Posted by Adam on October 18, 1999, at 9:38:44
In reply to Re: dropping Parnate& question for Adam, posted by Lynne on October 16, 1999, at 21:52:28
Hi, Lynne,
Unfortunately, it is difficult to answer both of your questions because of the manner in which I have gone about taking selegiline.
I am currently enrolled in a study being done at McLean hospital in Belmont, MA (and there are other such studies being done in other
parts of the country) where selegiline HCl is being delivered transdermally (via a "patch") rather than orally. This mode of delivery
has a few important implications:
-Because it avoids first-pass metabolism, a much lower dose of selegiline per patch is needed to achieve a therapeutic blood level
than would be needed in oral administration.
-The metabolite profile in transdermal delivery differs from that of oral delivery. Less L-amphetamine and L-methamphetamine seem to
be produced.
-Anecdotally, the response to selegeline delivered transdermally can be extremely rapid compared to other ADs taken orally. My doctors
have seen a full response in less than two weeks. Why this is I have no idea, and it hasn't been explained to me.
-Of course, no dietary restrictions.Now, the study began with an eight week long double-blind phase where the patient might get a) nothing, b) 10mg/patch or c) 20mg/patch
of selegiline. During this period, I didn't experience much relief from depression, though I did notice some benefit after about six
weeks, and also I slept far less than I did before on Remeron. But I really have no idea if I was on anything at that point or not.
Once the blinded phase was over I began the open-label phase where I knew I was getting 20mg/patch. The response I experienced was
dramatic. In about two to three days I knew something was up. I spent about a week after that being "hyper-Adam" which wasn't all bad
except my friends seemed a bit confused and I slept about four hours a night, max. I've since settled down a bit, but the improvement
in mood is still there. I sure hope it lasts.Anyway, it is possible I was not on anything to begin with, and just had a super-robust response as soon as I got on the drug. My
guess, however (and this is the merest guess) is that I was on a low dose patch, was very slowly responding, and went into high
gear as soon as I got on the elevated dose. This just seems most plausible to me. I can't rule out the placebo effect even at
this stage, but my response was so beyond what I expected, I find this unlikely.What all of this means for oral administration of selegiline I'm not certain. What I do know is that...
-It takes longer to respond to oral selegiline, on average. Expect the usual 4-6 week time frame for an AD trial.
-You might have to get up to 50mg, 60mg, or even more selegiline orally to experience a good antidepressant response. Since
selegiline only comes in 5mg tablets max., you'll be popping a lot of pills.
-Some of the more annoying side effects of selegiline may be more pronounced when it is administered orally, due to the
differences in metabolism.All of this has left me in a bit of a quandry: What do I do once the study is over? I might wind up trying tranylcypromine
orally instead of selegiline until the patch becomes available commercially. Or I might just take selegiline orally. I guess
I'll cross that bridge when I get to it.> I also had to stop using Parnate because of my blood pressure being too low. I then tried Marplan and it made me too tired. It seemed to be a smoother drug than Parnate. I am now using Selegiline.
>
> Adam, Could you tell me how long it took for you to notice the AD effect and also what doseage of Selegiline you are on.
>
> Thanks, Lynne
poster:Adam
thread:13117
URL: http://www.dr-bob.org/babble/19991016/msgs/13364.html