Posted by KaraS on August 9, 2004, at 5:39:15
In reply to Re: Ritalin and Selegiline » KaraS, posted by Ktemene on August 9, 2004, at 4:32:36
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> > > > > > Thanks so much for that comprehensive response. I read the chart from the address you gave me and a lot of the ADD descriptions match me but plenty of it doesn't. I guess you were right earlier (I think it was you anyway) when you said that the diagnosis per se is less important that the treatment. If Adderall or another medication helps me, then it really doesn't matter what the actual diagnosis is.
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> > > > > > Several months ago my pdoc said that I should increase the Ritalin and see if I have that response at 10 mg. Sometimes people react one way to the smaller dosages and a different way as the dosage is increased. I was just too scared to try a larger amount. > Sounds foolish I know.
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> > > > > Actually, it is very smart to be hesitant about taking these sorts of meds. It is the people who have no worries at all that are foolish. I certainly resisted my pdoc's suggestion that I start Adderall for a long time. But he told me that the people who are most benefited by Ritalin and Adderall are the very people who are least likely to become dependent. And there are certainly a lot of people on this board who have taken low doses of these meds for a long time and only had beneficial effects. Viridis is a good example. He has been taking low dose Adderall and Klonopin for years, and never felt any inclination to increase his dose. I think it might be worth while for you to take your doctor's advice on trying Ritalin on a slightly higher dose, and maybe letting the trial run for a few days, because it sometimes takes three or four days for the body to adjust to these meds. It took me almost a full week to get used to Adderall. But once I had adjusted the med was very helpful. Of course I realize that you can't do much because of the insurance problem right now, but whenever you have a chance, either Ritalin or Adderall might be worth a trial for you.
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> > > > Ritalin and Adderall are definitely on my list for future trial, if needed.
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> > > > > > It's not a bad thing for you not to develop tolerance or have withdrawal symptoms from stopping the Adderall - if there's a silver lining here... (I haven't seen my doctor in months > because of lack of health insurance so I can't really follow up on it right now.)
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> > > > > No, it is not a bad thing at all. I am very grateful that I don’t have to worry about tolerance or withdrawal because I know how much a lot of people on this board have had to go through in dealing with them. This is the one time when my ADD worked to my advantage.
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> > > > > > I'm really surprised that current thinking holds that dopamine is implicated in ADD. I > would have thought it was NE or at least both of them.
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> > > > > Since DA and NE are so closely related, it is likely that anything that affects DA is also going to have an immediate effect on NE. E.g. Strattera has an effect on DA. It is rather strange that so many docs think that the key to ADD is the dopamine system rather than NE, but there is a lot of literature supporting this claim. Here's a link to a site that has collected some article abstracts on it : http://www.neurotransmitter.net/adhdda.html
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> > > > Good site. Thanks.
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> > > > > > I have tried selegiline in 5 mg. and taken it for a couple of days at a time. I haven't tried it steadily. How long before you got an antidepressant effect from it? Was it right away or did it take weeks?
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> > > > > The antidepressant effect took several weeks to develop. It makes sense that it would. Since I am only taking 5mg it would certainly require several weeks for MAO-B to be eliminated. (I read somewhere that 5-10 mg Selegiline per day for several weeks will eliminate 90% of the brain’s MAO-B. A bigger dose would get the job done much quicker, but would also require conforming to the MAOI diet. But I did feel the activating effect from the very first day. By the way, you should always take Selegiline after a meal. The bioavailability of Selegiline increases more than 300% if it is taken with food. Also, you might try opening the Selegiline cap and pouring the powder into your mouth and holding it there for a few minutes. That would allow some of the med to be absorbed directly into the bloodstream. At such low doses it is important the maximize the bioavailability to the extent that one can.
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> > > > The selegiline I have is in pills, not powder. I have taken it with food so as to avoid stomach upset but didn't know that I was actually enhancing the absorption. That's amazing that only 5 mg.- 10 mg. can eliminate 90% of the MAO-B. If that's the case, then why is selegiline not considered an antidepressant until around the 30 mg. mark?
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> > > I should say that I don't remember the source for that so I don't know whether it is a reliable claim. But, assuming it is true, why isn't Selegiline considered an AD until the dose reaches around 30mg? Probably because most pdocs think that it is MAO-A that needs to be inhibited for a med to really count as an AD. Selegiline is not a significant MAO-A inhibitor at doses much lower than 30mg. And the pdocs are right. Most people need a med that directly increases the amount of serotonin and/or norepinephrine in their brains. But there are a few of us who aren't helped at all by meds that increase serotonin, and are helped to a limited degree by meds that increase norepinephrine, but are dramatically helped by meds that increase dopamine. And so for us Selegiline is an AD.
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> > You are taking other things besides selegiline (Adderall and I'm not sure what else). How much of the antidepressant effect do you think selegiline is responsible for? Could it just be the missing piece of the puzzle and the other things you take also fill out the puzzle?
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> Yes, I am taking other meds, both prescription and OTC meds. And I am doing other things that can have antidepressant effect, e.g. I exercise regularly and eat a lot of fish. So in principle I think the possibility that other factors are partly or even mainly responsible for the remission of my depression cannot be ruled out. However, I am still inclined to think that the 5 mg Selegiline I am taking is the main factor. There are two main reasons I think this. One reason is that the other prescription meds I am taking, 5-20 mg Adderall and 50-200 mg Provigil per day, are both meds that I have been taking for some time and found to have little antidepressant effect, although they are helpful for my ADD. My depression did not begin to lift until after I started taking 5 mg Selegiline per day. Of course the Adderall and Provigil might be augmenting the Selegiline so that in combination with them it has an antidepressant effect which it would not have otherwise. The reason I think this is unlikely is that my reaction to Selegiline is very similar to that of some other posters on this board, and none of them were taking Adderall, and only one of them was taking Provigil with Selegiline. There are several posters who had pretty much the same experience- here are some links to some of them:
> elleff: http://www.dr-bob.org/babble/20040614/msgs/357474.html
> germanium20: http://www.dr-bob.org/babble/alter/20040418/msgs/350645.html
> Jemma: 11http://www.dr-bob.org/babble/20030525/msgs/229420.html
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> To tell you the truth, I was very surprised when I had such a strong positive response to a mere 5 mg dose of Selegiline. I thought that I had no chance of any response until I reached the 45 mg dose that many docs say is the target dose for antidepressant effect. But I was wrong and 5 mg does work for me. It is a bit ironic after all these years of trying and failing to deal with my depression and after all the failed trials of all those more promising meds that I should discover that a tiny amount of a med that almost nobody has ever heard of is the one that saved me. But it did. I suppose the moral is to never stop searching because even the unlikeliest med may be the one you need. I’m sure you remember Gracie (Whiterabbit) who wrote so many great posts. In one of her last posts she describes what it is like to find the right med. She said the feeling was better than winning the jackpot: it felt like going home when you always believed there was no home to go to. She was right. Here’s the link to her post: http://www.dr-bob.org/babble/20030718/msgs/243355.html
>Ktemene,
You have no idea what a God send your previous post is to me right now. After failing or not tolerating so many medications and supplements for so many years now, including my current trial of Perika (SJW), I really needed to hear these good things about selegiline. I was feeling so hopeless about it all when I read your post. Selegiline is the next thing I'm planning on trying along with DLPA. I think I mentioned earlier that i have taken 5 mg. of it twice and tolerated it well. I have also tried 1000 mg. of DLPA and tolerated that well. I'm planning on trying them together once the SJW is out of my system and I'm off of the tiny amount of Effexor (<19 mg.) I'm now taking. I have some here at home now but if it works out, I will have to find a doctor to prescribe it. I will keep you posted.I had a question about Ron's (germanium20's) posting. He writes:
"Side effects are very modest at my low dose (2.5mg/day). A very very modest headache & mild tremors that appear sporadically (some days not at all but if I do get them it is usually in late afternoon or early evening). These appear to be mostly due to the metabolites of selegiline rather than the selegiline itself as there are currently preporations out there that avoide the first pass metabolization where most of the metabolites come from & from what I read it is relatively free of those side-effects"
Do you know what preparations of selegiline he is referring to that eliminate the first pass metabolization?
Also, here's an old post by "Adam" about how the selegiline patch helped him (if you haven't already read it). Of course it's the patch and not just a small amount of selegiline like we've been discussing, but it's a good post to read and reread for so many reasons.
http://www.dr-bob.org/babble/20001115/msgs/48935.html
Thanks again!
Kara
poster:KaraS
thread:373827
URL: http://www.dr-bob.org/babble/20040805/msgs/375524.html