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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Bones on September 17, 1999, at 6:14:42
Hi Folks:
As you can see I resume my search for the perfect med. I was off meds. for about three weeks. Life is too difficult without them. The "can't live with em" ... "can't live without em" predicament.
Anyway, a couple of questions for anyone who can answer. In a post about a month or so ago, JohnL mentioned his cocktail for Social Phobia ... Selegiline/Klonopin/Pindolol. I'm investigating this combo right now. Perhaps substituting a sedative tricyclic at night for the klonopin (still cautious about introducing a benzo into my regiment).
My questions are:
1) Are selegeline & manerix (moclobemide) the same kind of drug?
2) Can selegeline be prescribed in Canada??
3) Can Moclobemide / Tricyclics be combined together?
4) Can Moclobemide / SSRI's be combined together?Phew!! I know there's a lot there.
It looks like it's going to be a lovely September day in Toronto. Floyd is nowhere in sight!!
Take good care my cyberfriends!
Posted by Mike on September 17, 1999, at 13:22:18
In reply to Selegiline/Moclobemide-Same??, posted by Bones on September 17, 1999, at 6:14:42
> Hi Folks:
>
> As you can see I resume my search for the perfect med. I was off meds. for about three weeks. Life is too difficult without them. The "can't live with em" ... "can't live without em" predicament.
>
> Anyway, a couple of questions for anyone who can answer. In a post about a month or so ago, JohnL mentioned his cocktail for Social Phobia ... Selegiline/Klonopin/Pindolol. I'm investigating this combo right now. Perhaps substituting a sedative tricyclic at night for the klonopin (still cautious about introducing a benzo into my regiment).
>
> My questions are:
>
> 1) Are selegeline & manerix (moclobemide) the same kind of drug?
> 2) Can selegeline be prescribed in Canada??
> 3) Can Moclobemide / Tricyclics be combined together?
> 4) Can Moclobemide / SSRI's be combined together?
>
> Phew!! I know there's a lot there.
>
> It looks like it's going to be a lovely September day in Toronto. Floyd is nowhere in sight!!
>
> Take good care my cyberfriends!Hi,
Regarding your questions:
(1) My understanding is that selegiline (Deprenyl) and Moclobemide are not similar. Selegiline is typically prescribed at doses less than 10-15 mg/day to maintain its MAO-B inhibiting activity. This avoids the dietary restrictions associated with the non-selective MAOI's. Moclobemide, I understand is a reversible inhibitor of MAO-A. Your psychopharmacologist may be able to prescribe both Moclobemide and Deprenyl to you as a way to "fine-tune" the MAO-B inhibiting activity. However, I believe he would have to be careful to keep your Deprenyl under the 10-15mg/day limit to avoid MAO-A activity.
(2) As far as combining Moclobemide with SSRI's, I would think not, as both affect Serotonin levels and there could be a risk of Serotonin syndrome.
(3) The longer-acting benzodiazepines, such as Klonopin, are typically better tolerated than the shorter-acting benzo's, such as Xanax. Also, the benzodiazepines are not the "tranquilizers" of the past, such as valium. Klonopin, for example, on a maintenance dose of 2.0mg/day is not particularly sedating, but is quite effective in controlling panic and social phobia. You can augment your maintenance regimen with an addition 0.5 to 1.5 mg prior to a major event, such as public speaking, several hours beforehand.As always, please be sure you are obtaining your prescriptions and information from a personal consultation with an experienced psychopharmacologist. Most university-based anxiety disorder clinics have this level of experience and knowledge.
Posted by JohnL on September 17, 1999, at 16:37:50
In reply to Selegiline/Moclobemide-Same??, posted by Bones on September 17, 1999, at 6:14:42
Hi Bones. I remember the posts of Selegiline and Klonopin, but that wasn't me. Sounds like an intriquing combo though. I've never tried a benzo. But, answers to your questions.
1) Selegiline and Moclobemide are both MAOIs, but not at all the same. Selegiline in high doses, perhaps over 20mg and on up, might act more like Moclobemide, but still they are not really similar.
2) I don't know if Selegiline is available in Canada, but it is easily available on the net with quick delivery and no prescription.
3) & 4) Moclobemide and SSRIs or TCAs can be combined. The Canadian doc I spoke with does it. He uses Moclobemide as the primary treatment with small doses of any other AD as an add-on. Small doses I think is the important issue to keep the combo safe. He always starts the Moclobemide first, adding something else on later if needed, but NEVER the other way around. Not sure why, but he must have a good reason.Generally speaking, Moclobemide has a good reputation as far as side effects goes, but its efficacy is in question. Clinical studies indicating its weakness were done at medium doses. It apparently is very effective at its maximum dose and even higher, with supposedly very favorable side effects compared to SSRIs, according to excerpts of patients and doctors that have used it. I guess the same applies to Selegiline. From what I have read, a high dose is needed. Bottom line though, who knows, we all respond so differently.
Posted by Bones on September 18, 1999, at 9:06:12
In reply to Re: Selegiline/Moclobemide-Same??, posted by JohnL on September 17, 1999, at 16:37:50
> Hi Bones. I remember the posts of Selegiline and Klonopin, but that wasn't me. Sounds like an intriquing combo though. I've never tried a benzo. But, answers to your questions.
> 1) Selegiline and Moclobemide are both MAOIs, but not at all the same. Selegiline in high doses, perhaps over 20mg and on up, might act more like Moclobemide, but still they are not really similar.
> 2) I don't know if Selegiline is available in Canada, but it is easily available on the net with quick delivery and no prescription.
> 3) & 4) Moclobemide and SSRIs or TCAs can be combined. The Canadian doc I spoke with does it. He uses Moclobemide as the primary treatment with small doses of any other AD as an add-on. Small doses I think is the important issue to keep the combo safe. He always starts the Moclobemide first, adding something else on later if needed, but NEVER the other way around. Not sure why, but he must have a good reason.
>
> Generally speaking, Moclobemide has a good reputation as far as side effects goes, but its efficacy is in question. Clinical studies indicating its weakness were done at medium doses. It apparently is very effective at its maximum dose and even higher, with supposedly very favorable side effects compared to SSRIs, according to excerpts of patients and doctors that have used it. I guess the same applies to Selegiline. From what I have read, a high dose is needed. Bottom line though, who knows, we all respond so differently.Thanks guys!!
This is the end of the thread.
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