![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by matt66 on March 7, 2003, at 11:55:22
i've been a real nag lately, mostly because I seem to be trusting this board more than my pdoc. failing to respond to a med for so long, I'm asking questions faster than they can be answered, and I apologize for those who have heard my story a few times already and given me their much appreciated advice. anyway, I've been on oral selegiline 50mg for almost three weeks. I'm not doing bad by any means, but it's not "working" and I am overflowing with doubt. it seems from what I've read that selegiline is not used nearly as much as nardil or parnate. is this because it has been proven to be less efficacious? my doc gets it for me no problem, but I don't even know if they sell it in the states. this is discouraging- it seems to suggest that it's one of those long shot meds and that I may be wasting my time and should focus rather on parnate (nardil initially worked for a month, pooped out, and subsequest trials of it have given me paradoxical reactions. I never really sat on parnate however). side effects so far on selegiline: constipation (tolerable compared to what I've experienced in the past) and I can't get it up. I've had inorgasmia before, but this is the first time I haven't been able to get an erection. Granted, this means nothing to me (sexual side effects are not a deterrant- i just want the depression to lift). Do initial side effects indicate a future therapeutic effect? I would be interested if anyone had info or advice on seleligine (eldypryl). Obviously, I'm gonna stick it out for six weeks and see if I improve. I've also noticed many maoi users report a gradual lifting of the depression which they don't even reealize at first, and that remission often follows periods of feeling worse on the drug at first. hence my other question (being asked for like the tenth time, I apologize). the nardil was like the 5th drug i tried and kicked in virtually overnight, and when I told my doc it was slipping after about three weeks, we jumped to parnate rather than upping the nardil dose and waiting (I was only on 45 mg when it seemed to not be working anymore, and was panicking to feel right again. I was unfamiliar with AD's at the time, and didn't think to recommend staying on the nardil, waiting, and upping the dose. I thought it simply stopped working and that i needed another med. i put a ton of pressure on my father/pdoc, who may have panicked. anyway, we decided to move on, and for the past four years nothing, ect included, has worked). EVERYONE on this board has said that I didn't give the nardil a fair trial and that the initial response was not the true anti-depressant effect, but a good sign. (there's no doubt it was "working"- social anxiety gone, self-loathing gone, obsessing gone, anxiety gone, amazing self-confidence, creativity, newly discovered talents, increased energy, sucess with girls in their place) anyway, twice after that initial time, I've retried nardil at 90mg's and been taken off it within two weeks. this last time my parents came to visit and I was totally withdrawn, couldn't look them in the eyes, didn't say a word, and felt nervous and uncomfortable. They were just looking at me as we ate, and my mom kept up such a cheerful mood and tried so hard to engage me, it tore my heart out. my father is my psychiatrist, and no doubt one of the best, most liberal and aggressive there are. i think he saw me suffering and wanted to make a change, rather than being more objective and urging patience or thinking that the nastiness would lead to better things. Note: while I experienced all the above symptoms, I didn't FEEL worse. I was just totally unresponsive and incapable of feigning a personality, something I've been able to do for so long. while I was definately having a paradoxical reaction at the time, and am doing much better since stopping the nardil, i keep thinking that had I stayed on it, i would have passed through that phase and eventually found the same relief it gave me the first time, when it turned my life around 180 degrees. Basically, even when I am able to hold conversations, laugh, and engage my parents, I'm totally depressed beneath the surface. when they saw me however, i couldn't put on the act, and they assumed I was so much worse. I fight this illness so hard, and occasionally become more talkative etc. and I think my father/pdoc takes this as a good sign. it's all an act however: they have never seen me when I'm actually alive (I was at college when the nardil kicked in), and both my brothers and sister are depressed, so they see me when I'm numb on the inside, but putting on an outside act which seems to convince them that these times are "better" than when I'm withdrawn/spacey. underneath it's constant depression, regardless if I'm able to make myself a meal, or can't get out of bed. Recently, I've been harassing my dad for not allowing me to stay on the nardil and we've been fighting a lot. he thinks it was tachyphylaxis on the nardil, but people on the board keep trying to tell me to give it a full six weeks. reading ace's posts (while I'm ecstatic for him) kill me, because I remember everything he's describing feeling on the nardil. but my father is a professional psychopharmacologist and has been in the field over 25 years. I'm in such a pickle.
Posted by hawkeye on March 7, 2003, at 21:31:17
In reply to selegiline dosage/initial response vs. true effect, posted by matt66 on March 7, 2003, at 11:55:22
The recommended standard dosing for segiline is 5mgs-10mgs/day, depending on the purpose for which you are taking it. Many peeps take it for its anti-aging/neuro-protective effect. The recommended maximum dose for this purpose is 5mgs/day.
For psychiatric purposes the recommended dose is 5 mgs 2 times per day (total of 10mgs). At this level of dosing the MAIO effect is specific for MAIOB. At levels higher than 10mgs/day it acts in a non-specific manner on both A and B.
I have been taking 10mgs/day of Segeline for several years with absolutley no side-effects.
Given the dose you say you are taking 50mgs, I am not surprised to hear about your side-effects!!! I am surprised that you are still alive!!!!!!
THE FIRST THING YOU SHOULD DO IS GET YOURSELF A PDOC THAT KNOWS WHAT HE/SHE IS DOING BEFORE YOUR CURRENT PHYSICIAN KILLS YOU !!!!!!!!!!!
Posted by michael on March 8, 2003, at 23:30:55
In reply to I HOPE THAT 50 MGS IS A TYPO !!!!!!!!!!!!!!!!!!, posted by hawkeye on March 7, 2003, at 21:31:17
I'm no expert, but 50mg/day selegiline is certainly not outrageous.
If I recall corectly, 40 - 50 mg is typically the minimum range necessary to achieve an antidepressant response.
As noted in the previous post, at 10mg/day (give or take 5mg) it preferentially inhibits maoi-B. And at higher doses, it also inhibits maoi-A (& therefore necessites the maoi diet). From what I understand, this is generally necessary to achieve an antidepressant response.
Like I said, I'm no expert. Having said that, I am fairly certain that the 5-15mg/day range is well below the dose which is typically necessary to achieve an antidepressant response. If selegiline is being used as an antidepressant, 50mg is far from what would be considered a high dose.
Check the PB tips section, &/or depressincentral.com - I think you might find more info there regarding selegiline doses when it's used as an antidepressant.
michael
Posted by michael on March 8, 2003, at 23:51:25
In reply to selegiline dosage/initial response vs. true effect, posted by matt66 on March 7, 2003, at 11:55:22
matt66 -
Just to follow up, there is some info in the tips section - search for selegiline.
You might also search PB (w/google). A number of people have talked about their experiences w/selegiline as an antidepressant. However, a lot of them were regarding transdermal (the patch) rather than oral selegiline.
I know that at least one person tried oral selegiline after the study he was in ended (because the patch worked so well for him)...
There's a fair amount of info here - but it might take a bit of work to track down the relevant threads, but I think you'll be glad you invested the time. Good luck.
michael
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.