![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by uncouth on December 13, 2008, at 17:40:46
Anyone have any experience?
Seems like a powerful combo -- sam-e works on the input (increases production of neurotransmitters) and MAOI works on the output (decrease degredation). POtential problems:
serotonin syndrome
hypertensive crisis?But sam-e doesn't have acute effects and seems to take a while to kick in, so i figure hypertensive crisis wouldn't be an issue.
Anyone have any ideas? Good idea? Bad idea? Anyone seen response to sam-e, with or without an MAOI?
Thanks
Uncouth
Posted by raisinb on December 13, 2008, at 19:52:47
In reply to MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 17:40:46
sam-E gave me a VERY strong hypomanic response. Stronger than Wellbutrin, even. I had some truly crazy ideas for days, and it didn't occur to me for awhile that my thinking was rather odd, obsessive, and grandiose. I wasn't on anything else at the time. I would be careful with it. Some of these OTC supplements can be very powerful.
Posted by uncouth on December 13, 2008, at 19:58:44
In reply to Re: MAOI plus Sam-E » uncouth, posted by raisinb on December 13, 2008, at 19:52:47
hmm, interesting. how long were you on it before it gave you that? what dose? did you taper up? what is your diagnosis. was it a euphoric hypomania, or was it a dysphoric hypomania...how long after you went off of it did it take for the hypomania to disappear?
my doctor and i kinda agree that we need to push me to a hypomania, then tamp down with a mood stabilizer, but a mild hypomania would probably be good for me.
for one thing, i think for many people, mild hypomania's are the first time they've actually felt better in some time, so a lot of bottled up things occur. i think if you actually left someone in a mild hypomania for a while it would moderate. the idea is that a sense of feeling good is such a "new feeling" for a long term depressive that changes in thinking are going to occur that could be scary or feel out of control, but if one works with them, they can turn mild hypomania into wellness.
note this assums a firm dx of bipolar 2 or 3, and not bipolar 1, where a hypomania could rapidly turn into a mania.
anyway, your Sam-E details would be helpful.
Posted by JadeKelly on December 13, 2008, at 21:30:40
In reply to Re: MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 19:58:44
> hmm, interesting. how long were you on it before it gave you that? what dose? did you taper up? what is your diagnosis. was it a euphoric hypomania, or was it a dysphoric hypomania...how long after you went off of it did it take for the hypomania to disappear?
>
> my doctor and i kinda agree that we need to push me to a hypomania, then tamp down with a mood stabilizer, but a mild hypomania would probably be good for me.
>
> for one thing, i think for many people, mild hypomania's are the first time they've actually felt better in some time, so a lot of bottled up things occur. i think if you actually left someone in a mild hypomania for a while it would moderate. the idea is that a sense of feeling good is such a "new feeling" for a long term depressive that changes in thinking are going to occur that could be scary or feel out of control, but if one works with them, they can turn mild hypomania into wellness.
>
> note this assums a firm dx of bipolar 2 or 3, and not bipolar 1, where a hypomania could rapidly turn into a mania.
>
> anyway, your Sam-E details would be helpful.Hi uncouth,
Something you said in your post has been on my mind a lot lately, and that is I actually have a bit of fear about becoming well, if you can believe it. I've not had the courage to say that to anyone, as I have been as desperate as the next person here to be well. I'm on Parnate 9 weeks, mood is better, if I can eliminate this fatigue, well it may mean back to my life. I fear things like relapse in the middle of that VERY busy life (back to work full time,etc.) So much will be expected of me. And I've devoloped bad habits that will be hard to break. Any way, thanks for saying that out in the open. I don't feel so strange now, haha! Maybe when I'm really feeling strong I'll do a thread, probably wouldn't go over too well. (I have a little ways to go before that happens, I'll have to plan for that)
Thanks, any thoughts on this, please post!
~Jade
PS-how do you "push to a hypomania?"
Posted by raisinb on December 13, 2008, at 21:46:08
In reply to Re: MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 19:58:44
Hi--
I can't remember what dosage it was, but it was the one recommended on the label. I did taper up, but only over the course of a few days.It was a euphoric hypomania--but not what feeling well is like. Insomnia, feeling very "jacked up." I had all kinds of crazy ideas about starting businesses, moving across the country, taking off for Europe, etc., and I was feeling absolutely sure that these were the right things to do and they couldn't fail. My thinking had a very urgent, obsessive quality, just intense. As soon as it occurred to me that it might be the samE I stopped taking it and the mania/hypomania stopped in the next couple of days.
Posted by raisinb on December 13, 2008, at 21:49:38
In reply to Re: MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 19:58:44
My dx is major recurring depression, no bipolar features. The samE episode is the only manic type of thing I've experienced. I *was* suicidal at the time. It was probably a week before the hypomanic/manic feelings started.
Posted by Phillipa on December 13, 2008, at 23:46:14
In reply to sorry and, posted by raisinb on December 13, 2008, at 21:49:38
Raisin that must have been scarey. That sounded like true mania. Love Phillipa
Posted by desolationrower on December 14, 2008, at 0:01:11
In reply to Re: sorry and » raisinb, posted by Phillipa on December 13, 2008, at 23:46:14
I started taking some a few days ago because i had it in the big box of medicine i keep, and it doesn't last forever, so i decided to take it now instead of letting it go bad, mostly for liver protection and whatnot. I don't notice anything from it.
-d/r
Posted by Sigismund on December 14, 2008, at 0:48:59
In reply to sorry and, posted by raisinb on December 13, 2008, at 21:49:38
I'm OK with 400mg SAMe in the mornings.
It helps, but not much.
I only ever took 10mg/day Parnate, but when I took SAMe with it, it wasn't good.
I didn't want to be out in public, really needed my sunglasses, and had trouble walking past people.
Posted by Tomatheus on December 14, 2008, at 4:03:14
In reply to MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 17:40:46
uncouth,
I took SAMe with the Goldshield Parnate (U.K. version) for about three months before I became psychotic. The combo produced a nice antidepressant effect. It wasn't full remission, but I definitely felt more energized on the combo than I did when I was at my depressed baseline. What was also significant about my response to SAMe and Parnate was that the antidepressant benefits were actually consistent from one day to the next.
I found the best doses of Parnate and SAMe to be 20 mg and 150 mg, respectively. I took 20 mg of Parnate with 200 mg of SAMe for a while, but I felt too fatigued from the SAMe. Lowering the dose to 150 mg (which was a hassle because I had to cut the tablets in fourths and put the contents of them in enteric capsules) reduced my fatigue. At one point, I also tried taking 30 mg of Parnate with 150 mg of SAMe. I forget what happened, but somehow my response to the combo at that dose ended up being inferior to my response at 20 mg of Parnate and 150 mg of SAMe, so I ended up switching back to that dose.
I can't really say how Parnate and SAMe would mix at higher doses. While I was on the combo, I never went above 30 mg of Parnate and 400 mg of SAMe.
Tomatheus
Posted by Phillipa on December 14, 2008, at 13:06:52
In reply to Re: sorry and, posted by desolationrower on December 14, 2008, at 0:01:11
d/r I got one of those too under the sink some must date back l0 years. Love Phillipa that was a side note.
Posted by desolationrower on December 16, 2008, at 22:45:06
In reply to MAOI plus Sam-E, posted by uncouth on December 13, 2008, at 17:40:46
I came across this. I hadn't been aware of these effects. It might indicate SAMe might be good to add.
7. S-Adenosyl-L-Methionine-Saving Effect of COMT Inhibitors. It is well known that the levodopa therapy in PD patients depletes their body levels of AdoMet levels, and this depletion also occurs in the brain (Benson et al., 1993). This can be explained by enhanced O-methylation of the large doses of L-dopa present, which consumes the methyl groups of AdoMet. Long-term levodopa treatment leads to compensatory enhancement of the synthesis of AdoMet by increasing the activity of methionine adenosyl transferase (Benson et al., 1993). In turn, when high doses of exogenous AdoMet were administered, they depleted nigrostriatal and forebrain tyrosine hydroxylase and brain dopamine (Charlton, 1997). When the COMT-induced O-methylation was effectively inhibited by first-generation COMT inhibitors (like tropolone but not pyrogallol; Waldmeier and Feldtrauer, 1987) and second-generation compounds (like tolcapone; Da Prada et al., 1994; Miller et al., 1997; Yassin et al., 1998), AdoMet levels in the brain were increased. Homocysteine levels were restored by tolcapone (Da Prada et al., 1994; Miller et al., 1997). Tolcapone enhanced the activity of methionine adenosyl transferase (Yassin et al., 1998). Even CGP 28014, an atypical inhibitor of O-methylation that does not inhibit the COMT enzyme itself, elevated AdoMet levels in the brain (Waldmeier et al., 1990a). Interestingly, MAO inhibition appeared to have just the opposite effect as that observed after COMT inhibition (Yassin et al., 1998).
Enhanced AdoMet levels in the brain during tolcapone therapy may explain the antidepressive (Moreau et al., 1994; Männistö et al., 1995) and cognition-improving (Khromova et al., 1995, 1997) effects of COMT inhibitors. Some studies have shown that the quality of life is increased in PD patients receiving COMT inhibitor therapy (Welsh et al., 1995; Baas et al., 1997; Waters et al., 1997). One report has also described improved cognition during tolcapone therapy (Gasparini et al., 1997). In fact, these findings fit well to the animal data demonstrating both antidepressive and cognition-improving properties of COMT inhibitors (Moreau et al., 1994; Männistö et al., 1995; Khromova et al., 1997; Liljequist et al., 1997).
http://pharmrev.aspetjournals.org/cgi/content/full/51/4/593#SEC3_3_7It may be that MAOIs make SAMe be used, or are powerful antidepressants DESPITE reducing SAMe. Also,
Oral creatine supplementation attenuates L-DOPA-induced dyskinesia in 6-hydroxydopamine-lesioned rats
Abstract
L-DOPA-induced dyskinesia (LID) is among the motor complications that arise in Parkinson patients after a prolonged treatment with levodopa (L-DOPA). Since previous transcriptome and proteomic studies performed in the rat model of LID suggested important changes in striatal energy-related components, we hypothesize that oral creatine supplementation could prevent or attenuate the occurrence of LID. In this study, 6-hydroxydopamine-lesioned rats received a 2% creatine-supplemented diet for 1 month prior to L-DOPA therapy. During the 21 days of L-DOPA treatment, significant reductions in abnormal involuntary movements (AIMs) have been observed in the creatine-supplemented group, without any worsening of parkinsonism. In situ hybridization histochemistry and immunohistochemistry analysis of the striatum also showed a reduction in the levels of prodynorphin mRNA and FosB/ΔFosB-immunopositive cells in creatine-supplemented diet group, an effect that was dependant on the development of AIMs. Further investigation of the bioenergetics status of the denervated striatum revealed significant changes in the levels of creatine both after L-DOPA alone and with the supplemented diet. In conclusion, we demonstrated that combining L-DOPA therapy with a diet enriched in creatine could attenuate LID, which may represent a new way to control the motor complications associated with L-DOPA therapy.I wonder if SAMe, which something like 40% goes to production of creatine i think, would also help. We have seen small scale study of that creatine is antidepressent effective. At minimum i think creatine should be along with MAOI taken EXCEPT by bipolars.
-d/r
Posted by JadeKelly on December 17, 2008, at 16:17:47
In reply to MAO + COMT - SAMe, posted by desolationrower on December 16, 2008, at 22:45:06
You first,
Then share with the rest of the class. Please.
~Jade
Posted by desolationrower on December 17, 2008, at 22:35:41
In reply to Re: MAO + COMT - SAMe » desolationrower, posted by JadeKelly on December 17, 2008, at 16:17:47
> You first,
>
> Then share with the rest of the class. Please.
>
> ~JadeI have had two minor headaches in the last 3 days, but nothign that isn't reversable with some meditation. I also noticed some improvement in ADHD symptoms. Confounding is i moved up to 70mg on way to 90mg. I may take it every other day. Unfortunatly SAMe is very diva-y and i can't split the 200mg pills. I also drink a ton of green tea, which contains some thigns that are COMT inhibitors, further muddling things.
Jade or others who have MAOI fatigue: please try taking creatine to see if that helps. I take creatine anyways...have for years...so i can't do experiment. Like most psychic engergisers it has potential to induce switch in bipolars so if this is a risk for someone don't use 'loading' method, just take regular serving and let it slower build up to levels needed. While not as potent, this is a safe and very cheap way to potentially get most of the benefits here, at least for the energy/fatigue stuff on MAOI. I'm really curious if this could help. I can't find any studies on creatine and MAOIs (I mean if its actually helpful, not for saftey, i'm quite sure its safe).
I'd also be curious for input on the theory side of things if anyone has any.
-d/r
Posted by desolationrower on December 17, 2008, at 22:37:22
In reply to Re: sorry and » desolationrower, posted by Phillipa on December 14, 2008, at 13:06:52
> d/r I got one of those too under the sink some must date back l0 years. Love Phillipa that was a side note.
I keep all my old meds and even empty boxes (only one copy of a box for a drug though). not sure why
-d/r
Posted by Phillipa on December 18, 2008, at 0:32:45
In reply to Re: sorry and » Phillipa, posted by desolationrower on December 17, 2008, at 22:37:22
Yup me too they don't go bad think pharmacist said when they have outdated ones the military gets them. At least that's what mine said as asked. Love Phillipa
Posted by JadeKelly on December 18, 2008, at 23:27:30
In reply to MAO/COMT/SAMe/MAOI FATIGUE/CREATINE!!, posted by desolationrower on December 17, 2008, at 22:35:41
Thanks d/r,
I will keep chatting to a minimum, If you would kindly answer the last question, oh, i forgot. were in the same boat. hah! See how chatting helps? When I find nice doc i'll post u right away : ^ )> I have to go now and get some creatine, if im correct, ive had it before my nephew uses it and i take it if we work out at gym. Makes him a little crazy but i liked it ok, mildy euphoric and energy. i'll try some more and see if it builds up. ill let ya know!!
~Jade
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.