Posted by SLS on September 28, 2022, at 13:52:49
In reply to Responsive ) Refractory ) Responsive ) Remission » undopaminergic, posted by SLS on September 28, 2022, at 11:18:06
I left one thing out. Clorgyline is an irreversible monoamine oxidase inhibitor *specific* for MAO-A. It is probably the most potent antidepressant in the world. I was fortunate to be treated with it when I was a research patient at the NIH. It appears that if an MAOI doesn't inhibit MAO-A, it is ineffective in treating depression. However, low dosages of selegiline inhibit MAO-B only, which is sufficient for treating Parkinsons Disease. Parkinsons is a movement disorder caused by the deterioration of dopamine neuron terminal buttons.
MAO-A - Norepinephrine and Serotonin
MAO-B - Norepinephrine and Dopamine
Selegilne becomes effective for depression *only* once the dosage is increased to the point where it begins to inhibit MAO-A along with MAO-B. MAO-A raises serotonin levels. MAO-B does not. However, inhibiting MAO-B exclusively is sufficient to treat Parkinsons Disease. Parkinsons is a disorder in which dopamine activity becomes progressively impaired. At higher dosages, selegiline loses its selectivity for MAO-B and begins to inhibit MAO-A as well. EMSAM is the MAO-B inhibitor product that is approved for depression. If you read the label, the company is clear in describing that EMSAM is effective for treating depression, but only at a patch dosage that inhibits MAO-A.
> > > I have combined Parnate 120 mg/day with methylphenidate and also with amphetamine. On top of that, came T4 and desipramine. It was of little value if remission was to be my goal.> > What was the problem with the combination? Did it not elevate your mood enough, or did it have adverse effects?
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In 1987, after 5 years of treatment failures, a doctor put me on a combination of Parnate and desipramine. It was harsh at first, but it eventually brought me close to remission. Functionally, I was very much improved. However, anhedonia remained less improved. I was quite happy with that state of affairs. After 6 months of remission, a delusional mania emerged for the first time as an adverse effect of drug treatment. The doctor discontinued both antidepressants, and I relapsed within 2 months. My doctor had no intentions of giving me a MAOI + TCA combination ever again - which was a monumental mistake. In 1990, I became psychotically manic after *discontinuing* Nardil. I was still responsive to it, though. I entered a psychiatric clinic as an inpatient. They treated me with Thorazine and then Haldol, after which I became absolutely refractory to all treatments.Taking clorgyline, a specific and irreversible inhibitor of MAO-A was powerful enough to break through the wall of non-response. I became responsive to drugs again, but it would take another 20 years to find the right treatment for me.
I am now close to being in full remission.
Current treatment regime:
Nardil - 90 mg/day
Nortriptyline - 150 mg/day
Lamotrigine - 300 mg/day
Lithium - 300 mg/day
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1120765
URL: http://www.dr-bob.org/babble/20220917/msgs/1120815.html