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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by uncouth on August 14, 2008, at 19:55:35
Hi,
I'm wondering what the protocol is for combining MAOIs. I'm on Nardil 45mg but tried selegiline in the past. Selegiline had some great motivation effects and made me feel smarter, really cleared up my foggy thinking.Nardil perhaps because of the GABA impact, or due to some other property, isn't as good in that respect. I have severe ADHD and big time motivation problems. Not necessarily focus, but motivation, and reward deficiency (so choosing the right thing to do at the right time, instead of meaningless, harmful, and impulsive things).
I'm hopinga dding a low dose (2.5mg - 5mg/day) of oral selegiline to my nardil will help. Can't find any documentation on whether this makes sense or is safe...
ANYONE?
Posted by desolationrower on August 14, 2008, at 21:50:27
In reply to combining nardil and selegiline, posted by uncouth on August 14, 2008, at 19:55:35
I have been thinking about something similar. I don't seen any reason not to go for at least 15mg or so of selegiline to make sure you get complete inhibition of MAOB. You might be able to reduce the phenelzine that way.
I imagine the bigger effect might be getting a reduce dose of the phenelzine, so you can take only as much of the GABA-raising properties as you need. Also, there seems to be some anecdotal evidence that phenelzine is more serotonerigic as oppsed to the more catecholeminergic non-hydrazines.
Posted by Sigismund on August 14, 2008, at 23:21:36
In reply to combining nardil and selegiline, posted by uncouth on August 14, 2008, at 19:55:35
Does selegeline have any effect on substances that affect GABA?
Someone once said something about that, but I forget what.
Posted by SLS on August 15, 2008, at 4:45:48
In reply to Re: combining nardil and selegiline, posted by Sigismund on August 14, 2008, at 23:21:36
> Does selegeline have any effect on substances that affect GABA?
>
> Someone once said something about that, but I forget what.Nardil most definitely increases GABAergic neurotransmission. It does this through inhibiting the enzyme that manufactures GABA - GABA transaminase. In this regard, it is works on GABA much like an MAOI does for the monoamines. My guess is that this is why Nardil has antianxiety properties that Parnate lacks.
I am not inclined to recommend adding oral selegiline at dosages higher than 5mg when combining it with Nardil. Nardil already sufficiently blocks MAO-A and MAO-B at therapeutic dosages (60-90mg). However, there are properties of selegiline and its metabolites other than MAO inhibition that tend to be energizing at low dosages.
I would wait until you get more feedback regarding your proposed treatment plan. I tend to be very cautious when working with MAOIs, even though I am presently combining Nardil and nortriptyline. Perhaps you could titrate the selegiline very slowly if 5mg doesn't produce results. The thing about the oral preparation is that most of selegiline is metabolized to amphetamine-like compounds.
http://dmd.aspetjournals.org/cgi/content/full/25/6/657
"Nine urinary metabolites of selegiline hydrochloride [N-methyl-N-propargyl(2-phenyl-1-methyl)ethylammonium chloride], a monoamine oxidase inhibitor, after administration to humans were identified. Their identities were confirmed by comparison of the spectra from GC/MS of peaks with those of authentic compounds. The following metabolites and unchanged drug (selegiline) were detected in urine: (R)-desmethylselegiline, (R)-methamphetamine, (R)-amphetamine, (1S,2R)-norephedrine, (1R,2R)-norpseudoephedrine, (1S,2R)-ephedrine, (1R,2R)-pseudoephedrine, (R)-p-hydroxyamphetamine, and (R)-p-hydroxymethamphetamine. The metabolites excreted 2 days after administration of 2.5-10 mg of selegiline hydrochloride amounted to 44-58% of the dose. Selegiline was metabolized by three distinct pathways: N-dealkylation, beta -carbon hydroxylation, and ring-hydroxylation. The major metabolite was (R)-methamphetamine. During metabolism, no racemic transformation occurred and beta -carbon hydroxylation showed apparently product stereoselectivity."
While I have no problem with adding an amphetamine, I am concerned that at higher dosages, selegiline will produce a shotgun blast of stimulant compounds that will challenge the Nardil. This is why I recommend not exceeding 5mg to start with.
- Scott
Posted by uncouth on August 15, 2008, at 9:19:42
In reply to Re: combining nardil and selegiline, posted by SLS on August 15, 2008, at 4:45:48
Thanks so much for the help. I think I'm going to take it easy and am probably doing a bit too much "drug seeking" with these combos. I haven't been stabilized on Nardil 60mg for more than a week and I understand it can sometimes take up to 4 weeks at that dose to show it's real effects, so I'd hate to sabotage or screw with that.
The lithium, lunesta and occasional xanax, NAC, Omega-3, B-100, Eleuthero, and Chromium Picolinate are quite enough psychotropics for me right now I think :(
Posted by SLS on August 15, 2008, at 9:46:59
In reply to Re: combining nardil and selegiline » SLS, posted by uncouth on August 15, 2008, at 9:19:42
> Thanks so much for the help. I think I'm going to take it easy and am probably doing a bit too much "drug seeking" with these combos. I haven't been stabilized on Nardil 60mg for more than a week and I understand it can sometimes take up to 4 weeks at that dose to show it's real effects, so I'd hate to sabotage or screw with that.
>
> The lithium, lunesta and occasional xanax, NAC, Omega-3, B-100, Eleuthero, and Chromium Picolinate are quite enough psychotropics for me right now I think :(Patience is critical in successfully performing drug trials. I'm not sure that 4 weeks will represent a fair trial of Nardil. I would suggest that you remain at 60mg for at least 3 weeks before raising the dosage to 75mg. Once you reach this dosage, try to continue with it for another 3 weeks. If you experience a small improvement, don't underestimate the possibility that things will continue to improve, but at a slower rate. Keeping a mood chart can be helpful to portray trends in improvement. This way, you can see if you are truly "stuck", or that there be a trend towards gradual improvement. There are people in PB whom described a three month waiting period with Nardil to see a robust improvement.
Know that there is quite a latency between the initiation of treatmet and the establishment of a stable degree of MAO inhibition and resulting side effects.
It might be wise to go with 45mg for two weeks before moving up to 60mg so as not to get blind-sided by strong side effects.
I like to use this mood chart:
http://www.slschofield.com/medicine/mood_chart_beam.pdf
- Scott
Posted by blueboy on August 15, 2008, at 9:55:33
In reply to combining nardil and selegiline, posted by uncouth on August 14, 2008, at 19:55:35
> Hi,
> I'm wondering what the protocol is for combining MAOIs. I'm on Nardil 45mg but tried selegiline in the past. Selegiline had some great motivation effects and made me feel smarter, really cleared up my foggy thinking.
>
> Nardil perhaps because of the GABA impact, or due to some other property, isn't as good in that respect. I have severe ADHD and big time motivation problems. Not necessarily focus, but motivation, and reward deficiency (so choosing the right thing to do at the right time, instead of meaningless, harmful, and impulsive things).
>
> I'm hopinga dding a low dose (2.5mg - 5mg/day) of oral selegiline to my nardil will help. Can't find any documentation on whether this makes sense or is safe...Of all the drug combinations you might try, why screw around with Nardil and a drug that is uniformly contraindicated? You're playing with fire.
IMHO, just don't do it.
Posted by desolationrower on August 15, 2008, at 19:12:57
In reply to Re: combining nardil and selegiline, posted by blueboy on August 15, 2008, at 9:55:33
Could you post links to adverse reactions to this combination?
Posted by dcruik518 on August 19, 2008, at 9:21:56
In reply to Re: combining nardil and selegiline, posted by desolationrower on August 15, 2008, at 19:12:57
Uncouth,
I have moderate, inattentive type ADD, as well as social phobia and dysthymia. In the past Nardil has worked extremely well for all three. So it may help with your ADD. In grad school it greatly improved my writing abilities--perhaps partly by reducing inhibition, which might be a GABA effect. But my brain seemed to work better in general on it.
This is the end of the thread.
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