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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 Economist on March 25, 2010, at 16:13:28
I will be starting the 9 mg patch of EMSAM next week. This is the dose where there are regular MAOI dietary restrictions. I want to know if it's safe or even effective to take DLPA at this dose.
Posted by linkadge on March 27, 2010, at 6:53:54
In reply to Is it safe to take DLPA with MAOI?, posted by Economist on March 25, 2010, at 16:13:28
I think so. DLPA has been combined with oral selegeline, so I don't see an issue.
Just be aware of possible over stimulation. PEA in the brain acts just like amphetamine. Normally it it quickly deactivated by MAO-B, so the combination might be very upping. Perhaps not good if you have a propensity towards mania or psychosis.
Linkadge
Posted by Matryoshka on April 2, 2010, at 0:50:35
In reply to Is it safe to take DLPA with MAOI?, posted by Economist on March 25, 2010, at 16:13:28
I would really not risk it.
DLPA's actions are theoretically explained by improving the synthesis of norepinephrine and dopamine.
And, on 9mg/24h Emsam you're reaching the point where selegiline becomes non-selective - it stops being an MAO-B inhibitor and becomes an inhibitor of both MAO-A and MAO-B.
(This is why you start the diet. MAO-A breaks down tyramine, so your body can't break down a lot of tyramine quickly enough, and tyramine acts as a pressor...so consuming it causes acute hypertension.)MAO-A is also responsible for breaking down norepinephrine (along with serotonin and tyramine).
So, you have a reduced ability to break down excess norepinephrine in your body when you're on 9mg or 12mg/24h Emsam.
This is okay (and good for depression), until you take something stimulating that increases norepinephrine. Your body/brain can't quickly break down the excess.(For me, all stimulants - from caffeine to nicotine to Provigil and Nuvigil - feel more powerful physically on an MAOI. And not necessarily in a good way.)
So if you load up with something like DLPA, you could easily raise your blood pressure too high (and hypertensive crises can be really, really awful).
This is why doctors and pharmacists are so cautious about drug interactions with non-selective MAOIs like Parnate, Nardil, and higher-dose Emsam.
Anything and everything that increases serotonin or norepinephrine has the potential to cause serotonin syndrome or a hypertensive crisis (respectively).Some doctors will prescribe low and careful doses of stimulants with MAOIs in order to relieve fatigue. It takes slooooow titration and medical monitoring, though.
But taking an unregulated, and much less-studied, supplement like DLPA is unmonitored (I don't think most doctors would OK it) and it's much harder to gauge the dosage. (Supplements don't always have in the bottle what's on the label, sad to say.)
I'm not saying a problem is inevitable (at least not nearly so much as death and taxes). But hypertensive crisis is not fun, and I would avoid taking the risk.
If you have fatigue issues, I would discuss it with your doctor and find a way to address it cautiously.
(I'm on Emsam 12mg/24h and 50mg Nuvigil. I found a noticeable mood lift from Provigil/Nuvigil too (doc tried me on one then the other, it's a long story), and those are less risky than the amphetamines to take with MAOIs.)If you still have low mood...9mg/24h is where it starts to kick in for many people (it took 12mg/24h for me to feel really noticeably better), so I hope Emsam helps you.
(whew...helluva first post for me. :))
Posted by Economist on April 3, 2010, at 19:13:14
In reply to Re: Is it safe to take DLPA with MAOI? » Economist, posted by Matryoshka on April 2, 2010, at 0:50:35
Matryoshka, did you notice any change once you started taking 9 mg? I have been on the 6 mg EMSAM patch for three weeks and I haven't noticed a thing.
Posted by Matryoshka on April 5, 2010, at 13:54:52
In reply to Re: EMSAM patch » Matryoshka, posted by Economist on April 3, 2010, at 19:13:14
> Matryoshka, did you notice any change once you started taking 9 mg? I have been on the 6 mg EMSAM patch for three weeks and I haven't noticed a thing.
Well, for one, I did feel an energy boost on the 6mg, but not really any depression relief - the fact that you haven't felt a thing means our cases may be different.
On the other hand, Emsam becomes a different drug entirely when you move from 6mg to 9 or 12mg (going from an MAO-B inhibitor to a nonselective MAOI) so there is still a good chance that 9mg will feel differently to you after a couple of weeks.
It takes two or three weeks on average, from what I can tell, to feel the higher doses working. Some people seem to notice a much faster onset; a few seem to need a couple of months (!). It seems to vary a lot.I felt a bit of improvement after two weeks on 9mg, but not enough; it took 12mg. I noticed a real jump at 12mg (which, at first, was not pleasant - I was unusually weepy for a few days - but that faded). Also a little bit of morning nausea for a few days when moving up in dose.
What I really like about Emsam is the lack of weight gain and zero libido side effects.
(It's also not a horrible flattening, apathy-inducing drug like Lexapro.)If you decide to keep titrating on the Emsam, and therefore have to start the MAOI diet, I really recommend this guide:
http://www.mc.vanderbilt.edu/neurology/Tyramine Menu Book 06227101.pdf
(copy-paste the whole URL, it's showing up as an incomplete link)
Unless you're a big fan of cheese, soy sauce, tofu or preserved meats, it's not too hard to get into a routine with the diet.I like the username; Econ was my uni major :)
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