3 replies to this topic

[Urizen]

Hi there everyone,

 

First, some background information;

 

I've suffered from chronic fatigue and treatment-resistant depression for approximately the last fifteen years, with the severity of the former increasing exponentially following a six month bacterial labyrinthitis infection in 2005 which eventually left me partially housebound/bedbound. 

 

In 2010, I began an unsuccessful three year trial of numerous anti-depressants of the SSRI/SSNRI classes. No beneficial effects were observed - the severity of the fatigue was paradoxically exacerbated in most cases.

 

Based on my poor response to serotonergic anti-depressants, I felt it may be worthwhile to approach the issue from another angle, and decided to begin a short trial of dopaminergic agents.

 

I started selegiline in early August, at a dose of 5mg taken orally on alternating days, so as to ensure against irreversible MAO-B inhibition. The results were encouraging, with a sustained, light/moderate anti-depressant effect observed with no discernible side effects. However, selegiline had no appreciable impact on the fatigue - which is the primary issue - and I became interested in the anecdotal potentiality of combining selegiline with stimulants.

 

Before I continue - although this trial has progressed without incident, in hindsight, I would have felt much more comfortable had I conducted more research beforehand. I understand that this particular combination can be extremely dangerous (due to the possibility of hypertensive crisis, etc), and that it should only be undertaken under strict medical supervision, or by an individual highly versed in the properties/mechanisms of these substances - if at all.

 

Approximately five weeks into my alternating selegiline regimen - maintaining the same dose - I began to incorporate daily 15mg methylphenidate (Ritalin IR), with the following dosage regimen;

 

• Morning; 5mg
• 11am; 2.5mg
• 1pm; 2.5mg
• 3pm; 2.5mg
• 6pm; 2.5mg

 

I found this provided a controllable, sustained effect that encompassed the entire day. 

 

The results were (I don't use this word lightly) profound. Days 3 - 5 in particular, especially so. For the first time in close to a decade, I felt like I not only had the minimum requisite energy to complete basic daily tasks, but a surplus of energy that gave me the freedom to choose how to spend my time, rather than my illness dictating what I could and couldn't achieve. 

 

Of course, it was not to last - this was classic "honeymoon period" stimulant-induced euphoria that is often spoken of.

 

By day 7, the miraculous motivational effect had all but disappeared, along with a significant percentage of the stimulant effect. I unsuccessfully tried to resist the urge to increase the dosage of methylphenidate, adding an additional 2.5mg on day 8, and a further 2.5mg on day 10.

 

Today, I experienced some mild nausea/disorientation/headache, along with mild (non-productive) restlessness. My gut feeling is that if I continue to increase the dose of methylphenidate, I will only compound these negative side-effects, while the positive effects will continue to diminish. 

 

* * *

 

• Question 1;

 

What part did the selegiline play in the beneficial results observed on days 1 - 5? Did it potentiate the methylphenidate, and would such results have been achievable at the same dose, without the selegiline?

 

• Question 2;

 

I've read anecdotal reports that selegiline may inhibit some of the properties of stimulants, while enhancing others. Therefore, would it be worthwhile to taper off both, followed by a 1 - 2 week washout period to allow MAO-B to return to baseline, and then recommence the methylphenidate in isolation? 

 

• Question 3;

 

Or, taking the above into account, should I continue the methylphenidate, while simultaneously tapering off the selegiline?

 

• Question 4;

 

If so, what is the safest method for discontinuing selegiline, taking my current dosage regimen (5mg, every other day) into account?

 

* * *

 

I appreciate you taking the time to read this - and once again, I am extremely thankful that my lack of diligent initial research has not had any major consequences. 

 

Are there any routes for progression here? Methylphenidate is the first effective treatment I've encountered for my illness, and those early results were extremely promising. What does this response indicate, and what options are open to me?

 

 

Many thanks,

 

- Urizen

[jack black]

i don't have answers for you question but i do know deplin/methyfolate is used to treatment resistant depression. It's worth a shot, together with good sublingual hydroxy B12, and also B complex, C, D, and E.

[Urizen]

Hi there Jack, many thanks for your reply.

 

Although I - thankfully - don't fit the profile for CFS/ME (I lack the hallmark symptom of post-extertional malaise, amongst others) I have been a frequent visitor to the Phoenix Rising CFS/ME forum for several years now. A user on that forum created an experimental treatment "protocol" based around megadoses of methyfolate and sublingual methylcobalamin (methyl B12)/adrenosylcobalamin (adreno B12), alongside a comprehensive vitamin supplementation regimen (everything you outlined in your post, and more).

 

His theory, revolves around the methylation cycle, and how a breakdown or "block" within this cycle may be an underlying factor in CFS/ME, and chronic fatigue in general. 

 

I did a three month trial of the full methylation protocol in 2013 - as well as numerous "stripped down" variants of the protocol - with no observable beneficial results. It should be emphasized, that I evaluated many, many non-pharmaceutical options such as this over the course of the last fifteen years - and didn't "jump in at the deep end" with an aggressive treatment plan like the one outlined in my first post. Incidentally, before beginning selegiline/methylphenidate, by far the most effective treatment, of the multitude I've tried over the years, was diet and exercise!

 

- Urizen

Edited by Urizen, 20 September 2016 - 04:23 PM.

[jack black]

i see you have the basis covered. how did it start in the first place? infection, brain trauma, chemoradiation, toxicity? any medical issues? what are your testosterone, adrenal hormones, TSH, HgbA1c, ESR, CRP, CBC numbers?  how about gluten sensitivity, lactose intolerance, sleep apnea, etc?

 

to my untrained eye, looks like downregulation of dopamine receptors. there was a post here about benefits of low dose metampetamine course (the legal prescription one) to reset dopaminergic system. do a search and you should find one or something similar.

Edited by jack black, 21 September 2016 - 12:47 AM.