8 replies to this topic

[floweryriddle]

Hi Longecity, 

 

I am on the long journey to understand and find a solution for the my mental conditions. I have a post on fighting ADHD induced lack of motivation (https://www.longecit...on/#entry857707) but the more I read and learn about ADHD and my symptoms, the more I am starting to think that it might be better to try something that is tackling depression more directly instead of just ADHD symptoms. 

 

One group of medication that caught my attention were MAOIs. Things like Parnate seem to help with ADHD on a similar scale than Methylphenidate, but also tackle depression that often go hand in hand with ADHD, and even help with other conditions like rejection sensitive dysphoria (https://www.additude...alongside-adhd/). So yeah, things seem almost too good to be true. Just, the hoard of interactions and dietary restrictions that come with MAOIs is stopping me from giving it a fair try. 

 

Then I learned about RIMAs like Moclobermide and Pirlindole. Similar effects, far less risks and interactions. But there seems to be the argument whether MAOIs / RIMAs are even still necessary when SSRIs / SNRIs are already able to do most things these do. 

 

My question, does anyone here have some insights/opinions on RIMAs vs SSRIs for depression + ADHD symptoms like I stated above and can help me with making a informed decision which direction to go? 

 

 

Also if I were to start a RIMA, is Methylphenidate completely out of the question? ("Combining Stimulants and Monoamine Oxidase Inhibitors: A Reexamination of the Literature and a Report of a New Treatment Combination" - https://www.ncbi.nlm...es/PMC4805402/)

 

 

 

[cat-nips]

I don't think SSRIs will help with ADHD symptoms.  If you are staying with MPH then maybe SSRI treatment would be something to look into, but it's troublesome and hard to find that right balance between the two.  

 

Moclobemide is not approved in the US and I have no insight on it. I am curious, though. I eat a ton of kimchee on a daily basis and have never considered MAOIs because of the dietary restrictions, but have heard that they are effective. Moclobemide doesn't have those restrictions.  

 

The link is broken so I'm not sure what the paper said, but traditional MAOIs are RARELY or generally not prescribed concomitantly with stimulant ADHD meds because I think it greatly increases risk of serotonin syndrome and the MAOi activity will cause levels of other neurotransmitters to build up and/or fluctuate too wildly, potentially causing toxic consequences.  I could be wrong on that as it's been awhile since I checked.  I would think that RIMAs might do the same and it would be safest to either choose one or the other RIMA / MPH..  

 

Sorry, not too helpful. Just wanted to be supportive.   Please be careful especially if you're not doing this under medical supervision. 

[Hip]

This paper looks at the rates of sexual dysfunction reported in different antidepressants.
 
Table 1 shows SSRIs and SNRIs come out as the drugs most frequently associated with sexual dysfunction, with rates of sexual dysfunction up to 70%. By comparison, TCAs are at 30% and MAOIs at 40%.
 
But one MAOI drug, moclobemide, had a particularly low rate of just 3.9%.
 
So from the perspective of avoiding these sexual dysfunction side effects (which are often permanent and do not clear up when stopping the antidepressant), moclobemide seems like a good choice. Unfortunately it is not available in the US, although you should be able to import it using prescription-free online pharmacies.

 

When moclobemide first came out, it worked very well as was expected to become a blockbuster seller in the antidepressant market. But unfortunately SSRIs were then brought out, and dominated the market, and moclobemide fell out of the limelight.

 

See post-SSRI sexual dysfunction for more info on this permanent side effect of SSRIs etc.

 

 

As well as permanent sexual dysfunction, SSRI antidepressants can also cause permanent emotional blunting, where emotional responses become weak (called blunted affect by psychologists). 

Edited by Hip, 15 September 2018 - 01:35 AM.

[cat-nips]

Thanks for the info! It does seem like a better option for monotherapy at least in comparison to SSRI. I would think that taking with Methylphenidate might be problematic though. Please correct if that's not accurate.  

[Hip]

Yes there does appear to be an interaction (increased risk of a hypertensive crisis) between methylphenidate and moclobemide. Various moclobemide drug interactions given here.

[floweryriddle]

Yes there does appear to be an interaction (increased risk of a hypertensive crisis) between methylphenidate and moclobemide. Various moclobemide drug interactions given here.

 

That link is giving me a 404 page

 

But it seems like for what I want moclobemide might be the better choice. A very interesting substance indeed

 

For Methylphenidate, there was this paper here (https://www.ncbi.nlm...les/PMC4805402/) that looked at combining MPH + MAOI.

Then this post here adding some more comments - https://psychotropic...cns-stimulants/

[cat-nips]

Thanks for the data.  The first paper was a case study of one person that had combination therapy with Emsam (the selegeline skin patch, which is different from traditional MAOIs), and used in combination with lisdexamphetamine, or Vyvanse, not Methylphenidate.  

 

Second link and stated that methylphenidate is safer with MAOIs, and amphetamine are not, which is in opposition to the first study.  The opinion presented in the second site is interesting, and there may be truth there, but it's not conclusive enough to bet your brain or your life on and hasn't been tested on large populations of people to know if it's effective and/or has a safety margin that makes it acceptable for your situation.  Maybe after you've been on these medications for awhile and you know how you react to them in nearly every situation and with every combination in your life at varying dosages, and there isn't something else that is effective, then maybe a really low dosage of Moclobemide in combination with MPH, and constantly monitoring your blood pressure and heart rate and staying aware of any potential side effects that could arise and how to account for that.  

 

Low dose Moclobemide and Selegine, seem to be the safer of the options of the MAOIs to use with Methylphenidate, but you're walking in unchartered territory here, and maybe I'm being paranoid, but being that you're just starting your journey, I would think that you should avoid potentially hazardous combinations as a potential mistake made here could lead to a consequence of death, and it's just not worth all that.  Please do this under medical supervision if you're seriously considering it.  I'm not fear-mongering here and maybe it is just paranoia, but would you be ready to take a trip to the ER in hypertensive crisis or serotonin syndrome or cerebral hemorrhage and having to explain to the doctors that it was from combining an unsupervised and contraindicated treatment that you got from the internet?

 

Just my 2 cents. Maybe there are other opinions.  Best of luck finding a solution.  

 

 

 

[Finn]

In European countries where moclobemide is available, methylphenidate product leaflets usually specify that only the older non-selective irreversible MAOIs are contraindicated 

 

This one from UK, Finnish leaflets are similar

 

https://www.medicine...roduct/314/smpc

4.3 Contraindications

--

 • During treatment with non-selective, irreversible monoamine oxidase (MAO) inhibitors, or within a minimum of 14 days of discontinuing those drugs, due to the risk of hypertensive crisis (see section 4.5)

 

 

 

[floweryriddle]

I talked with my doctor today to check with him about his opinion on MAOIs for ADHD but his stance was more of to just stay away from MAOIs in general so that wasn't really helpful. It also looks like RIMAs aren't available where I live (Japan) so it might be a bit hard to find a doctor who would be willing to give it a try with constant monitoring. That's a shame. 

 

On the other hand, there was this post here (https://www.reddit.c..._as_ritalin_in/) on reddit a few days ago, talking about Selegiline for ADHD. Some people in the comment talk about dosaging, experiences, Moclobemide and taking Selegiline in low dosages alongside Methylphenidate, which seemed to be what I wanted. 

 

But people also pointed out some contradictions in the study like 

 

 

As someone who has used Selegiline before Methylphenidate, and someone who uses Selegiline with Methylphenidate i was curious about that conclusion, so i went on to see the dosages.

"Selegiline - starting with 5mg/day to a maximum of 15mg/day."

"Methylphenidate - starting with 10mg/day to a maximum of 40mg/day."

That kind of negates the study itself imo.

Selegiline on 5mg/d is selective for MAO-B, on 15mg/d is like a different substance because it goes to MAO-A too.

Methylphenidate in the 40mg/d range, on a adult 8 week perspective, is on the low side for a lot of people.

So, what Selegiline is as effective as Methylphenidate? The one who inhibits MAO-B, or the one who inhibits both? 

Then you have the low sample and the study ends up not saying much.

Anyway, that's just my experience and opinion, good post.

 

What do you guys think about that?