From: Rafal Smigrodzki (rms2g@virginia.edu)
Date: Thu Jan 30 2003 - 07:36:22 MST
gts wrote:
> Rafal Smigrodzki wrote:
>> gts wrote:
>> It's also an excellent antidepressant, especially when
>>> taken with DL-phenylalanine and B-6 (it increases levels of the
>>> natural mood enhancer phenylethylamine, and selectively inhibits the
>>> MAO-B enzyme that breaks down dopamine)
>>
>> ### How does it compare to MAOI's?
>
> It *is* a MAOI, but a unique and selective one. See below.
>
>> It's not a coincidence that MAOI's are third-line antidepressants -
>> they are too risky and not sufficiently effective compared to
>> SSRI's, TCA's, and atypicals.
>
> Selegiline, is as I wrote, a *selective* inhibitor of MAO-B. There
> are two MAO enzymes, MAO-A and MAO-B. Conventional MAOI's inhibit
> both enzymes, and it is the inhibition of MAO-A that creates risks
> (MAO-A is necessary for the breakdown of tyramine, an amino acid
> found in certain foods like aged cheeses. Excessive levels of
> tyramine can lead to hypertensive crises, so those who take
> conventional MAOI's must watch their diet.) Selegiline at modest
> dosages inhibits only MAO-B and requires no dietary restrictions.
### I know selegiline is a selective MAOI.
I meant to write "How does it compare to other MAOI's?"
In other words, since MAOI's suck, and selegiline is a MAOI, selegiline
sucks, too.
Give me some data supporting the contention that selegiline is "an excellent
antidepressant", compared to the SSRI's, TCA's, and atypicals I mentioned
above.
-------------------
>
>> . It enhances libido. It is
>>> neuroprotective; it almost certainly prevents or delays the onset of
>>> parkinson's disease in addition to being a treatment for it.
>>
>> ### Quote some studies giving us the "almost certain" feeling.
>
> Parkinson's Disease (PD) is characterized by the death of dopaminergic
> neurons. Numerous studies show that selegiline protects those
> neurons. In animal models of PD, the neurotoxin MPTP is used to cause
> PD. Selegiline protects against MPTP and numerous other neurotoxins
> and excitotoxins. It may also delay or prevent the onset of
> Alzheimer's Disease.
>
> Here are a few of many, many studies concerning the neuroprotective
> effects of selegiline:
<deleted for brevity>
### You have not quoted a single double-blind, placebo-controlled study
showing improved survival of PD patients on selegiline compared to standard
therapy. In other words, no class A evidence.
All the studies you quote are in vitro, or reviews, and therefore at best
class C evidence, if at all. The abstracts mention alleged improvements in
survival on selegiline. This is hearsay, unless you provide the actual
quotations.
There is conflicting class B evidence, with some observational studies
showing excess death in patients treated with selegiline (Lees AJ, and the
Parkinson's disease Research Group of the United Kingdom. Comparison of
therapeutic effects and mortality data of levodopa and levodopa combined
with selegiline in patients with early, mild Parkinson's disease. BMJ
1995;311:1602-7), others showing no effect at all (Parkinson Study Group.
Mortality in DATATOP: A multicenter trial in early Parkinson's disease. Ann
Neurol 1998;43:318-25).
To be "almost certain" that selegiline delays or prevents PD is plainly
wrong.
Rafal
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