Posted by christophrejmc on July 12, 2008, at 2:27:09
In reply to Re: Considering an MAOI » undopaminergic, posted by BrightEyed+Blueberry on July 5, 2008, at 2:26:36
Sleep was difficult for me, too, with EMSAM. I think Xanax worked but I don't develop tolerance to its sedative effect. I'm sure I also used Ambien with some success. Trazodone is probably something that you definitely want to avoid. I'm not sure how much risk there is of serotonin syndrome at small dosages used for sleep, but it's just not worth the danger.
I have used Wellbutrin with EMSAM. I think it was the XL version although I'm not sure. Wellbutrin tends to make me slightly anxious (at least at first) and gives me headaches; EMSAM seemed to make both side-effects worse (but it wasn't an occipital headache and my blood pressure was never very high while I was on them). I forget the current view of Wellbutrin's mechanisms, but I do believe it increases the release of norepinephrine. This isn't necessarily bad, but if you don't have as many enzymes available to break it down, it's obviously going to add to the effect. I've never heard that Wellbutrin affects serotonin, but I don't think it's in any way that really matters; it has very low affinity for serotonin receptors or the uptake pump and I don't think it directly affects its release in any way that would make it dangerous in that regard. (I'm relying on my [very much flawed] memory here, you should look it up and present the research to your doc if you want to try it.)
I had the exact same experience with Provigil--no serious side-effects, but the ones that I had had from Provigil without EMSAM were magnified. The headaches were much worse than with Wellbutrin. I've also used Provigil and Parnate before and that was actually smoother than with EMSAM.
I've also taken Ritalin and Dexedrine with MAOIs. There were actually much fewer side-effects from this than with Wellbutrin or Provigil. It is potentially dangerous, though.
I believe there is a reasonable amount of evidence that buprenorphine can be combined with MAOIs. But you would have to have a very open-minded and trusting doctor to receive buprenorphine even by itself... and it doesn't sound like you have one of those doctors. (My doc lets me try all kinds of things that are off-label and appreciates when I bring in research, but I'm quite sure there's no way, even after seeing her for nearly ten years, that she would consider giving me bup.)
poster:christophrejmc
thread:826622
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/839395.html