Posted by Crotale on August 3, 2008, at 22:22:53
In reply to Re: Considering an MAOI » christophrejmc, posted by BrightEyed+Blueberry on July 12, 2008, at 4:06:48
> Several years ago I would occasionally take Temgesic (buprenorphine .2 sublingual)
I wish this was available in the US. It would make life a lot easier for me! I gather the bioavailability is supposed to be similar SL and IM (which is how I take it). The only SL formulations we have here are Subutex and Suboxone, which don't come in anything less than 2mg. The injectable solution, Buprenex (my pharmacist says there's going to be a generic soon), is 0.3mg/mL. I tried taking it SL but it didn't seem to work. I really don't like having to inject it; the worst part is the amount of medical waste, not to mention ordinary trash it generates!
> - I was only on SSRIS at the time, and Wellbutrin (though for a short time I was overseas for 6 months and weaned off all ADs (subsequently getting depressed, which I wouldn't have believed, laying on beaches in tranquil off-the-beaten trackm cheap tropical enclaves--damn biological depression!
Clearly not winter depression! My sister says she gets this, but for me some of the worst times have been in the summer. I know what you mean about how frustrating it is when you do everything you can think of to feel good and you don't get an ounce of enjoyment.
> ... The usual occurred--lost all interest in doing anything-type depression returned, along with sleeping, and more sleeping (atypical))
I'm the opposite: I hardly sleep at all, waking up in the middle of the night or early in the morning, plus I stop eating. (Alas, I don't lose much weight, as I also hardly get any exercise. When I stopped taking Nardil - it had stopped working and all I was getting were the side effects - I did lose some of the weight I'd gained on it, but that was a while ago; I've regained it since then on various other meds I've tried.)
It sounds like there's at least one feature of atypical depression that you're missing: mood reactivity. That is, it sounds like when you're depressed, you don't feel better temporarily when something good happens. Am I right?
> In either case, on above ADs or off all ADs, the Tems helped me - especially the Next/NEXT day (but it really made me nod out--id take it in the evening, give it 45 minutesm and then I'd go cross-eyed on my laptop/book and that was my cue to just lay down and sleep--then I'd nod in and out of "sleep" and have movie-like almost lucid "dreams."
This sounds like the "opium dreams" that a lot of people experience on opioids. I don't get this at all; every opioid I've tried has acted more like a stimulant for me (besides buprenorphine, that includes morphine, codeine, hydrocodone, and hydromorphone). If I take too much I just get jittery and revved up, although not in the "hard-edged" way as you describe your response to stimulants. Oh yeah, not to mention I get sick to my stomach. The very concept of 2mg buprenorphine (that's the minimum *possible* dose; the actual recommended dose is 12-16 mg/day!) freaked me out when I read about Subutex and Suboxone...I couldn't possibly tolerate that stuff!
> So, it mellowed me out--as opposed to having really obviously stimulating ("hard-edged") effects of EMSAM or wellbutrin or amphetamine-class substances (btw, ive never had a euphoric response to cocaine--while everyone else was "blowing" away and having a good time. Talk about hard-edged irritability - no thanx).
This isn't that uncommon an effect with stimulants actually, including cocaine. Contrary to stereotype, not everybody gets high on the stuff. (I've never been interested in trying it myself, but I knew some people in college who were major cokeheads and a number who at least tried it once or twice...including a couple who never wanted to touch it after the first time!)
> But either I was really sensitive to it or took too many (2-4? tis been so long) .2 tablets under the tongue [i was always confused of the dosage; i took nowhere near what apparently is taken for heroin-addiction <gasp>! Damn I dont think I'd ever wake up on those dosages!]
I reduced it from 0.3 to about 0.2-0.25 (total of at most 1mg/day) to combat the side effects (nausea, constipation, itching, dry mouth, etc.). It sounds like maybe you were taking too much, if I have problems with side effects I try lowering the dose or dividing it (so you might take just one tab at a time, 2-4 times a day).
(I see you find the "blocking" dose used to treat addiction as scary as I do!)
> I'm guessing Tems the anti-depressant effects are re:opioids, (which I haven't ever researched because I know my doc would NEVER go there) as opposed to the "3 muskateer" monoamine standards: serotonin, norep, and dopamine?
Heh. :)
It is an opioid effect, but as a partial agonist, I think it's subtler and less euphoric. This is based on what drug addicts say about it in comparison to, say, hydrocodone. (I've always had weird responses to opioids, as I noted, so I'm afraid my experiences won't be terribly useful for you.)
I'm not sure about the dosing for EMSAM, but selegiline at higher doses should have the serotonergic effects.
> Anyway, with EMSAM, with wellbutrin, with Adderal - I've got the hard edge without the serotonin-ahhh feeling - which i liken to having a good stretch....but i have energy, motivation, focus, to varying degrees....
A problem with selegiline is that it has some L-amphetamine metabolites. These tend to have a lot of the unpleasant side effects without the more pleasant and/or useful effects that d-amphetamine gives a lot of people. (the d-isomer is about 4x as potent centrally, IIRC, as the l-, while l-amph is a little more potent in its cardiovascular effects). I didn't care for d-amph much but I take modafinil occasionally to help me concentrate.
> Anyway, I'm not ready to start ordering tems from overseas, I'm sure it's not as easy as it was back in 2000, and I'm not as quick to experiment now that I've started the MAOI route.
Buprenorphine is fine with MAOIs, I've been taking it with Parnate for much of the last nine years. I don't know for sure if there are any specific interactions with selegiline; I guess there might be a possibility of a pharmacokinetic interaction resulting from competitive inhibition of CYP3A4, although I think it's unlikely based on the research. If you ever do decide to try it, I would say start with a low dose and see how you do.
> I feel I had a strong response to it in the past, and I don't know if being on EMSAM would make me even more sensitive to it (therapeutic) or less.
I don't think it should have any effect either way, but like I said, you might want to take care, especially since it seemed to hit you pretty hard (with the sedation and whatnot) at the doses you used to take.
> I just remembered - I did try tems while on Effexor/Wellbutrin...a couple years ago...It had less to no effect on me-nada. So, something to do with the norepinephrine reuptake inhibition cancelled out bupe's effects on me? Yes, no? Why?!
I don't know why this would be. Maybe the ADs were stimulating and this reversed the sedating effect you usually get with the temgesic? I don't know...did you try it just once, or more than that, and how much did you take?
BTW as far as trazodone goes, that's okay in low doses with MAOIs too. Again, I don't know if there's any particular pharmacokinetic interaction with selegiline at clinical doses but I wouldn't think so. Personally I found I developed tolerance to the sedative effect of trazodone, which is probably related to its antihistamine activity. There's an antihistamine called hydroxyzine which is quite sedating and which might be worth a try, particularly if you also have allergies.
> I'm thinking of hustling in to CBT shortly - otherwise I feel like I'm relying to much on PDOC & Meds Russian Roulette, which makes me feel like a minor league drug addict and codependent (and a child constantly being denied permission to try or have my ideas really listened to.) And I'm not judging addicts or codependents; I would not speak on issues about which I know!
I dunno, CBT is supposedly effective for depression but I think it's better when dealing with a particular issue or problem...I mentioned this in my last post, in reply to christophrejmc (but just as much for you or anyone else who cares to read it).
> Unfortunately I don't have a doctorate, but i do have a graduate degree in clinical psych and did focus on biopsych/neuropsyc, but that was ages ago, and I don't think my doctor...appreciates that? she bats down my ideas one by one as I walk in her door-so i send her long, researched and cited emails ahead of time to make her have to do some thinking first! Guess I'm a toe-stepper with my current pdoc--eventually may have to part ways.
Something else I mentioned in my latest response to christophrejmc: I don't know what the equivalent is where you are, but I've found that residents (i.e. med school graduates who are in their postgraduate specialty training to be a psychiatrist) are often better in this way, in that they seem more willing to listen and take my ideas seriously.
> good night! lookin like another EMSAM one!
I'll think of you as I don't sleep. (Actually I've been sleeping better...well, not-sleeping less. :-})
All my best,
-Crotale
poster:Crotale
thread:826622
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/844022.html