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My PDR is of 1992 vintage and only Prozac is listed.  The other SSRI drugs of
Paxil and Zoloff are not listed.  SSRI stands for Selective Serotonin
Reuptake Inhibitors.  In effect they slow the metabolizim of serotonin which
increases the level of this neurotransmitter in the brain.  For a long time
it has been know that serotonin was low in PD.  Little was done about it
because the deficiency in dopamine was so obvious.  Patients seemed to do so
well on levodopa therapy that little was done about the reduced levels of
serotonin.  It is believed that reduced levels of serotonin are a possible
cause of depression.  In early articles on MPTP induced PD, something like
95% of the substantia nigra was destroyed in primates and still no PD
symptoms were evident.  As soon as the serotonin level lowered, the PD
symptoms appeared.
 
Now serotonin is used in the natural production of dopamine.  Since there is
a lack of production of dopamine in PD one would think there would be an
excess of serotonin.  There isn't and I do not know why.  But to complicate
the picture, carbidopa, I am told, acts as an inhibitor of the production of
serotonin outside of the blood brain barrier.  This may account for loss of
theraputic value of carbidopa/levodopa when carbidopa gets above 300 mg
daily.  (I had a member taking 30 of the 25/100 sinemet pills daily.  He is
now on Permax, about 2 mg daily and cut his sinemet to around 8 25/100 pills
daily).
 
What this all comes around to say:  Depression is more than a symptom of
cronic illness in PD.  It is part of PD and should be treated just like
tremor, etc.  The SSRI drugs make some sense because they increase the level
of serotonin which is low.  The SSRI drugs are contraindicted if someone is
also on a MAO inhibitor.  Your drugist will tell you that they will need to
talk to your physician to make them aware that they prescribed a drug that
was contraindicated with Eldepryl.  As it turns out, if the level of Eldepryl
is equal or less than 10 mg daily, there should be no problems.  I take 5 mg
of Eldepryl and Paxil without problems.  I know many using Zoloff, Paxil and
Prozac along with Eldepryl (<= 10 mg daily) who are not experiencing
problems.  Please check with your physician should you decide to try one of
these drugs.  By the way, all the bad publicity given Prozac is NOT FROM PD
Patients.  It is from wackos!!!  I know some neurologists who believe SSRI
drugs are as important as Sinemet.
 
For me, Paxil, takes the edge off the day.  Makes me nicer on the phone, a
better listener, more agreeable, you might say, a nice guy (this is from my
wife, so I wonder what I am like without Paxil).  It also seems to help me
sleep.  There is one known side effect.  The SSRI drugs are known to block
sexual climax.  I didn't say, block sexual drive, just climax.  Some patients
consider them a form of "birth control".  I will let you read into this what
ever you want.
 
Well, that is enough on this subject.  I would suggest those wanting more
than "I read recently" should look at recent publications for more
information.
 
Regards,
Alan Bonander ([log in to unmask])
 
PS: My neurologist has suggested that Paxil be put in the US water supply.
 It is that safe and we would substantically reduce the crime in this
country.  (All this was said with humor.)