Q: Deprenyl (Selegiline) for BP/ADD Issues?
Dear Dr. Phelps:
I've been a fairly high functioning adult having been treated for years with
antidepressant and stimulants (ADD). Two years ago at age 50 I had a nasty
bipolar mixed episode, first with mania then deep depression that lasted a year
and a half. I did a pretty good job of ruining my reputation and career during
that time. I was then diagnosed with bp. I'm taking trileptal, lamictal,
lithium and dexedrine currently and have slowly pulled out of the bad spot I was
in and was able to go back to work recently. The dexedrine is prescribed for
depression, ADD and lethargy.
I have taken deprenyl in the past for ADD and it worked well. Curious about
about your thoughts and if you are aware of any studies using low dose deprenyl
(5 mgs) with several mood stabilizers for the BP/ADD issues. The Dexedrine has
a tendency of making me a little nervous where the deprenyl never has.
Notes: Father bp 1 and had Parkinson's. Again diagnosed late in life.
Dear John --
For other readers: Deprenyl is selegiline, a unique form of an MAOI (monoamine
oxidase inhibitor, an antidepressant). It is also used in Parkinson's disease.
Let's see, where to start. First of all, glad to hear that you are able to get
back to work, which hopefully means things are substantially improved. That also
means something is working right, or in the right direction anyway.
Based only on the information you have sent, it seems to me that one of the
questions is: "what is it that's working?" If I follow you, you had
antidepressants and stimulants without Trileptal Lamictal and lithium; but you
have not had those latter three without a stimulant. You will think I'm crazy,
you will think I'm ignoring the problem with ADD. But since there is tremendous
overlap between ADD and bipolar symptoms; since at least in the United States it
is generally regarded as routine to treat bipolar disorder first, using mood
stabilizers; and since you have not had that treatment approach yet; at some
point you might want to talk with your doctor about a trial off of stimulants
entirely. Sometimes they can cause an agitation which interferes with
concentration, such that people improve when they are tapered off. This presumes
that the "ADD" you originally treated may have been a component of bipolar
disorder. Obviously that may not be the case: it is quite common to have both
conditions. To the extent that they are separate, another long story.
As for your question: there is some evidence that MAOI antidepressants may be
the least destabilizing antidepressant approach. The other candidate for that
claim is bupropion (formerly Wellbutrin, now generic). Many psychiatrists would
be comfortable giving you an antidepressant with the mood stabilizers you now
have on board, although I still worry about that myself. Interesting that the
Deprenyl helped with ADD symptoms. Perhaps Wellbutrin would be another candidate
for that role if Deprenyl did not work out. (No data on Deprenyl to my
knowledge. I searched selegiline bipolar disorder on
Pub Med and found
Good luck with the process --
Published December, 2007