![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by karaS on October 23, 2004, at 14:16:30
Some of you have remarked that you're not able to drink coffee now that you're on Cymbalta. Is this what most have experienced? I can't take it at all now. Even when I started on 10 mg. of Cymbalta and took 1/4 cup caf and 3/4 cup decaf, my heart felt like it was going crazy. I am obviously very sensitive to noradrenergics but I wonder if others of you are able to drink coffee or if you weren't able to drink it early on, whether you could later on in your trial.
Thanks,
KaraP.S. I haven't tried eating chocolate yet. It would be very hard to give that up.
Posted by boomarang on October 23, 2004, at 17:57:39
In reply to Cymbalta and coffee?, posted by karaS on October 23, 2004, at 14:16:30
i was probably one of the people who mentioned strong reactions to caffeine on cymbalta.
Being as i have an intravenous feed of coffee going, i am happy to report that caffeine no longer bothers me and i am back to my full dosage of lattes per day. It took about a month on cymbalta to be able to tolerate my usual intake again.
Posted by verne on October 24, 2004, at 5:36:13
In reply to Cymbalta and coffee?, posted by karaS on October 23, 2004, at 14:16:30
Hi Kara,
I've been on cymbalta about 5 weeks and finally settled at 20mgs per day after being at 40mgs to 60mgs per day.
At any dose, I definitely noticed less side effects after about a month. Yesterday I went for a long walk with my daughter and had a super-strong cup of gourmet coffee with no ill effects - although my heart raced last night when I had a little ice cream with my chocolate syrup.
Perhaps the combination of inderal LA 60mgs and cymbalta is key for me. I think the inderal counteracts some of the cymbalta SE's. I had to go down in dose mostly due to sexual side effects. I also experienced some drowsiness but also stimulation.
And although I felt less depressed and better able to concentrate, I barely knew my name at times. I had to get a pill organizer because I couldn't remember whether I had taken my daily dose. Yet in other ways, my mind has been as sharp as ever. Just can't remember my address or who I am. Maybe that's a good thing.
verne
Posted by Cairo on October 24, 2004, at 6:45:55
In reply to Re: Cymbalta and coffee? » karaS, posted by verne on October 24, 2004, at 5:36:13
I was sensitive to caffeine, even the little bit in decaf coffee, before I started Cymbalta. I also had to watch my chocolate intake and even alcohol, which would cause insomnia. I've been on Cymbalta two weeks and had to lower the dose from 30mg to 20mg. I'm considering lowering it even further to 15mg because the agitation is very hard to take and I'm getting stiff neck muscles which cause headaches, a big problem for me with Fibromyalgia and myofascial pain. My startle response is VERY significant and I'm also getting blurry vision sometimes, increased BP at 30mg or higher, disturbed sleep (anathema to Fibros), chest tightness even at 20mg. I wonder if Inderal LA would help, though I am prone to orthostatic dizziness.
The positives are that I have become a cleaning machine, but it feels like a long caffeine buzz (like I'm involuntarily being driven to do things). I still have that unreal feeling all the time. Losing weight is very welcome after years of weight gain and more weight gain on Neurontin and other ADs. Appetite is way down and I've lost 7 pounds in two weeks. Time will tell if SE go away and if there is improvement in pain, motivation, concentration, etc. I have a sneaking suspician that this might not be the med for me. I'm waiting for Lyrica.
Cairo
Posted by karaS on October 24, 2004, at 15:04:09
In reply to Re: Cymbalta and coffee? » karaS, posted by verne on October 24, 2004, at 5:36:13
> Hi Kara,
>
> I've been on cymbalta about 5 weeks and finally settled at 20mgs per day after being at 40mgs to 60mgs per day.
>
> At any dose, I definitely noticed less side effects after about a month. Yesterday I went for a long walk with my daughter and had a super-strong cup of gourmet coffee with no ill effects - although my heart raced last night when I had a little ice cream with my chocolate syrup.
>
> Perhaps the combination of inderal LA 60mgs and cymbalta is key for me. I think the inderal counteracts some of the cymbalta SE's. I had to go down in dose mostly due to sexual side effects. I also experienced some drowsiness but also stimulation.
>
> And although I felt less depressed and better able to concentrate, I barely knew my name at times. I had to get a pill organizer because I couldn't remember whether I had taken my daily dose. Yet in other ways, my mind has been as sharp as ever. Just can't remember my address or who I am. Maybe that's a good thing.
>
> verne
Verne,
You're too funny. As for your heart racing from ice cream with chocolate syrup and not from a strong cup of coffee, why do you think that is? That makes no sense to me.I'm still trying to sort out all of the different posts about Cymbalta even though I know that none of it really matters. The only thing that matters is your own reaction to it. I'm very surprised so far at the groggy unreal feeling I'm experiencing. I have read so many posts here about this being a cleaner drug than Effexor. My experience has been the opposite so far. Once I got on Effexor XR, after brief periods of adjustment time which were mild, I couldn't even tell I was taking anything (other than the sexual side effects). Same with Zoloft. To me, they were two of the cleanest drugs (not counting the withdrawal on Effexor of course). Unfortunately neither of them did jack for me. I wish now that I had had the guts to go up to 300 mg. on Effexor. My blood pressure started to rise at 225 and I freaked.
I'm so torn. What to do now? I haven't given Cymbalta a fair trial by any means but I just don't have 2 months to feel like this. I HAVE TO FUNCTION NOW!!
Kara
Posted by zeugma on October 27, 2004, at 18:46:40
In reply to Re: Cymbalta and coffee? » verne, posted by karaS on October 24, 2004, at 15:04:09
hi K
every new drug is marketed as 'cleaner' than its predecessor. Then its real pharmacology is uncovered :)
I can totally emphasize with that need to function NOW, I am in the same position.There are times when I honestly feel that the real antidepressant I am taking is caffeine.
I would say that if neither Effexor nor Zoloft helped, maybe maprotiline would be the way to go?
-z
Posted by karaS on October 28, 2004, at 0:20:14
In reply to Re: Cymbalta and coffee? » karaS, posted by zeugma on October 27, 2004, at 18:46:40
> hi K
>
> every new drug is marketed as 'cleaner' than its predecessor. Then its real pharmacology is uncovered :)> I can totally emphasize with that need to function NOW, I am in the same position.There are times when I honestly feel that the real antidepressant I am taking is caffeine.
> I would say that if neither Effexor nor Zoloft helped, maybe maprotiline would be the way to go?
>
> -z
Hey z,Missed you these past few days!
Re: Cymbalta, many people ARE finding it to be much cleaner than Effexor. I didn't have a good experience on Effexor until I took the XR version. Maybe it's not fair to compare the two until there's an XR version of Cymbalta.
I'm wondering if I shouldn't have tried a higher dose of Effexor. I tolerated it so well (as long as it was XR). Maybe I should have gone up to 300.
I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
Hope you're doing well.
Kara
Posted by zeugma on October 28, 2004, at 18:32:11
In reply to Re: Cymbalta and coffee? » zeugma, posted by karaS on October 28, 2004, at 0:20:14
> >
>
> Hey z,
>
> Missed you these past few days!Same here. I've been wretchedly busy.
>
> Re: Cymbalta, many people ARE finding it to be much cleaner than Effexor. I didn't have a good experience on Effexor until I took the XR version. Maybe it's not fair to compare the two until there's an XR version of Cymbalta.
>
I read on the PI sheet that Cymbalta is enteric coated to provide timed release. Or at least I think I read that. In any case, it's the cymbalta currently available that needs to be evaluated for cleanliness, especially since we don't always have infinite time at our disposal in our evaluations of meds.> I'm wondering if I shouldn't have tried a higher dose of Effexor. I tolerated it so well (as long as it was XR). Maybe I should have gone up to 300.
>
I'm guessing you don't have a dr. you trust to discuss your concerns about increased blood pressure on the higher doses of Effexor. That's a shame, because it's a necessity. Your concerns about blood pressure are a real concern that any M.D. should be able to provide reliable advice about.> I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
http://www.primarypsychiatry.com/pdf/art_453.pdf
(If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
As for weight gain, that's because of MAP's potent H1 blockade, but if you are using it at doses higher than those needed for sleep, its NE reuptake inhibition might counteract the sleepiness and weight gain. At the very least, you might be less depressed. It's easier to lose weight in that condition. And a good night's sleep is not a useless commodity. >
> Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
>
The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.> Hope you're doing well.
>I think I am, considering the circumstances. I know you're doing the same.
-z
> Kara
>-z
Posted by karaS on October 29, 2004, at 1:25:28
In reply to Re: Cymbalta and coffee? » karaS, posted by zeugma on October 28, 2004, at 18:32:11
> > >
> >
> > Hey z,
> >
> > Missed you these past few days!
>
> Same here. I've been wretchedly busy.Poor baby!
> > Re: Cymbalta, many people ARE finding it to be much cleaner than Effexor. I didn't have a good experience on Effexor until I took the XR version. Maybe it's not fair to compare the two until there's an XR version of Cymbalta.
>I read on the PI sheet that Cymbalta is enteric coated to provide timed release. Or at least I think I read that. In any case, it's the cymbalta currently available that needs to be evaluated for cleanliness, especially since we don't always have infinite time at our disposal in our evaluations of meds.
That's true and I do have the enteric coated capsules here rather than the pills.
> > I'm wondering if I shouldn't have tried a higher dose of Effexor. I tolerated it so well (as long as it was XR). Maybe I should have gone up to 300.
> I'm guessing you don't have a dr. you trust to discuss your concerns about increased blood pressure on the higher doses of Effexor. That's a shame, because it's a necessity. Your concerns about blood pressure are a real concern that any M.D. should be able to provide reliable advice about.
Actually I did run that by him many moons ago. He wasn't that concerned about the rise at that point but I was. I am such a coward. My blood pressure had gone from about 100 to 120 and I didn't want it to go over 120. Since I wasn't having much AD effect at 225 mg, I thought it wasn't worth the risk. However, if that last 75 mg. is much more noradrenergic, then I should have given it a try. It sure would have been nice to be able to have something work that you get so few side effects from. That's probably why I'm thinking about this now even though SE boosting is not the best way for me to go now. You are not a big fan of anything SSRI related, are you?
> > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
>
> I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
>
> http://www.primarypsychiatry.com/pdf/art_453.pdf
>
> (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
So it's the anticholinergic effects that cause the tachycardia? That would probably explain why some noradrenergics produce this effect and others don't. That always puzzled me.
I didn't see a chart on there that measured that. What am I not getting? That's a great source though, lots of information. Thanks.
> As for weight gain, that's because of MAP's potent H1 blockade, but if you are using it at doses higher than those needed for sleep, its NE reuptake inhibition might counteract the sleepiness and weight gain. At the very least, you might be less depressed. It's easier to lose weight in that condition. And a good night's sleep is not a useless commodity. >Once I adjusted to the small doses I took, 25 mg or 50 mg., I didn't have much daytime sleepiness... or did I? I'm trying to remember. Actually I think I did feel groggy in the AM. I realize now that I tend to feel that way in the morning anyway though so I don't know how much of that to attribute to the maprotiline. I also used to attribute all of my blurry morning vision to meds but recently I realized that I get that even when I don't take any medication.
I just remembered that I did try a therapeutic dosage of doxepin many, many years ago. It didn't help much. I wonder if maprotiline would be any different. I wonder if anything would be any different for that matter.
>
> > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
> >
> The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
Take care of yourself and try not to let all of the stress get to you.
K
Posted by zeugma on October 29, 2004, at 19:57:49
In reply to Re: Cymbalta and coffee? » zeugma, posted by karaS on October 29, 2004, at 1:25:28
> > > >
> > >
> > >
>
> > > I'm wondering if I shouldn't have tried a higher dose of Effexor. I tolerated it so well (as long as it was XR). Maybe I should have gone up to 300.
>
> > I'm guessing you don't have a dr. you trust to discuss your concerns about increased blood pressure on the higher doses of Effexor. That's a shame, because it's a necessity. Your concerns about blood pressure are a real concern that any M.D. should be able to provide reliable advice about.
>
> Actually I did run that by him many moons ago. He wasn't that concerned about the rise at that point but I was. I am such a coward. My blood pressure had gone from about 100 to 120 and I didn't want it to go over 120. Since I wasn't having much AD effect at 225 mg, I thought it wasn't worth the risk. However, if that last 75 mg. is much more noradrenergic, then I should have given it a try. It sure would have been nice to be able to have something work that you get so few side effects from. That's probably why I'm thinking about this now even though SE boosting is not the best way for me to go now. You are not a big fan of anything SSRI related, are you?
>
Well, some of my comments were more driven by some of your worries concerning the indirect anti-dopaminergic effects of powerful SRI's. I was also reacting to your comments that, simply, Zoloft and Effexor did nothing for your depression despite their cleanness. I read at Preskorn's web site (not the pdf I linked to) that 375 mg Effexor was equivalent in its noradrenergic effect to 150 mg maprotiline. I don't know if going from 225 to 300 mg Effexor would have helped you. But clearly Effexor at 75 mg + is an SRI equivalent to zoloft etc. Since the SRI component did nothing for you, why not try the NRI by itself?> > > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
> >
> > I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
> >
> > http://www.primarypsychiatry.com/pdf/art_453.pdf
> >
> > (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
>
>
> So it's the anticholinergic effects that cause the tachycardia? That would probably explain why some noradrenergics produce this effect and others don't. That always puzzled me.
>
> I didn't see a chart on there that measured that. What am I not getting? That's a great source though, lots of information. Thanks.
>
>There's charts for various AP's and AD's that list potencies for specific sites, you will find MAP listed among secondary amine TCA's. Of note, maprotiline and nortriptyline share a common property: they are the only two AD's whose highest affinities are for the NE reuptake protein and the H1 receptor, although nortriptyline is more selective for the NE reuptake mechanism and MAP is more selective for H1 (which is why you were able to use it as a sleep aid). But maprotiline is cleaner in general than nortriptyline, so there is a chance you might be able to tolerate an AD dose of it. If nortriptyline is dirty, then doxepin is pure filth, as you can see from the chart.
> > As for weight gain, that's because of MAP's potent H1 blockade, but if you are using it at doses higher than those needed for sleep, its NE reuptake inhibition might counteract the sleepiness and weight gain. At the very least, you might be less depressed. It's easier to lose weight in that condition. And a good night's sleep is not a useless commodity. >
>
> Once I adjusted to the small doses I took, 25 mg or 50 mg., I didn't have much daytime sleepiness... or did I? I'm trying to remember. Actually I think I did feel groggy in the AM. I realize now that I tend to feel that way in the morning anyway though so I don't know how much of that to attribute to the maprotiline. I also used to attribute all of my blurry morning vision to meds but recently I realized that I get that even when I don't take any medication.
>
> I just remembered that I did try a therapeutic dosage of doxepin many, many years ago. It didn't help much. I wonder if maprotiline would be any different. I wonder if anything would be any different for that matter.
>
See comment above on doxepin's filthiness. I don't know if maprotiline would be any different, either. Well, it would be different, but it might not work. But what do you think is more worth trying?
>
> >
> > > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
> > >
> > The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.
>
> OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
>
Thanks. I am more 'there' at work. This is both good and bad, but I cannot say more here.> I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.
Other than the bizarreness of using a stimulant as a sleeping pill, I don't see what the harm is in using it frequently- people use it frequently to wake themselves up! Of course, there could be something weird in the chemistry of the paradoxical reaction. I would be wary.
>
> Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
>
Well, I've answered a little, and asked a question or two of you. We're probably both too tired now to solve all of our problems. Those will have to wait :)> Take care of yourself and try not to let all of the stress get to you.
I'm trying, I'm trying. But trying not to stress is like trying not to think of a purple elephant. It is dancing now in my head :)-z>
> K
>
>
Posted by karaS on October 30, 2004, at 0:04:48
In reply to dirty drugs and filth » karaS, posted by zeugma on October 29, 2004, at 19:57:49
>You are not a big fan of anything SSRI related, are you?
> >
> Well, some of my comments were more driven by some of your worries concerning the indirect anti-dopaminergic effects of powerful SRI's. I was also reacting to your comments that, simply, Zoloft and Effexor did nothing for your depression despite their cleanness. I read at Preskorn's web site (not the pdf I linked to) that 375 mg Effexor was equivalent in its noradrenergic effect to 150 mg maprotiline. I don't know if going from 225 to 300 mg Effexor would have helped you. But clearly Effexor at 75 mg + is an SRI equivalent to zoloft etc. Since the SRI component did nothing for you, why not try the NRI by itself?I did know what you were reacting to in my situation but I've also read other posts where I thought you made rather contemptuous remarks about SSRIs. Could have been my misinterpretation. Nothing wrong with having that opinion though. I think I'm starting to feel that way about them. Actually, based on the title of this message, it sounds like your contempt is more for that gutter-dwelling doxepin. :-)
> > > > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
> > >
> > > I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:Therapeutically, it is an excellent suggestion. I guess the only thing worrying me is the weight gain issue. It might be less of a problem at higher doses but I'd hate to put on a lot of weight trying to find out. I'm finally thin after years of carrying around extra weight. I don't want to go back there ever again! I'll have to do more thinking and researching on this.
I wonder if taking extra choline or DMAE would offset the anticholinergic effects of TCAs. Do you know?
> http://www.primarypsychiatry.com/pdf/art_453.pdf
> > >
> > > (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
> >
> >There's charts for various AP's and AD's that list potencies for specific sites, you will find MAP listed among secondary amine TCA's. Of note, maprotiline and nortriptyline share a common property: they are the only two AD's whose highest affinities are for the NE reuptake protein and the H1 receptor, although nortriptyline is more selective for the NE reuptake mechanism and MAP is more selective for H1 (which is why you were able to use it as a sleep aid). But maprotiline is cleaner in general than nortriptyline, so there is a chance you might be able to tolerate an AD dose of it. If nortriptyline is dirty, then doxepin is pure filth, as you can see from the chart.
> > > As for weight gain, that's because of MAP's potent H1 blockadeH1 blockade does have some benefit. It would be nice to be able to exercise without the urticaria... I liked the energy I felt on Nortriptyline. What about Nort with Pindolol for the tachycardia? They don't seem to use Pindolol anymore to potentiate ADs, do they?
> See comment above on doxepin's filthiness. I don't know if maprotiline would be any different, either. Well, it would be different, but it might not work. But what do you think is more worth trying?MAP probably would be better than Effexor. I took doxepin. It is "filthy" - I can attest to that but I will always be grateful that it "cured" me of my horrible anxiety, panic attacks and agoraphobia many years ago (way before all of these other options). It allowed me to sleep and made me functional again.
> > > > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
> > > >
> > > The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.
> >
> > OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
> >Thanks. I am more 'there' at work. This is both good and bad, but I cannot say more here.
Ok, but if you want to talk more, you know where to find me.
> > I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.It's so ironic. I aways thought that I could fall back on stimulants if nothing else worked for my anergia and problems concentrating. I did a lot of reading on preventing tolerance. Lots of wasted time!!! I never dreamed that stimulants would put me to sleep.
> Other than the bizarreness of using a stimulant as a sleeping pill, I don't see what the harm is in using it frequently- people use it frequently to wake themselves up! Of course, there could be something weird in the chemistry of the paradoxical reaction. I would be wary.Yes, you're probalby right. But, on the otherhand, maybe flooding the synapses with dopamine would eventually force downregulation? It's too risky. I wouldn't try it but I do wonder.
> > Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
> >
> Well, I've answered a little, and asked a question or two of you. We're probably both too tired now to solve all of our problems. Those will have to wait :)Yes, both physically and emotionally tired. I'm sick to death of this process.
> > Take care of yourself and try not to let all of the stress get to you.
>
>
> I'm trying, I'm trying. But trying not to stress is like trying not to think of a purple elephant. It is dancing now in my head :)Maybe that's the answer. Keep thinking about the dancing purple elephant and your mind won't be worrying about anything else.
Thanks for all of your help! (really)
Later,
K
Posted by zeugma on October 31, 2004, at 14:53:38
In reply to Re: dirty drugs and filth » zeugma, posted by karaS on October 30, 2004, at 0:04:48
> >You are not a big fan of anything SSRI related, are you?
> > >
> > Well, some of my comments were more driven by some of your worries concerning the indirect anti-dopaminergic effects of powerful SRI's. I was also reacting to your comments that, simply, Zoloft and Effexor did nothing for your depression despite their cleanness. I read at Preskorn's web site (not the pdf I linked to) that 375 mg Effexor was equivalent in its noradrenergic effect to 150 mg maprotiline. I don't know if going from 225 to 300 mg Effexor would have helped you. But clearly Effexor at 75 mg + is an SRI equivalent to zoloft etc. Since the SRI component did nothing for you, why not try the NRI by itself?
>
> I did know what you were reacting to in my situation but I've also read other posts where I thought you made rather contemptuous remarks about SSRIs. Could have been my misinterpretation. Nothing wrong with having that opinion though. I think I'm starting to feel that way about them. Actually, based on the title of this message, it sounds like your contempt is more for that gutter-dwelling doxepin. :-)
>No, you weren't misinterpreting. But I need to qualify my attitudes towards them. A lot of my negative attitude comes from two sources: 1) observation of friends whose conditions actually worsened on SSRI's, in particular in terms of demotivation and apathy over the long term; and 2) the well-documented disruptive effects of SSRI's on sleep. These are obviously far from a comprehensive overview of the pluses and minuses of SSRI use. But they do bias me against them, yes.
> > > > > I'm curious why you suggested maprotiline. I used to take a small amount of it for years for sleep. I tolerated it well but I gained too much weight from it.
> > > >
> > > > I suggested maprotiline because it is the most NE-selective (relative to serotonin) reuptake inhibitor on the market that I'm aware of. It is also has less anticholinergic effects than desipramine, the least anticholinergic of the TCA's, according to the chart I am going by:
>
> Therapeutically, it is an excellent suggestion. I guess the only thing worrying me is the weight gain issue. It might be less of a problem at higher doses but I'd hate to put on a lot of weight trying to find out. I'm finally thin after years of carrying around extra weight. I don't want to go back there ever again! I'll have to do more thinking and researching on this.
>
> I wonder if taking extra choline or DMAE would offset the anticholinergic effects of TCAs. Do you know?
>
I don't know. I suggest asking on Alternative about the supplements. But they're good ideas :)
>
> > http://www.primarypsychiatry.com/pdf/art_453.pdf
> > > >
> > > > (If you scroll down past the dull text you get to the useful info.) I seem to remember that you had tachycardia from desipramine and nortriptyline. That sounds like an anticholinergic s/e.
> > >
> > >There's charts for various AP's and AD's that list potencies for specific sites, you will find MAP listed among secondary amine TCA's. Of note, maprotiline and nortriptyline share a common property: they are the only two AD's whose highest affinities are for the NE reuptake protein and the H1 receptor, although nortriptyline is more selective for the NE reuptake mechanism and MAP is more selective for H1 (which is why you were able to use it as a sleep aid). But maprotiline is cleaner in general than nortriptyline, so there is a chance you might be able to tolerate an AD dose of it. If nortriptyline is dirty, then doxepin is pure filth, as you can see from the chart.
> > > > As for weight gain, that's because of MAP's potent H1 blockade
>
> H1 blockade does have some benefit. It would be nice to be able to exercise without the urticaria... I liked the energy I felt on Nortriptyline. What about Nort with Pindolol for the tachycardia? They don't seem to use Pindolol anymore to potentiate ADs, do they?
>
> I don't know the answer to that either. I would guess that pindolol is an obscure drug to most pdocs when considered as a psychotropic. I have a long list of contraindicated meds to nortriptyline that came with my last refill, and pindolol was not one of them.
> > See comment above on doxepin's filthiness. I don't know if maprotiline would be any different, either. Well, it would be different, but it might not work. But what do you think is more worth trying?
>
> MAP probably would be better than Effexor. I took doxepin. It is "filthy" - I can attest to that but I will always be grateful that it "cured" me of my horrible anxiety, panic attacks and agoraphobia many years ago (way before all of these other options). It allowed me to sleep and made me functional again.
>
Associating with gutter elements can have benefits :) Who would have guessed?> > > > > Caffeine isn't an AD for me but it's sure the best drug I've ever taken for energy!
> > > > >
> > > > The Ritalin LA at 50 mg requires supplementation from caffeine. I can tell you that it seems much less stimulating than Provigil, and provides none of the 'jolting' effects of Strattera. It is doing something, though. Ask me in a week about it.
> > >
> > > OK, I will. Thank goodness for coffee! I've been lost without it on the Cymbalta. Hoping that the 50 Ritalin LA ends up working sufficiently for you.
> > >
>
> Thanks. I am more 'there' at work. This is both good and bad, but I cannot say more here.
>
> Ok, but if you want to talk more, you know where to find me.
>
>
> > > I've toyed with the idea of using the Ritalin I have here for a sleeping pill. I doubt there's any harm in using it periodically (assuming it isn't contrainidicated with anything else I'm taking) but I wonder if there would be any harm in usuing it frequently. I don't need it now but when I get stressed out and can't sleep, it could come in very handy.
>
> It's so ironic. I aways thought that I could fall back on stimulants if nothing else worked for my anergia and problems concentrating. I did a lot of reading on preventing tolerance. Lots of wasted time!!! I never dreamed that stimulants would put me to sleep.
>
>
> > Other than the bizarreness of using a stimulant as a sleeping pill, I don't see what the harm is in using it frequently- people use it frequently to wake themselves up! Of course, there could be something weird in the chemistry of the paradoxical reaction. I would be wary.
>
> Yes, you're probalby right. But, on the otherhand, maybe flooding the synapses with dopamine would eventually force downregulation? It's too risky. I wouldn't try it but I do wonder.
>
>
I wonder also. If you do need a sleeping pill, though, doxepin would seem more reasonable.> > > Well, I know you're really busy and you must be very tired so I won't ask you any more questions for now.
> > >
> > Well, I've answered a little, and asked a question or two of you. We're probably both too tired now to solve all of our problems. Those will have to wait :)
>
> Yes, both physically and emotionally tired. I'm sick to death of this process.
>
> > > Take care of yourself and try not to let all of the stress get to you.
> >
> >
> > I'm trying, I'm trying. But trying not to stress is like trying not to think of a purple elephant. It is dancing now in my head :)
>
> Maybe that's the answer. Keep thinking about the dancing purple elephant and your mind won't be worrying about anything else.
>
> Thanks for all of your help! (really)
>
> Later,
> KYou're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
-z
Posted by karaS on October 31, 2004, at 16:32:17
In reply to Re: dirty drugs and filth » karaS, posted by zeugma on October 31, 2004, at 14:53:38
> You're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
>
> -zI'm off of the Cymbalta completely now. I couldn't tolerate the side effects in my present situation. Also, I am afraid of using anything serotonergic (without a dopaminergic) right now that might possibly make my dopamine problems worse. I may reserve the right to try it again at a later date. I just have to figure out what to do next. I have been thinking of Parnate though that would probably also put me to sleep - at least initially. (I'm basing this on the fact that selegiline does and they're very similar). OTOH, I read/posted an abstract recently that spoke about its ability to downregulate those DA autoreceptors. I might have to deal with some major fatigue for a while to get the therapeutic effect.
Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
How are those purple dancing elephants?
K
Posted by zeugma on October 31, 2004, at 19:54:19
In reply to no more Cymbalta for now » zeugma, posted by karaS on October 31, 2004, at 16:32:17
> > You're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
> >
> > -z
>
> I'm off of the Cymbalta completely now. I couldn't tolerate the side effects in my present situation. Also, I am afraid of using anything serotonergic (without a dopaminergic) right now that might possibly make my dopamine problems worse. I may reserve the right to try it again at a later date. I just have to figure out what to do next. I have been thinking of Parnate though that would probably also put me to sleep - at least initially. (I'm basing this on the fact that selegiline does and they're very similar). OTOH, I read/posted an abstract recently that spoke about its ability to downregulate those DA autoreceptors. I might have to deal with some major fatigue for a while to get the therapeutic effect.
>
> Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
>
> How are those purple dancing elephants?
>
> KThe purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.
Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.
I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
-z
Posted by karaS on November 1, 2004, at 0:30:14
In reply to Re: no more Cymbalta for now » karaS, posted by zeugma on October 31, 2004, at 19:54:19
> > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> >
> > How are those purple dancing elephants?
> >
> > K
>
> The purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
You must have an incredible imagination!
> Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.2 more thoughts before I talk to my doctor again:
reboxetine and Amisulpride. The word on reboxetine as an AD isn't that great, is it? Hopefully, I'm wrong about that. Amisulpride and Sulpiride - are they related? I believe I read that one or both of them are the only medications specifically for my DA receptor problem. I would take it in AD dosage. I know that they are APs but what makes a medication an AP? If they're taken at AD dosage, do they still carry a risk of TD/movement disorder?
> Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.Other than uderstanding more about the origins of your issues, what can your research tell you? Can it lead to specific treatment?
> I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
It sounds like you could use the rest...
K
Posted by jujube on November 1, 2004, at 10:54:21
In reply to Re: no more Cymbalta for now » karaS, posted by zeugma on October 31, 2004, at 19:54:19
Z,
If you don't mind my asking, are you taking anything else with the Provigil? I am on my fourth AD trial in less than a year, and it is not doing a thing for me. I have a pdoc appointment tomorrow, and am researching options. I have Provigil on my list as a possible augmenter (not sure if the pdoc will go for it. He seems averse to augmentation.). So far I have tried Paxil, Prozac, Effexor (up to 225 mg) and now Celexa. I am thinking it may be time to go to a TCA, but am scared stiff because of all of the side effects. However, if a TCA will bring me out of the black hole I'm in, then maybe that's the route I will have to go. Do you know if you can combine Provigil with a TCA?
Thanks, and sorry for butting into the thread with all my questions.
Tamara
> > > You're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
> > >
> > > -z
> >
> > I'm off of the Cymbalta completely now. I couldn't tolerate the side effects in my present situation. Also, I am afraid of using anything serotonergic (without a dopaminergic) right now that might possibly make my dopamine problems worse. I may reserve the right to try it again at a later date. I just have to figure out what to do next. I have been thinking of Parnate though that would probably also put me to sleep - at least initially. (I'm basing this on the fact that selegiline does and they're very similar). OTOH, I read/posted an abstract recently that spoke about its ability to downregulate those DA autoreceptors. I might have to deal with some major fatigue for a while to get the therapeutic effect.
> >
> > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> >
> > How are those purple dancing elephants?
> >
> > K
>
> The purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
>
> Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.
>
> Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.
>
> I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
>
> -z
Posted by zeugma on November 1, 2004, at 18:16:42
In reply to Re: no more Cymbalta for now » zeugma, posted by jujube on November 1, 2004, at 10:54:21
> Z,
>
> If you don't mind my asking, are you taking anything else with the Provigil? I am on my fourth AD trial in less than a year, and it is not doing a thing for me. I have a pdoc appointment tomorrow, and am researching options. I have Provigil on my list as a possible augmenter (not sure if the pdoc will go for it. He seems averse to augmentation.). So far I have tried Paxil, Prozac, Effexor (up to 225 mg) and now Celexa. I am thinking it may be time to go to a TCA, but am scared stiff because of all of the side effects. However, if a TCA will bring me out of the black hole I'm in, then maybe that's the route I will have to go. Do you know if you can combine Provigil with a TCA?
>
> Thanks, and sorry for butting into the thread with all my questions.
>
> Tamara
>
> Hi Tamara, please don't feel that you're butting in. I am no longer on Provigil. I went up to 150 mg, and it has been the most helpful of all meds I have taken for ADD and also for energy. Unfortunately the side effects were not tolerable. I took it with nortriptyline, and there are no contraindications that I am aware of. Nortrip's s/e are dry mouth, sedation (NOT fatigue, at least not in my case- it knocks me out for a certain, dose-dependent time after I take it, and then I wake up feeling as energetic as I am capable of feeling. If the drug caused unusual fatigue, I would have discontinued it. I suffer from severe fatigue.) and orthostatic hypotension- dizziness on getting up from a seated position suddenly. There were many other s/e that faded with time.The problem with the Provigil s/e was that they did not fade with time. I don't know if there was an interaction between the TCA and Provigil. I would not discourage you from trying either med. Nortriptyline is a highly effective AD. Provigil helped me with my symptoms of anergia and inattention. I wish I could have stayed on Provigil. Ritalin is actually a much harder med for me to figure out, although it causes fewer s/e for me.
Hope some of this was helpful, and do not hesitate to ask anything else.
-z
> > > > You're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
> > > >
> > > > -z
> > >
> > > I'm off of the Cymbalta completely now. I couldn't tolerate the side effects in my present situation. Also, I am afraid of using anything serotonergic (without a dopaminergic) right now that might possibly make my dopamine problems worse. I may reserve the right to try it again at a later date. I just have to figure out what to do next. I have been thinking of Parnate though that would probably also put me to sleep - at least initially. (I'm basing this on the fact that selegiline does and they're very similar). OTOH, I read/posted an abstract recently that spoke about its ability to downregulate those DA autoreceptors. I might have to deal with some major fatigue for a while to get the therapeutic effect.
> > >
> > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > >
> > > How are those purple dancing elephants?
> > >
> > > K
> >
> > The purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
> >
> > Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.
> >
> > Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.
> >
> > I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
> >
> > -z
>
>
Posted by jujube on November 1, 2004, at 18:28:52
In reply to Re: no more Cymbalta for now » jujube, posted by zeugma on November 1, 2004, at 18:16:42
> > Z,
> >
> > If you don't mind my asking, are you taking anything else with the Provigil? I am on my fourth AD trial in less than a year, and it is not doing a thing for me. I have a pdoc appointment tomorrow, and am researching options. I have Provigil on my list as a possible augmenter (not sure if the pdoc will go for it. He seems averse to augmentation.). So far I have tried Paxil, Prozac, Effexor (up to 225 mg) and now Celexa. I am thinking it may be time to go to a TCA, but am scared stiff because of all of the side effects. However, if a TCA will bring me out of the black hole I'm in, then maybe that's the route I will have to go. Do you know if you can combine Provigil with a TCA?
> >
> > Thanks, and sorry for butting into the thread with all my questions.
> >
> > Tamara
> >
> > Hi Tamara, please don't feel that you're butting in. I am no longer on Provigil. I went up to 150 mg, and it has been the most helpful of all meds I have taken for ADD and also for energy. Unfortunately the side effects were not tolerable. I took it with nortriptyline, and there are no contraindications that I am aware of. Nortrip's s/e are dry mouth, sedation (NOT fatigue, at least not in my case- it knocks me out for a certain, dose-dependent time after I take it, and then I wake up feeling as energetic as I am capable of feeling. If the drug caused unusual fatigue, I would have discontinued it. I suffer from severe fatigue.) and orthostatic hypotension- dizziness on getting up from a seated position suddenly. There were many other s/e that faded with time.
>
> The problem with the Provigil s/e was that they did not fade with time. I don't know if there was an interaction between the TCA and Provigil. I would not discourage you from trying either med. Nortriptyline is a highly effective AD. Provigil helped me with my symptoms of anergia and inattention. I wish I could have stayed on Provigil. Ritalin is actually a much harder med for me to figure out, although it causes fewer s/e for me.
>
> Hope some of this was helpful, and do not hesitate to ask anything else.
>
> -zZ,
Very helpful. Thanks. I have a lot of options to discuss with the pdoc tomorrow. The orthostatic hypotension s/e worries me a bit since I since I already experience that now, and even when I am not on ADs. My blood pressure tends to be on the low side. Well, I'll see how things go tomorrow. I hope the pdoc is receptive to my suggestions.
Thanks again. Take care.
Tamara
> > > > > You're welcome. Your questions are also helpful to me. Has the Cymbalta done anything at all for you yet?
> > > > >
> > > > > -z
> > > >
> > > > I'm off of the Cymbalta completely now. I couldn't tolerate the side effects in my present situation. Also, I am afraid of using anything serotonergic (without a dopaminergic) right now that might possibly make my dopamine problems worse. I may reserve the right to try it again at a later date. I just have to figure out what to do next. I have been thinking of Parnate though that would probably also put me to sleep - at least initially. (I'm basing this on the fact that selegiline does and they're very similar). OTOH, I read/posted an abstract recently that spoke about its ability to downregulate those DA autoreceptors. I might have to deal with some major fatigue for a while to get the therapeutic effect.
> > > >
> > > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > > >
> > > > How are those purple dancing elephants?
> > > >
> > > > K
> > >
> > > The purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
> > >
> > > Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.
> > >
> > > Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.
> > >
> > > I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
> > >
> > > -z
> >
> >
>
>
Posted by zeugma on November 1, 2004, at 18:31:37
In reply to Re: no more Cymbalta for now » zeugma, posted by karaS on November 1, 2004, at 0:30:14
> > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > >
> > > How are those purple dancing elephants?
> > >
> > > K
> >
> > The purple dancing elephants are OK. But they make a lot of noise :)(plus it smells like a circus in here).
>
>
> You must have an incredible imagination!
>
> Spending so much time in REM has its benefits, along with the obvious drawbacks.> > Parnate sounds like an excellent idea. You might have to deal with the fatigue, and the dietary restrictions, but most sources say Parnate has fewer s/e than Nardil.
>
> 2 more thoughts before I talk to my doctor again:
> reboxetine and Amisulpride. The word on reboxetine as an AD isn't that great, is it? Hopefully, I'm wrong about that. Amisulpride and Sulpiride - are they related? I believe I read that one or both of them are the only medications specifically for my DA receptor problem. I would take it in AD dosage. I know that they are APs but what makes a medication an AP? If they're taken at AD dosage, do they still carry a risk of TD/movement disorder?
>
I wish I could recommend Strattera. The drug unquestionably has an AD effect. But the sedation/fatigue effect that I eventually got from it seems far from uncommon. Reboxetine has a bad reputation here, and most say desipramine is a superior AD. But in theory reboxetine should be a good AD.AP's are drugs that block the negative and positive symptoms of psychosis- delusions, paranoia, as well as apathy and withdrawal. The negative symptoms of schizophrenia and depression are similar, which is why many AP's have AD effects, at least at lower doses. AP's block the D2 receptor, which is thought to underlie the efficacy against the positive symptoms- delusions and such- while they also block 5HT-2 receptors which is thought to improve the positive symptoms. I think amisulpiride is a cleaner version of sulpiride.
Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.
-z>
> > Right now I'm in a fallow period. I'm positive, given my response to provigil and the recent discoveries of orexigenic transmission, that many of my problems localize in the hypothalamus. I plan to spend the coming months researching this in my spare time.
>
> Other than uderstanding more about the origins of your issues, what can your research tell you? Can it lead to specific treatment?
>
> > I took a 'holiday' from Ritalin today (only 20 mg). I feel completely exhausted.
>
> It sounds like you could use the rest...
>
> K
>
>
>
>
>
Posted by karaS on November 1, 2004, at 23:05:57
In reply to Re: no more Cymbalta for now » karaS, posted by zeugma on November 1, 2004, at 18:31:37
> > > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > 2 more thoughts before I talk to my doctor again:
> > reboxetine and Amisulpride. The word on reboxetine as an AD isn't that great, is it? Hopefully, I'm wrong about that. Amisulpride and Sulpiride - are they related? I believe I read that one or both of them are the only medications specifically for my DA receptor problem. I would take it in AD dosage. I know that they are APs but what makes a medication an AP? If they're taken at AD dosage, do they still carry a risk of TD/movement disorder?
> >
> I wish I could recommend Strattera. The drug unquestionably has an AD effect. But the sedation/fatigue effect that I eventually got from it seems far from uncommon. Reboxetine has a bad reputation here, and most say desipramine is a superior AD. But in theory reboxetine should be a good AD.Yes, in theory reboxetine should be good - desipramine without as much of the anticholinergic effects. But in reality if it doesn't pan out, who cares about the theory. I just wish that dispramine didn't give me so much tachycardia.
> AP's are drugs that block the negative and positive symptoms of psychosis- delusions, paranoia, as well as apathy and withdrawal. The negative symptoms of schizophrenia and depression are similar, which is why many AP's have AD effects, at least at lower doses. AP's block the D2 receptor, which is thought to underlie the efficacy against the positive symptoms- delusions and such- while they also block 5HT-2 receptors which is thought to improve the positive symptoms. I think amisulpiride is a cleaner version of sulpiride.So you think that there's still movement disorder risk to using amisulpride at AD dosage level?
> Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.My pdoc recommened Abilfy to add on to something else for my potential "soft bipolar'" condiiton - if in fact i have that. If so, might be able to kill two birds with one stone.
Thanks, as always for the info. I assume it's still to early to ask you how the 50 Ritalin LA is going?
K
Posted by KaraS on November 3, 2004, at 16:00:03
In reply to Re: no more Cymbalta for now » zeugma, posted by karaS on November 1, 2004, at 23:05:57
> > > > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > > 2 more thoughts before I talk to my doctor again:
> > > reboxetine and Amisulpride. The word on reboxetine as an AD isn't that great, is it? Hopefully, I'm wrong about that. Amisulpride and Sulpiride - are they related? I believe I read that one or both of them are the only medications specifically for my DA receptor problem. I would take it in AD dosage. I know that they are APs but what makes a medication an AP? If they're taken at AD dosage, do they still carry a risk of TD/movement disorder?
> > >
> > I wish I could recommend Strattera. The drug unquestionably has an AD effect. But the sedation/fatigue effect that I eventually got from it seems far from uncommon. Reboxetine has a bad reputation here, and most say desipramine is a superior AD. But in theory reboxetine should be a good AD.
>
> Yes, in theory reboxetine should be good - desipramine without as much of the anticholinergic effects. But in reality if it doesn't pan out, who cares about the theory. I just wish that dispramine didn't give me so much tachycardia.
>
>
> > AP's are drugs that block the negative and positive symptoms of psychosis- delusions, paranoia, as well as apathy and withdrawal. The negative symptoms of schizophrenia and depression are similar, which is why many AP's have AD effects, at least at lower doses. AP's block the D2 receptor, which is thought to underlie the efficacy against the positive symptoms- delusions and such- while they also block 5HT-2 receptors which is thought to improve the positive symptoms. I think amisulpiride is a cleaner version of sulpiride.
>
> So you think that there's still movement disorder risk to using amisulpride at AD dosage level?
>
>
> > Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.
>
> My pdoc recommened Abilfy to add on to something else for my potential "soft bipolar'" condiiton - if in fact i have that. If so, might be able to kill two birds with one stone.
>
> Thanks, as always for the info. I assume it's still to early to ask you how the 50 Ritalin LA is going?
>
> K
>
>z,
I wanted to repost the message above so it doesn't get lost because of the board turnover. (It's amazing how quickly it turnsover these days.) Also, I wanted to add to it a question about tianeptine. Do you think the anti-SSRI might be something for me to consider?
If, in fact, long-term SSRI usage contributed to my DA receptor problem, then maybe tianeptine could be a helpful antidote, no?Ok, now I think it's time to ask about the 50 mg. Ritalin LA... so how are you doing on it?
K
Posted by jujube on November 3, 2004, at 16:18:04
In reply to Re: no more Cymbalta for now » karaS, posted by KaraS on November 3, 2004, at 16:00:03
Kara,
Just saw this post, so excuse my questions in response to your post to me.
I don't know if you saw this Dr. Richard Brown discussion, but you may want to have it look. He talks about, among others, Tianeptine. The website is xxx.
I can't remember if you said you had tried Provigil before? Also, I noticed when I was researching older threads that a person named JohnL had good things to say about Adrafinil (not to be confused with Anafranil). It is one of the new pyschostimulants with little or no addicitive qualities compared to Ritalin. I think, though, that is has to be ordered from overseas. If I recall, one of his sources was xxx (I may be wrong).
Wishing you success in identifying meds that help.
Tamara
Posted by zeugma on November 3, 2004, at 18:48:09
In reply to Re: no more Cymbalta for now » karaS, posted by KaraS on November 3, 2004, at 16:00:03
> > > > > > Most likely I'll just sit here thinking about this and changing my mind a million times before I do anything.
> > > > 2 more thoughts before I talk to my doctor again:
> > > > reboxetine and Amisulpride. The word on reboxetine as an AD isn't that great, is it? Hopefully, I'm wrong about that. Amisulpride and Sulpiride - are they related? I believe I read that one or both of them are the only medications specifically for my DA receptor problem. I would take it in AD dosage. I know that they are APs but what makes a medication an AP? If they're taken at AD dosage, do they still carry a risk of TD/movement disorder?
> > > >
All Ap's except for clozapine, and possibly Abilify and Seroquel, carry the risk of TD. I believe the risk is greater with larger dosages but there is still a risk at any dose. Of course, the risks have to be weighed against benefits. I realize that doesn't sound reassuring. Both sulpiride and amisulpiride were developed as AP's and they have the advantages and disadvantages of that class of medications.
> > > I wish I could recommend Strattera. The drug unquestionably has an AD effect. But the sedation/fatigue effect that I eventually got from it seems far from uncommon. Reboxetine has a bad reputation here, and most say desipramine is a superior AD. But in theory reboxetine should be a good AD.
> >
> > Yes, in theory reboxetine should be good - desipramine without as much of the anticholinergic effects. But in reality if it doesn't pan out, who cares about the theory. I just wish that dispramine didn't give me so much tachycardia.
Well, maprotiline may be something to try. I think maprotiline has a better track record than reboxetine.
> >
> >
> > > AP's are drugs that block the negative and positive symptoms of psychosis- delusions, paranoia, as well as apathy and withdrawal. The negative symptoms of schizophrenia and depression are similar, which is why many AP's have AD effects, at least at lower doses. AP's block the D2 receptor, which is thought to underlie the efficacy against the positive symptoms- delusions and such- while they also block 5HT-2 receptors which is thought to improve the positive symptoms. I think amisulpiride is a cleaner version of sulpiride.
> >
> > So you think that there's still movement disorder risk to using amisulpride at AD dosage level?
Yes, there is a risk, which increases with duration and dosage.> >
> >
> > > Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.
> >
> > My pdoc recommened Abilfy to add on to something else for my potential "soft bipolar'" condiiton - if in fact i have that. If so, might be able to kill two birds with one stone.
> >Abilify MIGHT not be an agent that causes TD. It is still a new med so it is still uncertain, but I recall reading an article that compared its structure to clozapine, an agent known not to cause TD.
> > Thanks, as always for the info. I assume it's still to early to ask you how the 50 Ritalin LA is going?
> >It is a rough ride. I have noticed that the afternoons are generally bad on the Ritalin, which could mean that the 20 mg I take at noon does not ward off the crash. (I take 30 mg am, which does not make me irritable, just tired as usual but with slightly improved focus.) My job requires that I stay focused through the afternoon. It could be that I need to try 30 mg pm, or maybe ritalin is not the way to go. At any rate, the 30-20 mg dosing schedule is not working out.
-z
> > K
> >
> >
>
> z,
>
> I wanted to repost the message above so it doesn't get lost because of the board turnover. (It's amazing how quickly it turnsover these days.) Also, I wanted to add to it a question about tianeptine. Do you think the anti-SSRI might be something for me to consider?
> If, in fact, long-term SSRI usage contributed to my DA receptor problem, then maybe tianeptine could be a helpful antidote, no?
>
> Ok, now I think it's time to ask about the 50 mg. Ritalin LA... so how are you doing on it?
>
> K
Posted by KaraS on November 3, 2004, at 19:09:33
In reply to Re: no more Cymbalta for now » KaraS, posted by jujube on November 3, 2004, at 16:18:04
> Kara,
>
> Just saw this post, so excuse my questions in response to your post to me.
>
> I don't know if you saw this Dr. Richard Brown discussion, but you may want to have it look. He talks about, among others, Tianeptine. The website is xxx.
>
> I can't remember if you said you had tried Provigil before? Also, I noticed when I was researching older threads that a person named JohnL had good things to say about Adrafinil (not to be confused with Anafranil). It is one of the new pyschostimulants with little or no addicitive qualities compared to Ritalin. I think, though, that is has to be ordered from overseas. If I recall, one of his sources was xxx (I may be wrong).
>
> Wishing you success in identifying meds that help.
>
> Tamara
>Thanks, Tamara
I have read that article which is how I knew about tianeptine in the first place. I think I'll read it again though. I tried Provigil but it made my limbs feel like cement. I guess that's a fairly common side effect with it. Also I can't take most stimulants as they put me to sleep. Thanks for the suggestions though.Also, expect to be hearing from Dr. Bob. He doesn't allow citations from or mention of the above web site as they sell some meds there without prescriptions.
Kara
Posted by KaraS on November 3, 2004, at 19:18:11
In reply to Re: no more Cymbalta for now » KaraS, posted by zeugma on November 3, 2004, at 18:48:09
>> Well, maprotiline may be something to try. I think maprotiline has a better track record than reboxetine.
You've never worried about your weight, have you?
I haven't completely abandoned MAP but if reboxetine could do the job without the weight gain, then it might be worth the shot.
> > > > AP's are drugs that block the negative and positive symptoms of psychosis- delusions, paranoia, as well as apathy and withdrawal. The negative symptoms of schizophrenia and depression are similar, which is why many AP's have AD effects, at least at lower doses. AP's block the D2 receptor, which is thought to underlie the efficacy against the positive symptoms- delusions and such- while they also block 5HT-2 receptors which is thought to improve the positive symptoms. I think amisulpiride is a cleaner version of sulpiride.
> > >
> > > So you think that there's still movement disorder risk to using amisulpride at AD dosage level?
>
>
> Yes, there is a risk, which increases with duration and dosage.> >Very scary.
> > > > Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.
> > >
> > > My pdoc recommened Abilfy to add on to something else for my potential "soft bipolar'" condiiton - if in fact i have that. If so, might be able to kill two birds with one stone.
> > >
>
> Abilify MIGHT not be an agent that causes TD. It is still a new med so it is still uncertain, but I recall reading an article that compared its structure to clozapine, an agent known not to cause TD.What about EPS?
Also, what about the suggestion of tianeptine? Is that not very well thought of either?
> > > Thanks, as always for the info. I assume it's still to early to ask you how the 50 Ritalin LA is going?
> > >
>
> It is a rough ride. I have noticed that the afternoons are generally bad on the Ritalin, which could mean that the 20 mg I take at noon does not ward off the crash. (I take 30 mg am, which does not make me irritable, just tired as usual but with slightly improved focus.) My job requires that I stay focused through the afternoon. It could be that I need to try 30 mg pm, or maybe ritalin is not the way to go. At any rate, the 30-20 mg dosing schedule is not working out.I'm so sorry to hear that. I assume that you'll go up to 30 for your second dose. It doesn't sound like it will be any miracle result for you but it may allow you to function better until you figure out your next move.
K
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.