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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by trotten on July 23, 2007, at 4:07:43
I wastaking cynbalta foe a long time,but I felt it poped-up. So I decided to use desipramine 200mg/day. paroxetine 40mg/day andin a few days putted selegiline(oral form)20mg. This combo is an triciclic plus SSRI and a MAOI. Soon I'll add SAMe.
So what do you think about this? I am in my 4rd day am felt only imsomnia palpitationbut not satisfected as much as I was waiting. Can I expect more in some weeks?
Tanks, please give me your ideas. I am alone on it.
Regards, RVP.
Posted by linkadge on July 23, 2007, at 9:16:34
In reply to How abou this:Desipr.+paroxet+selegiline?, posted by trotten on July 23, 2007, at 4:07:43
Yeah be carefull, the combination of selegiline and desipramine could raise blood pressure and/or heart rate.
Linkadge
Posted by Darkness At Noon on July 23, 2007, at 9:28:02
In reply to How abou this:Desipr.+paroxet+selegiline?, posted by trotten on July 23, 2007, at 4:07:43
> I wastaking cynbalta foe a long time,but I felt it poped-up. So I decided to use desipramine 200mg/day. paroxetine 40mg/day andin a few days putted selegiline(oral form)20mg. This combo is an triciclic plus SSRI and a MAOI. Soon I'll add SAMe.
> So what do you think about this?Are you doing this in consultation with your pdoc? Almost everyone (FDA, pdocs, patients) seems to think combining MAOIs with SSRIs like Paxil is an invitation to serotonin syndrome. To a lesser extent, they're afraid of hypertensive crisis when combining MAOIs with tricyclics, although perhaps less so with with TCAs like desiprimine, which has less serotonergic effect.
I'd advise checking this out with a competent pdoc ASAP.
Posted by girlnterrupted78 on July 23, 2007, at 10:55:10
In reply to How abou this:Desipr.+paroxet+selegiline?, posted by trotten on July 23, 2007, at 4:07:43
Isn't combining an SSRI and MAOI really dangerous and life threatening?
I remember reading from someone here in babble, who accidentally ingested a pill of Zoloft while on Nardil or Parnate, and he ended up in the emergency room with seizures so strong that several nurses had to hold him down.
I would not combine these two (Paroxetine and Selegiline) until I got approval from a real doctor who KNOWS exactly what he's doing.
Please don't do it until you find out, you could end up dead. And you're also adding Sam-e and a bunch of other stuff without a physician's approval.
DON'T DO THIS UNTIL YOU TALK TO A DOCTOR PLEASE!!!
Posted by Phillipa on July 23, 2007, at 11:35:30
In reply to Re: How abou this:Desipr.+paroxet+selegiline? » trotten, posted by girlnterrupted78 on July 23, 2007, at 10:55:10
GI I remember it too think it was Football? Love Phillipa
Posted by linkadge on July 23, 2007, at 13:27:17
In reply to Re: How abou this:Desipr.+paroxet+selegiline? » girlnterrupted78, posted by Phillipa on July 23, 2007, at 11:35:30
Selegiline is not the same as Nardil/Parnate. It can (more) safely be combined with other drugs so long as the dose is kept low.
Selegiline on has significant MAO-A inhibition at higher doses, so serotonin syndrome is a lot less likely than the combination of older MAOI's with an SSRI.
Linkadge
Posted by girlnterrupted78 on July 23, 2007, at 13:57:10
In reply to Re: How abou this:Desipr.+paroxet+selegiline?, posted by linkadge on July 23, 2007, at 13:27:17
Linkadge, are you saying that Selegiline can safely be combined with any SSRI?
Have you done this before, have you heard a pdoc say that, or have you read in a legitimate site that it is safe?
Because if you're simply assuming, it's better to err in the side of cautiousness.
If you have certainty, could you post a link that verifies your claim? Thanks.
Posted by linkadge on July 23, 2007, at 15:33:05
In reply to Re: How abou this:Desipr.+paroxet+selegiline? » linkadge, posted by girlnterrupted78 on July 23, 2007, at 13:57:10
Well, officially it is contraindicated. However, many people have combined low (MAO-B selective) doses of selegiline with SSRI's relatively safely.
Here is one study:
------------
Clin Neuropharmacol. 1997 Oct;20(5):419-33.
Lack of adverse interactions between concomitantly administered selegiline and citalopram.
Department of Pharmacology and Clinical Pharmacology, University of Turku, Finland.
We have evaluated the risk for pharmacokinetic and/or pharmacodynamic interactions of concomitantly administered selegiline, a selective monoamine oxidase type B inhibitor, and citalopram, a widely used selective serotonin uptake inhibitor antidepressant. Two parallel groups of healthy volunteers received 20 mg of citalopram (n = 12) or placebo (n = 6) once daily for 10 days in a randomized, double-blind fashion, followed by concomitant selegiline 10 mg once daily for 4 days. The safety of this drug combination was assessed by measurements of blood pressure, heart rate, body temperature, and inquiries for adverse events. Blood samples were taken for the analysis of serum concentrations of both study drugs and their metabolites and plasma prolactin, adrenaline, noradrenaline, and 3,4-dihydroxyphenylglycol (DHPG); urinary excretion of serotonin and 5-hydroxyindoleacetic acid (5-HIAA) were assessed. After a 5-week washout, the 12 subjects who took citalopram in the first part of the study received 10 mg of selegiline once daily for 4 days to compare the pharmacokinetics of selegiline with and without concomitant citalopram. The safety analysis showed no significant differences in vital signs or the frequency of adverse events between the study groups. Plasma prolactin concentrations were increased by 40% after 10 days' treatment with citalopram (p = 0.03); this was not potentiated by concomitantly administered selegiline. The comparison of plasma concentrations of noradrenaline, adrenaline, and DHPG and the amount of serotonin and 5-HIAA excreted into urine between the study groups indicated no signs of subclinical pharmacodynamic interaction between selegiline and citalopram. The relative bioavailability of selegiline was slightly reduced (by 29%; p = 0.008) when citalopram was coadministered compared with selegiline alone. However, no indication of a pharmacokinetic interaction was found in the analysis of serum concentrations of the three main metabolites of selegiline. The pharmacokinetics of citalopram remained unaffected by concomitant selegiline. The present results indicate lack of clinically relevant pharmacodynamic or pharmacokinetic interactions between selegiline and citalopram.
PMID: 9331518
Linkadge
Posted by Oppycat on July 24, 2007, at 7:13:19
In reply to How abou this:Desipr.+paroxet+selegiline?, posted by trotten on July 23, 2007, at 4:07:43
> I wastaking cynbalta foe a long time,but I felt it poped-up. So I decided to use desipramine 200mg/day. paroxetine 40mg/day andin a few days putted selegiline(oral form)20mg. This combo is an triciclic plus SSRI and a MAOI. Soon I'll add SAMe.
> So what do you think about this? I am in my 4rd day am felt only imsomnia palpitationbut not satisfected as much as I was waiting. Can I expect more in some weeks?
> Tanks, please give me your ideas. I am alone on it.
> Regards, RVP.
Not only does the combo of the 3 AD's sound somewhat risky, I wouldn't minimize the possible danger of adding the SAM-e either. I tried adding it to Parnate one time and felt very strange and felt no benefit after a week. Whatever you do, move slowly and cautiously.
Posted by trotten on September 6, 2007, at 14:58:00
In reply to Re: How abou this:Desipr.+paroxet+selegiline? » trotten, posted by Oppycat on July 24, 2007, at 7:13:19
Well, actually I said to my pdoc, but here in Brasil there arent pdocs good enough(at least in my city) that could say an securely info on my combo. So I tried it. The results were weaker than cymbalta alone. I just got very sleepy. So now I am back to cymbalta 6om plus 20mg selegiline and felt no dangerous side effect. IMO cymbalta is without doubt the best AD that are disponible in the market. I think it will take a good time to be released a better one. Only aripiprazole(tooooooo much expensive here) goes fine with duloxetine. Tanks to all.
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