Posted by SLS on October 21, 2014, at 9:15:50
In reply to Re: possible interaction among these drugs » Chinaboy, posted by phidippus on October 20, 2014, at 21:16:53
> Selegeline is an MAOI and Dietary restrictions are common for MAOI treatments. Eating the wrong thing can lead to a hypertensive crisis.
THIS IS SUPER-IMPORTANT!
Sslegiline is not a "safe" MAOI. It is true that it is selective for MAO-B, but only at relatively low dosages. However, at the lowest effective dosage of Emsam (6 mg/24hr), it loses its selectivisty. Therefore, it is still a requirement that people using Emsam follow the food and medication restrictions.
The antidepressant response to Emsam probably requires the inhibition of MAO-A. At low dosages, selegiline is very selective for MAO-B. Its actions at such dosages are sufficiently robust to improve symptoms of Parkinsons Disease, which involves the loss of dopamine function.
It turns out that Emsam does not become effective at treating depression until it loses its selectivity and produces sufficient inhibition of MAO-A. When MAOI-A is inhibited, the increase in serotonergic tone requires that one avoid serotonergic drugs in order to prevent dangerous episodes of seroton syndrome.
Hypertensive crisis? Does the lowest dosage of Emsam require food restrictions? The drug company says no. Additionally, my brief study of Pubmed abstracts revealed a consensus of opinion that tyramine can be ingested while taking Emsam at the lowest recommended dosage (6 mg/24hr).
* Generalization: Emsam does not become effective at treating depression and anxiety disorders until a dosage is reached that will inhibit sufficient MAO-A to potentiate serotonin. I don't think it makes much sense to choose to be treated with Emsam if it is an absolute requrement that you not have to follow the diet restrictions. Chances are that you will require a dosage of Emsam that is greater than the minimum recommended in order to obtain a persistent therapeutic response.
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MAO-A = Depression; Anxiety Disorders, OCD
MAO-B = ParkinsonsSelective = Inhibits both enzymes, but is preferential to one of them as it acts on one more than the other.
Specific = Inhibits one enzyme only, regardless of dosage.
Irreversible = The dug won't let go of the enzyme; it becomes permanently disabled.
Reversible = The drug can fall off the enzyme, allowing it to function again.
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Clorgyline was a hell of an antidepressant. It was a potent, specific, and irreversable inhibitor of MAO-A.
Clorgyline is only manufactured for lab experiments now. The NIH had used it clinically for years when attending to the most treatment-resistant cases. At a time when my system was least capable of responding to antidepressants, clorgyline actually produced a robust, albeit varisble response. It definitely broke through the wall of complete refractoriness and left me more responsive to other treatments.
Good luck to you.
Be well.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1072277
URL: http://www.dr-bob.org/babble/20141017/msgs/1072630.html