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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by natg on November 30, 2000, at 21:35:47
Hi All:
I want to add 5mg of Selegiline to Risperdal.
My only concern is can I start immediately or do I need to wait 9 days for the Prozac to be out of my system. I took it for the last time yesterday.
I'm just concerned because I read that these drugs have severe interactions: increase risk of CNS toxicity and musle rigidity.
But I'm wondering if this is for higher Selegiline doses ( 10mg and above)
Anyway, any suggestions would be greatly appreciated.
Thanks!Nat
Posted by AndrewB on December 1, 2000, at 2:56:06
In reply to Selegiline question, for AndrewB or anybody, posted by natg on November 30, 2000, at 21:35:47
Selegiline in combo with an SSRI may in rare occassions result in bad drug interactions. If you want to be very safe, wait before you add on selegiline.
AndrewB
Posted by JohnL on December 1, 2000, at 6:05:48
In reply to Selegiline question, for AndrewB or anybody, posted by natg on November 30, 2000, at 21:35:47
> Hi All:
> I want to add 5mg of Selegiline to Risperdal.
> My only concern is can I start immediately or do I need to wait 9 days for the Prozac to be out of my system. I took it for the last time yesterday.
> I'm just concerned because I read that these drugs have severe interactions: increase risk of CNS toxicity and musle rigidity.
> But I'm wondering if this is for higher Selegiline doses ( 10mg and above)
> Anyway, any suggestions would be greatly appreciated.
> Thanks!
>
> NatI would think you would be fine breaking the tab into quarters. Start with 1/4 per day. After a week, when the Prozac is half gone, then you could go up to 1/2 per day. You might even be able to do 5mg right now. In all reality, I don't think there would be any problem combining Prozac+Selegiline unless you were taking 10mg or more per day of Selegiline. My suggestion of 1/4 per day could be excessively cautious and way too conservative. But that's just how I am when I start something new. You'll just have to feel it out and see what happens. I generally prefer to start very low at first though, and then increase once I have a feel for it. Kind of like dipping one's toes in the water before diving in.
I don't see any problem with what you want to do. I took 5mg and 10mg Selegiline about a year ago when I was also taking 20mg Prozac per day, and had no problems or adverse reactions. (except for impotence...isn't that weird...a drug that is supposed to be beneficial for sex actually made me limp? It did the same thing later even when I wasn't taking Prozac. Damn. It's not supposed to do that!) Other than that, I had no problems at all combining the two. In clinical studies they have been combined as well. Adverse events are generally not expected except with doses higher than 10mg. Regardless, I always err on the side of safety and start low.
Johnps...due to the impotence I experienced, I was not on the drug long enough to tell you if it helped or not.
Posted by Adam on December 1, 2000, at 12:11:10
In reply to Selegiline question, for AndrewB or anybody, posted by natg on November 30, 2000, at 21:35:47
As a rule of thumb, I think most MDs wait about a month or a little more before switching someone from Prozac to an MAOI. This is because Prozac (well, its active metabolite, norfluoxetine) has such a long half life in the body (upwards of 16 days).
Dangerous interactions with low-dose selegiline and Prozac have been known to occur, though rarely. These cases have been referred to as "serotonin syndrome", though the quality of these diagnoses, depending on what paper you read, may be in doubt. In theory, a 5mg dose shouldn't cause any problems, since only MAO-B ought to be inhibited, and it isn't involved in serotonin deamination. However, in practice, it seems this isn't an airtight assumption.
Given this small but apparently real risk, I would imagine the vast majority of doctors would opt to wait about a month before you could take any dose of selegiline.
If you are somehow treating yourself, be aware of the potential risks, and act accordingly.
> Hi All:
> I want to add 5mg of Selegiline to Risperdal.
> My only concern is can I start immediately or do I need to wait 9 days for the Prozac to be out of my system. I took it for the last time yesterday.
> I'm just concerned because I read that these drugs have severe interactions: increase risk of CNS toxicity and musle rigidity.
> But I'm wondering if this is for higher Selegiline doses ( 10mg and above)
> Anyway, any suggestions would be greatly appreciated.
> Thanks!
>
> Nat
Posted by felix on December 2, 2000, at 5:19:00
In reply to Selegiline question, for AndrewB or anybody, posted by natg on November 30, 2000, at 21:35:47
.
> But I'm wondering if this is for higher Selegiline doses ( 10mg and above)
Play 'Moth Aircraft Carriers' by floating a shoe box in the bath with a torch attached. Leave a window open for ten minutes, then turn off the room lights and watch as the moths attempt to make their dramatic and dangerous landings.
Posted by natg on December 2, 2000, at 13:19:05
In reply to Re: Selegiline question, for AndrewB or anybody, posted by felix on December 2, 2000, at 5:19:00
> .
> > But I'm wondering if this is for higher Selegiline doses ( 10mg and above)
>
>
> Play 'Moth Aircraft Carriers' by floating a shoe box in the bath with a torch attached. Leave a window open for ten minutes, then turn off the room lights and watch as the moths attempt to make their dramatic and dangerous landings.
Posted by Dr. Bob on December 2, 2000, at 18:05:08
In reply to Re: Selegiline question, for AndrewB or anybody, posted by felix on December 2, 2000, at 5:19:00
> Play 'Moth Aircraft Carriers' by floating a shoe box in the bath with a torch attached. Leave a window open for ten minutes, then turn off the room lights and watch as the moths attempt to make their dramatic and dangerous landings.
Sorry, but I don't see how the above could be considered support or education.
Bob
PS: To follow up on this (as opposed to the original topic of this thread), please direct your post to the Psycho-Babble Administration board when you confirm it. Thanks.
Posted by natg on December 3, 2000, at 9:57:11
In reply to Selegiline question, for AndrewB or anybody, posted by natg on November 30, 2000, at 21:35:47
Andrew:
How much Selegiline do you take? And how does it help you?
What other meds are you taking?Thanks for your input, it is much appreciated.
Nat
Posted by AndrewB on December 3, 2000, at 12:32:00
In reply to To Andrew, posted by natg on December 3, 2000, at 9:57:11
NatG,
I take 5mg./day of selegiline. Standard low dose is 10mg. One study suggests 2.5mgs is sufficient for complete MAO-B inhibition. Since selegiline has a multitude of effects at low doses, it is possible a lower dose may be sufficient or the higher dose (10mg.) more desirable. All I know is myself and 1 or 2 others are doing quite well on 5 mg. It increases motivation, energy and confidence for me. Some of the effects of selegiline at low doses are: 1) increase of dopamine in the synaptic cleft, prevention of dopamine neuron death by a metabolite of dopamine, and the prevention of general neuron death by the prevention of glutaminergic neurotoxicity. Note: glutaminergic dysfuntion and consequent neurotixic results are a common if not prevalent in bipolar depression and often is also occurring in other types of depression, but that is another topic for another posting.
As I said anxiety can be effect of selegiline, as with other drugs that act on the whole dopamine system. I don't suffer from anxiety (or any other side effects) from it. It is my pet theory, that combination of an antipsychotic like amisulpride will prevent anxiety from selegiline if it were to occur.
I take: 5mg. selegiline/day, 15mg. adderall a day (for further arousal, motivation and confidence), amisulpride at 50mg.s/day (takes away low mood, anhedonia, apathy, fatigue, a sense of detachment, persistant negative thoughts, and social anxiety), and klonopin at night a few night a weeks for a more refressing sleep (I think it helps to keep dopamine levels low at night).
You wouldn't recognize me now from before I started taking these meds. I am really loving life. This and other med combos can be very effective in dealing with dopaminergic hypofunction and can turn one's life around.
Best wishes,
AndrewB.
Posted by Adam on December 5, 2000, at 10:39:53
In reply to Re: To Andrew, posted by AndrewB on December 3, 2000, at 12:32:00
Andrew, I had a couple of questions:
1) Klonapin/clonazepam has a very long half life compared to other benzodiazepines, no less than about 18 hours. Although it is certainly lowering the excitability of dopaminergic neurons at night, chances are, if you are taking it chronically, it is having this effect during the day, too. I wonder if it might be in effect negating some of the enhancement of dopaminergic signaling you are trying to achieve by adding things like low-dose amisulpride.
2) Also, since benzos are considered an effective (if not ideal) treatment for social phobia, could it be the Klonapin that is the main contributor to your decreased social anxiety?
If this coctail works for you, these questions are really moot, of course, but I wonder if maybe a shorter-acting benzo like Ativan or Xanax might be what you're looking for in a sleep aid. There's always ambien too.
Just wondering, and am interested in your reply.
> NatG,
>
> I take 5mg./day of selegiline. Standard low dose is 10mg. One study suggests 2.5mgs is sufficient for complete MAO-B inhibition. Since selegiline has a multitude of effects at low doses, it is possible a lower dose may be sufficient or the higher dose (10mg.) more desirable. All I know is myself and 1 or 2 others are doing quite well on 5 mg. It increases motivation, energy and confidence for me. Some of the effects of selegiline at low doses are: 1) increase of dopamine in the synaptic cleft, prevention of dopamine neuron death by a metabolite of dopamine, and the prevention of general neuron death by the prevention of glutaminergic neurotoxicity. Note: glutaminergic dysfuntion and consequent neurotixic results are a common if not prevalent in bipolar depression and often is also occurring in other types of depression, but that is another topic for another posting.
>
> As I said anxiety can be effect of selegiline, as with other drugs that act on the whole dopamine system. I don't suffer from anxiety (or any other side effects) from it. It is my pet theory, that combination of an antipsychotic like amisulpride will prevent anxiety from selegiline if it were to occur.
>
> I take: 5mg. selegiline/day, 15mg. adderall a day (for further arousal, motivation and confidence), amisulpride at 50mg.s/day (takes away low mood, anhedonia, apathy, fatigue, a sense of detachment, persistant negative thoughts, and social anxiety), and klonopin at night a few night a weeks for a more refressing sleep (I think it helps to keep dopamine levels low at night).
>
> You wouldn't recognize me now from before I started taking these meds. I am really loving life. This and other med combos can be very effective in dealing with dopaminergic hypofunction and can turn one's life around.
>
> Best wishes,
>
> AndrewB.
Posted by AndrewB on December 6, 2000, at 9:55:38
In reply to Re: To Andrew » AndrewB, posted by Adam on December 5, 2000, at 10:39:53
Adam,
Always good to hear from you. As I started taking the other drugs before the klonopin (and I don't take klonopin every day), I can say that it isn't the klonopin that has taken away my social anxiety.
Your point about a long half life and possible unwanted residual effects during the day from klono are well taken. I will bring up the issue of using a shorter acting benzo with my pdoc. I am concerned about the increased addiction potential of the shorter acting benzos though.
AndrewB
This is the end of the thread.
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