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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by cache-monkey on April 26, 2005, at 0:41:02
Hey all,
So, I need to make some moves in my med regimine. Not feeling so good lately. I'm cycling a little. I think I'm possibly BPII, but this is all cycling amongst the bad stuff: anxiety, dysphoria and depression. Also prominent are anhedonia and asociality. My pdoc has me on Depakote ER 1000 mg/day and Ativan 3 mg/day and I feel more depressed.
At some point I'd like to try low-dose (MAOB selective) selegiline as an add on, which I would like to do at some point regardless. My "normal" state exhibits dysthymia and a reliance on nicotine, so that might be something useful for that.
My anxiety is being kept in check mainly by benzos, and the Depakote isn't really doing much in that department. Nor is it helping my dysphoria. So, Seroquel seems kind of promising for the dysphoria, depression, cycling, and could help against anxiety w/o relying a benzo. (I'm really liking what I've read coming out of Calabrese's recent studies on Seroquel.)
So, I'm thinking either:
a) just add selegiline to the Depakote
b) drop Depakote, add seroquel, then see about adding selegiline
c) keep the Depakote, add seroquel, then see about adding selegiline.Any advice here? Particularly, has anyone tried selegiline with either Depakote, Seroquel, or possibly both?
Thanks!
cache-monkey
Posted by chemist on April 26, 2005, at 2:20:34
In reply to Advice: Selegiline + (Depakote/Seroquel)?, posted by cache-monkey on April 26, 2005, at 0:41:02
> Hey all,
>
> So, I need to make some moves in my med regimine. Not feeling so good lately. I'm cycling a little. I think I'm possibly BPII, but this is all cycling amongst the bad stuff: anxiety, dysphoria and depression. Also prominent are anhedonia and asociality. My pdoc has me on Depakote ER 1000 mg/day and Ativan 3 mg/day and I feel more depressed.
>
> At some point I'd like to try low-dose (MAOB selective) selegiline as an add on, which I would like to do at some point regardless. My "normal" state exhibits dysthymia and a reliance on nicotine, so that might be something useful for that.
>
> My anxiety is being kept in check mainly by benzos, and the Depakote isn't really doing much in that department. Nor is it helping my dysphoria. So, Seroquel seems kind of promising for the dysphoria, depression, cycling, and could help against anxiety w/o relying a benzo. (I'm really liking what I've read coming out of Calabrese's recent studies on Seroquel.)
>
> So, I'm thinking either:
> a) just add selegiline to the Depakote
> b) drop Depakote, add seroquel, then see about adding selegiline
> c) keep the Depakote, add seroquel, then see about adding selegiline.
>
> Any advice here? Particularly, has anyone tried selegiline with either Depakote, Seroquel, or possibly both?
>
> Thanks!
> cache-monkeyhello there, me again...you and i read the same authors...i can comment on depakote and seroquel, as well as ativan: my very pleasant run with parnate years back does not quite address your concerns...if i were given your choices above, i would opt for (b), if only because depakote was - for me - a murky walk through muddy waters for a few weeks while my waistline steadily increased. i was dx bpII - this is off the table now, but who knows - and lithium was not an option due to climate and exercise not going with the therapeutic range indicated.
seroquel is, as you likely know, a strange animal, with heavy sedation and histaminergic activity in the 25 to perhaps 100 mg range: when 200 mg and above are titrated, the sedation goes away for the most part and the manic side of bp is addressed first (in my experience and from a bit of reading).
however, your lorazepam will hit harder: seroquel is metabolized by 3A4 (major) and (of course!) 2D6 (minor) , and almost all of the 1,4-benzodiazepines are substrates of 3A4, thus expect competitive binding (at least). the figure i have at hand is that the metabolism of lorazepam is reduced by 20% when taken with seroquel (Lexi-Comp's Drug Information Handbook, 12th Ed., 2004-2005, and not a bad resource). diazepam and clonazepam are also to be dose-adjusted.
my parting shot would be to add the selegiline gradually and decrease the lorazepam as the seroquel is titrated, should you go that route. there ought not be trouble with the benzo/AAP/MAOBI combo other than the 3A4 business with the benzo/AAP.....i see serotonin syndrome fingered if the MAOBI is used in high doses with amphetamine (among others). however, since the amphetamine is a metabolite of the AAP - and unfortunately the l isomer but no matter - i suspect that a qualified psychopharmacologist can set you right if you are not already there! best, chemist
Posted by cache-monkey on April 26, 2005, at 22:04:27
In reply to Re: Advice: Selegiline + (Depakote/Seroquel)? » cache-monkey, posted by chemist on April 26, 2005, at 2:20:34
<< hello there, me again...you and i read the same authors... >>
Hey chemist,
Not sure what you mean about reading the same authors. Is that re: the above bupropion thread?
<< i can comment on depakote and seroquel, as well as ativan: my very pleasant run with parnate years back does not quite address your concerns...if i were given your choices above, i would opt for (b), if only because depakote was - for me - a murky walk through muddy waters for a few weeks while my waistline steadily increased. >>
Luckily no waistline effects yet. Loss if anything. I attribute this to having gotten more dysphoric on the Depakote. Although today I had a brief brush with hypomania, so I actually think Depakote might be increasing my cycling. Is that possible? (I'll actually start another thread on it.)
<< i was dx bpII - this is off the table now, but who knows - and lithium was not an option due to climate and exercise not going with the therapeutic range indicated. >>
Yeah, Li ended up not working for me either. Largely because of preexisting dehydration issues.
<< seroquel is, as you likely know, a strange animal, with heavy sedation and histaminergic activity in the 25 to perhaps 100 mg range: when 200 mg and above are titrated, the sedation goes away for the most part and the manic side of bp is addressed first (in my experience and from a bit of reading). >>
A question about this: is this a dose related effect, so that there wouldn't be much sedation when starting at 200. Or does (rapid) titration to 200 basically indundate the H-1 receptors so that they rapidly adapt? (I actually asked this in another thread below: http://www.dr-bob.org/babble/20050423/msgs/490104.html If you have time, please feel free to answer there if you have any knowledge that might enlighten.)
<< however, your lorazepam will hit harder: seroquel is metabolized by 3A4 (major) and (of course!) 2D6 (minor) , and almost all of the 1,4-benzodiazepines are substrates of 3A4, thus expect competitive binding (at least). the figure i have at hand is that the metabolism of lorazepam is reduced by 20% when taken with seroquel (Lexi-Comp's Drug Information Handbook, 12th Ed., 2004-2005, and not a bad resource). diazepam and clonazepam are also to be dose-adjusted. >>
I didn't know that, even without enzyme inhibition, drugs could interact through competitive binding. Thanks for that info!
<< my parting shot would be to add the selegiline gradually and decrease the lorazepam as the seroquel is titrated, should you go that route. >>
My pdoc is a strict one-change-at-time guys, so I'll probably start with seroquel titration and then adjust the lorazepam accordingly. The finaly step will be selegiline, depending on how I'm feelin w/rt the whole smoking/anhedonia situation.
<< there ought not be trouble with the benzo/AAP/MAOBI combo other than the 3A4 business with the benzo/AAP.....i see serotonin syndrome fingered if the MAOBI is used in high doses with amphetamine (among others). however, since the amphetamine is a metabolite of the AAP - and unfortunately the l isomer but no matter - i suspect that a qualified psychopharmacologist can set you right if you are not already there! best, chemist >>
I didn't think amphetamine was a metabolite of the AAP, although I did know that would come from the selegiline. I will look more into that.
Your knowledge and advice is most appreciated!
Best,
cache-monkey
Posted by theo on April 27, 2005, at 22:44:45
In reply to Advice: Selegiline + (Depakote/Seroquel)?, posted by cache-monkey on April 26, 2005, at 0:41:02
What does Depakote seem to help with, anything?
Posted by cache-monkey on April 28, 2005, at 12:08:29
In reply to Re: Advice: Selegiline + (Depakote/Seroquel)? » cache-monkey, posted by theo on April 27, 2005, at 22:44:45
> What does Depakote seem to help with, anything?
Hard to say. I feel like, if anything I'm cycling a bit more than before going on it. Pre-Depakote I was basically on the down and depressed side the whole time. Now I feel like I'm getting slightly worse depression at times. And then I'll bounce into slightly racy hypomania...
This is the end of the thread.
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