Misc MAOI antidepressants for ADHD? (a theory)

[JackiesBabyy]

Yes, I'm aware that MAOIs are dangerous and no, I don't plan on testing the theory myself. No need for a lecture.

But, apparently MAOIs(I'm referring to the irreversible MAOIs still used for severe depression in the US, nardil and parnate) drastically increase the amount of dopamine in the brain. ADHD is mostly a lack of dopamine(or possibly too many dopamine receptors). I know MAOIs have far more side effects than stimulants, but it seems like it'd be a good option for people who can't get a stimulant script due to abusing them in the past and people who have no self control and want a way to treat their ADHD that both works and has no abuse potential. (right now you need to choose one or the other)

If this wouldn't work for ADHD, explain why not?

Keep in mind, I'm referring to non-selective, irreversable MAOIs. (not selegiline or moclobemide)

Edit: Also, a LOT of people with ADHD also have anxiety and some have depression too, and Nardil is known for completely destroying anxiety(mainly social anxiety) and atypical depression.

 

[polymath]

It doesn't have to be a non-selective MAOI like parnate (tranylcypromine). The drug selegiline, which prevents breakdown of dopamine by selectively inhibiting MAO-B, has also been found effective in ADHD:

http://priory.com/psych/selegiline.htm

Abstract

OBJECTIVE: This study evaluated the efficacy and safety of Selegiline in treating children with tic disorders and attention deficit hyperactivity disorder (ADHD). METHOD: Subjects from a specialty tic disorders clinic were randomly assigned to receive 2 weeks of treatment with Selegiline or placebo under double-blind conditions. Follow-up visits occurred every week for safety monitoring and dose adjustment. RESULTS: Fourty-four medication-free subjects (41 boys and three girls with a mean age of 10.4 years) with ADHD, combined type, and a tic disorder participated. After 2 weeks of treatment, Selegiline was associated with a mean improvement of 41% in the total score on the teacher-rated ADHD Rating Scale, compared to 7% improvement for placebo. Eleven of 22 subjects who received Selegiline were blindly rated on the Clinical Global Improvement scale as either much improved or very much improved, compared with none of 22 subjects who received placebo. The mean score on the parent-rated hyperactivity index improved by 29% in the Selegiline group and 18% in the placebo group, not a significant difference. On the Continuous Performance Test, commission errors decreased by 25% and omission errors by 20% in the Selegiline group, compared with increases of 33% in commission errors and of 36% in omission errors in the placebo group. Tic severity decreased by 27% in the Selegiline group, compared to 0% in the placebo group. One Selegiline subject with sedation withdrew at week 4. Selegiline was associated with insignificant decreases in blood pressure and pulse. CONCLUSIONS: In some cases, Selegiline appear to be a relatively safe and effective treatment for children with tic disorders and ADHD

http://www.ncbi.nlm.nih.gov/pubmed/12921918

Abstract

Attention deficit hyperactivity disorder (ADHD) is a common disorder of childhood that affects 3% to 6% of school-age children. Conventional stimulant medications are recognized by both specialists and parents as useful symptomatic treatment. Nevertheless, approximately 30% of ADHD children treated with them do not respond adequately or cannot tolerate the associated adverse effects. Such difficulties highlight the need for alternative safe and effective medications in the treatment of this disorder. Selegiline is a type B monoamine oxidase inhibitor (MAOI) that is metabolized to amphetamine and methamphetamine stimulant compounds that may be useful in the treatment of ADHD. The authors undertook this study to further evaluate, under double-blind and controlled conditions, the efficacy of selegiline for ADHD in children. A total of 28 children with ADHD as defined by DSM IV were randomized to selegiline or methylphenidate dosed on an age and weight-adjusted basis at selegiline 5 mg/day (under 5 years) and 10 mg/day (over 5 years) (Group 1) and methylphenidate 1 mg/kg/day (Group 2) for a 4-week double-blind clinical trial. The principal measure of the outcome was the Teacher and Parent ADHD Rating Scale. Patients were assessed by a child psychiatrist at baseline, 14 and 28 days after the medication started. No significant differences were observed between the two protocols on the Parent and Teacher Rating Scale scores. Although the number of dropouts in the methylphenidate group was higher than in the selegiline group, there was no significant difference between the two protocols in terms of the dropouts. Decreased appetite, difficulty falling asleep and headaches were observed more in the methylphenidate group. The results of this study must be considered preliminary, but they do suggest that selegiline may be beneficial in the treatment of ADHD. In addition, a tolerable side effect profile may be considered as one of the advantages of selegiline in the treatment of ADHD.

Selegiline is not nearly as dangerous as the nonselective MAOI:s. Also, tobacco smoke inhibits MAO-B to some extent, which might explain increased incidence of smoking in ADHD patients as some form of self-medication.

 

[JackiesBabyy]

Oh, I know MAO-B inhibitors would help too.

I was asking about nonselectives though because I have both severe ADHD and treatment resistant social anxiety. My psychiatrist suggested MAOIs(Nardil or parnate, not sure which one) but said I'd need to come off of the adderall, and it's not worth it unless the MAOI will at least have some benefit for my ADHD as well even if not as much so as a stimulant. I'm more than willing to take the side effects and dietary restrictions in exchange for no longer having social anxiety.

I asked about Selegiline, he said "that's a parkinson's medication that sometimes helps with depression, but not anxiety.". While that's probably not true, looks like the only option I have are the nonselectives.

 

[AlphaMethylPhenyl]

Parnate is essentially a stimulant. It's supposed to be 1/10th as potent as amphetamine. Adderall, mixed amphetamine salts, has the potential to aggravate social anxiety or improve symptoms. If your doctor is not considering Selegiline at the moment then he's probably referring to Nardil, which increases GABA, an inhibitory neurotransmitter which conquers social anxiety in most cases.

Do you still have this anxiety when not under the influence of amphetamine?

 

[JackiesBabyy]

Parnate is essentially a stimulant. It's supposed to be 1/10th as potent as amphetamine. Adderall, mixed amphetamine salts, has the potential to aggravate social anxiety or improve symptoms. If your doctor is not considering Selegiline at the moment then he's probably referring to Nardil, which increases GABA, an inhibitory neurotransmitter which conquers social anxiety in most cases.

Do you still have this anxiety when not under the influence of amphetamine?

I've had this anxiety many years before I've ever touched a stimulant. At therapeutic doses, they don't aggravate it or help it. At recreational doses they help it a little bit but it's not good to use for social situations unless the other person is high too. Serotonergic stimulants like methylone, 4-FA, and of course MDMA completely destroy it, but methylone is banned, 4-FA's serotonin effects go away quickly and you need a decent break to bring them back, and rolling balls on MDMA would not be good in a normal social situation.

Benzos also destroy it but the sedation is too much and they make me totally lose interest in being social. Alcohol would be great if my stomach didn't hate it. (two drinks and I'm nauseous as all hell) Weed aggravates it, and opiates, like benzos, sedate me to the point I no longer care to socialize. I've been on a two SSRIs and two TCAs, neither of them worked. So MAOIs are pretty much my last option. I'm almost sure they'd work for the social anxiety, they usually do work in people where everything else has failed. I'm just curious if the fact MAOIs dopamine effects would help focus/inattentiveness, or if MAOIs and stimulants increase dopamine in different parts of the brain and MAOIs wouldn't do anything. My doctor even has no idea because he's never prescribed an MAOI to a person with ADHD(not due to not wanting to, but by chance never seeing a person with both ADHD and treatment-resistant depression and/or social anxiety severe enough for an MAOI)

 

[AlphaMethylPhenyl]

They are clinically viable in some instances of ADHD (as evidenced in my previous post).

 

[JackiesBabyy]

They are clinically viable in some instances of ADHD (as evidenced in my previous post).

I'd guess they'd help me because most of my ADHD symptoms clearly come from low dopamine. The most stand-outish ones are no motivation, being unable to finish things, and being constantly bored. I should ask over on that social anxiety forum, they all basically worship MAOIs as if they were made by God himself as a cure for social anxiety, and shun everything else. haha

I gotta ask, I've read that nardil's MAO inhibition is 80%, leading to drastically more dopamine (and other things) being in the brain. How does it go about giving you a huge dopamine boost without any euphoria or abuse potential? (Well, some people get euphoria on it for a few days, but it goes away quick and doesn't come back with a higher dose or a break like stimulant euphoria.)

 

[AlphaMethylPhenyl]

I'd imagine that what you're talking about is simply tolerance.

MAOIs are rarely prescribed anymore due to dietary restrictions and their frankly dramatic effect, so when they are its usually for someone who really needs it, and who will feel just normal on it. Also, dopamine is only one of several neurotransmitters and trace amines being inhibited from breaking down when MAOIs are taken, discouraging its abuse potential relative to other, less recreational-feeling chemicals being increased.

I would bet that this class is moderately recreational in a large segment of the population.

 

[JackiesBabyy]

I'd imagine that what you're talking about is simply tolerance.

MAOIs are rarely prescribed anymore due to dietary restrictions and their frankly dramatic effect, so when they are its usually for someone who really needs it, and who will feel just normal on it. Also, dopamine is only one of several neurotransmitters and trace amines being inhibited from breaking down when MAOIs are taken, discouraging its abuse potential relative to other, less recreational-feeling chemicals being increased.

I would bet that this class is moderately recreational in a large segment of the population.

Yeah, as cigarettes contain an MAOI, as does syrian rue, and they can both cause Euphoria.

Anyway, I thought of tolerance, but I've heard the euphoria side effect when people do get it, only lasts a day or two and doesn't ever come back, even at higher doses and after a break. But I'm not interested in euphoria, I'm simply interested in not feeling choking anxiety whenever I have to meet someone (and possibly ADHD symptom relief). Maybe I should order some moclobemide online and try it for a few days, it's reversible and far less dangerous and will give me an idea if they'll be of help.

Also, does selegiline have recreational potential? MAO-B only effects dopamine, if I recall right. But I never hear of people abusing it except in one case where a 55 year old with parkinsons took huge doses for euphoria. (or maybe that was l-dopa. not sure.)

 

[AlphaMethylPhenyl]

I wouldn't try to treat yourself.

Selegiline definitely has recreational potential. I'm surprised abuse isn't more widespread.

MAOI-B deals with dopamine and to a lesser extent phenethylamine and related chemicals. Its a stimulant in essence.

 

[JackiesBabyy]

I wouldn't try to treat yourself.

Selegiline definitely has recreational potential. I'm surprised abuse isn't more widespread.

MAOI-B deals with dopamine and to a lesser extent phenethylamine and related chemicals. Its a stimulant in essence.

Since Phenethylamine has the same mechanism of action as stimulants (albeit with a shorter half life), so Selegiline would certainly help with ADHD. Not sure how it'd fare for social anxiety, though. Probably not good unless it has another hidden mechanism. Maybe it's not in widespread use because I'm guessing it's not commonly prescribed for depression as I've seen one person in all the years I've read up on MAOIs actually have the Emsam patch, and Parkinson's patients are older and far less likely to abuse the stuff.

And eh, I don't think taking a daily therapeutic dose of moclobemide would be TOO dangerous as long as I don't eat any tyramine or take any other meds, seeing as it's generally safe and clinically tested. Probably 1/10th as dangerous as eating the copious amounts of 4-FA and 2-FMA I have, the former being largely untested except on a few rats and of course human experience reports, and the 2-FMA having no rat tests and less experience reports, haha.

 

[Woodburner]

Hi @JackiesBabyy

Have you tried any natural MAOIs?

I'm lucky, caffeine has no effect on me, so I'm using coffee.

For a few years, up to about three or four years ago, I used to drink one mug a day, but never noticed any effect, other than finding it 'more filling' than tea, and once in a blue moon it did actually help me sleep, though that wasn't limited to when I drank it regularly.

It may be that I just wasn't aware of the effect, it's pretty subtle, although definite, or it may be that one mug a day really wasn't enough. I suspect the latter, as I have been cutting back down from 4 mugs. (I used to drink four mugs of tea a day, and switched from tea to coffee, to be sure that any difference could not be put down as an increase in caffeine consumption.)

To cut a long story short, it does help, not a great deal, but enough to differentiate between some of the effects of not enough dopamine, and other things that are more likely to be directly due to the way ADHD brains work, and in between the two, some ingrained habits from years of dopamine boosting activities.

I'd be interested to know how you got on with 'stronger' things.