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.

Thank you,
John
 

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 nothing).

Good luck with the process --
Dr. Phelps