Posted by Chairman_MAO on March 8, 2006, at 22:12:39
In reply to Re: Emsam-Anxiety, posted by willyee on March 8, 2006, at 14:44:25
Actually, tranylcypromine is more atypical of an MAOI than the hydrazines or selegiline. Its mechanism of inhibition is not that of a suicide substrate. The exact mechanics of it are beyond the scope of my knowledge, and I am not sure if they've even been fully elucidated. However, it is a "semi-reversible" inhibitor, i.e. MAO activity returns to normal sooner upon withdrawal of tranylcypromine.
The antidepressant effect of tranylcypromine is more robust than that of oral selegiline (even at up to 80mg/day)--even in the patch, most likely. Tranylcypromine is a vastly more potent DA releaser, and in doses of 1.5mg/kg+ (90-200mg/day) its active metabolites block monoamine uptake (SE, DA, NE) and also perhaps cause amphetamine-like K+-stimulated DA release as well. This is not surprising given it is trans-2-phenylcyclopropylamine (cyclicized amphetamine). Amphetamine can also be called phenylisocyclopropylamine.
Selegiline does act as a "catecholamine activity enhancer" (see articles by Jozef Knoll) and is a good antidepressant, especially for those with marked vegitative symptoms/psychomotor retardation. Tranylcypromine is probably suprior for social phobia.
Unless you throw on two or more patches at once, I would be surprised if the patch would be as robust as 1.5mg/kg tranylcypromine. :)Note that tranylcypromine is an excellent antidepressant for those suffering from Parkinson's disease as well. Selegiline is used more frequently because it has substantially less toxicity, especially at low doses.
If you have an anxiety disorder and are willing to tolerate MAO drug/dietary restrictions, then I'd say tranylcypromine is probably a better choice than selegiline (assuming monotherapy). What you describe as "tolerance" is actually the first-run MAOI effects waning and a growing sensitization to the psychostimulant effect of tranylcypromine and its metabolites. Due to its short half-life, you are constantly reminded of this, unfortunately. I had to dose 150-200mg/day to sustain full benefits all day.
For anxiety, I would try d-amphetamine with a hydrazine MAOI, d-amphetamine with 0.7mg/kg tranylcypromine + benzodiazepine, or d-amphetamine with low-dose selegiline patch + benzo.
poster:Chairman_MAO
thread:616554
URL: http://www.dr-bob.org/babble/20060304/msgs/617798.html