High-dose selegiline in treatment-resistant
older depressive patients
by
Sunderland T, Cohen RM, Molchan S, Lawlor BA, Mellow AM,
Newhouse PA, Tariot PN, Mueller EA, Murphy DL
Section on Geriatric Psychiatry,
National Institute of Mental Health,
Bethesda, Md.
Arch Gen Psychiatry 1994 Aug; 51(8):607-15

ABSTRACT

BACKGROUND: We examined the effect of high-dose selegiline in 16 treatment-resistant older depressive patients. We hypothesized that selegiline, at a dosage of 60 mg/d, would be at least partially effective but that the higher doses would not maintain the monoamine oxidase B selectivity observed with the lower doses of selegiline. METHODS: Sixteen treatment-resistant subjects (mean [+/- SD] age, 65.6 +/- 9.3 years) entered a double-blind, randomized, crossover study of placebo vs 3 weeks of selegiline at a dosage of 60 mg/d. Objective measures of mood and behavior were obtained in all subjects, and 10 of the subjects underwent repeated lumbar punctures for analysis of monoamine metabolites in the cerebrospinal fluid. RESULTS: Objective measures of mood and behavior revealed significant improvement in the Hamilton Depression Rating Scale score (37.4% decrease), the Global Depression score (22.7% decrease), and the Brief Psychiatric Rating Scale score (19.3% decrease); subjective behavioral measures, however, did not show significant improvement during the 3-week medication trial. Cerebrospinal fluid values revealed a statistically significant drop in 3-methoxy-4-hydroxyphenylglycol (51%) and 5-hydroxyindoleacetic acid (17%) levels, and there was a significant lowering of systolic blood pressure on standing (15%), but these changes were not accompanied by clinical side effects. CONCLUSIONS: Our results suggest that high-dose selegiline can be an effective antidepressant in treatment-resistant older depressive patients. While the selegiline dose required has nonselective monoamine oxidase effects and thus would not be free of possible tyramine interactions, other advantages suggest that further investigations with selegiline are warranted in this population.

High-dosage
Antidepressant
Phenylethylamine
Antioxidant dosage
Atypical depressives
Long-term high-dosage
Selegiline plus phenylalanine
Selegiline and life-expectancy
Selegiline for longer-lived flies
Selegiline as an immunostimulant
Selegiline for cocaine-dependence
Selegiline and Parkinson's disease
Selegiline, NO and Alzheimer's disease
Transdermal selegiline as an antidepressant
Somerset's new transdermal selegiline patch

Refs
HOME
HedWeb
Future Opioids
BLTC Research
Paradise-Engineering
Utopian Pharmacology
The Hedonistic Imperative
When Is It Best To Take Crack Cocaine?