Richard Thompson,  I am responding to your request for comments.  My
initial medication was Sinemet 100/25 three times each day just before
meals.  That was in 1984 perhaps November.  There was little or no
discussion about waiting.  this was before Eldepryl.  The amantadine and
others were considered not very useful.  I do not recall all the details,
but the increases made after a year or so were adding half pills but
staying with three doses per day just before meals.
 
I will not include the whole history - the point now made by some to delay
using levodopa is based upon the conjecture that it will become less
effective and the second conjecture that it may reduce the body's
production of dopamine.  I believe the word "conjecture" is valid.  I would
probably have used less and made increases only when this seemed rather
necessary if that had been suggested.
 
I retrospectively think that starting with less levodopa and using the
delay from taking the pill or half-pill before eating of fifteen to 30
minutes might be better in cost-effectiveness terms as well as putting less
medication that is destroyed by digestion processes.
 
Second better choice now available might be starting with CR Sinemet (no
generic allowed yet, so expensive).  This is available with more carbidopa
only - and might suffice if one pill taken with a small breakfast at only
one pill (100/25) per day.  The gathering of valid data about these
conjectures is unlikely to ever occur in that subjective opinions rather
than test measurements are the apparent usual criterion of dosage per what
I read and hear in discussions as well as my own interactions with about
six neurologists I have consulted over the past 12 years.
 
My starting Eldepryl was at my request after reading that it was beneficial
against depression.  I took one pill in morning for a couple of years and
believe it made some difference.  When Dr. A. D. Will withdrew from Loma
Linda teaching, research, and medical practice, I was forced to select
another physician to get pills.  Dr. Yu-en Lee prescribed two seligilene
pills per day at start of day and noon, so I tried this for some months;
assessed that the added pill did nothing discernible and went back to one
per day.
 
There is much variation intra-patient and inter-patients as our attitude
and chemistry changes.  The response expected is often "felt".  Accurate
knowledge and beliefs are goals and achievements - improving eating and
exercise habits - and achieving ability to take increasing difficulties "in
stride" with conscious effort to remain calm rather than choose to become
angry or depressed are definitely beneficial to coping without the
"freezing" that comes from anxiety, worry, panic, et cetera.  Keeping
pleasure and humor and making oneself sensitive to one's body deterioration
so that one functions as a pleasant, useful person (staying in command per
the poet's words: I am the Master of my fate, I am the Captain of my soul)
rather than feeling wronged by fate or god and becoming bitter is perhaps
more important in how long levodopa therapy will do enough for one.
 
There is conjecture that carbidopa may be detrimental when in excess of 200
mg./day.  The effectiveness and complications of Eldepryl are not totally
known.  The complexity of foods, drugs, contaminants in air, water, and
things ingested reacting with each other and our many neurotransmitters is
being studied - and will remain more understood by our unconscious brain
than our cognition perhaps forever.  We live in interesting times.  Some
continue to live longer than they want to live or seek no pleasure when
there seems little benefit when striving becomes more and more difficult.
Perhaps the optimum drug consumption is dependent upon the spiritual
maturity of the inner self or factors unknownable.
 
Sorry that I am so long-winded - and not even poetic or humorous.
 
ron      1936, dz PD 1984
Ronald F. Vetter <[log in to unmask]>
http://www1.ridgecrest.ca.us/~rfvetter/