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Margie - Thanks for your input on the MAO-B inhibitors being less dangerous. We don't really trust the pharmacists and doctors at my father's HMO -- they seem overworked and undermotivated. Also my Dad asked for Remeron based on the Neurology journal article; it wasn't the psychiatrist's idea. Meanwhile, I did find something helpful on Medline (I included the abstract below, for those who are interested), and my father finally agreed to stop the selegiline for now. - Roxanna Serotonin syndrome and the combined use of deprenyl and an antidepressant in Parkinson's disease. Parkinson Study Group. Neurology 1997 Apr;48(4):1070-7 Richard IH, Kurlan R, Tanner C, Factor S, Hubble J, Suchowersky O, Waters C University of Rochester Medical Center, Department of Neurology, NY 14642-8673, USA. The manufacturer of deprenyl (selegeline; Eldepryl) (Somerset Pharmaceuticals, Tampa, FL) recently advised physicians to avoid prescribing the drug in combination with an antidepressant because of potentially serious CNS toxicity that may represent the serotonin syndrome. Manifestations of the serotonin syndrome vary but may include changes in mental status and motor and autonomic function. To better estimate the frequency of the serotonin syndrome in patients with Parkinson's disease (PD) treated with deprenyl and an antidepressant, we surveyed all investigators in the Parkinson Study Group. Based on estimates provided by the 47 investigators (75%) who responded, 4,568 patients were treated with the combination of deprenyl and an antidepressant medication. Eleven patients (0.24%) were reported to have experienced symptoms possibly consistent with the serotonin syndrome. Only two patients (0.04%) experienced symptoms considered to be serious. No deaths were reported. We also reviewed all published case reports and adverse experiences reported to the U.S. Food and Drug Administration and the manufacturer of Eldepryl. Available information indicates that serious adverse experiences resulting from the combined use of deprenyl and an antidepressant medication in patients with PD are quite rare and that the frequency of the true "serotonin syndrome" is even rarer. PMID: 9109902, UI: 97264030 >Date: Mon, 13 Mar 2000 15:36:58 -0500 >From: Dick Swindler <[log in to unmask]> >Subject: Re: Remeron + selegiline = danger? (corrected version) > >Roxanne - > >I don't know the answer to your question specifically, but I can tell you >many of the drug interaction warnings you'll see don't distinguish between >MAO-A and MAO-B. So far, everytime we've seen the "don't take with MAO >inhibitors" warning, asking knowledgeable experts about it has resulted in >the answer that the warning only applies to MAO-A inhibitors, and doesn't >apply to seligiline. I'd suggest a call to your pharmacist first - they're >usually the easiest to get in touch with. If you're not satisfied with the >answer, call another pharmacist. Eventually you could ask the neuro to look >into it, but I'm always more comfortable if I hear it from more than one >souce. > >Margie Swindler