Posted by SLS on June 7, 2022, at 7:28:09
In reply to Re: Oral deprenyl vs bupropion?, posted by linkadge on June 6, 2022, at 18:39:45
Hi.
L-Deprenyl / selegeline / EMSAM is *selective* for MAO-B, but only at low dosages. At higher dosages, selegeline becomes non-selective and MAO-A is also inhibited, Of these two types of MAO enzymes, MAO-A is the the one that is associated with antidepressant effects. The package label for EMSAM is explicit regarding this. Clorgyline is no longer available, but it is an irreversible *specific* inhibitor of MAO-A. It doesn't inhibit MAO-B at all. The NIH had considered it the most powerful antidepressant in the world, but reserved it for their most treatment-resistant cases of treatment-resistant depression - TRD. It left me improved, but they would not allow me to combine it with a tricyclic antidepressant (TCA) like desipramine or nortriptyline, which I had needed to add to Nardil or Parnets in order to respond. Ultimately, they had to discontinue giving clorgyline to their patients because adverse cardiac events were reported.
Moclobemide is another MAOI that is specific for MAO-A. It is a reversible inhibitor of monoamine oxidase (RIMA). Unfortunately, it is reversible rather than irreversible, leaving it an inferior choice. Some people get amazing results in the first week at 300 mg/day. However, dosage escalation is usually inevitable to retain the antidepressant response. The maximum dosage is usually considered to be 1200 mg/day. Still, very few people remain improved indefinitely on moclobemide.
In summary, inhibiting MAO-A is sufficient to yield an improvement in depression.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1119824
URL: http://www.dr-bob.org/babble/20220530/msgs/1119850.html