Posted by Chairman_MAO on September 21, 2005, at 19:36:06
In reply to MAOI+Ritalin/Buprenorphine, posted by EERRIICC on September 20, 2005, at 13:48:20
How much buprenorphine were you on? It seems that for depression, the common dosage 0.3-0.6mg qid sublingually. This is because previous to Suboxone coming onto the US market, the only form of bupe were ampoules for injection. Unfortunately, sublingual bioavailability is only ~15% of IM/IV bioavailability. This could be WAY too little for you.
What your ceiling dose is ultimately depends upon bodyweight, but for most it falls around 16mg sublingually, either taken 4mg qid or 16mg all at once. This will produce FAR stronger effects than what you have likely tried. Unfortunately, getting Suboxone without having a d/x of opioid depndency is next to impossible. One option would be for a close friend or family memeber to write an affadivait asserting that you have had repeated opioid problems--including a recent stint of abuse--and as such need maintenance despite the lack of withdrawal symptoms. Not honest, but remember the reason you're doing it is insane, cruel drug laws ... The other option is to persuade your doctor to let you inject the bupe; whether you want to bang something three-four times daily is up to you, though (in theory one to two times daily might work).
Your parnate + ritalin combination seems all wrong to me. Either up the ritalin dose to something useful (10-20mg tid) or drop the ritalin and increase the tranylcyrpomine to 120-200mg/day (its effect IMO is far superior once 80-90mg is exceeded due to clinically significant concentrations of sympathomimetic metabolites and more robust MAO inhibition). The second option is probably the best idea. Alternatively, you could try phenelzine 1mg/kg and add methylphenidate to that; phenelzine's calming properties would likely bring the agitation down to a manageable level.
I strongly believe, moreoever, the memantine added to an MAOI+buprenorphine combination would potentiate the antidepressant effect and prevent "poop-out". I personally have added cabergoline to phenelzine (for sexual dysfunction) and noticed an antidepressant effect that waned significantly after a month or so, but far from vanished completely. The dose you'll have to work up to is probably around 2.5mg/day; the twice-weekly 0.5-1.5mg dose is for prolactin suppression ONLY.
Cabergoline has an extraordinarily benign side effect profile for a DA agonist; you can self-medicate with it unless you have a psychotic disorder or another contradindication.If I can help you in any way, let me know. Best of luck. And FWIW, I feel d-amphetamine or d-methamphetamine are FAR cleaner, more robust stimulants than methylphenidate.
poster:Chairman_MAO
thread:557295
URL: http://www.dr-bob.org/babble/20050921/msgs/557833.html