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Dr. Bob is Robert Hsiung, MD,
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Posted by Robin on September 20, 1999, at 16:45:06
I have tried many AD's and nothing has worked for me except Parnate, but the problem with Parnate was low blood pressure and dizziness. So had to stop using it. I am going to try Deprenyl. What does anyone think about Generic(Selegiline) vs Deprenyl?
Thanks
Posted by Jen on September 30, 1999, at 11:28:04
In reply to Selegiline :Deprenyl or Generic??, posted by Robin on September 20, 1999, at 16:45:06
I've tried Deprenyl, but not the generic. Have also stayed on Parnate for extended periods of time.
My experience and understanding:
1) Parnate caused excessive dry mouth, sweating, and some degree of cognitive dysfunction (for example, the pace of my speech significantly slowed). I also did not find that it significantly reduce my social phobia, so I augmented with Klonopin (Clonazepam) which is very effective.
2) Deprenyl (at less than 15 mg/day) affects only MAO-B
3) Let me back up: discussion of MAO Inhibitors (confirm with your psychdoc - I'm not an MD)
a. Reversible and Non-reversible
- Non-reversible are the older type, which can cause a hypertensive crisis
if you consume foods rich in tyramine. The worst are dates, figs, aged cheeses
and red wines. I've never had a problem, and I eat pizza like crazy and enjoy
beer and white wines. Moclobemide falls into the reversible category. Deprenyl,
Phenelzine, Tranylcypromine (Parnate), and Isocarboxazid (Marplan) are non-reversible.
b. Inhibitors of MAO-A or MAO-B or both
- Deprenyl is selective for MAO-B at less than 15 mg/day. This means you can avoid the
"cheese effect" or the tyramine induced hypertensive crisis.
- Deprenyl above 15 mg/day loses its selectivity and acts on MAO-A and MAO-B
- Inhibitors of MAO-A, such as the reversible MAOI Moclobemide have been found to
lack efficacy in treating social phobia
c. Hydrazine and Non-Hydrazine MAOI's
-Phenelzine (Nardil) and Isocarboxazid (Marplan) are hydrazine MAOI's, non-reversible, and
non-selective. That is, they affect both MAO-A and MAO-B.
-Hydrazine MAOI's are thought to achieve their efficacy by their added effect on GABA,
the primary inhibitory neurotransmitter in the brain.
-Non-Hydrazine MAOI's, such as Parnate and Deprenyl to not affect GABA levelsTo summarize:
(a) Deprenyl at less than 15 mg/day will primarily affect dopamine, which, by itself, does
not appear to exhibit efficacy in treating social phobia.
(b) Deprenyl above 15 mg/day should be closer to Parnate, but without the dry mouth and
and slowed speech, excessive sweating, etc. I've found that up to 60 mg/day of
Deprenyl did not appear to help my social anxiety.
(c) You may want to consider Nardil (Phenelzine). You need at least a two week washout
of Parnate, of course, before you could start this. You could also supplement with
Klonopin in the interim, to get you through. Phenelzine does have some side effects,
but you might want to see how it affects you, individually, before you make up your
mind.
(d) Marplan (Isocarboxazid) is another alternative to Phenelzine. It's recently been
reintroduced to the market. As a Hydrazine, non-rerversible and non-selective MAO
inhibitor, it should exert both anti-panic and anti-anxiety effects. I'm not aware
of its side effect profile, but you might want to switch to this if your experience
with Phenelzine (Nardil) is not positive.Good Luck!
Jen
Posted by Robin on September 30, 1999, at 22:46:35
In reply to Re: Selegiline :Deprenyl or Generic??, posted by Jen on September 30, 1999, at 11:28:04
> I've tried Deprenyl, but not the generic. Have also stayed on Parnate for extended periods of time.
>
> My experience and understanding:
> 1) Parnate caused excessive dry mouth, sweating, and some degree of cognitive dysfunction (for example, the pace of my speech significantly slowed). I also did not find that it significantly reduce my social phobia, so I augmented with Klonopin (Clonazepam) which is very effective.
> 2) Deprenyl (at less than 15 mg/day) affects only MAO-B
> 3) Let me back up: discussion of MAO Inhibitors (confirm with your psychdoc - I'm not an MD)
> a. Reversible and Non-reversible
> - Non-reversible are the older type, which can cause a hypertensive crisis
> if you consume foods rich in tyramine. The worst are dates, figs, aged cheeses
> and red wines. I've never had a problem, and I eat pizza like crazy and enjoy
> beer and white wines. Moclobemide falls into the reversible category. Deprenyl,
> Phenelzine, Tranylcypromine (Parnate), and Isocarboxazid (Marplan) are non-reversible.
> b. Inhibitors of MAO-A or MAO-B or both
> - Deprenyl is selective for MAO-B at less than 15 mg/day. This means you can avoid the
> "cheese effect" or the tyramine induced hypertensive crisis.
> - Deprenyl above 15 mg/day loses its selectivity and acts on MAO-A and MAO-B
> - Inhibitors of MAO-A, such as the reversible MAOI Moclobemide have been found to
> lack efficacy in treating social phobia
> c. Hydrazine and Non-Hydrazine MAOI's
> -Phenelzine (Nardil) and Isocarboxazid (Marplan) are hydrazine MAOI's, non-reversible, and
> non-selective. That is, they affect both MAO-A and MAO-B.
> -Hydrazine MAOI's are thought to achieve their efficacy by their added effect on GABA,
> the primary inhibitory neurotransmitter in the brain.
> -Non-Hydrazine MAOI's, such as Parnate and Deprenyl to not affect GABA levels
>
> To summarize:
> (a) Deprenyl at less than 15 mg/day will primarily affect dopamine, which, by itself, does
> not appear to exhibit efficacy in treating social phobia.
> (b) Deprenyl above 15 mg/day should be closer to Parnate, but without the dry mouth and
> and slowed speech, excessive sweating, etc. I've found that up to 60 mg/day of
> Deprenyl did not appear to help my social anxiety.
> (c) You may want to consider Nardil (Phenelzine). You need at least a two week washout
> of Parnate, of course, before you could start this. You could also supplement with
> Klonopin in the interim, to get you through. Phenelzine does have some side effects,
> but you might want to see how it affects you, individually, before you make up your
> mind.
> (d) Marplan (Isocarboxazid) is another alternative to Phenelzine. It's recently been
> reintroduced to the market. As a Hydrazine, non-rerversible and non-selective MAO
> inhibitor, it should exert both anti-panic and anti-anxiety effects. I'm not aware
> of its side effect profile, but you might want to switch to this if your experience
> with Phenelzine (Nardil) is not positive.
>
> Good Luck!
>
> JenJen,
Thank You so much for taking the time to explain the MAOI drugs for me. It was very helpful.Robin
This is the end of the thread.
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