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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Axmann on May 14, 2016, at 16:51:25
It's very likely that I have the three-repeats variant of the MAO-A gene. (rs909525), which I believe means I have less activity of MAO-A
I'm currently on selegiline 6 mg, and I was wanting to increase it to 9 mg.
Is this safe to do, even though my MAO-A activity may already be low?
I do have ADHD-PI, dysthymia/depression, and social anxiety.
Posted by J Kelly on May 14, 2016, at 16:58:04
In reply to Genetic interactions with Selegiline (Warrior gene, posted by Axmann on May 14, 2016, at 16:51:25
> It's very likely that I have the three-repeats variant of the MAO-A gene. (rs909525), which I believe means I have less activity of MAO-A
>
> I'm currently on selegiline 6 mg, and I was wanting to increase it to 9 mg.
>
> Is this safe to do, even though my MAO-A activity may already be low?
>
> I do have ADHD-PI, dysthymia/depression, and social anxiety.What is PI?
Posted by Axmann on May 14, 2016, at 21:17:00
In reply to Re: Genetic interactions with Selegiline (Warrior gene » Axmann, posted by J Kelly on May 14, 2016, at 16:58:04
ADHD-PI is the "primarily inattentive" subtype. It's what used to be called "ADD" without the H. It's basically characterized mostly by lethargy and very low motivation.
The naming scheme for ADHD really need to be revised, because people with ADHD-PI don't actually have the "H", they just have "ADD"
Posted by J Kelly on May 15, 2016, at 1:45:43
In reply to Re: Genetic interactions with Selegiline (Warrior gene, posted by Axmann on May 14, 2016, at 21:17:00
Posted by J Kelly on May 15, 2016, at 5:44:00
In reply to Genetic interactions with Selegiline (Warrior gene, posted by Axmann on May 14, 2016, at 16:51:25
> It's very likely that I have the three-repeats variant of the MAO-A gene. (rs909525), which I believe means I have less activity of MAO-A
>
> I'm currently on selegiline 6 mg, and I was wanting to increase it to 9 mg.
>
> Is this safe to do, even though my MAO-A activity may already be low?
>I don't know anything about selegine so all I have to offer is my own experience. In addition, I've noted two things. First, that you have tried Parnate with good effect but poor sleep patterns, and second, the "warrior" gene can cause aggression and I would imagine other symptoms common to the aggressive state.
To have to abandon a good outcome due to poor sleep seems a shame. Would you be willing to try an AAP like Seroquel or Zyprexa with Parnate? Both are excellent sleep aids in my experience and may very well be effective treatments for symptoms relating to the MAO-A gene. Just a guess though.
> I do have ADHD-PI, dysthymia/depression, and
social anxiety.I did well on Emsam but kept having to increase the dose so ultimately I switched to Parnate which worked well for me at doses below 80mg.
I find Nardil to be much smoother and more mellow than Parnate. It's also VERY effective for depression and social anxiety *for me*.
I'm not sure any of this helps you as your question was Selegine.
Good luck,
Jade
Posted by linkadge on May 15, 2016, at 7:00:29
In reply to Re: Genetic interactions with Selegiline (Warrior gene » Axmann, posted by J Kelly on May 15, 2016, at 5:44:00
Have you undergone a genetic test regarding the MAO gene you mention?
I would hesitate to jump to conclusions based on symptom patterns alone.
I suppose that if you did have a functionally low level of MAO-A then a MAO inhibitor may not be the best treatment option. However, selegiline is more selective to MAO-B. I don't know how this would improve or complicate matters for an individual with low levels of MAO-A.
Was Dexedrine not working for you?
Linkadge
Posted by SLS on May 15, 2016, at 7:14:01
In reply to Genetic interactions with Selegiline (Warrior gene, posted by Axmann on May 14, 2016, at 16:51:25
For depression, it is MAO-A inhibition that is most important in the therapeutic action of MAOIs. You can block 90% of MAO-A and be perfectly safe. Some people will go up to 120 mg/day of Nardil.
If you want the Emsam version of selegiline to work as an antidepressant, the minimum dosage is 9 mg/24. Even 6 mg/24 inhibits MAO-A to some extent.
- Scott----------------------------------------------
"CLINICAL PHARMACOLOGY
Pharmacodynamics
Selegiline (the drug substance of EMSAM) is an irreversible inhibitor of monoamine oxidase (MAO),
an intracellular enzyme associated with the outer membrane of mitochondria. MAO exists as two
isoenzymes, referred to as MAO-A and MAO-B. Selegiline has a greater affinity for MAO-B,
compared to MAO-A. However, at antidepressant doses, selegiline inhibits both isoenzymes (see
below).
The mechanism of action of EMSAM as an antidepressant is not fully understood, but is presumed to
be linked to potentiation of monoamine neurotransmitter activity in the central nervous system (CNS)
resulting from its inhibition of MAO activity. In an in vivo animal model used to test for
antidepressant activity (Forced Swim Test), selegiline administered by transdermal patch exhibited
antidepressant properties only at doses that inhibited both MAO-A and MAO-B activity in the brain.
In the CNS, MAO-A and MAO-B play important roles in the catabolism of neurotransmitter amines
such as norepinephrine, dopamine, and serotonin, as well as neuromodulators such as
phenylethylamine."
Posted by SLS on May 15, 2016, at 7:16:01
In reply to Re: Genetic interactions with Selegiline (Warrior gene, posted by SLS on May 15, 2016, at 7:14:01
> For depression, it is MAO-A inhibition that is most important in the therapeutic action of MAOIs. You can block 90% of MAO-A and be perfectly safe.
Of course, the diet restrictions apply!
- Scott
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