Posted by Matryoshka on April 2, 2010, at 0:50:35
In reply to Is it safe to take DLPA with MAOI?, posted by Economist on March 25, 2010, at 16:13:28
I would really not risk it.
DLPA's actions are theoretically explained by improving the synthesis of norepinephrine and dopamine.
And, on 9mg/24h Emsam you're reaching the point where selegiline becomes non-selective - it stops being an MAO-B inhibitor and becomes an inhibitor of both MAO-A and MAO-B.
(This is why you start the diet. MAO-A breaks down tyramine, so your body can't break down a lot of tyramine quickly enough, and tyramine acts as a pressor...so consuming it causes acute hypertension.)MAO-A is also responsible for breaking down norepinephrine (along with serotonin and tyramine).
So, you have a reduced ability to break down excess norepinephrine in your body when you're on 9mg or 12mg/24h Emsam.
This is okay (and good for depression), until you take something stimulating that increases norepinephrine. Your body/brain can't quickly break down the excess.(For me, all stimulants - from caffeine to nicotine to Provigil and Nuvigil - feel more powerful physically on an MAOI. And not necessarily in a good way.)
So if you load up with something like DLPA, you could easily raise your blood pressure too high (and hypertensive crises can be really, really awful).
This is why doctors and pharmacists are so cautious about drug interactions with non-selective MAOIs like Parnate, Nardil, and higher-dose Emsam.
Anything and everything that increases serotonin or norepinephrine has the potential to cause serotonin syndrome or a hypertensive crisis (respectively).Some doctors will prescribe low and careful doses of stimulants with MAOIs in order to relieve fatigue. It takes slooooow titration and medical monitoring, though.
But taking an unregulated, and much less-studied, supplement like DLPA is unmonitored (I don't think most doctors would OK it) and it's much harder to gauge the dosage. (Supplements don't always have in the bottle what's on the label, sad to say.)
I'm not saying a problem is inevitable (at least not nearly so much as death and taxes). But hypertensive crisis is not fun, and I would avoid taking the risk.
If you have fatigue issues, I would discuss it with your doctor and find a way to address it cautiously.
(I'm on Emsam 12mg/24h and 50mg Nuvigil. I found a noticeable mood lift from Provigil/Nuvigil too (doc tried me on one then the other, it's a long story), and those are less risky than the amphetamines to take with MAOIs.)If you still have low mood...9mg/24h is where it starts to kick in for many people (it took 12mg/24h for me to feel really noticeably better), so I hope Emsam helps you.
(whew...helluva first post for me. :))
poster:Matryoshka
thread:940819
URL: http://www.dr-bob.org/babble/20100328/msgs/941729.html