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warning: Emsam + phenylalanine


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I know there are only a very few people on Emsam but:

So, there are a couple of studies that show that adding l or dl phenylalanine to selegiline (Emsam) can augment the antidepressant effect of selegiline. DON'T TRY IT. yes, I think it can work. I also think it can induce involuntary movements, life-threatening hypertension, and panic attacks. So, when on selegiline, phenylalanine is converted to phenylethylamine (the "love drug" in chocolate) it has amphetamine-like effects and primates will self-administer PEA like amphetamines. Its primary route of metabolism is to phenylacetic acid (harmless) but it can also be converted to tyramine (the "cheese reaction" chemical that causes hypertension and anxiety). Selegiline inhibits the enzyme that would normally turn it into phenylacetic acid such that PEA accumulates in brain.

My experience: felt super-awesome-high for a few days (like speed) then experienced complete insomnia, anorexia, and then developed loss of control over the movement of my arms, like I couldn't predict where they would wind up and they weren't mine any more. I think this is one step below dyskinesia. I felt like I had to concentrate to prevent them from flailing about and my limbs did twitch violently as I started to drift off to sleep. Then I developed cold hands and pins-and-needles as well as rapid heartbeat and panic attacks. It took several days for it to dissipate and I had to eat high protein meals every 4 hours to feel normal (other amino acids compete for transport into brain). About 20 minutes after eating eggs I would feel fine then 4-5 hours later I would get the whole set of symptoms all over again. It is difficult to convey how terrifying losing the control over the movement of your own limbs can be. There were a few times I almost tripped over myself while walking and I felt my arms were someone else's pieces of flesh stuck to my shoulders. It was really terrifying. And wondering what was going on with my blood pressure while having a panic attack; also not fun

Anywho, the studies looked solid and I don't doubt that there is therapeutic potential. DON'T go to GNC and buy a bottle and swallow a 500mg capsule. That's the purpose of this post.

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You shouldn't combine it with any MAO-I or drug that does serotonin reuptake inhibition without checking with your doc first.

l-phenylalanine is a precusor to l-tyrosine which is in turn converted to l-dopa and then to dopamine, norepenephrine and epenephrine.

It can be an OK anti-depreassant when taken by itself but it probobly shouldn't be in the same room as anyone who is bipolar. It's for sale in the crazystore.

http://www.pdrhealth.com/drug_info/nmdrugp.../lph_0201.shtml

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You shouldn't combine it with any MAO-I or drug that does serotonin reuptake inhibition without checking with your doc first.

Tyramine, the amino acid that causes the "cheese effect", like serotonin, is deaminated by MAO-A. SSRIs aren't part of that equation. The issue with supplementing with tyrosine or phenylalanine on an SSRI would be that you're working to increase the neurotransmitters associated with anxiety - which some people are taking SSRIs to avoid. Bipolar folks usually should avoid SSRIs, but for those that are on one, supplementing with either amino acid is probably a fast(er) route to mania.

l-phenylalanine is a precusor to l-tyrosine which is in turn converted to l-dopa and then to dopamine, norepenephrine and epenephrine.

And it is norepinephrine, NOT tyramine, that is the primary neurotransmitter associated with the "flight or flight" mental reactions - anxiety, elevated blood pressure, and especially panic attacks. Norepinephrine is a substrate for both MAO-A and MAO-B, so any MAOI should raise NE levels. Dopamine, NOT tyramine, is associated with some very nasty dyskinesias. Excess dopamine can play hell with controlling voluntary motion: easy to start movement, not so easy to stop it.

It should be remembered that the dreaded "cheese effect" is caused by tyramine IN WHAT THE PERSON EATS. Normally there is sufficient MAO-A produced in the gut to deaminate tyramine before it can enter the bloodstream and jack up blood pressure. MAOIs that inhibit MAO-A (including ORAL selegiline, and primarily only above a certain dose) block that action, endangering persons who aren't careful about what they eat (this includes knowing which foods actually have "excess" tyramine in them)

Assuming bxt227us isn't chewing on the Emsam patch, selegiline from that source goes straight through the skin into the bloodstream and bypassing the gut. Tyramine just isn't part of the problem. The lack of motor control reported should sound familiar to anyone acquainted with what excess l-dopa (intermediates between tyrosine and dopamine) can do to a person. The anxiety/shocky symptoms match norepinephrine in excess.

The moral of the text that most people just skipped over, is that bxt227us's second paragraph explains what can happen to an Emsam user on an adequate-protein diet who supplements with dopamine precursors. It's just not needed if you are getting enough complete protein in the diet.

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Hello All;

I find this thread very interesting. Unfortunately, I am not as cerebral as the learned people who have posted this truly enlightening info...however, I am kind and forgiving so don't totally ignore me, OK? My questions: (I am preparing myself to be blasted with, "Duh...can't you read???")

Will taking a small or moderate dose of L-Phenylalaniine or DL-Phenylalanine (OTC Capsul or tablet) while on the Emsam Patch be likely to increase one's feelings of general well being? Could it better enable you to get to and do your job? Will it motivate you more to accomplish tasks that pile up to nightmare proportions, or better enable you to keep yourself & your abode tidy and hygenic, or increase your energy level closer to the lowest of acceptable levels? May such an addition, in your opinions, give a very, very long time Chronic Unipolar Major Depressive a last chance at a life before it is too late?

Thank You in advance to any who are kind and generous to reply with your opinions. Please know all replies will be very much appreciated.

Following is a short Bio to better equip you to help me and answer any questions. PM me if you prefer. Discretion is assured.

Emsam Patch is my last AD med left to try and I am almost 2 weeks in.

I have never been manic, I do not hear voices, I have tried all available SSRI's, Tryciclic's (sp), MAOI Med's over and over and in countless combinations over a lifetime w/ no positive effect on TRMD.

I have always had low Blood Pressure to the point that a couple of my Dr's suggested I eat more salt.

I have Low to Moderate Hypothyroidism.

I suffer from Severe Insomnia at night and have been unable to fall asleep since childhood.

I have been tested twice over the last 9 years for ADD and am dianosed as having Adult ADD nonattentive, non-hyper type, only.

I do not now, nor have I ever used Alcohol, Recreational Drugs, or Smoked Cigarretts.

Sincerely; scp

PS...If I sound pathetic to you, I wholeheartedly agree. Please take my question seriously and know that I am receptive, peaceful and trying to attain a life worth saving. My Dr has only one last suggestion for me if Emsam fails to work: Lamictal; to be taken alone, or added to Emsam if there is any even slight improvement from it. Lastly; I have a tendancy to be reclusive due to depression and severe lack of energy and motivation.

Sorry this is so long and contains so many questions.

BTW...The fact I am even able to ask these questions and put forth this much effort to post this leads me to hope that for the first time ever I may be experiencing a slight, but positive response to an Anti Depressant Med. The Emsam Patch, Day 13, at 6mg; is the only Med. I'm taking now.

Usually I take a small dose of Thyroid, & something for sleep (which I still badly need), but I stopped all other AD 's & meds for 4 months before starting Emsam to find a new DR for a last ditch effort to save my life.

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A feeling of well being might be a bit much to ask. They'd find a way to ban it if it actually did that.

Take a look here for more info. For sure talk to your doc before you try it.

If you haven't tried the old school MAO-Is or ECT, you've got plenty of stuff left to try.

Take a look here for more info

http://www.pdrhealth.com/drug_info/nmdrugp.../lph_0201.shtml

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Will taking a small or moderate dose of L-Phenylalanine or DL-Phenylalanine (OTC Capsul or tablet) while on the Emsam Patch be likely to increase one's feelings of general well being? Could it better enable you to get to and do your job? Will it motivate you more to accomplish tasks that pile up to nightmare proportions, or better enable you to keep yourself & your abode tidy and hygenic, or increase your energy level closer to the lowest of acceptable levels? May such an addition, in your opinions, give a very, very long time Chronic Unipolar Major Depressive a last chance at a life before it is too late?

Might as well get whichever is cheapest, as the point is to get it converted to other chemicals. Bear in mind that you can get the same amino acids from lean meat and some protein supplements. The key is that it's easy to take an amino acid pill well before a meal so that there's less competition for absorption from more agile aminos.

I have never been manic, I do not hear voices, I have tried all available SSRI's, Tricyclic's (sp), MAOI Med's over and over and in countless combinations over a lifetime w/ no positive effect on TRMD.

You can't have done all the possible combinations, as some are a bit on the dangerous and/or counterproductive side.

If you do have ADD, even inattentive, one thing that could be added would be a stimulant, to see if neurotransmitter

release is part of the problem. Stimulants can increase the effect of activating ADs like Wellbutrin, Cymbalta, Vivactil,

Norpramin, and even the MAOIs. However, there can be such a thing as too much synergy!

I have always had low Blood Pressure to the point that a couple of my Dr's suggested I eat more salt.

I have Low to Moderate Hypothyroidism.

Low thyroid can really screw a person's head. There's a possibility that you may still need a higher dose,

or even need to switch to a T3/T4 prep.

I suffer from Severe Insomnia at night and have been unable to fall asleep since childhood.

That was one thing I never had to worry about while on Wellbutrin... The question is WHY you aren't sleeping.

There are so many causes for insomnia, and it really interferes with antidepressant function. That would be something

to get resolved.

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A feeling of well being might be a bit much to ask. They'd find a way to ban it if it actually did that.

Take a look here for more info. For sure talk to your doc before you try it.

If you haven't tried the old school MAO-Is or ECT, you've got plenty of stuff left to try.

Take a look here for more info

http://www.pdrhealth.com/drug_info/nmdrugp.../lph_0201.shtml

Thank You for your reply, Velvet Elvis. I am very well aquainted with traditional MAOI's and have dedicated over 6 years to Parnate and Nardil taking them in all different prescribed combinations with and w/o other meds.

I have been evaluated by Three ECT Specialists over the last several decades while searching for relief from Major Unipolar Depression. Each time I have been told that I was not a canidate for ECT. My last ECT evaluation was less than one month ago.

scp

PS...I like your name.

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Dear null0trooper;

Thank You for your kind and thoughtful answer to my questions. Your information is always helpful.

I have done the T3/T4 treatment and only stopped after inccurring several fractures is a period of 3 years. Seems Anti Depressant meds taken constantly over a lifetime not only deplete you financially and cause you to feel continuously sick from the S/E's, they also cause severe brittle bones in women pre-disposed to Osteopororsis. This is now documented; btw. Too late for me, but hopefully not for other's.

I do plan to restart my Thyroid Therapy as soon as my most recent fracture completely heals.

While I have been prescribed many, many, med combinations, (all counter productive, BTW), I am sure you are correct in saying that I have not been prescribed all the AD med combinations possible. I admit that I have no experience at all w/ Mood Stablizers or the

Anti Psychotic Meds.

When you said that the amino acid med would be cheaper than an Rx, you read my mind. You see...I may be having a positive reaction w/ Emsam, which is so exciting as this is my first positive effect ever from any AD Med. It is only a slight increase in energy thus far, so I am trying to keep that in perspective. The high price I am paying for the Emsam patch has not escaped me, nor has the fact that my medical insurance does not cover it. The sentence "If this works...how long will I be able to afford it???" has been richochetting around inside my brain since yesterday when I first felt the slight bit of improvement.

That is why I am entertaining idea of asking my Dr to prescribe the higher dose patches, then cutting those patches into pieces and possibly augumenting them w/ with Phenylalaline to try to stretch the supply of Emsam Patches. Thus all my questions.

Before any one suggests I ask/tell my Dr about the above plan to be able to afford the Emsam, don't worry... that is a given. I need the Dr to write the Rx. I do find, however that I must come up with the ideas to make things work as most Dr's are too busy to go the extra mile. If I did not advocate for myself I would still be back in the dark ages on Imipramine or Tofanil, which never worked, yet I took by themselves, in combination, and every other way, for many years while waiting for the first SSRI 'wonder pill' Prozac, to be availble to end my pain. I called the FDA monthly to check the progress for over 2 years! Trust me, it was not a small letdown to have nothing positive happen after taking it for over 6 months that first time.

Snce that first time I have been talked into trying Prozac 3 more times, although not in the last 10 years. I was hopeful then...but I am not that stupid any more. Hope no longer springs eternal for me.

I have wanted to try EMSAM Patch since the day it became available. Look how long it took to get a Dr to prescribe it...and it's only b/c I changed to a new Dr that I finally got the prescription. BTW...the new DR didn't want to prescribe it either b/c he had NO experience with it. I told him we'd learn together. It was the only AD med left I had not tried, and I am not going to leave any stone unturned..

Depression will be the death of me, I have no doubt. But I am determined to die trying.

scp

thank's for trying to help...You did!

Will taking a small or moderate dose of L-Phenylalanine or DL-Phenylalanine (OTC Capsul or tablet) while on the Emsam Patch be likely to increase one's feelings of general well being? Could it better enable you to get to and do your job? Will it motivate you more to accomplish tasks that pile up to nightmare proportions, or better enable you to keep yourself & your abode tidy and hygenic, or increase your energy level closer to the lowest of acceptable levels? May such an addition, in your opinions, give a very, very long time Chronic Unipolar Major Depressive a last chance at a life before it is too late?

Might as well get whichever is cheapest, as the point is to get it converted to other chemicals. Bear in mind that you can get the same amino acids from lean meat and some protein supplements. The key is that it's easy to take an amino acid pill well before a meal so that there's less competition for absorption from more agile aminos.

I have never been manic, I do not hear voices, I have tried all available SSRI's, Tricyclic's (sp), MAOI Med's over and over and in countless combinations over a lifetime w/ no positive effect on TRMD.

You can't have done all the possible combinations, as some are a bit on the dangerous and/or counterproductive side.

If you do have ADD, even inattentive, one thing that could be added would be a stimulant, to see if neurotransmitter

release is part of the problem. Stimulants can increase the effect of activating ADs like Wellbutrin, Cymbalta, Vivactil,

Norpramin, and even the MAOIs. However, there can be such a thing as too much synergy!

I have always had low Blood Pressure to the point that a couple of my Dr's suggested I eat more salt.

I have Low to Moderate Hypothyroidism.

Low thyroid can really screw a person's head. There's a possibility that you may still need a higher dose,

or even need to switch to a T3/T4 prep.

I suffer from Severe Insomnia at night and have been unable to fall asleep since childhood.

That was one thing I never had to worry about while on Wellbutrin... The question is WHY you aren't sleeping.

There are so many causes for insomnia, and it really interferes with antidepressant function. That would be something

to get resolved.

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When you said that the amino acid med would be cheaper than an Rx, you read my mind.

Actually, I meant pick the cheapest among l-phenylalanine and d,l-phenylalanine sources available. Either one may help on the supply end of the neurotransmitter pipeline. The Emsam does its work on the drain end - preventing the cells from trashing the molecules made. Between the two, turning up the taps and blocking the drain usually allows a tub to fill.

What the brain-in-its-tub gets filled with, and what happens if the juice is too hot, too cold, or it overflows ... that's another matter altogether!

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  • 2 weeks later...

Update (I think Nullo got it right). So I took my blood pressure many, many times and it never broke 119/73, 140 BPM, and that was during a panic attack (I had many during the last several days but am not usually prone to them) So for 5 days after the last dose I had muscle rigidity: when I contracted a muscle it took an extra second or two uncontract and I felt like I had to concentrate to get my hands where I wanted them; I felt like they weren't my hands any more. I also had spasms when I tried to sleep. Then on day 5 I felt better and I took a mere 125mg and the same symptoms came back! I have read that phenylethylamine can cause dopamine depletion; my best guess is that is what has happened and I am yet to fully recover. Let me restate that for several days I felt like I was on amphetamine (I was taking 1g/day) I was so, SO SO! HIGH, but BP was fine. I stopped eating and sleeping but BP was still ok. That's why I now think effects were due to PEA, not tyramine. PEA also increases norepinephrine, which, especially in the absence of euphoria, produces panic. I think it's risky. If you must try it, don't exceed 100mg and know that other large, neutral amino acids should be able to compete pretty well for transport into brain. So if you don't have any leucine capsules lying around, eggs work best to reduce the effect; in my experience, the reduction in symptoms was dramatic and lasted about 4 hours post meal.. I feel like a hypocrite suggesting that phenylalanine supplementation is a high-risk, dangerous endeavor. I'm going to wait 30 days and start all over again. I will keep good records of BP/heart rate/symptoms, start at a low dose, and see what happens. It's amazing the risks you'll take when between a rock and hard place. Is there somewhere between here and rip-roaring high? Do I care anymore? For a few days I thought, "I've found a sustainable high ;) " the whole time knowing that something would go wrong. One funny thing: I never did "crash" like I used to on amphetamine. Of all the fucked up ways I felt, depressed was not one of them. Did you know that the "love drug" (PEA) can produce stereotyped behavior and prepulse inhibition defects in mice? It has been suggested to induce an animal model of schizophrenia. Fun times.

If anyone does try it, please be careful and please post.

Oh, one more thing: do NOT NOT NOT combine Emsam, phenylalanine and antipsychotics of any kind. There is a very high risk of neuroleptic malignant syndrome.

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on a related note, Null or anyone else there - are there types of foods to avoid, to avoid getting too much phyenylalanine or tyrosine? after reading these posts i've pretty much decided to cut out diet sodas - but i'm wondering if there's other ways to reduce my norepinephrine levels on a dietary level. i know turkey has tryptophan, and that's good, but i was wondering if there were other ways of tipping the balance away from stress hormones - but without depleting dopamine too much, or going all serotonin.

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on a related note, Null or anyone else there - are there types of foods to avoid, to avoid getting too much phenylalanine or tyrosine? after reading these posts i've pretty much decided to cut out diet sodas - but i'm wondering if there's other ways to reduce my norepinephrine levels on a dietary level. i know turkey has tryptophan, and that's good, but i was wondering if there were other ways of tipping the balance away from stress hormones - but without depleting dopamine too much, or going all serotonin.

You could look at the vast diet restrictions for phenylketonuria as a starter. Most of what you'll find online is a result of people looking to increase tryptophan and serotonin/melatonin as a diet change for MI.

For supplements, hemp protein seems to fit a more more pro-tyrosine/phenylalanine balance than soy protein. (Don't ask about whey, I cannot tolerate milk products without a lot of chemical help, so I've had no reason to research it) Or, if it's important enough to you, evaluate your weekly diet to see if you could fit in more protein at the expense of non-fiber carbs - consider fish for the EFAs.

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