![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by zeugma on February 10, 2004, at 17:45:48
I am curious as h*ll about the new selegilene patch that is supposed to come out soon. I've found a combination of meds (nortriptyline, atomoxetine, buspirone, a tiny bit of clonazepam) that more or less treats my various and debilitating syndromes of depression, anxiety, and inattentive ADD, but I wonder if there isn't something better out there, and this selegilene patch is the only plausible possibility. How does selegilene compare to Strattera as an ADD med? what about its antidepressant properties? Does selgilene help with social anxiety as well? Does it cause problems with insomnia?
Posted by Chairman_MAO on February 10, 2004, at 20:07:45
In reply to strattera vs. selegilene for ADD, posted by zeugma on February 10, 2004, at 17:45:48
>but I wonder if there isn't something better out there, and this selegilene patch is the only plausible possibility. How does selegilene compare to Strattera as an ADD med?
Selegiline has myriad mechanisms of action (I mean, one could easily write 4 pages _summarizing_ everything it does) in addition to MAO inhibition; I wouldn't be surprised if in the higher doses the patch allows for it would be a robust ADD med. My guess is that the patch would be better for inattentive ADD/adult AD[H]D whereas Strattera is better as a chemical straightjacket for children in classrooms. Or, to phrase it differently, I found selegiline to be a mood-brightening cognitive enhancer that increased my "joi de vivre" whereas atomoxetine dampened my emotions and allowed me to "zone in" more easily without feeling distracted. Atomoxetine is good for melancholic depression, probably, but I doubt it provides the coarse effect that 20-40mg/day of selegiline does.
>what about its antidepressant properties?
see above
>Does selgilene help with social anxiety as well?
It probably helps with the motivational "oh-I-think-I'll-talk-to-those-people" and cognitive "I-feel-like-I-know-what-to-say-and-enjoy-saying-it" aspects of social PHOBIA. Insofar as the actual "I-feel-physically-anxious-and-it-makes-me-uncomfortable" is concerned, that probably depends upon the individual and/or requires 30mg/day or more of selegiline (so you get some serotonergic effect). But who knows, this is wild conjecture on my part.
>Does it cause problems with insomnia?
Unless amphetamine puts you to sleep, it will.
Posted by zeugma on February 11, 2004, at 20:13:42
In reply to Re: strattera vs. selegilene for ADD » zeugma, posted by Chairman_MAO on February 10, 2004, at 20:07:45
> >but I wonder if there isn't something better out there, and this selegilene patch is the only plausible possibility. How does selegilene compare to Strattera as an ADD med?
>
> Selegiline has myriad mechanisms of action (I mean, one could easily write 4 pages _summarizing_ everything it does) in addition to MAO inhibition; I wouldn't be surprised if in the higher doses the patch allows for it would be a robust ADD med. My guess is that the patch would be better for inattentive ADD/adult AD[H]D whereas Strattera is better as a chemical straightjacket for children in classrooms. Or, to phrase it differently, I found selegiline to be a mood-brightening cognitive enhancer that increased my "joi de vivre" whereas atomoxetine dampened my emotions and allowed me to "zone in" more easily without feeling distracted. Atomoxetine is good for melancholic depression, probably, but I doubt it provides the coarse effect that 20-40mg/day of selegiline does.
FWIW, I don't find that atomoxetine dampens my emotions. On the contrary, its effect on me is something I would describe as 'emotional stimulation.' It didn't feel like a physical stimulant except at the very beginning. Things seem more important, emotionally speaking, on it, and so I'm more likely to concentrate on something instead of regard it wih indifference (and lose my focus- since focus requires so much effort).Nortriptyline's emotional effect was similar, so I'm guessing this has to do with NE reuptake inhibition. The difference between atomoxetine and nortriptyline seems to be that while nortriptyline is emotionally stimulating, it doesn't promote the clarity that atomoxetine does.
I probably have these favorable effects from the NE reuptake inhibitors because I have melancholicdepression. What I am wondering about is whether there is really any special benefit that TCA's and other NRI's have over MAO inhibitors when it comes to this form of depression. Or were TCA's used for this type of depression simply because MAOI's were considered too risky? Some of the evidence I have seen suggests the former but it isn't clear to me what effect the differences in mechanism could play.
>
> >what about its antidepressant properties?
>
> see above
>
> >Does selgilene help with social anxiety as well?
>
> It probably helps with the motivational "oh-I-think-I'll-talk-to-those-people" and cognitive "I-feel-like-I-know-what-to-say-and-enjoy-saying-it" aspects of social PHOBIA. Insofar as the actual "I-feel-physically-anxious-and-it-makes-me-uncomfortable" is concerned, that probably depends upon the individual and/or requires 30mg/day or more of selegiline (so you get some serotonergic effect). But who knows, this is wild conjecture on my part.
>
> >Does it cause problems with insomnia?
>
> Unless amphetamine puts you to sleep, it will.
I need something to put me to sleep every night. If I was on selegilene, I would continue to supplement with a TCA for sleep and IBS.
>
>
Posted by micro on February 12, 2004, at 23:23:36
In reply to strattera vs. selegilene for ADD, posted by zeugma on February 10, 2004, at 17:45:48
> I am curious as h*ll about the new selegilene patch that is supposed to come out soon. I've found a combination of meds (nortriptyline, atomoxetine, buspirone, a tiny bit of clonazepam) that more or less treats my various and debilitating syndromes of depression, anxiety, and inattentive ADD, but I wonder if there isn't something better out there, and this selegilene patch is the only plausible possibility. How does selegilene compare to Strattera as an ADD med? what about its antidepressant properties? Does selgilene help with social anxiety as well? Does it cause problems with insomnia?
Hello, I was wondering, if you are currently happy with the results of your therapy,why are you searching for a new drug especially one that has little to no history regarding its use for Add/Adhd in adults or children? Are you concerned with polypharmacy and want to reduce the number of meds you take?
Please Read "Healing ADD" by Daniel G. Amen M.D. and refer to his website www.amenclinics.com Best Wishes, Micro
Posted by zeugma on February 13, 2004, at 4:52:47
In reply to Re: strattera vs. selegilene for ADD, posted by micro on February 12, 2004, at 23:23:36
I am concerned with polypharmacy, but have no intention of changing my meds at this point. That would be the easiest way of making myself 'treatment-resistant.' My concern with the selegilene patch is strictly theoretical at this point. For a lot of people, of course, it will be their best option, and the sooner it comes out the better.
Amen's book "Healing ADD" is one of the more useful ADD books. I have what he would call 'limbic' ADD, and TCA's such as nortriptyline, and atomoxetine, are his preferred treatments for this form of ADD. These treatments have been efficacious for me, so his judgments to that extent are vindicated.
The main reason i became interested in MAOI's was for my social anxiety. It had seemed my pdoc was dead-set against letting me try clonazepam, so i thought MAOI's would be my only option for treating this condition. He relented in November and my social anxiety has cleared up a great deal. I still have a strong theoretical interest in MAOI's, but have no reason to change my current cocktail.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.