Posted by ben on February 5, 2002, at 2:45:48
In reply to Re: New Celexa...BORING! @ OldSchool, posted by OldSchool on February 4, 2002, at 17:55:45
Cheese like effect: Tyramine is like a prodrug of noradrenaline, so eating food including much tyramine elevates the noradrenaline level. MAOIs inhibit the turn over to inactive metabolites of noradrenaline (dopamine and serotonin) like 3-OH-noradrenaline. MAOIs do influence the MAO in the brain much more than in the liver (plasma levels of of monamines are not very high compared with concentrations in the brain) Patches do only affect the first pass metabolism in the liver so you have do give less amounts of the drug reaching a similar plasma level. So why should the patch do not have the cheese like effect ? The drug mechanism is the same, as well as the final elimination through the liver.¨
> > Hi OldSchool
> >
> > Why should this be an improvement or breakthrough ? Selegiline is on the market since years and other MAOIs/RIMAs as well.
> > Pdocs are allowed to use Selegiline for depression without any FDA approval. And dont forget: if MAIOs/RIMAs would work great they would be more prescribed !!! It isnt only the fear of severe blood pression. Venlafaxine is the only one which has been superior to other ADs in several studys including faster onset of action. We dont have any real alternative to Venlafaxine (tricyclics are much more nastier concerning anticholinergic side-effects ) yet...so Duloxetine is welcome.
> > I agree that we have enough SSRIs and more new mechanisms (e.g. Venlafaxine, Nefadozone, Mirtazapine) should be developped. I read abou the company MERCK investigate an substance which acts like an SSRI BUT including blocking the 5HT1 receptor. From my experience SSRIs are hitting mood much more than Reboxetine/Desipramine....so the serotonine mechanism has to bee present for an AD. I dont know much about the MAO-B inhibitor Selegiline (parkinsons disease). Should it work better than Tranylcypromine or the RIMA Moclobemide ??? Give us some facts, that would be nice.
> >
> > thanks ben
> >
>
> Ben, I am fully aware Selegiline can already currently be used off label for depression. In pill form. In fact I had a discussion about using selegiline the last time I saw my psychiatrist. However in this pill form if you go above the usual parkinsons dose of 10 mg a day, Selegiline becomes an irreversible MAOI and the "cheese effect" kicks in. Thus at the dosages needed to fight resistant depression, you must go on the MAOI diet with oral selegiline.
>
> The whole point of this new MAOI patch that uses selegiline is that it is not oral, it bypasses the gut and liver and goes directly into your bloodstream like a needle shot. This reportedly eliminates the need for the troublesome MAOI diet and dramatically decreases, probably pretty much eliminates the possibility of an MAOI hypertensive crisis. I dont know about you my friend, but to me this represents a quantum leap ahead in psychopharmacology. MAOIs are by far the best antidepressants. MAOIs are very useful for refractory depression. But the current problem is quite a few folks could benefit from this robust MAOI antidepressant effect but are turned off bigtime by the idea of the MAOI diet and the possibility of having a stroke. No pepperoni pizzas, no maccaroni and cheese, no subs at Jersey Mikes. And the looming possibility your blood pressure could suddenly spike sky high, sending you to the ER and possibly even have a stroke. Ever seen someone who had a stroke and survived? Trust me, its way worse than the worst case of depression.
>
> The patch dramatically decreases all of these MAOI problems Ben. Thats why I would like to see this patch FDA approved. Keep in mind youd still have to go by the drug restrictions list if on the MAOI patch, as drugs go into the bloodstream. So you could ditch the MAOI diet, eat cheese all the time but would still have to restrict various drugs that can interact with MAOIs.
>
> Do you see my point? The selegiline MAOI patch kicks the shit out of a "new and improved" Celexa. Its a truly good idea thats truly unique. Someone actually put their brain into this one. New Celexa is just another "me too" SSRI. Boring.
>
> Eric
poster:ben
thread:91928
URL: http://www.dr-bob.org/babble/20020131/msgs/92935.html