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Re: Selegiline without the Patch

Posted by Adam on April 11, 2000, at 15:34:04

In reply to Patchless...Re: Subverting the system..., posted by Adam on March 27, 2000, at 22:55:36

Hey, folks,

I've been a busy boy.

Anyway, for those interested in selegiline administered both transdermally and orally...

I miss the patch! I'm doing OK, but taking selegiline orally vs. through my arm is indeed a different experience.

I started out on 15mg/day. For the life of me, I can't figure out why it was suggested I try this, since I've seen no evidence anywhere of antidepressant efficacy at that dose, but the head of the selegiline transdermal system (STS) study I was in thought I should give it a go. It didn't really work. After experiencing some subtle changes in mood that became less subtle, I suggested (insisted, rather) I up the dose, and have done so accordingly.

I'm up to 30mg/day now, which is still on the low end, though this dose may work. I've got big time jitters, though, and even dividing it up 15mg t.i.d., I feel like I'm crashing at around midnight or 1:00 AM, hard. And although I experience this change late at night, it's not easy to get to sleep unaided. One plus about not being in the study is I can augment and/or take hypnotics as appropriate. Benedryl for those times I just need to sleep works pretty well. I've noticed for jitters I can take a little lorazepam on occasion if it's really annoying, but then I feel spacey, so I try not too.

I'm hoping this wound-up feeling gets better with time. It's nothing at all like the "hypomanic" (not sure of the validity of that term for the state I was in) feeling I had when first getting the active drug transdermally. This is like the worst experience I ever had with coffee multiplied. It's hard to sit still, and my hands are all over myself. That was an annoying habit I had that I was told was connected to OCD: The tendancy to kind of pick at myself or bite my nails compulsively. I really do find myself rubbing at my scalp or face without even noticing it, biting nails or fingertips, etc. and then catching myself and feeling embarassed.

On the plus side, I'm feeling a bit better emotionally. I don't know if this is due to MAO inhibition or just plain stimulant high. But it's a step in the right direction.

Some thoughts I have had about augmentation have been:

Inositol: As many of you know, this has shown some efficacy for OCD in a very limited, double-blinded study done in Israel, though I think it had a good design (near perfect placebo, for one thing). Only trouble is, the dose assayed was 18g/day, which is kind of absurd. I may try to buy myo-inositol by the kg from Sigma. It's relatively cheap that way, and I know it's pure. They may not go for it, though. Even still, something I have to take by the shovel-full doesn't appeal to me entirely.

Risperidone: Not sure if anyone will go for this one. In some cases, this atypical antipsychotic has shown some promise for refractory OCD patients at low doses. It is theorized that in the low dose range it may help by blocking dopamine receptors, while higher doses it might exacerbate OCD symptoms by antagonizing 5-HT receptors. I'm thinking this might be a good choice if administered carefully, mostly to counteract some of selegiline's more troublesome (for me) properties: Mainly it's a big-time dopamine potentiator, with MAO-B and DA-reuptake inhibitory properties, as well as (weak) amphetamine metabolites. My main worries are (in no special order) A) My doctor will laugh at the mere suggestion B) Loss of some good antidepressant effects, and C) All the other crap that comes with taking antipsychotics.

Well, we'll see. It hasn't all been a barrel of laughs. But then again, it's a far cry from the suicidal nightmare of early 1999. I'm still grateful for that.




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