Posted by Pitviper on October 16, 2007, at 5:14:46
In reply to Re: Please help w new ? about selegiline prozac co, posted by amigan on October 11, 2007, at 16:06:58
> - The combination of SSRI+MAOI is considered a no-no by some doctors.
This is true of the traditional nonselective MAOIs -- Nardil, Parnate, Marplan, etc. I can't imagine any situation that would justify the very serious danger of prescribing these with Prozac or another SSRI. Selegiline, in the low dose Meagan is taking, is another story.
> - Selegiline at more than 10mg, starts to lose its selectivity and thus becomes potentionally dangerous.
The key word is "starts," and I'm not even certain that's true, although 10 mg is the typical dose used in Parkinson's disease. The doses of oral selegiline typically required to treat depression effectively are quite a bit higher. I doubt Meagan will have a problem in the 15-20 mg range, particularly if she tapers the Prozac, although careful monitoring is of course essential.
> - 40mg of fluoxetine is double the usual, suggested dosage.
No...the usual recommended *starting* dose is 20 mg (although a lot of people may need to start lower because of side effects such as agitation and increased anxiety, especially those with panic disorder). The recommended *maximum* dose is 80 mg.
And of course, we're all individuals with different needs. Some people might do great on 20 mg, or even 10, while others might need 80. But anyway, there is no such thing as "one size fits all" when it comes to the human brain. (Although there is no established therapeutic serum level for fluoxetine, it is possible that differences in metabolism also contribute to variation in dose requirements.) When deciding what is the right dose for an individual, it's more important to look at what works for that person than to rely on claims based on statistics.
I know of at least one drug monograph in the PDR (Ambien) that actually does essentially claim there is only one "right" dose for adult patients (it allows for a half dose for elderly patients). This betrays a misunderstanding of what statistics do and don't tell us. I've known several people who did not benefit from the standard 10 mg of Ambien but did well on 15-20 mg.
> Since you asked, i would reduce selegiline at 10mg or less, daily.
I think ditching the Prozac and going all-out with the selegiline (or perhaps switching to the transdermal patch) sounds like a better idea. It doesn't sound like she's getting much out of the Prozac.
Pitviper
poster:Pitviper
thread:788058
URL: http://www.dr-bob.org/babble/20071009/msgs/789532.html