A lot that I'll break down in each reply.
Thanks so much for the reply! It's greatly appreciated. (y) I had missed those! I went ahead & located & read the full articles as well as any relevant referenced articles. I really appreciate you pointing them out.
A little alarming, perhaps, but then - here is a study where the 2 medications were combined, without apparent serious negative effects:
Strategies for the treatment of antipsychotic-induced sexual dysfunction and/or hyperprolactinemia among patients of the schizophrenia spectrum: a review.
I admit, I only read the Abstract so you might want to peruse that study further just to confirm that these medications were indeed administered to the same patients simultaneously.
I read the article & found a possibly relevant section. Sadly enough the study did not seem to indicate that the medications had been administered simultaneously though.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
I appreciate you pointing it out as it led me to another study
The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings. I'm not sure how I got that study! I thought I was reading the study you linked until I noticed the link didn't match when I copy pasted to post this
. Both the study you linked & the following study referenced the same study though. I noticed this statement in said study that may be relevant?
The Facts About Sexual (Dys)function in Schizophrenia: An Overview of Clinically Relevant Findings said:
Adding selegiline
102 or cyproheptadine
103 did not seem to improve sexual function.
I followed the reference to
Selegiline in the treatment of sexual dysfunction in schizophrenic patients maintained on neuroleptics: a pilot study & found this of interest.
Selegiline in the treatment of sexual dysfunction in schizophrenic patients maintained on neuroleptics: a pilot study said:
All had been in the remission phase for at least 6 months and were treated with typical neuroleptic agents (perphen-azine or haloperidol), which remained unchangedthroughout the study period.
Each patient received randomly either 15 mg/day selegiline or placebo for 2 time periods of 3 weeks each in a double-blind crossover design.
Again I was unable to find information in this study directly relating to aripriprazole & selegiline. As the study stated; the agents used where perphenazine or haloperidol. I'm not sure that I can necessarily infer much from the combination of other anti-psychotics being combined with selegiline but it's additional data at least. It would appear there is very limited to no data on the actual combination of selegiline & aripiprazole! I'm hoping someone with a better understanding of the mechanisms in question can chime in with there thoughts on whether or not anything can be inferred from other medication combinations that include selegiline & an anti-psychotic with similar mechanism of action & affinitities as aripiprazole. Though as you mentioned depending on the dosage different factors are at play. Also the Emsam patch in particular can differ from other MAOI's but I would think that if anything the other MAOI's would be higher risk or comparable to selegeline in higher doses when one is trying to compare a different MAOI to selegiline (in this case Emsam). It would appear that perphenazine & haloperidol lack activity at
5-HT1B,
5-HT1D &
5-HT2B where as aripiprazole does have activity. Honestly I'm not that familiar with receptors, ki values, etc. but off the top of my head IIRC those are most responsible for cardiovascular effects?
So for the selegiline it seems it might be possible to extrapolate from information regarding other MAOI's? I would need someone more knowledgeable to answer whether or not one can attempt to infer or extropolate anything from other anti-psychotics as opposed to aripiprazole in combination with an MAOI. I just don't know enough to hazard an opinion as my knowledge of the topic is less than what it should / will be in the future. I'm working on doing what I can to garner a better understanding to fully appreciate the information I'm trying my best to digest. As such I'm choosing to ask as many questions as possible & not jump to any conclusions prematurely. Again perhaps someone with more knowledge on the topic could inform me further on if anything can be inferred. I'll go further into depth on the situation which may help elucidate things a bit in my conclusion.
Finally, there is one other report from 2016 of a female who combined the medications and experienced side effects -
https://www.ehealthme.com/drug-interaction/abilify/selegiline-hydrochloride/ Those links don't actually provide any more info - just that these side effects did occur in 1 female patient.
Obviously serotonergic interactions are the major concern, although I can't say how much of a serious risk this is. Generally in doses under ~10mg or so selegiline is selective for MAO-B, meaning serotonergic effects interactions should be minimal. Above that dose it becomes unselective or whatever the term is and inhibits both MAO-A and MAO-B so serotonergic side effects become more relevant. If your doctor is considering prescribing this they should be aware of the inherent dangers of MAOIs in general be able to provide advice as to whether this is a serious risk at the dose they intent to administer. I would expect that it would be a low dose, under ~10mg daily to start. If it's higher than that your doctor should be giving dietary advice about which foods to avoid (for example, tyramine is in cheese and could trigger a hypertensive crisis).
I notice that strangely the risk quoted by the BNF states that both aripiprazole and selegiline can increase the risk of
hypotension, which is weird to me, I can't think why that would be the case. But then. I'm not a doctor or medical professional of any kind... /disclaimer.
Nonetheless I hope this information is of some use or interest to you and do discuss any concerns with your doctor, my layperson's opinion would be that at a low dose the risk of interactions, specifically dangerous interactions, would also be low - but, again, don't take what I say or what anyone else here says as gospel - do discuss this with your doctor. I would think almost certainly they will want to start with a fairly low dose though - by which I mean under 10mg where the more dangerous MAO-A inhibition is not so much of an issue.
Thanks again! This is exactly what my concern was to be perfectly honest. The serotenergic interactions are where I have many questions. Based on your reply on MAO-A vs B & inhibition / selectivity & such it would appear that I have a general understanding as you post is exactly what I was thinking. I had the same concerns regarding serotonergic interactions as well as a risk of hypertensive crisis. I was also boggled the idea of a risk of
hypo versus
hypertension! I can't think of why that would be the case either!
To get a better understanding of why I'm asking & perhaps more input I'll mention the Dr. is of no help. The "Dr." is not a Dr. He is a resident who is supervised via video. At least that's my understanding of his role. Suffice to say that he is not sufficiently informed on the topic at hand.
As an example you mentioned tyramines. The "Dr." suggested we "Check the Mayo clinic or just google it & I'll talk to my supervisor & see if I can't find a more accurate list but that shouldn't be a big deal". That's somewhat understandable; I guess? However the following example is partially what lead to me posting this thread...
The "Dr." speaking to my wife told her to "Research Zyprexa in case the selegiline causes an interaction." "Abilify has a huge half-life by comparison. Just in case there's an interaction it'd be much easier to switch to & taper off a shorter acting medication like Zyprexa."
Unless I'm seriously misunderstanding the risks of interactions I'm at a loss on this? My understanding of the risks involved with an interaction involve a hypertensive crisis, serotonin syndrome or some other
IMMEDIATE issue? Am I really misunderstanding the potential interactions? As to the best of my knowledge the interactions that are possible in terms of the combination of aripiprazole & selegiline are things that would require immediate action. I can't think of any interaction that would result in needing to switch to a shorter acting medication &/or tapering off it?
My wife takes the aripiprazole to help control schizophrenia. Again there is an issue there. She is not diagnosed schizophrenic. She is diagnosed as bipolar. Like you I'm not a medical professional of any kind. However: I have read & studied the various iterations of the DSM & ICD over the years. Using CBT I was able to help her to overcome severe OCD & successfully wean off the Depakote (valproate) that was used to treat OCD but was causing negative side effects. Sorry I'm autistic & not always the best at communicating my point. What I'm trying to say through an example is that I'm relatively versed in mental health.
The reason I mention this is use the right terminology as best I can. She has never exhibited a period of "mania" or anything other feeling remotely related to feeling "up". She experiences major depression & anxiety punctuated by episodes of tearfullness, intrusive thoughts, visual & auditory disturbances (voices, etc.). She is flat in effect, experiences no pleasure from any activities & is always EXTREMELY fatigued. The only person I've ever met who will just drop right where they're standing, kneel down & pass out face first on the floor.
My apologies for the digression but I wanted to try & give a bit of a picture to illustrate her condition. I don't want to contradict her "Dr.'s" but in this case I'm 99.9% sure that there's a diagnosis issue in this case.
Regardless of the reasoning I'm trying my best to help her get proper treatment. Honestly it seems that trying selegiline will likely have to wait until after the current CV situation resolves itself based on the lack of information regarding interactions. Regardless; I'd like to continue to gather information. Outside of perhaps TMS (which due to CV is not an option at this point) my wife is very difficult to get be willing to try a new treatment. As is the nature of depression (MDD) she has a hard time believing anything will ever help or actually getting herself to try anything. Obviously the nature of severe depression is self defeating but I am able to help her with that aspect in some regard.
I'm beginning to ramble though in my effort to gather information & do what I can to help improve things. So thanks again for the information you have posted & I'd greatly appreciate any further information that you or anyone else may be able to offer. It would appear my concerns regarding serotergenic interactions &/or hypertensive issues being a worry are valid. I'm hoping that I can gather more information as to what degree &/or how valid those worries are. It would appear the "Dr." & I share the concern that there is very little information indicating that there are interactions in the literature but that the lack of information regarding said interactions does not preclude the possibility of them.
Again I'm hoping someone more knowledgeable can elucidate as to how likely the possibilities actually are? Thanks to anyone that might be able to help do so.
Edited: To fix a few errors. Hopefully I caught most of them & that this wall of text is formatted well enough to be readable. Also my apologies for the excessive use of emoji. Being autistic I've found it to be a useful tool in avoiding miscommunication mishaps.
