![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by University on August 3, 2004, at 23:18:34
I have been VERY lucky to be free from depression for over six years now--via Prozac with occasional Klonopin for anxiety. Nevertheless, I began taking Ritalin a couple of years ago, after trying Provigil, for Prozac-related daytime sleepiness.
It really helps with my motivation, concentration, and mental energy. But I can take a 10mg tablet and fall asleep no problem. :(
Interestingly, the only drug I have found that keeps me from drowsiness--and the desire to sleep--ironically, is hydrocodone.
ANYWAY, as I knew it would, methylphenidate is not working as well. Even increasing the dose hasn't really made it as effective as before. But it does make me more jittery, and makes me have "nervous stomach."
I've tried Adderall and straight dexedrine AND normethylphenidate (or whatever the other methylphenidate without one isomer is). None of these has worked.
I think the onlly solution for me is frequent vacations from ritalin. Any advice?
Posted by Bill LL on August 4, 2004, at 9:11:50
In reply to Ritalin's Diminishing Returns, posted by University on August 3, 2004, at 23:18:34
Do you think adding Provigil to the Ritalin would help? What happened last time you tried Provigil?
Posted by Ktemene on August 4, 2004, at 16:04:48
In reply to Ritalin's Diminishing Returns, posted by University on August 3, 2004, at 23:18:34
Do you have ADD/ADHD as well as depression? My pdoc told me that your reaction to
Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD. I have ADD, and can take 10 mg Adderall and fall asleep if I want to. Doses of Adderall over 20 mg don't make me feel euphoric and wired, they just make me feel irritated.My experience was that amphetamine did not help much at all with drowsiness, although it does help with focus and concentration. Provigil on the other hand did help make me less drowsy, and improved my concentration as well, but even at the 400 mg maximum dosage of Provigil I was still struggling with excessive daytime sleepiness. You mentioned that you tried Provigil but did not continue it, so I guess that it did not work for you. The meds that helped me most with drowsiness are Wellbutrin and Selegiline. You did not say how much Prozac you are taking. If it is a high dose you might try lowering the Prozac dose and adding Wellbutrin. Strattera is another med that can be added to Prozac and can increase wakefulness in some people (although it can also make some people even more drowsy). If you have already tried Wellbutrin, and it did not help, you might try quitting Prozac altogether and starting on an activating TCA like Desipramine or Protriptyline.
The med that has helped me the most with drowsiness and anhedonia is Selegiline. I only take 5 mg, but my body is so sensitive to Selegiline that even 5 mg is vastly more activating than the 450 mg Wellbutrin + 80 mg Strattera + 400 mg Provigil + 20 mg Adderall that I used to take. I mention this last because I gather that most people who have atypical depression do not have this response to low dose Selegiline. But a few people do- in fact it was by reading posters on Psycho-Babble who had had success with Selegiline that I got the idea to try it. My pdoc was a little dubious, but it has worked much better for me than the ten medications I tried before. But Selegiline probably shouldn't be your first choice. Your chances are better with Wellbutrin or a TCA. Good luck!
> I have been VERY lucky to be free from depression for over six years now--via Prozac with occasional Klonopin for anxiety. Nevertheless, I began taking Ritalin a couple of years ago, after trying Provigil, for Prozac-related daytime sleepiness.
>
> It really helps with my motivation, concentration, and mental energy. But I can take a 10mg tablet and fall asleep no problem. :(
>
> Interestingly, the only drug I have found that keeps me from drowsiness--and the desire to sleep--ironically, is hydrocodone.
>
> ANYWAY, as I knew it would, methylphenidate is not working as well. Even increasing the dose hasn't really made it as effective as before. But it does make me more jittery, and makes me have "nervous stomach."
>
> I've tried Adderall and straight dexedrine AND normethylphenidate (or whatever the other methylphenidate without one isomer is). None of these has worked.
>
> I think the onlly solution for me is frequent vacations from ritalin. Any advice?
Posted by KaraS on August 4, 2004, at 16:57:21
In reply to Re: Ritalin's Diminishing Returns, posted by Ktemene on August 4, 2004, at 16:04:48
> Do you have ADD/ADHD as well as depression? My pdoc told me that your reaction to
> Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD. I have ADD, and can take 10 mg Adderall and fall asleep if I want to. Doses of Adderall over 20 mg don't make me feel euphoric and wired, they just make me feel irritated.
>
> My experience was that amphetamine did not help much at all with drowsiness, although it does help with focus and concentration. Provigil on the other hand did help make me less drowsy, and improved my concentration as well, but even at the 400 mg maximum dosage of Provigil I was still struggling with excessive daytime sleepiness. You mentioned that you tried Provigil but did not continue it, so I guess that it did not work for you. The meds that helped me most with drowsiness are Wellbutrin and Selegiline. You did not say how much Prozac you are taking. If it is a high dose you might try lowering the Prozac dose and adding Wellbutrin. Strattera is another med that can be added to Prozac and can increase wakefulness in some people (although it can also make some people even more drowsy). If you have already tried Wellbutrin, and it did not help, you might try quitting Prozac altogether and starting on an activating TCA like Desipramine or Protriptyline.
>
> The med that has helped me the most with drowsiness and anhedonia is Selegiline. I only take 5 mg, but my body is so sensitive to Selegiline that even 5 mg is vastly more activating than the 450 mg Wellbutrin + 80 mg Strattera + 400 mg Provigil + 20 mg Adderall that I used to take. I mention this last because I gather that most people who have atypical depression do not have this response to low dose Selegiline. But a few people do- in fact it was by reading posters on Psycho-Babble who had had success with Selegiline that I got the idea to try it. My pdoc was a little dubious, but it has worked much better for me than the ten medications I tried before. But Selegiline probably shouldn't be your first choice. Your chances are better with Wellbutrin or a TCA. Good luck!
>
>
>
>
> > I have been VERY lucky to be free from depression for over six years now--via Prozac with occasional Klonopin for anxiety. Nevertheless, I began taking Ritalin a couple of years ago, after trying Provigil, for Prozac-related daytime sleepiness.
> >
> > It really helps with my motivation, concentration, and mental energy. But I can take a 10mg tablet and fall asleep no problem. :(
> >
> > Interestingly, the only drug I have found that keeps me from drowsiness--and the desire to sleep--ironically, is hydrocodone.
> >
> > ANYWAY, as I knew it would, methylphenidate is not working as well. Even increasing the dose hasn't really made it as effective as before. But it does make me more jittery, and makes me have "nervous stomach."
> >
> > I've tried Adderall and straight dexedrine AND normethylphenidate (or whatever the other methylphenidate without one isomer is). None of these has worked.
> >
> > I think the onlly solution for me is frequent vacations from ritalin. Any advice?
>
>Ktemene,
Forgive me for barging in here. You said above:"My pdoc told me that your reaction to
Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD."Is this something that your pdoc told you recently? I may have had this conversation with you earlier (I'm sorry but I can't remember if it were with you or zuegma) about my falling asleep after taking 5 mg. of methylphenidate. Other things that people find stimulating also tend to make me drowsy. I don't know if i have ADD or not. I took the Strattera test and it didn't seem to suggest that I have it but I still have my doubts. Maybe what you or z said to me earlier was that those with ADD or ADHD tend to fall asleep from stimulants but the fact that you do fall asleep from them does not in and of itself prove that you have ADD.
-K
Posted by Ktemene on August 5, 2004, at 3:45:17
In reply to Re: Ritalin's Diminishing Returns » Ktemene, posted by KaraS on August 4, 2004, at 16:57:21
Hi Kara,
It was a few months ago that my pdoc mentioned to me that my reaction to Adderall (feeling calm and collected rather than wired and euphoric) was typical of ADDers. Another aspect of my response to Adderall he considered typical is that I never feel the need to increase the dosage and I never have any withdrawal symptoms when I don't take Adderall for a few days- I'm just less focused. Some people have proposed this "paradoxical" reaction to amphetamines as a marker for ADD, but most doctors are unwilling to accept this as a definitive test. This may be partly because so many doctors make so much money providing an ADD Dx on the basis of high-tech brain scans and labor-intensive evaluations of written tests. But it is too cynical to claim that this is the only reason. ADD is a complicated condition and there is no reason to expect that a single simple amphetamine-reaction test will neatly distinguish all ADDers from all non-ADDers. At any rate, there is no such simple test for Depression or OCD or GAD etc.
But it does seem to be the case that most people who have ADD also respond to Adderall and Ritalin the way you responded to Ritalin. So this should at least provide a strong suspicion that you do have ADD. As I am sure you know, ADD is often hard to recognize in girls and women because many of us lack the most noticeable ADHD trait: hyperactivity. Many of us fall into the inattentive ADD category and that is hard to spot. I found a description of the difference between ADHD and ADD without hyperactivity that sounded so much like me as a child that I became convinced that I had ADD. On the chance that it might be useful to you, I'll include the URL: http://www.ldpride.net/addsub-types.htm
One of the problems with determining the right Dx is that it is possible to have Depression and ADD as independent conditions. But it is also possible to have ADD as the primary condition, which then generates so much stress and trauma over the years that it causes Depression. And of course Depression can cause one to have most of the symptoms of ADD.
Many doctors seem to think that ADD/ADHD is a dopamine dysfunction of some sort. I think it is a good strategy for people who are depressed and fit the ADD/ADHD profile (and aren't helped by SSRIs) to try a med that targets dopamine, at least as an augmentation strategy.
By the way, on another thread you mentioned a poster who had argued in response to Todd (King Vulcan) that Selegiline's amphetamine metabolites were not responsible for its antidepressant effect. I think that poster was me. I wasn't arguing that when Selegiline metabolizes to l-amphetamine and l-methamphetamine there is never any antidepressant effect. I am sure that Todd is right to say that there is, especially when the Selegiline dose is large. But I am also sure that the l-amphetamine metabolites from my tiny 5 mg dose of Selegiline could not be the cause of the antidepressant effect Selegiline has produced in me, because if it were, then the 20 mg of Adderall (which is mostly the more powerful d-amphetamine) I used to take should have produced a vastly greater antidepressant effect, but Adderall had almost no antidepressant effect on me. And there are a few other posters here who have had the same very positive response to low dose Selegiline. In our case at least there must be some other explanation for Selegiline’s antidepressant effect.
Ktemene
> Ktemene,
> Forgive me for barging in here. You said above:
>
> "My pdoc told me that your reaction to
> Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD."
>
> Is this something that your pdoc told you recently? I may have had this conversation with you earlier (I'm sorry but I can't remember if it were with you or zuegma) about my falling asleep after taking 5 mg. of methylphenidate. Other things that people find stimulating also tend to make me drowsy. I don't know if i have ADD or not. I took the Strattera test and it didn't seem to suggest that I have it but I still have my doubts. Maybe what you or z said to me earlier was that those with ADD or ADHD tend to fall asleep from stimulants but the fact that you do fall asleep from them does not in and of itself prove that you have ADD.
>
> -K
Posted by KaraS on August 5, 2004, at 12:59:38
In reply to Re: Ritalin's Diminishing Returns » KaraS, posted by Ktemene on August 5, 2004, at 3:45:17
> Hi Kara,
>
> It was a few months ago that my pdoc mentioned to me that my reaction to Adderall (feeling calm and collected rather than wired and euphoric) was typical of ADDers. Another aspect of my response to Adderall he considered typical is that I never feel the need to increase the dosage and I never have any withdrawal symptoms when I don't take Adderall for a few days- I'm just less focused. Some people have proposed this "paradoxical" reaction to amphetamines as a marker for ADD, but most doctors are unwilling to accept this as a definitive test. This may be partly because so many doctors make so much money providing an ADD Dx on the basis of high-tech brain scans and labor-intensive evaluations of written tests. But it is too cynical to claim that this is the only reason. ADD is a complicated condition and there is no reason to expect that a single simple amphetamine-reaction test will neatly distinguish all ADDers from all non-ADDers. At any rate, there is no such simple test for Depression or OCD or GAD etc.
>
> But it does seem to be the case that most people who have ADD also respond to Adderall and Ritalin the way you responded to Ritalin. So this should at least provide a strong suspicion that you do have ADD. As I am sure you know, ADD is often hard to recognize in girls and women because many of us lack the most noticeable ADHD trait: hyperactivity. Many of us fall into the inattentive ADD category and that is hard to spot. I found a description of the difference between ADHD and ADD without hyperactivity that sounded so much like me as a child that I became convinced that I had ADD. On the chance that it might be useful to you, I'll include the URL: http://www.ldpride.net/addsub-types.htm
>
> One of the problems with determining the right Dx is that it is possible to have Depression and ADD as independent conditions. But it is also possible to have ADD as the primary condition, which then generates so much stress and trauma over the years that it causes Depression. And of course Depression can cause one to have most of the symptoms of ADD.
>
> Many doctors seem to think that ADD/ADHD is a dopamine dysfunction of some sort. I think it is a good strategy for people who are depressed and fit the ADD/ADHD profile (and aren't helped by SSRIs) to try a med that targets dopamine, at least as an augmentation strategy.
>
> By the way, on another thread you mentioned a poster who had argued in response to Todd (King Vulcan) that Selegiline's amphetamine metabolites were not responsible for its antidepressant effect. I think that poster was me. I wasn't arguing that when Selegiline metabolizes to l-amphetamine and l-methamphetamine there is never any antidepressant effect. I am sure that Todd is right to say that there is, especially when the Selegiline dose is large. But I am also sure that the l-amphetamine metabolites from my tiny 5 mg dose of Selegiline could not be the cause of the antidepressant effect Selegiline has produced in me, because if it were, then the 20 mg of Adderall (which is mostly the more powerful d-amphetamine) I used to take should have produced a vastly greater antidepressant effect, but Adderall had almost no antidepressant effect on me. And there are a few other posters here who have had the same very positive response to low dose Selegiline. In our case at least there must be some other explanation for Selegiline’s antidepressant effect.
>
> Ktemene
>
> > Ktemene,
> > Forgive me for barging in here. You said above:
> >
> > "My pdoc told me that your reaction to
> > Ritalin, being able to fall asleep after you have taken it, is typical of people who have ADD."
> >
> > Is this something that your pdoc told you recently? I may have had this conversation with you earlier (I'm sorry but I can't remember if it were with you or zuegma) about my falling asleep after taking 5 mg. of methylphenidate. Other things that people find stimulating also tend to make me drowsy. I don't know if i have ADD or not. I took the Strattera test and it didn't seem to suggest that I have it but I still have my doubts. Maybe what you or z said to me earlier was that those with ADD or ADHD tend to fall asleep from stimulants but the fact that you do fall asleep from them does not in and of itself prove that you have ADD.
> >
> > -K
>
>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.
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. 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.)
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.
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?
Posted by Ktemene on August 7, 2004, at 2:17:26
In reply to Re: Ritalin's Diminishing Returns, posted by KaraS on August 5, 2004, at 12:59:38
> 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.
>
> 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.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.
> 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.)
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.>
> 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.
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
>
> 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?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.
Posted by KaraS on August 8, 2004, at 3:53:30
In reply to Ritalin and Selegiline » KaraS, posted by Ktemene on August 7, 2004, at 2:17:26
>
> > 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.
> >
> > 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.
>
> 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.
Ritalin and Adderall are definitely on my list for future trial, if needed.>
> > 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.)
>> 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.
>
> >
> > 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.
>
> 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
>Good site. Thanks.
> >
> > 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?
>
> 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.
>
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?
Posted by Ktemene on August 8, 2004, at 4:36:17
In reply to Re: Ritalin and Selegiline, posted by KaraS on August 8, 2004, at 3:53:30
> >
> > > 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.
> > >
> > > 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.
> >
> > 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.
>
>
> Ritalin and Adderall are definitely on my list for future trial, if needed.
>
> >
> > > 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.)
> >
>
> > 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.
> >
> > >
> > > 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.
> >
> > 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
> >
>
> Good site. Thanks.
>
> > >
> > > 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?
> >
> > 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.
> >
>
> 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?
>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.
Posted by KaraS on August 8, 2004, at 13:57:19
In reply to Re: Ritalin and Selegiline » KaraS, posted by Ktemene on August 8, 2004, at 4:36:17
> > >
> > > > 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.
> > > >
> > > > 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.
> > >
> > > 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.
> >
> >
> > Ritalin and Adderall are definitely on my list for future trial, if needed.
> >
> > >
> > > > 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.)
> > >
> >
> > > 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.
> > >
> > > >
> > > > 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.
> > >
> > > 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
> > >
> >
> > Good site. Thanks.
> >
> > > >
> > > > 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?
> > >
> > > 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.
> > >
> >
> > 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?
> >
>
> 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.
>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?
Posted by Ktemene on August 9, 2004, at 4:32:36
In reply to Re: Ritalin and Selegiline, posted by KaraS on August 8, 2004, at 13:57:19
> > > >
> > > > > 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.
> > > > >
> > > > > 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.
> > > >
> > > > 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.
> > >
> > >
> > > Ritalin and Adderall are definitely on my list for future trial, if needed.
> > >
> > > >
> > > > > 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.)
> > > >
> > >
> > > > 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.
> > > >
> > > > >
> > > > > 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.
> > > >
> > > > 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
> > > >
> > >
> > > Good site. Thanks.
> > >
> > > > >
> > > > > 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?
> > > >
> > > > 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.
> > > >
> > >
> > > 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?
> > >
> >
> > 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.
> >
>
> 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?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.htmlTo 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
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
> > > > >
> > > > > > 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.
> > > > > >
> > > > > > 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.
> > > > >
> > > > > 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.
> > > >
> > > >
> > > > Ritalin and Adderall are definitely on my list for future trial, if needed.
> > > >
> > > > >
> > > > > > 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.)
> > > > >
> > > >
> > > > > 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.
> > > > >
> > > > > >
> > > > > > 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.
> > > > >
> > > > > 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
> > > > >
> > > >
> > > > Good site. Thanks.
> > > >
> > > > > >
> > > > > > 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?
> > > > >
> > > > > 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.
> > > > >
> > > >
> > > > 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?
> > > >
> > >
> > > 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.
> > >
> >
> > 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?
>
> 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
>
> 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
Posted by Ktemene on August 12, 2004, at 0:08:44
In reply to Re: Ritalin and Selegiline » Ktemene, posted by KaraS on August 9, 2004, at 5:39:15
> > > 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?
> >
> > 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
> >
> > 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!
> KaraHi Kara,
I am so glad my post was helpful. I certainly know what it feels like when you try a series of meds that don't work and all hope seems to be draining away. And I am sorry to be getting back to you so late-I was away for a couple of days. That post of Adam’s that you linked to is one of my all time favorite posts. It gave me a lot of hope at a time when I really didn't know where to turn. One of the great things about Adam's post is that he acknowledges how hard it is sometimes to keep trying, and that makes you believe him when he says that it really is worth it to keep trying. I wish there were a place on Psycho-Babble called "Classic Posts" to archive wonderful unforgettable posts like Adam's and Gracie's, because so many new people never get a chance to read them except by accident. (By the way I would include among the classic posts the funny ones that you and Simus reposted on the Alternative board. They were hilarious. After I read them I kept bursting into giggles for the rest of the day…and got some strange looks from my colleagues.)
Adam’s first very positive response was to the Selegiline patch, which finally received an approvable letter back in Febuary and is supposed to be available at the end of this year or in early 2005. But when he wrote the post you mention he was taking oral Selegiline and the dose (I think) was around 30 mg per day. Close to a year after he wrote that post, he went off oral Selegiline because of some odd problems he was having that he thought might have been connected to the insomnia caused by oral Selegiline. After he went off oral Selegiline and began sleeping well the odd problems he had been having did disappear. But he continued to remain depression-free and did not relapse even though he was no long taking Selegiline or any other antidepressant. Here’s a post where he briefly summarizes the whole story: http://www.dr-bob.org/babble/20011123/msgs/85472.html
Adam never really tried to deal with his Selegiline insomnia, because it did not bother him very much, until those odd problems developed. I have similar insomnia, and it does not really bother me either- it just gives me lots more time to catch up on all the work I didn’t do when I was depressed. But I am taking some advice from Adam and trying to find some meds to help with sleep because it may be some time before the patch comes out. I just thought I would mention this because you said that you had found 5 mg Selegiline somewhat activating on the couple of occasions when you tried it, and if you have the response to Selegiline that Adam and I had then you may also have some insomnia as well. Of course some people have a really positive response to Selegiline and don’t have to worry about insomnia. At any rate elleff and Jemma and Ron and some others don’t mention any problems with insomnia.But to turn to your question. I am not sure which preparations of Selegiline Ron was referring to but there are three preparations that I know of that avoid the first pass effect at least to some extent. The patch avoids the first pass effect altogether and consequently has the fewest side effects. There is also Zydis Selegiline which is a pill designed to dissolve in the mouth and allow some of the med to be absorbed directly into the bloodstream, “buccal absorbtion” as they call it. In addition there is a liquid preparation of Selegiline called Jumax I think, and that also is meant to be held in the mouth so that as much as possible can be absorbed directly into the blood stream. Unfortunately both Zydis and the liquid form are unavailable in the U.S., although they are marketed in Europe. I try to get some “buccal absorption” by opening the Selegiline cap and pouring the powder into my mouth and holding it there for a few minutes.
To my mind Selegiline is an underrated med that has lots of advantages. It is neuroprotective and even at high doses it is much less likely to cause a hypertensive crisis than Parnate and Nardil and it goes well with lots of other meds. But of course I am prejudiced because Selegiline was the med that finally put my pretty much life-long depression into remission. I really hope it works for you. I think your idea of trying Selegiline with DLPA is a good one- taking DLPA has magnified Selegiline’s effect for a lot of people. In fact I think that strategy is recommended in the Psychopharmacological Tips section of Psycho-Babble.
By the way, I found the place where I read that 5 mg Selegiline after a number of weeks builds up to the point of inhibiting almost all MAO-B. It was AndrewB. Here’s the post: http://www.dr-bob.org/babble/20010310/msgs/56574.html AndrewB has some more interesting info on low-dose Selegiline at this post: http://www.dr-bob.org/babble/20010417/msgs/60824.html
If the pdoc that you get is hesitant about prescribing Selegiline, be sure to tell him/her about the patch. A lot of pdocs have never heard of the patch, and think that Selegiline is only used for PD. But there is now a lot of literature on Selegiline as an AD because the patch is so close to being marketed.
Good luck, and keep us posted!
Ktemene
Posted by university on August 12, 2004, at 15:03:16
In reply to Selegiline Adam Gracie » KaraS, posted by Ktemene on August 12, 2004, at 0:08:44
Thanks for responding, everyone.
Right now, I think I'm going to try increasing the methylphenidate to as-needed per day up to, maybe, 80mg, AND decreasing Prozac to 30mg/day, AND getting regular, rigorous exercise. Wish me luck--the exercise will be the most difficult :( not because I'm overweight, etc., but because any kind of effort--especially physical or creative/mental--right now is so difficult!
Posted by KaraS on August 13, 2004, at 17:27:51
In reply to Thanks, posted by university on August 12, 2004, at 15:03:16
Posted by KaraS on August 13, 2004, at 18:17:20
In reply to Selegiline Adam Gracie » KaraS, posted by Ktemene on August 12, 2004, at 0:08:44
> Hi Kara,
>
> I am so glad my post was helpful. I certainly know what it feels like when you try a series of meds that don't work and all hope seems to be draining away. And I am sorry to be getting back to you so late-I was away for a couple of days. That post of Adam’s that you linked to is one of my all time favorite posts. It gave me a lot of hope at a time when I really didn't know where to turn. One of the great things about Adam's post is that he acknowledges how hard it is sometimes to keep trying, and that makes you believe him when he says that it really is worth it to keep trying. I wish there were a place on Psycho-Babble called "Classic Posts" to archive wonderful unforgettable posts like Adam's and Gracie's, because so many new people never get a chance to read them except by accident. (By the way I would include among the classic posts the funny ones that you and Simus reposted on the Alternative board. They were hilarious. After I read them I kept bursting into giggles for the rest of the day…and got some strange looks from my colleagues.)That's an excellent idea about a classics board!!! There could be a section for inspirational posts and another for humorous posts. You can easily do searches on specific meds or treatments, but you can't do a search for inspirational or humorous posts. You just have to get lucky and run into them by mistake when searching for something else in the archives. It would be so helpful for anyone who needs reassurance to go to the inspirational section and read Adam's post or Gracie's post. Wish I had known about them a long time ago. (How about it Dr. Bob?)
I agree that those old posts about the person following his dog Cletus' example and the other one about the person eating Tom's of Maine toothpaste were a hoot. In the first one after the guy talks about eating grass and pigs ears and then says something to the effect of "the embarrassment of riches that the natural world has to offer" I nearly fell off of my chair laughing.
> Adam’s first very positive response was to the Selegiline patch, which finally received an approvable letter back in Febuary and is supposed to be available at the end of this year or in early 2005. But when he wrote the post you mention he was taking oral Selegiline and the dose (I think) was around 30 mg per day. Close to a year after he wrote that post, he went off oral Selegiline because of some odd problems he was having that he thought might have been connected to the insomnia caused by oral Selegiline. After he went off oral Selegiline and began sleeping well the odd problems he had been having did disappear. But he continued to remain depression-free and did not relapse even though he was no long taking Selegiline or any other antidepressant. Here’s a post where he briefly summarizes the whole story: http://www.dr-bob.org/babble/20011123/msgs/85472.html> Adam never really tried to deal with his Selegiline insomnia, because it did not bother him very much, until those odd problems developed. I have similar insomnia, and it does not really bother me either- it just gives me lots more time to catch up on all the work I didn’t do when I was depressed. But I am taking some advice from Adam and trying to find some meds to help with sleep because it may be some time before the patch comes out. I just thought I would mention this because you said that you had found 5 mg Selegiline somewhat activating on the couple of occasions when you tried it, and if you have the response to Selegiline that Adam and I had then you may also have some insomnia as well. Of course some people have a really positive response to Selegiline and don’t have to worry about insomnia. At any rate elleff and Jemma and Ron and some others don’t mention any problems with insomnia.
How can having insomnia for an extended period of time not bother someone? Eventually the bad effects from not getting enough sleep would have to be devastating, wouldn't they? At least there are some things you can take for the insomnia. I'm fully anticipating that I will have to do something.
>
> But to turn to your question. I am not sure which preparations of Selegiline Ron was referring to but there are three preparations that I know of that avoid the first pass effect at least to some extent. The patch avoids the first pass effect altogether and consequently has the fewest side effects. There is also Zydis Selegiline which is a pill designed to dissolve in the mouth and allow some of the med to be absorbed directly into the bloodstream, “buccal absorbtion” as they call it. In addition there is a liquid preparation of Selegiline called Jumax I think, and that also is meant to be held in the mouth so that as much as possible can be absorbed directly into the blood stream. Unfortunately both Zydis and the liquid form are unavailable in the U.S., although they are marketed in Europe. I try to get some “buccal absorption” by opening the Selegiline cap and pouring the powder into my mouth and holding it there for a few minutes.
>Thanks. I had never heard of Zydis selegiline. Good to know. I have read about Jumex and heard that it was superior to pill form but I wasn't sure if that were true or just a result of all of the political hype around it. What kind do you take? I don't recall if you mentioned it or not in earlier posts (other than to say it's in capsule form).
> To my mind Selegiline is an underrated med that has lots of advantages. It is neuroprotective and even at high doses it is much less likely to cause a hypertensive crisis than Parnate and Nardil and it goes well with lots of other meds. But of course I am prejudiced because Selegiline was the med that finally put my pretty much life-long depression into remission. I really hope it works for you. I think your idea of trying Selegiline with DLPA is a good one- taking DLPA has magnified Selegiline’s effect for a lot of people. In fact I think that strategy is recommended in the Psychopharmacological Tips section of Psycho-Babble.
>Yes, I love the fact that it's supposed to be neuroprotective. The claims for life extension are encouraging as well. I wasn't under the impression that it was a medication that mixed well with others though. (That's probably just because of the problems when you're above 10 mg and the MAO-A effects kick in.)
> By the way, I found the place where I read that 5 mg Selegiline after a number of weeks builds up to the point of inhibiting almost all MAO-B. It was AndrewB. Here’s the post: http://www.dr-bob.org/babble/20010310/msgs/56574.html AndrewB has some more interesting info on low-dose Selegiline at this post: http://www.dr-bob.org/babble/20010417/msgs/60824.html
>Thanks. I'll have to read those later this weekend. I love reading AndrewB's posts. I've read a lot of his stuff before and learned so much. Wonder how he is doing...
> If the pdoc that you get is hesitant about prescribing Selegiline, be sure to tell him/her about the patch. A lot of pdocs have never heard of the patch, and think that Selegiline is only used for PD. But there is now a lot of literature on Selegiline as an AD because the patch is so close to being marketed.
>
> Good luck, and keep us posted!
>
> Ktemene
Fingers crossed on the patch being marketed soon. Are you thinking of switching when it comes out or are you perfectly happy with your treatment as is?Yes, telling my doctor about the patch and bringing some literature on it and selegiline as an antidepressant could help. I remember the first time I brought up selegiline to my pdoc and he gave me that blank stare. He really didn't know anything about its use as an ntidepressant. So many of these doctors are so limited in their approaches. If they didn't learn it in medical school and if the big drug companies aren't pushing it to them, then they don't know anything about it. Fortunately this isn't the case with all of them and you can find some who are more proactive and keep up with the literature and the newest ideas in treatment (and are willing to take the considerable risks of new treatment I might add).
Thanks again for all of your help and have a great weekend!
-K
Posted by university on August 13, 2004, at 18:22:18
In reply to Re: Good luck, sorry to have hijacked your thread (nm), posted by KaraS on August 13, 2004, at 17:27:51
Posted by Dr. Bob on August 14, 2004, at 12:55:14
In reply to Re: Selegiline Adam Gracie » Ktemene, posted by KaraS on August 13, 2004, at 18:17:20
> That's an excellent idea about a classics board!!! ... (How about it Dr. Bob?)
I agree, see Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20040717/msgs/377580.html
Thanks,
Bob
This is the end of the thread.
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