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Dr. Bob is Robert Hsiung, MD,
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Posted by sukarno on April 18, 2005, at 4:53:38
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I've noticed that Xanax is not half as effective as it was prior to taking Stablon (tianeptine).
When I feel nervous from tianeptine, I usually don't take an extra Xanax, but I did a few days ago and also today and noticed very little additional anxiolytic effect from it.
Overall I'd say that for me, Stablon is not an anxiolytic, but is good for depression (in my case anyway).
I thought about adding or switching to Klonopin/Rivotril since it is very long-acting (one tablet seems to last about 12 hours) to counter the nervousness caused by Stablon.
Posted by ed_uk on April 18, 2005, at 11:17:07
In reply to Tianeptine decreasing effects of Xanax, posted by sukarno on April 18, 2005, at 4:53:38
Hi Paul!
>What is interesting is that I actually had a panic attack (hyperventilation attack actually) inside the dream.
I'm sorry to hear that :-(
I have heard of tianeptine causing nightmares. I've never heard of amineptine causing nighmares but I would imagine that it is possible!>I'm afraid to try it now though because of my reaction to Effexor (venlafaxine).
Was your BP normal when you tried nortriptyline before?
>Did Effexor raise my blood pressure because of its norepinephrine reputake inhibition or because of some other mechanism?
Possibly. Nortriptyline is more likely to decrease blood pressure because it blocks alpha-1 receptors.
>Come on over to Dr. Shipko's website if you haven't already been there.
I'd like to but I really mustn't- I already spend such a vast amount of time on the internet. If I go to a new site I will probably become addicted to it!!
>Xanax
Do you take the Xanax four times a day? Do you ever suffer from anxiety/withdrawal symptoms between doses? Do you have Xanax XR in Indonesia?
Kind regards,
Ed.
Posted by sukarno on April 18, 2005, at 21:54:19
In reply to Re: Tianeptine » sukarno, posted by ed_uk on April 18, 2005, at 11:17:07
Hi Ed! :-)
"Was your BP normal when you tried nortriptyline before?"
Back in those days I never checked my BP, but my psychiatrist did when I was on imipramine or nortriptyline (forgot which) and she said, "Your blood pressure could be a bit lower. You should take up some exercise."
I think she didn't want to scare me...maybe my BP was high.So I took up exercise and apparently it came down to normal, but that was back in the days when they didn't have BP machines in the supermarkets and shopping malls.
I'm still surprised how such a minute dose of Effexor could have raised my blood pressure and caused such symptoms. How did you like Effexor?
"Do you take the Xanax four times a day? Do you ever suffer from anxiety/withdrawal symptoms between doses? Do you have Xanax XR in Indonesia?"
Yep, four times a day, so I take it every 6 hours to keep the level as even as possible. At 0.5mg 4x/day I had rebound anxiety between doses, so I raised the dose gradually to 1mg 4x/day... at that point there was no more rebound anxiety.
Good thing about Xanax is that it's easy to reach steady-state! :-) Sometimes with Valium it takes a while to reach that "peak" and then "fine-tuning" the dose isn't easy as it can take days to feel any difference.
I wish there was Xanax XR here, but can't find it. I also asked a friend of mine up in Malaysia that works at Pfizer if they have it there, but she said there are no plans to market it in Malaysia.
Here in Indonesia we are further behind when it comes to meds (I think), so we probably won't ever see Xanax XR here.
What meds do you take now? Are they working well?
Posted by ed_uk on April 20, 2005, at 7:13:37
In reply to Re: Tianeptine, posted by sukarno on April 18, 2005, at 21:54:19
Hi Paul!!
>BP
I think you'd have to be sure to get your BP monitored regularly if you were to take nortriptyline again.
>reboxetine
It's possible that reboxetine might raise your BP quite a lot (considering your reaction to Effexor). It might actually be considerably worse than Effexor! - just a hypothesis....
>How did you like Effexor?
It made me drowsy and lazy like an SSRI. It didn't help my depression. I only took 150mg but I didn't want to increase the dose because of the side effects.
>At 0.5mg 4x/day I had rebound anxiety between doses, so I raised the dose gradually to 1mg 4x/day... at that point there was no more rebound anxiety.
Perhaps you'd have less side effects if you reduced your dose to 0.5mg six times a day. Hopefully this would avoid inter-dose anxiety.
>We probably won't ever see Xanax XR here.
I'm certain that we won't ever see it here either. 'Regular' Xanax isn't available on the National Health Service so it's virtually never prescribed.
>What meds do you take now? Are they working well?
I was taking lofepramine up until last week, I've been on it for about 2 years. I stopped taking it when I ran out! I'm not sure whether I'll get another prescription or not.
Kind regards,
Ed.
Posted by sukarno on April 24, 2005, at 9:51:19
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
This is scary. I hope it isn't that dangerous to take tianeptine, since it is metabolised by beta-oxidation? I've been on it for one month and have remained depression-free, and feel a more anxiolytic effect from it now, although in the morning I sometimes feel a bit "down"...I assume this is because of the short half-life of tianeptine.
1: Pharmacol Ther. 1995;67(1):101-54.
Inhibition of mitochondrial beta-oxidation as a mechanism of hepatotoxicity.Fromenty B, Pessayre D.
Institut National de la Sante et de la Recherche Medicale Unite 24, Hopital Beaujon, Clichy, France.
Severe and prolonged impairment of mitochondrial beta-oxidation leads to microvesicular steatosis, and, in severe forms, to liver failure, coma and death. Impairment of mitochondrial beta-oxidation may be either genetic or acquired, and different causes may add their effects to inhibit beta-oxidation severely and trigger the syndrome. Drugs and some endogenous compounds can sequester coenzyme A and/or inhibit mitochondrial beta-oxidation enzymes (aspirin, valproic acid, tetracyclines, several 2-arylpropionate anti-inflammatory drugs, amineptine and tianeptine); they may inhibit both mitochondrial beta-oxidation and oxidative phosphorylation (endogenous bile acids, amiodarone, perhexiline and diethylaminoethoxyhexestrol), or they may impair mitochondrial DNA transcription (interferon-alpha), or decrease mitochondrial DNA replication (dideoxynucleoside analogues), while other compounds (ethanol, female sex hormones) act through a combination of different mechanisms. Any investigational molecule should be screened for such effects.
Publication Types:
* Review
PMID: 7494860 [PubMed - indexed for MEDLINE]
Posted by ed_uk on April 24, 2005, at 12:00:30
In reply to Stablon (tianeptine) and hepatotoxicity, posted by sukarno on April 24, 2005, at 9:51:19
Hi Paul!
Take care not to combine tianeptine with other drugs which may increase it's hepatotoxicity- such as aspirin and the tetracycline antibiotics.
I think you should consider having regular LFTs, including a prothrombin time/INR, as is recommended for valproate.
Kind regards,
Ed.
Posted by sukarno on April 25, 2005, at 3:43:30
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Seems like a few people have taken large doses, in some cases up to 240 tablets/day, of tianeptine without serious consequences.
Tricyclic antidepressants are well known for their toxicity in overdose with serious cardiac complications.
Why is this (supposedly) lacking in tianeptine? It is a TCA, eh?
I took 3 tablets yesterday and did notice a few heart palpitations and when I stood up I felt like I would faint (orthostatic hypotension), but nothing like imipramine or other classic TCAs.
Posted by sukarno on April 26, 2005, at 4:35:35
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Seems like the longer I take this, the better I feel. The one thing I've noticed the past few days is a feeling like I am so "comfortable".. hard to describe and relaxed and want to hug everyone. Weird. Well, I read about Ecstasy and it has those effects.
Some sort of psychostimulant "hug-drug" effect.. I can definitely feel it. Mild euphoria. In the mornings I feel a bit down, but after taking Stablon I can feel it kick in about 30-60 minutes later.
Now I can see why a few people might abuse it. Very nice, clean drug. :) I just hope it continues to work!
:)
Posted by ed_uk on April 26, 2005, at 8:03:59
In reply to Stablon an entactogen? hehheh, posted by sukarno on April 26, 2005, at 4:35:35
Hi Paul!
>Why is this (supposedly) lacking in tianeptine? It is a TCA, eh?
Yes, it's a TCA. Most TCAs can cause arrhythmias in overdose because they block specific ion channels in the heart. Perhaps this effect is much less marked with tianeptine.
>Seems like the longer I take this, the better I feel. The one thing I've noticed the past few days is a feeling like I am so "comfortable".. hard to describe and relaxed and want to hug everyone.
Sounds good to me!
Regards,
Ed.
Posted by Declan on April 26, 2005, at 23:24:29
In reply to Stablon an entactogen? hehheh, posted by sukarno on April 26, 2005, at 4:35:35
Very interesting. Keep us posted.
Declan
Posted by sukarno on April 28, 2005, at 2:42:36
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Hi, I have some Valium and Klonopin (Rivotril) which are 2 1/2 and 4 years old respectively.
Do these medications become toxic with age? I thought I had read that Klonopin can become toxic to the kidneys when it is expired, but a pharmacist I asked wasn't sure if it will become toxic or not.
What's the general consensus on expired benzodiazepines?
Reason I ask is because I'm almost out of Xanax and it isn't working well enough to stop my night terrors (nocturnal panic attacks), so I was thinking of substituting either Valium or Klonopin for my nighttime Xanax dose.
Thanks very much in advance! :)Paul
Posted by pro_social_soon on April 30, 2005, at 7:37:59
In reply to Expired medications... safe to take?, posted by sukarno on April 28, 2005, at 2:42:36
> Hi, I have some Valium and Klonopin (Rivotril) which are 2 1/2 and 4 years old respectively.
>
> Do these medications become toxic with age? I thought I had read that Klonopin can become toxic to the kidneys when it is expired, but a pharmacist I asked wasn't sure if it will become toxic or not.I used to take Valium which was 4 years expired and was working like normal Valium. Just my 2 cents.
Oh btw. what dose of Stablon are you on? Do you take any other meds?
Take care
Posted by sukarno on April 30, 2005, at 10:35:49
In reply to Re: Expired medications... safe to take? » sukarno, posted by pro_social_soon on April 30, 2005, at 7:37:59
Hi there. :-)
I'm back up to the manufacturer's recommended dose of 12.5mg 3x a day.
Other meds I take are Xanax 1mg 3x/day and 1.5 to 2mg at bedtime; famotidine (Pepcid) 20mg every 6 hours for acid reflux.
I've found Stablon to reduce the effectiveness of Xanax and have had headaches and nightmares which haven't gone away with prolonged use (of Stablon).
I'm about to give up on the Stablon "experiment" because of the headaches (a chronic, vascular headache in the temples and front part of the head that starts up after my 2nd pill of the day in the late afternoon and goes away by morning) and nightmares/vivid dreams.
It also hasn't lifted me out of my amotivational syndrome despite its antidepressant effect.The good side is that I feel better in terms of less anxiety/worry, less asthma symptoms and no depression whatsoever.
I think the headaches are just too much, so I'm going to try Survector (amineptine) next at a low dose (maybe 25 to 50mg to start) and have a liver function test.
I'm also contemplating a Xanax withdrawal via gradual Valium substitution and taper.
Xanax just isn't effective enough on Stablon. Even higher doses don't do much good. I feel I probably need a longer acting benzo if I'm going to be on antidepressants.
I just hope Survector doesn't give me headaches! :-)
Overall, I'd say Stablon is excellent for depression and also somatic complaints or accompanied excessive worrying..and possibly even good for panic attacks!
Has anyone else here had headaches on Stablon? You know how a caffeine withdrawal headache is eh? It's exactly like that, except I don't drink coffee or any caffeinated beverages.
Thanks for writing. I hope others can find Stablon useful. I don't think taking paracetamol or ibuprofen on a daily basis would be a good idea just to reduce the headaches caused by it.
Paul
Posted by ed_uk on April 30, 2005, at 14:07:30
In reply to Stablon experiment coming to an end., posted by sukarno on April 30, 2005, at 10:35:49
Hi Paul!
It's seems you've had a love-hate relationship with Stablon! I hope Survector works well :-) Did you ever find out whether it is still being manufactured in Indonesia?
When will you be starting Survector?
Kind regards,
Ed.
Posted by sukarno on April 30, 2005, at 15:14:10
In reply to Re: Stablon experiment coming to an end. » sukarno, posted by ed_uk on April 30, 2005, at 14:07:30
Hi Ed! :-) Great to see you back here again. How are you doing? Are you still on lofepramine?
Yeah, too bad about the headaches. The headache did seem to dissipate quite a bit when I took another Xanax. Maybe I should try taking more benzos if that will help the headaches and night terrors?
Maybe I should just go straight to Survector though.
I still haven't heard from that doctor friend of mine. She is so busy. I did call the pharmacy that she recommended, but just got voice mail, so I sent her an SMS (text message) to ask the pharmacist for some Survector.
I'll just try my best to speak the local language with the pharmacist and find out if it is being locally produced. That would be great if it was! :-)
Putting things into perspective, abuse and liver damage are quite rare when compared to the possible millions of prescriptions which were filled for Survector over a 20 year period.
I really need something to give me a healthy motivation. Survector seems to be good at doing that from what I've read.
I hate to be my own doctor, but the pdocs here, just as in the US, are all on the SSRI bandwagon. When it comes to panic disorder, they are even less knowledgeable.
I know what I'll do... I'll ask my wife to translate into Indonesian language what I need to ask the pharmacist about whether it is being produced locally. That oughta do the trick! Or just go there in person. :-)
I'm really looking forward to having a normal life for once... it has been 17 years of a somewhat non-existance. :(
Posted by ed_uk on April 30, 2005, at 16:14:25
In reply to Re: Stablon experiment coming to an end., posted by sukarno on April 30, 2005, at 15:14:10
Hi Paul!
>How are you doing? Are you still on lofepramine?
I'm ok thank you :-) I stopped the lofepramine a couple of weeks ago, I haven't had any withdrawal symptoms. I'm not taking any medication at the moment. I might go back on medication in the future but only if I find someone who is willing to prescribe something other than an SSRI or Effexor! A stimulant might help me but only if it didn't cause anxiety, obsessiveness or 'hyperfocusing'.
>Maybe I should try taking more benzos if that will help the headaches and night terrors?
You might have more side effects if you do :-(
Does paracetamol help the headaches?>I still haven't heard from that doctor friend of mine.
Keep texting! Do people even say 'texting' in other countries? I've been wondering whether it's a 'UK thing'.
>I'll ask my wife to translate into Indonesian language.......
Is your wife Indonesian?
Kind regards,
Ed.
Posted by sukarno on May 1, 2005, at 3:24:03
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I have confirmed that Survector is manufactured locally here in Indonesia. The supply is not limited. Pharmacist said it is only being produced in Indonesia. I think it is still being made for Servier (the local pharmaceutical company has a license from Servier to produce it here...that's my guess). That's all I can say on Dr. Bob's site.
You'll have to email me if you want to know more. xxx
hehheh.. :-)
Posted by ed_uk on May 1, 2005, at 11:43:36
In reply to Survector, posted by sukarno on May 1, 2005, at 3:24:03
Hi Paul,
>I have confirmed that Survector is manufactured locally here in Indonesia. The supply is not limited.
Wow! Do you think you'll be starting Survector soon?
Ed.
Posted by sukarno on May 1, 2005, at 13:57:20
In reply to Re: Survector » sukarno, posted by ed_uk on May 1, 2005, at 11:43:36
Hi Ed! :-)
I'm not sure when I'll start taking it, but I just ordered 30 tablets (5 strips of 6 tablets each, 100mg) from the pharmacy and he should deliver tomorrow or the next day. He said he'll call me if there's a problem.
When I asked about diazepam, he didn't want to have anything to do with that and said, "diazepam is illegal drug." but after explaining that I could produce a prescription for it he said it is ok, but he doesn't stock that.
Funny thing is that he will sell me Xanax without a prescription. Weird...
At least I can get Survector from this guy without any hassles. I can get diazepam from another pharmacy I guess. I'm just afraid to go to a GP or pdoc and say, "Hey, well, you know I was thinking about quitting Xanax and Prof. Heather Ashton says 1mg Xanax is equivalent to 20mg diazepam for purposes of tapering...." Well, I think I would have a hard time finding a doc who would give me 80mg of Valium a day. *lol*
If I wasn't on Stablon or Survector then I would be ok with just Xanax, but Stablon has enough of a "stimulant" effect that Xanax can't keep away the night terrors caused by it (unless I take a double-dose at bedtime of 2mg) and it seems much more short-acting while I am on Stablon. Maybe my body will eventually adjust more to Stablon with time *shrugs* :-( I hope so!
It's just the headaches (they weren't so bad today) and the vivid dreams/night terrors which are the problem.
Xanax just won't cover for the nighttime anxiety in the prescribed dose of 1mg 4x/day.
I suppose I could remain on Xanax for daytime use and take something like Rivotril or Valium for nighttime to suppress night terrors? What would you do?
Is that a good idea? I hate to be my own doctor, but I've seen the psychiatrists here and they are equally or more clueless than the ones back in the states.So far, so good with the depression though! I feel happy! :-)
Take care!
Paul
Posted by ed_uk on May 1, 2005, at 15:48:06
In reply to Re: Survector, posted by sukarno on May 1, 2005, at 13:57:20
Hi Paul!
>When I asked about diazepam, he didn't want to have anything to do with that and said, "diazepam is illegal drug." but after explaining that I could produce a prescription for it he said it is ok, but he doesn't stock that.
It's strange how opinions are so different in different countries. Here, diazepam is THE benzo for anxiety. Lorazepam is the benzo which docs won't prescribe. To be fair, all benzos are stigmatised here. My old pdoc *never* prescribed any other benzos for anxiety apart from diazepam.
>I suppose I could remain on Xanax for daytime use and take something like Rivotril or Valium for nighttime to suppress night terrors?
You could try taking Xanax three times a day and Rivotril in the evening. Do you still have no motivation?
Kind regards,
Ed.
Posted by sukarno on May 1, 2005, at 19:05:38
In reply to Re: Survector » sukarno, posted by ed_uk on May 1, 2005, at 15:48:06
Hi Ed. :-)
Is it difficult to get diazepam in the UK if you have an anxiety disorder such as panic disorder or something similar?
I wonder what would happen if I visited the UK and told them I am on Xanax. Would they switch me over to diazepam right away? hehheh.
I still don't feel any motivation, even though I did indeed feel a bit "high"/euphoric after taking the 3rd dose of Stablon 5 hours ago.
I was reading some French website about Stablon where a French doctor was giving his opinion of it. He was saying that it isn't well-studied and only a minority of patients benefit from it, and because there are many other "proven" antidepressants already on the market, he doesn't prescribe Stablon.
Another doctor there said it was more of a "light" antidepressant and is well-tolerated.
It certainly doesn't feel like a strong antidepressant...I'd have to agree there. However, it has helped my depression quite a bit.
Posted by ed_uk on May 1, 2005, at 20:28:28
In reply to Re: Survector, posted by sukarno on May 1, 2005, at 19:05:38
Hi Paul!
>Is it difficult to get diazepam in the UK if you have an anxiety disorder such as panic disorder or something similar?
Yes, it's difficult. On the other hand, some docs will prescribe a few 2mg diazepam tabs to take 'when required'. Few patients take more than 6mg diazepam per day. High doses raise eyebrows, it is very uncommon for anyone to be prescribed more than 30mg/day. Many docs refuse to prescribe even short-term diazepam treatment for severe anxiety. Most UK docs believe that benzos are always ineffective in the long term, only a few docs accept than some patients don't develop tolerance to the anxiolyic effect. Some people are forced to withdraw from diazepam, even if they've been benefitting from it for many years. They will be told, 'it's not helping you' and the treatment will be withdrawn. The chance of finding a doc in the UK who's willing to prescribe 80mg diazepam is virtually zero. Xanax is not available on the NHS, it's 'black listed', most docs will not have heard of it. You would probably be prescribed diazepam 2mg three times a day for a few weeks and then the treatment would be withdrawn.... You would then be prescribed an SSRI.
Ed.
Posted by sukarno on May 2, 2005, at 3:39:14
In reply to Re: Survector » sukarno, posted by ed_uk on May 1, 2005, at 20:28:28
Oh my God... that's horrible. What started all the benzophobia in the UK? I had heard that the Church of Scientology and the anti-drug Dr. Peter Breggin were behind some lawsuits there not too long ago.
So, they can basically just take me off my medication cold turkey.... that could be deadly in the case of alprazolam (Xanax) because of seizures. The least of the withdrawal would be a trauma that the patient would never forget.
Is it common for people to go to the Netherlands to get their benzos? Is the UK strict about British citizens bringing back medications from the Netherlands and other countries?Professor Heather Ashton resides in Newcastle and she was giving out that protocol to switch patients from Xanax to Valium and then tapering them off over a 1 year period or so.
Can she prescribe medications or is she just a lecturer?
Posted by sukarno on May 2, 2005, at 4:19:56
In reply to Re: Survector, posted by sukarno on May 2, 2005, at 3:39:14
I just found out from the pharmacist some disturbing news. :-( :-( :-(
He just told me by SMS (text message), "I am very sorry Mr. Paul, after I called by phone the man who distribution this medicine to me, he said the Survector tab has been expired for all."
Arrghh!!!
I told him I will buy it even if it is expired. Maybe his definition of expired means "gone"?
I hope it just means it is past the expiration date!
Well, I SMS'd my doctor friend and asked her to check more pharmacies.
Maybe it was discontinued here, but in the year 2004, it was still being manufactured here.
I'm sure there is a huge stockpile...unless they destroyed it. I hope not!
I really hope this can be resolved soon, because I want to get good treatment for my amotivation syndrome since I cannot tolerate SSRIs or classic TCAs.
If I can't get Survector, is Adderall (amphetamine salts) a good idea?
Ed? What's your take on this? Would amphetamine in low doses be good for amotivational syndromes and depression?
I'm desperate to try anything to help my lack of motivation and depression.
Posted by Chairman_MAO on May 2, 2005, at 10:28:27
In reply to Survector expired, posted by sukarno on May 2, 2005, at 4:19:56
Amphetamine is certainly good for motivation. A good dose to start with as an adult is 30mg/day in divided doses.
I'm sure people are tiring of my Parnate plugging, but honestly from what you describe it sounds like a good drug for you. :) If they have it in indonesia I would look at it. Also, do you have nomifensine, medifoxamine, or minaprine on the market there? Those also have a significant dopaminergic effect.
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