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Dr. Bob is Robert Hsiung, MD,
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Posted by Donna Louise on May 29, 2006, at 6:43:17
In reply to Re: Are Family Doctors prescribing EMSAM? » cecilia, posted by pulse on May 28, 2006, at 18:14:36
It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.Donna
Posted by crazy777girl on May 30, 2006, at 6:17:33
In reply to Re: Are Family Doctors prescribing EMSAM? » cecilia, posted by pulse on May 28, 2006, at 18:14:36
I think, in part, it (the Rx of transdermal delivery) may be the illusion (delusion?) that we are merely swallowing one less pill. Call me crazy.
A.> For me, though, when I've very rarely had to take antibiotics, my GP will order in a anti-biotic shot, administer that, and I have NO GI side-effects whatsoever...plus I'm virtually well in 3 days vs. the standard 10.
>
> pulse
Posted by SFY on May 30, 2006, at 10:38:05
In reply to delivery difference, posted by Donna Louise on May 29, 2006, at 6:43:17
> It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
>
> DonnaI posted this below in another thread that may have been overlooked:
EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
According to one study:
Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
Posted by Iansf on May 30, 2006, at 11:53:05
In reply to Re: delivery difference, posted by SFY on May 30, 2006, at 10:38:05
Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
Ian
> > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> >
> > Donna
>
> I posted this below in another thread that may have been overlooked:
>
> EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
>
> According to one study:
>
> Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
>
> http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
>
> The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
>
>
Posted by yxibow on May 30, 2006, at 13:50:34
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
Sublingual and orally disintegrating pills merely make them easier to swallow in an oral method -- they still pass through your mouth, the esophagus, and the GI tract and eventually the liver or kidney system depending on the drug.
Remeron e.g. has a orally disintegrating preparation, or it did at one time.]
Frequently you see Zinc and Vitamin C sublingual tablets for colds (which typically through studies only cut a day off one at best), and they dissolve in anywhere from 5-15 minutes at most.
Posted by Jakeman on May 30, 2006, at 20:01:48
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
Good question. So far I have not seen any studies comparing sublingual and transdermal delivery. Maybe do an experiment? Emsam is outrageously expensive. But Squibb is pushing it and you can probably get a two week sample supply from your medical professional. I'm cutting the patch in half for now so maybe a months supply for some people. Might be a worthwhile trial.
good luck, Jake
> Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
>
> So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
>
> Ian
>
> > > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> > >
> > > Donna
> >
> > I posted this below in another thread that may have been overlooked:
> >
> > EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
> >
> > According to one study:
> >
> > Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> > intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
> >
> > http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
> >
> > The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
> >
> >
>
>
Posted by Jakeman on May 30, 2006, at 21:34:12
In reply to Re: delivery difference » Iansf, posted by Jakeman on May 30, 2006, at 20:01:48
Another thought..maybe a compounding pharmacy could provide a patch for selegiline. A court case this week seems to have gotten the FDA off their backs. I'm a layman, but it appears to be an old, well tested drug with many benefits. And now we have a new method of delivery that may work better.
http://www.upi.com/HealthBusiness/view.php?StoryID=20060526-014622-8737r
Posted by Donna Louise on May 30, 2006, at 22:02:43
In reply to Re: delivery difference, posted by Iansf on May 30, 2006, at 11:53:05
> Again, my question: wouldn't sublingual delivery work in the equivalent manner? Liquid forms of selegiline meant for sublingual delivery are available. If 6mg of selegiline delivered suglingually turns out to be equivalent to 6mg delivered transdermally, then what you achieve with Emsam can be achieved at less than a sixth the price with liquid preparations. This may not be an issue for those whose insurance pays for Emsam, but it is for those of us without insurance.
>
> So does anyone know if 6mg suglingual and 6mg transdermal are equivalent? (And please forget 6mg oral - I know that's not equivalent, and that's not part of the question.) Thanks.
>
> Ian
>
> > > It seems to me that I read somewhere that by transdermal delivery some of the unwanted type metabolites that result in first past gut metabolism in the liver are not created. Maybe one of the more amphetamine type metabolites?? I will see if I can find where I read that.
> > > At any rate, for me, I have had no side effects from the patch, maybe I wouldn't from oral administration either. I guess another plus with transdermal delivery is the slow and steady plasma state. no ups and downs. What do I know, just that I like it. May need to go to 9mg though for more depression relief.
> > >
> > > Donna
> >
> > I posted this below in another thread that may have been overlooked:
> >
> > EMSAM does deliver selegiline directly into the blood thereby significantly reducing its exposure to the GI tract. But because blood flows to all internal organs including the liver, intestines, and stomach there will be some selegiline exposure which explains why some people are having GI tract-related side effects.
> >
> > According to one study:
> >
> > Transdermal delivery of selegiline provides several pharmacological advantages over oral delivery. First, it sufficiently reduces exposure of the gastrointestinal tract to the drug to limit inhibition of intestinal MAOA activity. Thus, adequate gastrointestinal MAOA enzyme is left
> > intact to metabolize dietary tyramine. Second, transdermal administration of selegiline circumvents first-pass hepatic metabolism, which results in sustained high plasma levels of the parent compound with a concomitant decrease in metabolite formation. This provides sufficient brain concentrations of selegiline to produce an antidepressant effect, presumably involving substantial MAOA as well as MAOB inhibition. This also may permit the expression of additional pharmacological properties of selegiline other than MAO inhibition previously observed in vitro. At the same time, there is less exposure to L-methamphetamine and L-amphetamine metabolites than observed with oral selegiline.
> >
> > http://ajp.psychiatryonline.org/cgi/content/full/159/11/1869
> >
> > The EMSAM drug insert clearly states that at least 1 in 100 users may experience GI-related side effects such as "Constipation, flatulence, anorexia, gastroenteritis, vomiting."
> >
> >
>
>regardless of the origin of absorbtion, 6mg EMSAM is equal to 20mg of selegiline as oppossed to 6mg of sublingual selegiline. so it is at least not equal in terms of selectivity. AT 20mgs it is not selective and inhibits MAO-A and B. At 6mg it only deanimates MAO-B, generally not useful as an antidepressant in that case. The substitution would fail for me.
Donna
Posted by Iansf on May 31, 2006, at 1:11:35
In reply to Re: delivery difference » Iansf, posted by Jakeman on May 30, 2006, at 20:01:48
> Good question. So far I have not seen any studies comparing sublingual and transdermal delivery. Maybe do an experiment? Emsam is outrageously expensive. But Squibb is pushing it and you can probably get a two week sample supply from your medical professional. I'm cutting the patch in half for now so maybe a months supply for some people. Might be a worthwhile trial.
>
> good luck, Jake
>
Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
Posted by Jakeman on June 3, 2006, at 13:28:43
In reply to Re: delivery difference, posted by Iansf on May 31, 2006, at 1:11:35
Iansf,
Squibb has a patient assistance program:
http://www.bmspaf.org/A few posters on anxietyhelp.org have been approved for Emsam.
warm regards, Jake
> Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
Posted by Last Chance on June 3, 2006, at 14:32:28
In reply to Re: delivery difference, posted by Iansf on May 31, 2006, at 1:11:35
Iansf - if you want to take Emsam give the patient assistance program a try - just download the form on their website - fill out your part, and ask your doc if he or she would just fill in their little part - it is very short, easy (I hate paperwork) and have doc fax in. It can't hurt - it took about 5 weeks, but I got a free 3 mos. supply of the 6mg, with approval for 11 mos. if it is working for me. After that I don't know, but one day at a time. I have been cutting in half for a week, but today I stuck on the full patch. I am still optimistic, but guarded. Richard
Posted by Jakeman on June 3, 2006, at 16:03:49
In reply to Squibb Patient Assistance - Iansf, posted by Last Chance on June 3, 2006, at 14:32:28
Here's a link to the application:
http://www.needymeds.com/papforms/brispa0042.pdf
> Iansf - if you want to take Emsam give the patient assistance program a try - just download the form on their website - fill out your part, and ask your doc if he or she would just fill in their little part - it is very short, easy (I hate paperwork) and have doc fax in. It can't hurt - it took about 5 weeks, but I got a free 3 mos. supply of the 6mg, with approval for 11 mos. if it is working for me. After that I don't know, but one day at a time. I have been cutting in half for a week, but today I stuck on the full patch. I am still optimistic, but guarded. Richard
Posted by Iansf on June 3, 2006, at 17:40:10
In reply to Re: Emsam patient assistance program » Iansf, posted by Jakeman on June 3, 2006, at 13:28:43
Thanks for the link. I'll give it a try.
Iansf,
>
> Squibb has a patient assistance program:
> http://www.bmspaf.org/
>
> A few posters on anxietyhelp.org have been approved for Emsam.
>
> warm regards, Jake
>
> > Unfortunately my medical professional is at a city clinic and the Squibb reps won't give Emsam samples to the clinic. They give samples only to doctors who are likely to prescribe it, which the clinic doctors aren't because Emsam is not on the city formulary. Not that I blame the city - with resources for public health stretched extremely thin, I can see why it wants to avoid paying for $400 a month medicines if it doesn't absolutely have to.
>
>
Posted by jealibeanz on June 19, 2006, at 4:13:14
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Phillipa on May 27, 2006, at 19:38:11
Are there any updates to this question?
Posted by Donna Louise on June 19, 2006, at 6:41:58
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 4:13:14
> Are there any updates to this question?
I don't know about other's but mine is not pleased that my pdoc has put me on it. We had a little talk about it and it seems the problem is he is afraid he will prescribe something that is contraindicated and that I will get sick or die. I told him that I know what I can take, I made it my business to know as I don't expect any other dr.'s to know. For example, he didn't know that demeral is a big no-no. Which scared him. I said but I know it. But I guess most of the patients won't know and neither does he. I told my husband if he wants to try the patch he will need to see my pdoc. I think most family dr.'s are mostly comfortable with just the sri's. At least they feel they can't kill us with those. I told him it was a shame that a milestone drug won't reach many due to ignorance on everyone's part.donna
Posted by jealibeanz on June 19, 2006, at 15:15:31
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
really? I'm a little surprised since there's been so much press about it.
Posted by jealibeanz on June 19, 2006, at 17:18:18
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 6:41:58
Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Posted by Donna Louise on June 19, 2006, at 17:31:03
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 17:18:18
> Really? Well that makes me a little discouraged and depressed. I like to think there's hope for my future. Possibly soon. There's no way I'm going to make it past August without help. :(
Oh please, don't let what I said discourage you from asking. That is just the attitude I have encountered and then generalized which may or may not be accurate. It sure doesn't hurt to ask and you could take info from the internet to help plead your case. You could assure hiim that you know which drugs are forbidden and that on the 6mg you don't even need to watch the diet. (I will be finding out it that is true for the 9mg as I suspect you don't need to watch diet on that dose either). Some people go to psychiatric nurse practioners who are usually pretty up to speed on things too. Do you have other dr.'s you could appeal to if your gp turns you down?donna
Posted by jealibeanz on June 19, 2006, at 20:49:24
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 19, 2006, at 17:31:03
Well, actually I was hoping he may have this idea on trying EMSAM on his own, since it's the newest antidepressant to be released. Apparently it may not be terribly attractibe to doctors?
I do think it could possibly help. I'm mood reactive... happy when around happy people and encouraged by others. The second I'm by myself (like even stepping away into the bathroom!) I want to cry. I'm afraid to mention the crying part though, because that may suggest serotonin deficits, right? I don't think I cry because of that. I cry because I know I am unhappy and let my guard down when alone.
Posted by lisa67 on June 20, 2006, at 11:45:36
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 20:49:24
My GYN.. prescribed Emsam for me. She was going to put me on an SSRI but I told her my neg. experiences with all SSRI's. I then told HER about Emsam. She had never heard of it but investigated it on her own. She decided it might be worth a try. I pick up my RX soon, had to be ordered. She is making me come in every 2 weeks to have my blood pressure checked. I will be cutting the patch in quarters due to the advice here and removing it at bedtime. So thanks to all for good advice.
Posted by jealibeanz on June 20, 2006, at 12:32:00
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by lisa67 on June 20, 2006, at 11:45:36
Let me know how it goes. What were your experiences with SSRI's? Reactions? Why did you think EMSAM would be a good choice?
My doc's a DO. Aren't they usually in to natural choices? Actually he's pretty prescription happy! Haha! He'll give me a nonstop supply of Xanax or Klonopin. I used to work as a pharm tech. Half the prescripition in the city for Zoloft came from him (at least 30 docs). I hope he reads up! But I reallllly don't know. I'm sure they play it very safe.
In the past I actually have suggested medications, but now that I'm in PA school, I'm not going try to act like I know what I'm talk about! I know no more about pharmacology than I did before, but now I just feel a little awkward.
Posted by Donna Louise on June 20, 2006, at 13:00:14
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 19, 2006, at 20:49:24
> Well, actually I was hoping he may have this idea on trying EMSAM on his own, since it's the newest antidepressant to be released. Apparently it may not be terribly attractibe to doctors?
>
> I do think it could possibly help. I'm mood reactive... happy when around happy people and encouraged by others. The second I'm by myself (like even stepping away into the bathroom!) I want to cry. I'm afraid to mention the crying part though, because that may suggest serotonin deficits, right? I don't think I cry because of that. I cry because I know I am unhappy and let my guard down when alone.The crying thing just means you are sad or grief stricken or depressed. EMSAM effects all the monoamines, seratonin, norepinephrine, dopamine. So it is not a negative to let him know how you are feeling. On the contrary, it may indicate to him your need for an intervention. If you don't want to take an sri or have had bad experiences with them, just tell him that. And tell him you want to try EMSAM. Nothing to fear here. And there is nothing about "acting" like you know something when you do know something. That is not acting. A good dr. is not put off by an informed patient.
I wish you the best of luck and courage, you can take care of yourself!donna
Posted by jealibeanz on June 20, 2006, at 13:14:16
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:00:14
I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
Posted by Donna Louise on June 20, 2006, at 13:46:22
In reply to Re: Are Family Doctors prescribing EMSAM?, posted by jealibeanz on June 20, 2006, at 13:14:16
> I know there's nothing wrong with being an informed patient, but there are just so many sensitive and personal issues when dealing with anxiety and depression. It makes it so much harder to be assertive with symptoms and treatment.
>
> I thought EMSAM doesn't have anything to do with SE at the doses currently available, only at very high amounts. I'm put off by serotonin because I suspect that it may have something to do with the weight gain side effect. I know that it has been reported on EMSAM, but it wasn't reported on Wellbutrin, which made me gain quite a bit. I am completely clueless as to how/why it actually occurs. Does it have something to due with the liver? stomach? brain? metabolism? I just don't get it!
>
>I am rife with anxiety and depression. I know exactly how it feels. (Currently I am not as the EMSAM is working for me.) So I do understand it is hard to be assertive but you can do it.
It is confusing about the EMSAM dosage. It says 6mg but that is not the same as 6mg orally as the transdermal delivery system skips first pass metabolism, 20 mg worth (or there abouts) actually gets in the blood stream. Orally, it is metabolized much more in the liver and therefore you have lower levels of the parent compound (selegiline) and much higher levels of amphetamine metabolites. They have a diagram of it in the info sheet that comes with the rx, on line too.
So, the 6mg patch actually delivers an amount that is no longer MAO-B selective. It does catabolize MAO-A too which allows higher levels of seratonin. But I do not believe there is much of chance of weight gain on EMSAM although anything is possible. Someone reported an actual statistical weight loss.
Hope that is not just more confusing.donna
Posted by jealibeanz on June 20, 2006, at 17:16:28
In reply to Re: Are Family Doctors prescribing EMSAM? » jealibeanz, posted by Donna Louise on June 20, 2006, at 13:46:22
Donna, what dose are you on? How long have you been on it? What else have you tried? Are you on anything else?
It's strange that something that is stimulating for some can control anxiety for others. I'd really like to find something longterm. I don't like the idea of continuous Xanax and I have always had recurrent depressions.
I thought that the 6 mg was supposed to be MAOI B selective, 9 mg was questionable, and 12 mg was both MAOI A and B. I can't remember where I read that. I could be wrong. The literature could be wrong to for that matter!
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