MAO is the garbage man of the brain and kills off your neurotransmitters. Interfering with it helps with virtually all mental illnesses.
Well I took this line as comedy.
MAO inhibitors are not used frequently in the clinical setting.
Indeed; and IMHO it's a pity. They should be used more -- more frequently, and also with more understanding and (it rarely hurts) caution.
I might go so far as to say a lot of psychiatrists don't want to be as involved with their patients as MAOI prescriptions require, but I will refrain from this line of inquiry. Suffice it to say that they are extraordinarily useful in some cases, and also possibly quite dangerous in their unique fashion -- much like pretty much any psychiatric agent of strength.
Except he's using Selegiline, not your run-off-the-mill MAOI.
Ain't no such thing as a run-of-the-mill MAOI; certainly no such thing in available clinical use.
Just sayin'.
Selegiline has a low oral bioavailability.
First of all, while MAO-B is not (as far as current medicinal opinion knows) the twin
directly responsible for norepinephrine deamination, the potential interaction between MAO-B inhibitors and methylphenidate (and most sympathomimetics) lies especially in the fact that MAO-B is directly responsible for deamination of phenethylamine, and thus MAO-B is NOT unlikely to play some role in removing the
substituted phenethylamines: e.g. methylphenidate (sometimes labelled methyl2-phenyl-2-(2-piperidyl)ethanoate -- chemistry geeks can locate the
"phenyl-ethyl-amine" in there with ease it seems), and most e.g. OTC decongestants, which is why decongestants and sympathomimetics in general receive a sharp contraindication in the selegiline monograph even at doses thought to be MAO-B selective.
Second, regardless of relative considerations like bioavailability the issue of whether MAO-A ends up being affected or not on various different regimens of chronic dosing of "low-dose" selegiline is far from a settled question or a sure thing either way, despite what some have thought or what has been advertised by some speculators.
Caution! Caution!
The thing that actually makes me think (IMHO again
) that selegiline might have a higher basic margin of safety in combination with sympathomimetics than e.g. phenelzine or tranylcypromine is its peculiar and still-not-totally-elucidated activity at the adrenergic receptors. I think it might exert an
positively adrenergic effect on its own (rather than a2 agonists, for instance) but act something like e.g. buprenorphine does with the opioid receptors, tying up the receptors and blocking exogenous and endogenous stimulation within certain margins. That is my speculation however. In any case it decreases tyramine-evoked release of norepinephrine and might interfere with other things that hit up the adrenergic system too.
But this is a partial, vague effect and the drug combinations still are dangerous and still need CAUTION.
A controversial idea, anyone any ideas?, beta-blocker, ritalin, selegeline
To the OP: MAOI/psychostimulant combinations need to be done with a doctor, very carefully, titrating up slowly.
W/R/T hypotensive agent you generally are not going to want a daily medication for MAOI/psychostimulant combination (see, Tranylcypromine and especially phenelzine
are typically hypotensive -- they LOWER blood pressure -- outside of hypertensive crisis occurring due to ingestion of adrenergic agents in food/drug ... selegiline, OTOH, may be different and seems to raise blood pressure alone in a significant group of users ... again this might be due to the adrenergic receptor interactions) ... but instead a rescue medication to take in the event of hypertensive crisis (you still would want to receive medical attention immediately ... for various reasons ... your doctor should tell you about all this and more if you use the combination). Unbreakable gave nice suggestions.
Now, guanfacine is quite often used in clinical practice with methylphenidate ALONE in the case of excessive peripheral side effects, to lower these without (this is the intent anyway) compromising effectiveness in ADHD ...
ritalin causes a transient rise in dopamine. i just want that transient rise to remain longer.. the dopamine is actually more for motivation rather than cognition in the sense of better memory etc.... i should have been specific.
I take memantine for the purposes I believe you are describing. A combination of selegiline with psychostimulant, for me, was not a long-term aid in this. YMMV ... and remain cautious.
As a total aside, for a few reasons I suspect phenelzine is a glutamate antagonist through some pathway, maybe just GABAnergic but.
By the way: If the combination of a MAOI with a stimulant results in a hypertensive crisis in some people, I wouldn't treat it with any betablocker except maybe Carvedilol as it acts as a alphablocker too. I would go for Nifedepine, Clonidine or Chlorpromazine. Pure beta-receptor-antagonism could result in overstimulation of alpha-receptors which would be very counterproductive.
Unbreakable, I cosign everything in your excellent posts in this thread, and also this is an great point, thanks for making it clear to people. I will remember to publicize this in my future posts.
"SSRIs are a scalpel, MAOIs are a broadsword." Heh heh heh.
Edited by graatch, 13 January 2009 - 07:32 AM.
