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Re: Adam

Posted by Adam on November 27, 2000, at 10:49:41

In reply to Adam, posted by AndrewB on November 24, 2000, at 12:04:46

Hi, AndrewB,


>
> Adam,
>
> You take a total of 30mg./day?
>
Yes. I tried lower oral doses, and didn't feel they worked as well as I wanted.

> I would be curious if an add-on low dose antipsychotic (i.e. zyprexa, amisulpride) would reduce jitteriness and mood instability of selegiline. It is a pet theory of mine that these med.s can, at least sometimes, accomplish this.
>
Others agree with your pet theory. There are at least a couple published reports of the used of risperadol as an antidote to selegiline-induced psychosis in Parkinson's patients, and it is reasonable to conclude that other atypical antipsychotics with similar mechanisms of action would also serve to ameliorate selegiline's negative side-effects. Risp. is one I looked at closely because it has also shown promise as an adjunct to SSRIs in refractory OCD patients.

> I presume the insomnia is caused by night time release of the amphetamine metabolite that selegiline produces. Counter with a short acting D2 blocker at bedtime? Mirapex, a D2/D3 agonist, seems to last about 6 hours and at low doses blocks D2 activity. There are other options too along this line but I just thought I would bring the idea to your attention.
>
> I also wonder what your p-doc thinks the effect would be of slightly lowering your selegiline dose and adding on a COMT inhibitor (i.e. talcopone)?
>
I think all of these are reasonable options, and I have, as mentioned above, considered strategies essentially along these lines. Talcopone is one I hand't considered, and might be worth studying a bit. At any rate, I have opted to avoid polypharmacy for now, and rather try to deal with some of selegiline's negative effects without other drugs. Like I said above, the side effects aren't all that terrible (though admittedly, bothersome at times). If I change my mind, I'll share my experiences in this forum.

Thanks!

Adam

> Best Wishes, glad to hear from you again,
>
> AndrewB


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