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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by pal ed ism on October 5, 2011, at 15:31:54
Have been treated for depression x 20 years. Current phenelzine at 82.5 mgs daily not working, concentration is poor.
Starting dextroamphetamine at 2.5 mgs daily to potentiate the phenelzine.
Has anyone tried this combo, and how was it?
Posted by Chairman_MAO on October 5, 2011, at 22:45:13
In reply to dextroamphetamine and phenelzine, posted by pal ed ism on October 5, 2011, at 15:31:54
Yes. I took phenelzine + d-amphetamine for about two and a half years. It took forever to raise the dose of d-amphetamine because I was on an MAOI, but I ended up at 20mg t.i.d. Right now I'm only taking the dexedrine + clonazepam (went off Nardil for weight gain). Doctor is hesitant to put me back on MAOI now but I want to go on Marplan. Dexedrine worked better on MAOI and seemed to last a little longer. Phenelzine was more effective than clonazepam long-term for social anxiety/phobia for me. Wish I never got on the benzo, but I made a bad choice during a tough time. Now I'm going to have to taper off of it--what fun. Oh well, I just hope my doctor is amenable to putting me back on the MAOI + d-amphetamine combination because nothing else works.
Best of luck.
Effective dose of phenelzine for most people seems to be about 1mg/kg/day in divided doses.
Honestly, the danger of d-amphetamine + phenelzine is exaggerated. It is something to be treated with respect, but the hysteria over it is IMHO unwarranted.
Now ephedrine--there's a stimulant I wouldn't dare touch on an MAOI.
Posted by pal ed ism on October 6, 2011, at 13:43:24
In reply to Re: dextroamphetamine and phenelzine » pal ed ism, posted by Chairman_MAO on October 5, 2011, at 22:45:13
Thanks Chairman MAO:
What brought me to consider dexedrine was a really difficulty trying to concentrate at work, to the point of where I was saying, "I am going to be putting somebody in jeopardy here. . ."
Mood, ruminations, not that black, but just low low bodily energy and concentration.
Two days on 2.5 mgs Dex wth 82.5 mgs Nardil concentration improved by 100 percent, bodily energy unchanged. Ambience seems probably 50 percent brighter.
Posted by Chairman_MAO on October 6, 2011, at 13:54:30
In reply to Re: dextroamphetamine and phenelzine, posted by pal ed ism on October 6, 2011, at 13:43:24
> Thanks Chairman MAO:
>
> What brought me to consider dexedrine was a really difficulty trying to concentrate at work, to the point of where I was saying, "I am going to be putting somebody in jeopardy here. . ."
>
> Mood, ruminations, not that black, but just low low bodily energy and concentration.
>
> Two days on 2.5 mgs Dex wth 82.5 mgs Nardil concentration improved by 100 percent, bodily energy unchanged. Ambience seems probably 50 percent brighter.Just some advice: _try using memantine before the tolerance develops_. You can still eliminate it now. I started at 5mg twice daily and went all the way up to 60mg/day.
Plus, memantine tends to have antidepressant effects itself. If you don't like it, you can stop taking it, but I urge you to consider this.
Posted by stargazer2 on October 8, 2011, at 21:54:28
In reply to Re: dextroamphetamine and phenelzine » pal ed ism, posted by Chairman_MAO on October 6, 2011, at 13:54:30
I had a hypertensive reaction when I increased the D-amphetamine from 5 mg to 7.5 mg so be careful. I think the dose of Nardil was 40 as I never went above this dosage. My BP was 240/160, if I can remember accurately. I also got a headache before I checked my BP. I did take Nifedepine and monitored the BP myself while lying on the bathroom floor. It took an hour or two to come down to an acceptable level.
I switched over to Marplan after Nardil became ineffective. It seems to be working relatively well, along with Lithium and Seroquel.
Stargazer
Posted by Chairman_MAO on October 8, 2011, at 23:08:40
In reply to Hypertensive Reaction on D-amphet/Nardil, posted by stargazer2 on October 8, 2011, at 21:54:28
I'm sorry you had to suffer through that. I guess I'm one of the lucky ones. I suspect more people are lucky than are unlucky in this respect, but who could even know?
When I was on 90mg/day of Nardil, my doctor started me immediately at 5mg bid d-amphetamine. No issues all the way up to 60mg/day (tapered up over about a year and a half). There was a period of time I wasn't taking it, then restarted it again right at 60mg/day. No issues.
The only hypertensive reaction I've ever had was to Thai food from Parnate. I doubt it was as severe as yours, but I had a splitting headache and had to lie down waiting for the clonidine to kick in.
The treatment of choice would be an injection of phentolamine. I'm not so sure my doctor would be keen on prescribing me that given that it's only available for inection ... but that is what they'd use in an ER.
Posted by Chairman_MAO on October 8, 2011, at 23:12:31
In reply to Hypertensive Reaction on D-amphet/Nardil, posted by stargazer2 on October 8, 2011, at 21:54:28
You'd have to give something else in addition to the phentolamine if it was from d-amphetamine, though, because it has a short half-life. Perhaps that's why.
This is the end of the thread.
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