Posted by cache-monkey on April 26, 2005, at 22:04:27
In reply to Re: Advice: Selegiline + (Depakote/Seroquel)? » cache-monkey, posted by chemist on April 26, 2005, at 2:20:34
<< hello there, me again...you and i read the same authors... >>
Hey chemist,
Not sure what you mean about reading the same authors. Is that re: the above bupropion thread?
<< i can comment on depakote and seroquel, as well as ativan: my very pleasant run with parnate years back does not quite address your concerns...if i were given your choices above, i would opt for (b), if only because depakote was - for me - a murky walk through muddy waters for a few weeks while my waistline steadily increased. >>
Luckily no waistline effects yet. Loss if anything. I attribute this to having gotten more dysphoric on the Depakote. Although today I had a brief brush with hypomania, so I actually think Depakote might be increasing my cycling. Is that possible? (I'll actually start another thread on it.)
<< i was dx bpII - this is off the table now, but who knows - and lithium was not an option due to climate and exercise not going with the therapeutic range indicated. >>
Yeah, Li ended up not working for me either. Largely because of preexisting dehydration issues.
<< seroquel is, as you likely know, a strange animal, with heavy sedation and histaminergic activity in the 25 to perhaps 100 mg range: when 200 mg and above are titrated, the sedation goes away for the most part and the manic side of bp is addressed first (in my experience and from a bit of reading). >>
A question about this: is this a dose related effect, so that there wouldn't be much sedation when starting at 200. Or does (rapid) titration to 200 basically indundate the H-1 receptors so that they rapidly adapt? (I actually asked this in another thread below: http://www.dr-bob.org/babble/20050423/msgs/490104.html If you have time, please feel free to answer there if you have any knowledge that might enlighten.)
<< however, your lorazepam will hit harder: seroquel is metabolized by 3A4 (major) and (of course!) 2D6 (minor) , and almost all of the 1,4-benzodiazepines are substrates of 3A4, thus expect competitive binding (at least). the figure i have at hand is that the metabolism of lorazepam is reduced by 20% when taken with seroquel (Lexi-Comp's Drug Information Handbook, 12th Ed., 2004-2005, and not a bad resource). diazepam and clonazepam are also to be dose-adjusted. >>
I didn't know that, even without enzyme inhibition, drugs could interact through competitive binding. Thanks for that info!
<< my parting shot would be to add the selegiline gradually and decrease the lorazepam as the seroquel is titrated, should you go that route. >>
My pdoc is a strict one-change-at-time guys, so I'll probably start with seroquel titration and then adjust the lorazepam accordingly. The finaly step will be selegiline, depending on how I'm feelin w/rt the whole smoking/anhedonia situation.
<< there ought not be trouble with the benzo/AAP/MAOBI combo other than the 3A4 business with the benzo/AAP.....i see serotonin syndrome fingered if the MAOBI is used in high doses with amphetamine (among others). however, since the amphetamine is a metabolite of the AAP - and unfortunately the l isomer but no matter - i suspect that a qualified psychopharmacologist can set you right if you are not already there! best, chemist >>
I didn't think amphetamine was a metabolite of the AAP, although I did know that would come from the selegiline. I will look more into that.
Your knowledge and advice is most appreciated!
Best,
cache-monkey
poster:cache-monkey
thread:489624
URL: http://www.dr-bob.org/babble/20050423/msgs/490117.html