
In reply to Re: MAOI Working!... But..., posted by Avenarius on August 29, 2011, at 9:01:15
> My understanding is that trazodone, at low doses, is widely prescribed for sleep because you don't get acclimated to it so you needn't keep increasing the dose, and it's relatively harmless over the long term.
I've used low dosage trazodone in the past for Nardil induced insomnia. It works long term, but I could never get used to the nasty drugged feeling before I would go to sleep. Not pleasant at all. And I would always have a drug hangover from it. Not bad, but I didn't like it. Luckily for me, I am very sensitive to all of the medications that affect histamine. I've been using 50mg of diphenhydramine hydrochloride(Benadryl) for years. Most people would build up a tolerance to the drowsiness effect. Not me, still knocks me out after years.
Jedi
Posted by floatingbridge on August 31, 2011, at 3:33:59
In reply to Re: MAOI Working!... But... » Avenarius, posted by jedi on August 31, 2011, at 1:35:09
Jedi, that's wonderful luck. Does the intense insomnia of Nardil diminish over time? At least in you experience.
fb
Posted by jedi on August 31, 2011, at 13:01:30
In reply to Re: MAOI Working!... But... » jedi, posted by floatingbridge on August 31, 2011, at 3:33:59
> Jedi, that's wonderful luck. Does the intense insomnia of Nardil diminish over time? At least in you experience.
>
> fbI don't think the insomnia is as bad as it used to be. But I still use a sleep aid. Seems that is something that has never completely gone away for me. It gets a lot better after the daytime tiredness effect goes away. In the past, if I succumbed to that and took a late afternoon nap, then the insomnia would be a lot worse. Dah, Noe Schitt!
I did have hypomania when Nardil first kicked in. The insomnia was terrible then. If I got working on something, I could be up all night. Kind of miss that hypomanic feeling. After struggling with depression, it felt pretty good. The medication induced hypomania is one reason I believe that atypical depression lies somewhere on the bipolar spectrum. Funny, it has never come back, even after being off of Nardil for months and restarting. These medications do change our brains, I guess we all know that. Somehow, I suspect the 2003 formulation change, may have had something to do with it also.
Be well FB,
Jedi
Posted by Avenarius on August 31, 2011, at 19:06:45
In reply to Re: MAOI Working!... But... » floatingbridge, posted by jedi on August 31, 2011, at 13:01:30
Well, the knonopin hasn't worked for sleep the last couple of nights so I had to rely on Ambien.
Switching topics... I'm feeling more alert and alive now that selegiline is working but I've lost my personality. My affect is flat. It's hard to smile and laugh.
I also feel a little dazed and confused by the end of a workday - alert but brain-dead. It's similar to the feeling I had when under stress and taking Adderall. Makes sense dopamine-wise I suppose.
So, do MAOIs kill your personality and make you stupid and joyless?
This is the end of the thread.
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