![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by S.D. on July 17, 2000, at 1:39:54
I'm concerned about some people here who may be combining an MAOI with a stimulant or adrafinil or amisulpride, so if that's you, please let me/us know how you are doing.
The selfish part of my concern is that I'm taking the OTC "herbal supplement" kava (for social anxiety) which is a reversible inhibitor of MAO-B. (MAO-B is the one that oxidizes dopamine and PEA).
I don't want to stop the kava if it is unlikely to be a real danger, although I know it's also possible either could inhibit the effectiveness of the other. Since I can't find any direct indication at all that this particular combination is unsafe, the only thing I wonder is if a sufficient degree of MAO-B inhibition would cause a problem with the dopaminergic effect of low-dose amisulpride.
So please let me know if you have any specific idea that I'm "heading for trouble"!
Thanks, peace and health,
S.D.
Posted by AndrewB on July 17, 2000, at 8:22:13
In reply to MAO-B inhibitor + dopamine-releaser dangerous?!, posted by S.D. on July 17, 2000, at 1:39:54
I take the combination of amisulpride with seligiline. I've been on this combo for over a month. Seligiline is an MAO-B inhibitor (at the low doses I take), much stronger than kava I believe. No problems that I've noticed. No drug interactions are listed between seligiline and amisulpride, or any neuroleptics for that matter, or any dopamine active agents. In Parkinsons Disease seligiline is routinely combined with other dopaminergics (agonists, precursors, etc.).
I take selegiline to amplify the effect of amiuslpride. Seligiline in low doses has been shown to be effective for social anxiety.
I have taken amisulpride and kava together before and didn't notice any side effects.
AndrewB
Posted by S.D. on July 17, 2000, at 16:11:41
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?!, posted by AndrewB on July 17, 2000, at 8:22:13
Thanks Andrew, I shoulda thought of that (checking interactions between selegiline and amisulpride/otherstuff)
Is this what you were referring to regarding low-dose selegiline being effective for social phobia...
1: Simpson HB, Schneier FR, Marshall RD, Campeas RB, Vermes D, Silvestre J,
Davies S, Liebowitz MR.
Low dose selegiline (L-Deprenyl) in social phobia.
Depress Anxiety. 1998;7(3):126-9. No abstract available.
PMID: 9656093; UI: 98320198If so, is the abstract online somewhere? Did you get the article from a library? (I have a list of articles that had 'no abstract available' and I think I can get or request them from the university library, but never have done so :-( )
Given the dopamine and PEA specificity of low-dose selegiline, it sure makes me wonder about the psychiatrists I've personally asked almost unanimously saying "It's totally a serotonin thing!".
peace and health,
S.D.
Posted by Sunnely on July 17, 2000, at 20:24:37
In reply to Thanks a bunch! + Q re: rsrch on Selegiline for SP » AndrewB, posted by S.D. on July 17, 2000, at 16:11:41
> Given the dopamine and PEA specificity of low-dose selegiline, it sure makes me wonder about the psychiatrists I've personally asked almost unanimously saying "It's totally a serotonin thing!".
The maker of selegiline had issued an advisory against prescribing the drug with antidepressants because of potential central nervous system (CNS) toxicity such as "serotonin syndrome."
As of 1997, the FDA had received 57 adverse event reports of combined treatment with selegiline and a serotonergic drug. Of these, 48 reports involved patients with Parkinson's disease. Four cases (including 2 of patients with Parkinson's disease) might have possibly met criteria for serotonin syndrome. None of the antidepressant-selegiline reactions described included myoclonus or hyperreflexia, major symptoms of serotonin syndrome. The one patient with these symptoms was taking selegiline with carbidopa-levodopa (Sinemet) and bromocriptine (Parlodel), and no antidepressant. Another adverse event indicative of serotonin syndrome was associated with the combination of selegiline and meperidine (Demerol), now contraindicated in Parkinson's disease. One death was attributed to combined selegiline-antidepressant therapy who did not have Parkinson's disease.
Although probably rare, the combined use of selegiline and dopamine agonists (releasers) have the potential to cause CNS toxicity such as "serotonin syndrome."
No such drug-drug interaction exists with selegiline and an antipsychotic drug with amisulpride (with selective D2/D3 receptor blocker).
Reference:
Richard I, et al: Serotonin syndrome and the combined use of selegiline and an antidepressant in Parkinson's disease. Neurology 1997;48(April):1070-1077.
Posted by Rick on July 18, 2000, at 0:18:07
In reply to Re: Thanks a bunch! + Q re: rsrch on Selegiline for SP, posted by Sunnely on July 17, 2000, at 20:24:37
Some thoughts relating to these topics:
Solo selegiline was the second med I ever tried for social phobia, and it did nothing for my anxiety after six weeks, even after we tried several potentiating agents. It was great for cognition, wakefulness and sexual stimulation, however.Frankly, I'm glad it failed, because that allowed me to convince my pdoc to let me try maintenance Klonopin, whose response rate in the 70%'s has never been bested in placebo-controlled studies of social phobia (Nardil came pretty close, though.) Branded Klonopin has been a benign life-saver for me. I've never developed tolerance. Indeed I discovered that LOW doses work a lot better than larger ones. Also, I have had no side effects except lasting GOOD ones since week 2 (I'm now in week 52). (Note: If anyone writes about the dangers of regular benzo use, I will refer them to a detailed response to that assertion which I wrote abou a month ago, and won't discuss it any further. Those debates simply become too time-consuming.)
-- At one point, I added a little Selegiline to the Klonopin seeking a return of the wonderful cognition, wakefulness, and sexual benefits. Those quickly returned, but so did a lot of anxiety. So it was gooodbye, Selegiline.
--I'm really happy to hear that Selegiline has helped your social phobia, Andrew! As usual, everybody's different. But I do believe you're in the minority. While the theory that social phobia is primarily dopamine-based had been gaining momentum, every medication-based study I've seen testing that theory (including a few on selegiline) has shown disappointing results. I believe the no-abstract citation cited above did NOT report that Selegiline proved effective for social phobia. There was a recent study listed in Medline testing the high-powered dopamine-agonist pergolide for social phobia. I ordered the article out of curiosity, and read that there had been no positive results among any of the sujects -- not even the usual placebo responses.
In my experience, every dopamine-based med I've taken has *increased* my anxiety in tandem with the welcome cognition effects. I began to believe *any* stimulanting med would increase anxiety. That's why I was flabbergasted (and delighted) to find that the new non-amphetamine stimulant Provigil(modafinil) actually complemented my Klonopin (and Serzone) by providing gentle stimulation WITHOUT working against the calm that the other meds produced. Provigil actually makes me MORE outgoing. (My guess is that BY ITSELF the Provigil would have a minimal-to-negative impact on my social phobia...strictly conjecture.)
-- Devil's advocate: While most of what I've seen (and personally experienced) fail to support
the dopamine connection that earlier studies suggested might exist for Social Anxiety, we need to take into account that dopamine is a VERY complex hormone, almost paradoxical in many ways. E.g., it strongly increases blood pressure at certain sites, and strongly lowers it at others. It's possible that different brain receptor sites could have very different reactions to dopaminergic activity, so I guess we can't completely rule out some kind of dopamine connection for Social Anxiety. Serotonin itself have some indirect impact on dopamine regulation, so if a certain kind of dopamine deficiency/dysfunction IS somehow related to social anxiety in many people, that could conceivably explain why SSRI's help many socially anxious people. Despite all of these possibilities, to-date I've seen no research on human subjects -- certainly not any med-based research -- clearly supporting dopamine deficiency/dysregulation as the driving factor in Social Anxiety.
-- While I'm not sure about Amisulpride, etc., most evidence and research suggests that serotonin syndrome (especially beyond very mild cases) from mixing low-dose Selegiline with other meds is extremely rare. Search Medline for "citalopram and selegiline" and you'll find a study supporting the general safety of this combo. (Citalopram is Celexa, the most purely serotonergic of all SSRI's.) There are other, smaller-scale studies (you can find the abstracts in Medline) that suppport the general safety of this combo. There are, as printed in a post above, some cautionary abstracts as well -- especially early ones -- but they are very much in the minority.In fact, here's something which I found kind of amusing: As usual, the Celexa monograph sternly warns against taking any kind of MAOI concurrently. But on the "professionals" section of their own website (www.Celexa.com), they have a link to a Geriatrics journal Parkinson's-care article stating that low-dose selegiline and SSRI's are routinely prescribed together, and that problems are very rare (and usually mild and reversible in the few cases where they do occur). I was going to include the link here, but I see that the journal now requires that you sign up ($$$) for limited or long-term access before viewing the article.
Rick
Posted by SLS on July 18, 2000, at 7:39:24
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?!, posted by AndrewB on July 17, 2000, at 8:22:13
> I take the combination of amisulpride with seligiline. I've been on this combo for over a month. Seligiline is an MAO-B inhibitor (at the low doses I take), much stronger than kava I believe. No problems that I've noticed. No drug interactions are listed between seligiline and amisulpride, or any neuroleptics for that matter, or any dopamine active agents. In Parkinsons Disease seligiline is routinely combined with other dopaminergics (agonists, precursors, etc.).
>
> I take selegiline to amplify the effect of amiuslpride. Seligiline in low doses has been shown to be effective for social anxiety.
>
> I have taken amisulpride and kava together before and didn't notice any side effects.
>
> AndrewB
Hi Andrew,You may want to consider the possibility that any improvement you glean from selegiline (Eldepryl) might be due to its amphetamine-like properties, including NE potentiation. If you have never taken Dexedrine or Adderal, perhaps you should give it some consideration.
- Scott
Posted by AndrewB on July 18, 2000, at 9:12:56
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?! » AndrewB, posted by SLS on July 18, 2000, at 7:39:24
Thank you Rick for your informative post. I always enjoy reading your posts and have printed out copies of them before.
I didn't make this clear at all in my previous post, but even though I feel my social anxiety is as under control as it has ever been now, I can't say that selegiline (at 5mg/day) has given me any benefit at all. I'm just giving it a trial and watching and hoping for the best.
The one study that looked at low dose selegiline and social phobia saw a 33% response rate. This is a modest response, but the result was described to have significance above placebo, if I remember right.
It was interesting that selegiline increased your anxiety Rick. Taking amineptine, a dopamine reuptake inhibitor, increased my anxiety or tension. Amineptine is well known for this.
My impression is that while evidence shows social anxiety to have a dopaminergic component, it may be more to the point to say that it has a D2 (and possibly D3) receptor component. A recent study indicated that social phobics had lower D2 receptor binding potentials.
The antipsychotics amisulpride and sulpiride specifically target the dopamine D2 and D3 receptors. Amisulpride and sulpiride are prescribed overseas sometimes for social anxiety. Evidence shows both of these drugs to be anxiolytic though no studies specific to social anxiety have been done.
All in all, social anxiety seems to be poorly understood; biochemical abnormalities in the GABA, serotonergic, andrenergic and dopaminergic neurotransmitter systems have been suggested.
I don’t feel I have totally gotten at my social anxiety with my combo of amisulpride and reboxetine. Perhaps some of us need to target more than one neurotransmitter system. I intend to try other anxiolytics in the future such as low dose Klonopin.
One more note on selegiline. One study indicated that low dose selegiline was effective for ADD. This study showed a response rate of 60%, comparable to that of stimulants. A poster on another board claimed it improved his ADD symptoms when used with Adderall.
Scott, does selegiline metabolize into amphetamine at low doses?
AndrewB
Posted by JohnB on July 18, 2000, at 14:47:26
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?!, posted by AndrewB on July 17, 2000, at 8:22:13
> I take the combination of amisulpride with seligiline. I've been on this combo for over a month. Seligiline is an MAO-B inhibitor (at the low doses I take), much stronger than kava I believe.
Andrew, thanks for the info. I've been taking kava on and off for a while, and you are saying that it's a MAO-B inhibitor? Am I interpreting correctly? I did read in a book that kava is similar in action to Klonopin. BTW has anyone gotten sex urges after taking kava?
Thinking of trying adrafinil; any drug interactions to be aware of? Thanks; --JB
Posted by Rick on July 18, 2000, at 21:31:48
In reply to selegiline, dopamine, social anxiety, posted by AndrewB on July 18, 2000, at 9:12:56
> All in all, social anxiety seems to be poorly understood; biochemical abnormalities in the GABA, serotonergic, andrenergic and dopaminergic neurotransmitter systems have been suggested.It is pretty poorly understood, isn't it? I'm beginning to feel that it's an extremely heterogenous disorder. The specific symptoms seem to vary so much by person, even if there are certain commonalities. Could this reflect a wide variation in chemical triggers by person? As far as the "nurture" side of social anxiety etiology, I have been seeing some interesting recent studies in Medline that actually seem to be showing some convergence, for a change! That's good to see.
> One more note on selegiline. One study indicated that low dose selegiline was effective for ADD. This study showed a response rate of 60%, comparable to that of stimulants. A poster on another board claimed it improved his ADD symptoms when used with Adderall.Based on my own reaction to selegiline, it's not hard to believe that it could help in ADD.
Thanks for sharing lots of interesting observations!
Rick
Posted by Adam on July 19, 2000, at 0:17:10
In reply to selegiline, dopamine, social anxiety, posted by AndrewB on July 18, 2000, at 9:12:56
AndrewB,
Oral selegiline is metabolized into l-amphetamine and l-methamphetamine (as well as desmethylselegiline, which has weak MAO-B inhibatory properties) at all doses, and the levels of those metabolites are related, obviously, to the levels of the parent compound.
The l- enantiomers of amphetamine are, simplistically, "weaker" than their d- counterparts. I think it may be more accurate to say they are not very potent inhibitors of dopamine reuptake, but do have comparable effects on norepinephrine release, and I believe can also inhibit MAO to some extent, just as the d- enantiomers do. It is somewhat of a wonder that people do not have more problems with selegiline, especially at high doses, that would be reminiscent of parnate, given the effects its metabolites have on the sympathetic nervous system.
Selegiline is thought to have some dopamine reuptake properties of its own; there's a lot more going on than just MAO-inhibition, even at low doses, though I think the lower the dose, the more the MAO-B-inhibitory effects clearly dominate. Selegiline is an interesting drug with many potential uses that are either indirectly or not related to its role as an MAOI.
I hadn't heard of it used as a treatment for social phobia, except anecdotally through my doctor, who prescribes it to me at a relatively high dose, where it is thought to behave in that manner like the other non-specific MAOIs. My guess is it probably isn't particularly good for that indication, since it seems to cause agitation and anxiety in some. People take antipsychotics like risperidol sometimes while taking selegiline to reduce some of the side-effects, related to its strong dopaminergic activity. Risperidol as an antidote to selegiline+levodopa-induced psychosis in Parkinson's patients is one thing that comes to mind. I imagine amisulpride would behave similarly.
It's not suprising that it might have some benefit for people suffering from ADD. The parent compound, without mentioning the metabolites, behaves a bit like an amphetamine.
I do believe I read somewhere that Kava was, to its indigenous users, a "social lubricant". Since it is a weak MAO-B inibitor, it would seem to follow that selegiline might also be of benefit for social anxiety. It may be, though, that the active compound(s) in Kava behave in other, very different ways than selegiline. I think if one could isolate the effects of enhanced beta-phenylethylamine from some of the more anxiogenic properties of selegiline, this might be a partial explanation. PEA, after all, is the "love chemical", and being in love certainly makes one more ebullient, even in a crowd.
>
>
> Thank you Rick for your informative post. I always enjoy reading your posts and have printed out copies of them before.
>
> I didn't make this clear at all in my previous post, but even though I feel my social anxiety is as under control as it has ever been now, I can't say that selegiline (at 5mg/day) has given me any benefit at all. I'm just giving it a trial and watching and hoping for the best.
>
> The one study that looked at low dose selegiline and social phobia saw a 33% response rate. This is a modest response, but the result was described to have significance above placebo, if I remember right.
>
> It was interesting that selegiline increased your anxiety Rick. Taking amineptine, a dopamine reuptake inhibitor, increased my anxiety or tension. Amineptine is well known for this.
>
> My impression is that while evidence shows social anxiety to have a dopaminergic component, it may be more to the point to say that it has a D2 (and possibly D3) receptor component. A recent study indicated that social phobics had lower D2 receptor binding potentials.
>
> The antipsychotics amisulpride and sulpiride specifically target the dopamine D2 and D3 receptors. Amisulpride and sulpiride are prescribed overseas sometimes for social anxiety. Evidence shows both of these drugs to be anxiolytic though no studies specific to social anxiety have been done.
>
> All in all, social anxiety seems to be poorly understood; biochemical abnormalities in the GABA, serotonergic, andrenergic and dopaminergic neurotransmitter systems have been suggested.
>
> I don’t feel I have totally gotten at my social anxiety with my combo of amisulpride and reboxetine. Perhaps some of us need to target more than one neurotransmitter system. I intend to try other anxiolytics in the future such as low dose Klonopin.
>
> One more note on selegiline. One study indicated that low dose selegiline was effective for ADD. This study showed a response rate of 60%, comparable to that of stimulants. A poster on another board claimed it improved his ADD symptoms when used with Adderall.
>
> Scott, does selegiline metabolize into amphetamine at low doses?
>
> AndrewB
Posted by AndrewB on July 19, 2000, at 1:32:59
In reply to Re: selegiline, dopamine, social anxiety » AndrewB, posted by Adam on July 19, 2000, at 0:17:10
Adam,
Thanks for all the good info. Haven't heard from you for a while. You have been settled in with high dose selegiline for a while now since you were taken off the patch.
Did you like the patch better? Where do you think high dose selegiline's place is in the antidepressant spectrum. For who may it be particularly efficacious.
AndrewB
Posted by Adam on July 19, 2000, at 9:08:56
In reply to Re: selegiline, dopamine, social anxiety: Adam, posted by AndrewB on July 19, 2000, at 1:32:59
> Adam,
>
> Thanks for all the good info. Haven't heard from you for a while. You have been settled in with high dose selegiline for a while now since you were taken off the patch.No prob!
>
> Did you like the patch better?Yes. Especially at first. When I first took oral selegiline I wasn't on an efficacious dose. I then rapidly increased the dose and felt really wound-up and jittery for days, much more so than I ever did on the patch. I still deal with feelings of restlessness, especially around the time of dosing, and insomnia. These were also concerns with the patch, but not nearly as uneven and severe. As time has gone on, I've gotten used to selegiline in my system, and probably don't notice it as much, but I've never felt as good as I did on the patch. Also, in case you don't remember, I had great antidepressant response on the patch with no dietary restrictions. I've found dietary restrictions to be not a big problem, but still I do get these Pavlovian reactions to and cravings for certain foods that I just can't eat anymore, and it was nice not to have to worry about it.
>Where do you think high dose selegiline's place is in the antidepressant spectrum. For who may it be particularly efficacious.
I guess it would probably fit best next to Parnate in the spectrum, and maybe to some limited extent Welbutrin. Like all of the MAOIs, it has enough unique and relevant non-MAOI properties that it's sort of in a class by itself, but non-hydrazine MAOI would be the best description and classification, I think.
It's hard to know who would it would be best for, since the MAOIs can be helpful for a variety of diagnoses. I'm not a physician so I can only speculate like any semi-educated person, and say that it might be best for atypical depressives and ideal for those with comorbid attention deficit issues. It might not be best for those who have anxiety disorders, but then again, there are paradoxical responses to certain drugs, and you do hear weird stories about people with social anxiety doing great on dextroamphetamine, etc., when you think they would respond best to a benzodiazapine.
I guess there's always the "give it to people who it works for" response, like me. Thinking logically, I'm not sure I would have given myself oral selegiline, and my participation in the patch study was as much an experiment for me as it was for the investigators. The truth is I was running out of options, having tried just about every class of drug available with little or no success. An MAOI was the obvious choice at that point, and the patch study seemed like a relatively painless way to explore that class. I never expected to benefit so much from it. I imagine if I hadn't tried the patch, I might be on Parnate right now, and probably would be doing pretty well. But there's no way to know, unfortunately.
>
> AndrewB
Posted by jojo on July 19, 2000, at 18:48:12
In reply to Re: selegiline, dopamine, social anxiety » AndrewB, posted by Adam on July 19, 2000, at 0:17:10
> AndrewB,
>
> Oral selegiline is metabolized into l-amphetamine and l-methamphetamine (as well as desmethylselegiline, which has weak MAO-B inhibatory properties) at all doses, and the levels of those metabolites are related, obviously, to the levels of the parent compound.
>
> The l- enantiomers of amphetamine are, simplistically, "weaker" than their d- counterparts. I think it may be more accurate to say they are not very potent inhibitors of dopamine reuptake, but do have comparable effects on norepinephrine release, and I believe can also inhibit MAO to some extent, just as the d- enantiomers do. It is somewhat of a wonder that people do not have more problems with selegiline, especially at high doses, that would be reminiscent of parnate, given the effects its metabolites have on the sympathetic nervous system.
>
> Selegiline is thought to have some dopamine reuptake properties of its own; there's a lot more going on than just MAO-inhibition, even at low doses, though I think the lower the dose, the more the MAO-B-inhibitory effects clearly dominate. Selegiline is an interesting drug with many potential uses that are either indirectly or not related to its role as an MAOI.
>
> I hadn't heard of it used as a treatment for social phobia, except anecdotally through my doctor, who prescribes it to me at a relatively high dose, where it is thought to behave in that manner like the other non-specific MAOIs. My guess is it probably isn't particularly good for that indication, since it seems to cause agitation and anxiety in some. People take antipsychotics like risperidol sometimes while taking selegiline to reduce some of the side-effects, related to its strong dopaminergic activity. Risperidol as an antidote to selegiline+levodopa-induced psychosis in Parkinson's patients is one thing that comes to mind. I imagine amisulpride would behave similarly.
>
> It's not suprising that it might have some benefit for people suffering from ADD. The parent compound, without mentioning the metabolites, behaves a bit like an amphetamine.
>
> I do believe I read somewhere that Kava was, to its indigenous users, a "social lubricant". Since it is a weak MAO-B inibitor, it would seem to follow that selegiline might also be of benefit for social anxiety. It may be, though, that the active compound(s) in Kava behave in other, very different ways than selegiline. I think if one could isolate the effects of enhanced beta-phenylethylamine from some of the more anxiogenic properties of selegiline, this might be a partial explanation. PEA, after all, is the "love chemical", and being in love certainly makes one more ebullient, even in a crowd.
> >
> >
> > Thank you Rick for your informative post. I always enjoy reading your posts and have printed out copies of them before.
> >
> > I didn't make this clear at all in my previous post, but even though I feel my social anxiety is as under control as it has ever been now, I can't say that selegiline (at 5mg/day) has given me any benefit at all. I'm just giving it a trial and watching and hoping for the best.
> >
> > The one study that looked at low dose selegiline and social phobia saw a 33% response rate. This is a modest response, but the result was described to have significance above placebo, if I remember right.
> >
> > It was interesting that selegiline increased your anxiety Rick. Taking amineptine, a dopamine reuptake inhibitor, increased my anxiety or tension. Amineptine is well known for this.
> >
> > My impression is that while evidence shows social anxiety to have a dopaminergic component, it may be more to the point to say that it has a D2 (and possibly D3) receptor component. A recent study indicated that social phobics had lower D2 receptor binding potentials.
> >
> > The antipsychotics amisulpride and sulpiride specifically target the dopamine D2 and D3 receptors. Amisulpride and sulpiride are prescribed overseas sometimes for social anxiety. Evidence shows both of these drugs to be anxiolytic though no studies specific to social anxiety have been done.
> >
> > All in all, social anxiety seems to be poorly understood; biochemical abnormalities in the GABA, serotonergic, andrenergic and dopaminergic neurotransmitter systems have been suggested.
> >
> > I don’t feel I have totally gotten at my social anxiety with my combo of amisulpride and reboxetine. Perhaps some of us need to target more than one neurotransmitter system. I intend to try other anxiolytics in the future such as low dose Klonopin.
> >
> > One more note on selegiline. One study indicated that low dose selegiline was effective for ADD. This study showed a response rate of 60%, comparable to that of stimulants. A poster on another board claimed it improved his ADD symptoms when used with Adderall.
> >
> > Scott, does selegiline metabolize into amphetamine at low doses?
> >
> > AndrewBJust happened to have read an abstract of an article
that presents evidence that even d-amphetamine appears to
have its major activity on post-synaptic receptors
http://www-east.elsevier.com/bps/abstracts/5203abs.htm
Posted by S.D. on July 20, 2000, at 16:06:40
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?, posted by JohnB on July 18, 2000, at 14:47:26
> Andrew, thanks for the info. I've been taking kava on and off for a while, and you are saying that it's a MAO-B inhibitor? Am I interpreting correctly? I did read in a book that kava is similar in action to Klonopin. BTW has anyone gotten sex urges after taking kava?
>http://www.lef.org/protocols/abstracts/abstr-090.html#17
Pharmacopsychiatry 1998 Sep;31(5):187-92Inhibition of platelet MAO-B by kava pyrone-enriched extract from Piper
methysticum Forster (kava-kava).
----------
more on Kava:
http://www.lef.org/protocols/abstracts/abstr-090.htmlhttp://www.tnp.com/substance.asp?ID=65
------------Kava reduced my social anxiety similarly to Klonopin. Perhaps not as much, but without as much tiredness or negative cognitive effect (may be having some of that with Klonopin, fairly subtly). I am taking both now in moderation, attempting to get good efficacy with minimal side effects from either. Though they might be synergistically increasing the sedation effect.
No particular sex urges due to Kava. More morning wood recently, but I haven't been keeping careful notes.
peace and health,
S.D.
Posted by Rick on July 22, 2000, at 2:20:27
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous?, posted by S.D. on July 20, 2000, at 16:06:40
> > Andrew, thanks for the info. I've been taking kava on and off for a while, and you are saying that it's a MAO-B inhibitor? Am I interpreting correctly? I did read in a book that kava is similar in action to Klonopin. BTW has anyone gotten sex urges after taking kava?
> >
>
> http://www.lef.org/protocols/abstracts/abstr-090.html#17
> Pharmacopsychiatry 1998 Sep;31(5):187-92
>
> Inhibition of platelet MAO-B by kava pyrone-enriched extract from Piper
> methysticum Forster (kava-kava).
> ----------
> more on Kava:
> http://www.lef.org/protocols/abstracts/abstr-090.html
>
> http://www.tnp.com/substance.asp?ID=65
> ------------
>
> Kava reduced my social anxiety similarly to Klonopin. Perhaps not as much, but without as much tiredness or negative cognitive effect (may be having some of that with Klonopin, fairly subtly). I am taking both now in moderation, attempting to get good efficacy with minimal side effects from either. Though they might be synergistically increasing the sedation effect.
>
> No particular sex urges due to Kava. More morning wood recently, but I haven't been keeping careful notes.
>
> peace and health,
>
> S.D.S.D., would you mind sharing (1) your daily dosage of Klonopin, including dosing schedule, (2) how long you've been taking it, and (3) whether you're taking anything other than K & KK?
I'm always curious about the dosing when someone who takes Klonopin daily talks about it causing fatigue. When I began taking it, I was surprised to find that taking LESS actually worked a lot better for my Social Anxiety. When I went from 2.5-3.0 mg. a day down to 1.5-2.0, it not only worked much better in relieving my Social Anxiety, but it also eliminated all traces of fatigue or slowness (I'm now at 1.25 mg/day, but with Serzone and Provigil as well). Even when the daily dose is low enough, taking more than 1.0 mg at a time also reduces benefits for me and brings back at least temporary sluggishness. I wish that the widely-circulated, dated Brazilian article that recommends 3.0-6.0 mg/day would just disappear from the net, especially from Doctor Bob's site!! Almost all other research, including reputable, placebo-controlled studies, suggest prime efficacy at doses maxing out at 3.0 mg. And they're NOT lowballing the dosage recommendations simply due to concerns over dependence or addiction.
Also, I find it of interest that when people are taking a maintenance benzo with an AD, they tend to assume the benzo is the med driving the fatigue.
Rick
Posted by S.D. on July 22, 2000, at 20:32:17
In reply to Re: MAO-B inhibitor + dopamine-releaser dangerous? » S.D., posted by Rick on July 22, 2000, at 2:20:27
> S.D., would you mind sharing (1) your daily
>dosage of Klonopin, including dosing schedule,
>(2) how long you've been taking it, and (3)
>whether you're taking anything other than K & KK?
...
I D/T Neurontin (N) secondary to amnestic sideFX after incr. to 1200mg qd. PDoc suggested continuing Neurontin at lower dose while doing Klonopin (K) and I agreed but soon after decided substituting kava kava (KK) in place of N was smarter because if cognitive side effects continued I'd want to know if it was the Klonopin (KK hadn't caused any previously by itself.)1) and 2): It has varied slightly but it's like this...
One capsule of KK = 200mg of 30%-kavalactones kava kava extract, plus probably-small amounts of herbal crap that possibly are affecting fatigue (but the capsules were on sale *really cheap!!*)
Steady on K and KK for 20 days after abut 4 days ramping up both.
Dosing: .5mg K and 2 capsules KK at a.m./breakfast; .25 K and 1 capsule KK at each of noon and 5pm. Occassionally will either take 5pm K at noon, or take additional .25mg K at 5pm or later.3)
Additional med being taken for about past 10 days is ephedrine (Primatine tablets) to try to get my ass out of bed. Std dosage on label is 2 tabs every 4 hours but I've been taking only 2 tabs a.m. in bed, then probably max. 3 more tabs rest of day, with ocassionally also some caffeine or phenypropanolamine.
These probably aren't the greatest things for me but my current pdoc isn't wild about stims. Is there anything more similar to/indicative of response to adderall? Preferably not something cooked up in basement labs and distributed by Hell's Angels members.I may see what effect discontinuing KK has. I know it helped social anxiety by itself, at 5 capsules/qd.
>
>I wish that the widely-circulated, dated
>Brazilian article that recommends 3.0-6.0 mg/day
>would just disappear from the net, especiallyDoes it refer to clonazepam? People say the ® trademarked real Klonopin (which I'm taking now, BTW) is better; maybe it is equiv. to a higher dose of Brazilian clonazepam. I know the clonazepam I was given for a while secondary to antidepressent-induced anxiety had not as much benefit as K now (else I would have cajoled, wheedled or threatened anyone I had to in order to not have had to stop taking it then.)
>from Doctor Bob's site!! Almost all other
>research, including reputable, placebo->controlled studies, suggest prime efficacy at >doses maxing out at 3.0 mg.I thought only *one* controlled study on the stuff existed. Not that I need any efficacy studies to sell me... ;-)
peace and health,
S.D.
Posted by S.D. on July 22, 2000, at 20:53:43
In reply to Klonopin cocktail details (Re: MAO-B ...) » Rick, posted by S.D. on July 22, 2000, at 20:32:17
Also started trial of amisulpride.
25mg/day for 2 days then 25mg BiD past 6 days.
So the increased tiredness since starting Klon existed before starting amisulpride.
I generally have a lot of sleep and fatigue problems, though. And I don't keep a daily journal of sleep, energy, meds, bowel-movements, whatever. I was kidding about the last; even if I had the energy discipline and motivation, keeping track of that one seems a bit too anal.peace and health,
S.D.
Posted by Bkitts on July 27, 2000, at 9:09:55
In reply to Klonopin cocktail details (Re: MAO-B ...) » Rick, posted by S.D. on July 22, 2000, at 20:32:17
Please don't mix Klonopin and Kava together... You stand the chance of coma!!! I've seen it with xanax and kava... Be careful...
Posted by michael on May 14, 2001, at 18:07:43
In reply to Re: selegiline, dopamine, social anxiety: Adam, posted by Adam on July 19, 2000, at 9:08:56
Any word (ie: news) lately on selegiline patch fda approval?
> > Adam,
> >
> > Thanks for all the good info. Haven't heard from you for a while. You have been settled in with high dose selegiline for a while now since you were taken off the patch.
>
> No prob!
> >
> > Did you like the patch better?
>
> Yes. Especially at first. When I first took oral selegiline I wasn't on an efficacious dose. I then rapidly increased the dose and felt really wound-up and jittery for days, much more so than I ever did on the patch. I still deal with feelings of restlessness, especially around the time of dosing, and insomnia. These were also concerns with the patch, but not nearly as uneven and severe. As time has gone on, I've gotten used to selegiline in my system, and probably don't notice it as much, but I've never felt as good as I did on the patch. Also, in case you don't remember, I had great antidepressant response on the patch with no dietary restrictions. I've found dietary restrictions to be not a big problem, but still I do get these Pavlovian reactions to and cravings for certain foods that I just can't eat anymore, and it was nice not to have to worry about it.
>
> >Where do you think high dose selegiline's place is in the antidepressant spectrum. For who may it be particularly efficacious.
>
> I guess it would probably fit best next to Parnate in the spectrum, and maybe to some limited extent Welbutrin. Like all of the MAOIs, it has enough unique and relevant non-MAOI properties that it's sort of in a class by itself, but non-hydrazine MAOI would be the best description and classification, I think.
>
> It's hard to know who would it would be best for, since the MAOIs can be helpful for a variety of diagnoses. I'm not a physician so I can only speculate like any semi-educated person, and say that it might be best for atypical depressives and ideal for those with comorbid attention deficit issues. It might not be best for those who have anxiety disorders, but then again, there are paradoxical responses to certain drugs, and you do hear weird stories about people with social anxiety doing great on dextroamphetamine, etc., when you think they would respond best to a benzodiazapine.
>
> I guess there's always the "give it to people who it works for" response, like me. Thinking logically, I'm not sure I would have given myself oral selegiline, and my participation in the patch study was as much an experiment for me as it was for the investigators. The truth is I was running out of options, having tried just about every class of drug available with little or no success. An MAOI was the obvious choice at that point, and the patch study seemed like a relatively painless way to explore that class. I never expected to benefit so much from it. I imagine if I hadn't tried the patch, I might be on Parnate right now, and probably would be doing pretty well. But there's no way to know, unfortunately.
> >
> > AndrewB
Posted by shelliR on May 14, 2001, at 19:01:31
In reply to Re: selegiline patch, posted by michael on May 14, 2001, at 18:07:43
> Any word (ie: news) lately on selegiline patch fda approval?
>
Yes, last week right from the mouth of the head of the "patch research team" at McLean Hospital, outside Boston: ONE MORE YEAR.
Posted by michael on May 14, 2001, at 21:38:02
In reply to Re: selegiline patch » michael, posted by shelliR on May 14, 2001, at 19:01:31
Shelli,
Thanks for the info - one year is better than never...
I don't suppose you would have a reference to a press release, etc.? Just curious... Thanks again for the reply, michael
> > Any word (ie: news) lately on selegiline patch fda approval?
> >
> Yes, last week right from the mouth of the head of the "patch research team" at McLean Hospital, outside Boston: ONE MORE YEAR.
Posted by shelliR on May 14, 2001, at 23:37:46
In reply to Re: selegiline patch, posted by michael on May 14, 2001, at 21:38:02
> Shelli,
>
> Thanks for the info - one year is better than never...
>
> I don't suppose you would have a reference to a press release, etc.? Just curious... Thanks again for the reply, michaelMichael. I spoke to Dr. Bodkin for about three minutes last week and that's what he told me.
So it was purely verbal. Haven't even looked for any press releases, etc.Shelli
Posted by Cecilia on May 15, 2001, at 3:42:29
In reply to Re: selegiline patch » michael, posted by shelliR on May 14, 2001, at 23:37:46
> > Shelli,
> >
> > Thanks for the info - one year is better than never...
> >
> > I don't suppose you would have a reference to a press release, etc.? Just curious... Thanks again for the reply, michael
>
> Michael. I spoke to Dr. Bodkin for about three minutes last week and that's what he told me.
> So it was purely verbal. Haven't even looked for any press releases, etc.
>
> ShelliIs one year the expected time for approval or just for submission to the FDA-If it`s the latter it`ll probably be a lot longer before we ever see it.
This is the end of the thread.
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