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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by hgi698 on August 4, 2006, at 17:02:44
Hi I have a couple questions actually. I am currently taking 45 mg of Remeron (mirtazapine) 20 mg adderall and 25 mg of amisulpride. I was wondering if it is safe to add a low dose of selegiline (5 to 10 mg) to my meds? Is there still a risk of serotonin syndrome? Also if I add phenylalanine to the mix, will this cause any rise in blood pressure? I am thinking selegiline might be beneficial because I have mostly "negative" symptoms. (apathy, alogia attention deficit, anhedonia etc.) Help is appreciated.
Posted by Crazy Horse on August 6, 2006, at 12:15:39
In reply to Safe to Combine Selegiline/Remeron?, posted by hgi698 on August 4, 2006, at 17:02:44
> Hi I have a couple questions actually. I am currently taking 45 mg of Remeron (mirtazapine) 20 mg adderall and 25 mg of amisulpride. I was wondering if it is safe to add a low dose of selegiline (5 to 10 mg) to my meds? Is there still a risk of serotonin syndrome? Also if I add phenylalanine to the mix, will this cause any rise in blood pressure? I am thinking selegiline might be beneficial because I have mostly "negative" symptoms. (apathy, alogia attention deficit, anhedonia etc.) Help is appreciated.
NO!!! But most importantly, don't add anything without consulting w/your PDoc. Adding selegiline to your current medication regime could be Lethal. Get in to see your Psyciatrist/Doctor asap, please.
Monte
Posted by hgi698 on August 7, 2006, at 10:16:51
In reply to Re: Safe to Combine Selegiline/Remeron? » hgi698, posted by Crazy Horse on August 6, 2006, at 12:15:39
I thought an MAO-B selective dose would be ok. It is only when you go above 15 mg that you would risk having serotonin syndrome or a hypertensive crisis when it starts inhibiting MAO-A. Am I right or wrong?
Posted by linkadge on August 8, 2006, at 21:17:44
In reply to Safe to Combine Selegiline/Remeron?, posted by hgi698 on August 4, 2006, at 17:02:44
Heres what I would see:
45 mg of Remeron
20 mg adderall
25 mg of amisulpride.Remeron affects norepinephrine and dopamine release, via alpha-2 adrenoreceptors, adderall affects dopamine release too.
Selegeline will affect the metabolism of dopamine, so it could be very stimulating.
There is the low possability of getting serotonin syndrome from MAO-A inhibition of selegeline and 5-ht release from remeron, but I don't think that would happen.Linkadge
Posted by SLS on August 9, 2006, at 1:12:37
In reply to Re: Safe to Combine Selegiline/Remeron?, posted by linkadge on August 8, 2006, at 21:17:44
> Remeron affects norepinephrine and dopamine release, via alpha-2 adrenoreceptors,
Are these via heteroreceptors located on DA neurons or secondary to modulation of NE activity?
- Scott
Posted by linkadge on August 10, 2006, at 17:05:21
In reply to Re: Safe to Combine Selegiline/Remeron?, posted by SLS on August 9, 2006, at 1:12:37
Taken from www.rxlist.com
"These studies have shown that mirtazapine acts as an antagonist at central presynaptic a2 adrenergic inhibitory autoreceptors and heteroreceptors, an action that is postulated to result in an increase in central noradrenergic and serotonergic activity."
But, I read from some other source, that there was a co-release of dopamine (in certain areas of the brain) after blocade of these receptors. I could be mistaken though.
Linkadge
Posted by SLS on August 10, 2006, at 19:50:04
In reply to Re: Safe to Combine Selegiline/Remeron?, posted by linkadge on August 10, 2006, at 17:05:21
> Taken from www.rxlist.com
>
>
>
> "These studies have shown that mirtazapine acts as an antagonist at central presynaptic a2 adrenergic inhibitory autoreceptors and heteroreceptors, an action that is postulated to result in an increase in central noradrenergic and serotonergic activity."
>
> But, I read from some other source, that there was a co-release of dopamine (in certain areas of the brain) after blocade of these receptors. I could be mistaken though.
You are not mistaken. I read the same thing. However, I was interested in the mechanism by which this occurred since the drug I'm taking, sibutramine, has been reported to force an accelerated downregulation of NE alpha-2 receptors. It would be nice if it were to promote an increase in the release of dopamine this way.
- Scott
Posted by linkadge on August 11, 2006, at 17:24:53
In reply to Re: Safe to Combine Selegiline/Remeron?, posted by SLS on August 10, 2006, at 19:50:04
YOu never know !
Linkadge
Posted by psychobot5000 on August 17, 2006, at 18:12:29
In reply to Safe to Combine Selegiline/Remeron?, posted by hgi698 on August 4, 2006, at 17:02:44
> Hi I have a couple questions actually. I am currently taking 45 mg of Remeron (mirtazapine) 20 mg adderall and 25 mg of amisulpride. I was wondering if it is safe to add a low dose of selegiline (5 to 10 mg) to my meds?
Harvard affiliate psychiatrists Alexander Bodkin and Jonathan Cole, experts on MAO inhibitors (Bodkin in particular was involved with the development of EMSAM), consider Remeron/mirtazapine to be safe to use with MAO inhibitors. Since selegiline has only weak MAO-A related activity, at 5-10mg, I should think that the combination of the two would be quite safe.
Having atypical, unmotivated depression myself, I tried the combination several years ago, and it was better than either drug alone, I was still left without motivation--overly relaxed. There were no safety issues during my trial.
But in any case, while those two may be safe, combining them with 20mg Adderall is probably not safe, let alone adding amisulpride. Besides all the other interactions and concerns, that's a lot of dopamine enhancing drugs. It sounds quite dangerous, and I would stay away.
If you're willing to undergo the dietary restrictions, though, I'd suggest (under proper medical supervision) trying a more powerful MAO inhibitor, (phenelzine or tranylcipromine) with Remeron. I wouldn't add them to your current cocktail, but according to Bodkin and Cole, they can safely be augmented with Remeron or most tricyclics.
Relevant Article at:
http://www.currentpsychiatry.com/
"Mao inhibitors: An option worth trying in treatment-resistant cases"
Jonathan O. Cole, MD; J. Alexander Bodkin, MD
Release date: 6/1/2002I hope things go well for you.
P-bot
This is the end of the thread.
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