5 replies to this topic

[Mixter]

As this has been discussed too often here lately...

Hypertensive Crisis: http://www.mayoclini...-crisis/AN00626

and such symptoms it may also occur on stopping the medication.

Don't do this. Treating severe ADHD and other conditions != nootropics,
even though they might help you. Please don't post such suggestions or other
questions on the nootropics forum as other people here might try them out.

If you're under prescription and know what you're doing, please inform
your physician. Either he'll help you implement it, or if it is too dangerous,
he'll see you're desperate for better treatment and hopefully offer you a
better alternative. If not, just switch docs, don't experiment.

[Duke]

Contingent on the stimulant and the type of MAOI, but ok.

[Duke]

blame the slow site, not me.

Edited by Duke, 21 January 2009 - 08:55 AM.

[bgwithadd]

And for god's sake don't do anything I do. I'm a trained brain clown.

Or if you must, do it because you have serious, otherwise unmanageable problems and do it all CAREFULLY. One new herb or supplement at a time, and a careful eye on your blood pressure, liver, and bleed potential. Not because it sounds cooler to say you take deprenyl and ritalin when you study than a redbull. If you're normal, caffeine is more than enough. If I took as much as I need to concentrate every day I'd be bouncing off the walls in mania. I know because when I did I was.

[yoyo]

MAOI + stim is one of the best treatments for depression. I have no idea why this topic exists, especially since i'm guessing you mean selegiline+modafinil, which isn't even going to cause hypertensive crisis no matter what. i take parnate and adrafinil, btw. i should admit that i'm posting from a dark corner of hell.

[NickCage]

Methylphenidate
Methylphenidate and MAOIs have been in use together for 40 years, so it would be surprising if someone had not ingested the combination by now: death, or morbidity, from such an event has not been reported (whereas it has with amphetamine). Methylphenidate is most widely used as a treatment for attention-deficit hyperactivity disorder (ADH) in children. It has been supposed to have serotonergic effects; if that is so it would be predicted to be at high risk of precipitating serotonin toxicity if combined with MAOIs. There are no definite case reports indicating serotonin toxicity with methylphenidate in combination with MAOIs, or other serotonergic drugs (see above) [17-20].

Also, as with mirtazapine and amitriptyline, methylphenidate does not produce serotonergic side effects, or signs of serotonergic toxicity in over-dose or if combined with MAOIs (see Markowitz). Eg the Sherman case was not serotonin toxicity, but blood pressure elevation [21-28].

These observations of serotonergic side effects, and signs of serotonergic toxicity in over-dose, or if combined with MAOIs, have been proposed as a measure of a drugs clinically significant serotonergic effect in humans. If these effects are not produced clinically significant serotonergic effects are unlikely. [29-32].

Methylphenidate also appears safe in combination with MAOIs; see Feinberg's recent and helpful review of MAOIs and CNS stimulants.[1-33-35].

http://www.psychotro...ith_MAOIs.shtml

uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI.

http://www.biopsychi...m/maoi-stim.htm

We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard
antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patient

J Clin Psychopharmacol. 1991 Apr;11(2):127-32. CNS stimulant potentiation of monoamine oxidase inhibitors in
treatment-refractory depression.

Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.

Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center,
Chicago,
Illinois

PMID: 2056139 [PubMed - indexed for MEDLINE]

Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative
therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.

J Clin Psychiatry. 1985 Jun;46(6):206-9. Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.

Feighner JP, Herbstein J, Damlouji N.

PMID: 3997787 [PubMed - indexed for MEDLINE]