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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 35. Go back in thread:
Posted by rmshed on October 4, 2001, at 21:46:45
In reply to Re: Will more Prozac help? » rmshed, posted by SalArmy4me on October 4, 2001, at 0:01:17
> What other stuff have you tried before?
I have tried Paxil, Zoloft, Remeron (sp?)Celexa. My doctor tried augmenting Cytomel to help with Prozac, this did nothing. I have tried Wellbutrin, Effexor XR. I also take doxepin and Xanax. Effexor XR did wonders for my type of depression, but I could not deal with the physical side effects. My doctor says that I have treatment resistant depression. My doctor doesn't know what to try, I am very reluctant to begin another drug that is jammed packed with clinical studied side effects. I guess I am stuck with no place to go!
Posted by SLS on October 4, 2001, at 22:06:32
In reply to Re: Will more Prozac help?, posted by rmshed on October 4, 2001, at 21:46:45
> > What other stuff have you tried before?
>
> I have tried Paxil, Zoloft, Remeron (sp?)Celexa. My doctor tried augmenting Cytomel to help with Prozac, this did nothing. I have tried Wellbutrin, Effexor XR. I also take doxepin and Xanax. Effexor XR did wonders for my type of depression, but I could not deal with the physical side effects. My doctor says that I have treatment resistant depression. My doctor doesn't know what to try, I am very reluctant to begin another drug that is jammed packed with clinical studied side effects. I guess I am stuck with no place to go!Hi rmshed.
People who respond well to Effexor often respond well to MAOIs - Parnate and Nardil. I have never found the special diet much of a big deal, and these drugs are often very well tolerated with respect to side effects.
Just a thought.
- Scott
Posted by pat c. on November 3, 2001, at 15:24:24
In reply to Re: Will more Prozac help? » Cam W., posted by SLS on October 4, 2001, at 12:20:02
Do you know if Gepirone will be available soon?
I heard it's good for atypical depression.
Other than MAOIs and Klonopin, are there
any other drugs that have been affective against atypical depression.Will Buspar work? I think I rememeber trying it, and it didn't work.
Thanks.
Pat
Posted by SLS on November 4, 2001, at 10:27:45
In reply to Gepirone and Atypical Depression, posted by pat c. on November 3, 2001, at 15:24:24
> Do you know if Gepirone will be available soon?
>
> I heard it's good for atypical depression.
>
> Other than MAOIs and Klonopin, are there
> any other drugs that have been affective against atypical depression.
>
> Will Buspar work? I think I rememeber trying it, and it didn't work.
>
> Thanks.
>
> Pat
Hi Pat.Where did you find the information declaring gepirone as being effective specifically for atypical depression? I know that Columbia has announced wanting to conduct a study of this, but I don't know that they have concluded it.
The only thing I could find on Google regarding FDA approval of gepirone indicated that it is currently under review. I imagine this means that the results of phase III clinical trials have been submitted.
August 8, 2001
http://www.centrere.com/newsroom/press/2001_08_08.html
Gepirone is an azapirone (buspirone, gepirone, ipsapirone, etc.) that is a partial agonist at serotonin 5-HT1a receptors, and is somewhat selective for autoreceptors. Unlike buspirone, a related drug, it does not bind to dopamine receptors and seems to be less sedating. Although gepirone has shown modest anxiolytic (anti-anxiety) effects, it is being developed as an antidepressant. An important feature of gepirone is that its major metabolite, 1-PP, is a potent norepinephrine NE alpha-2 receptor antagonist. This is a property it shares with Remeron.
As anxiolytics, it seems that both buspirone and gepirone can be very effective, but their therapeutic effects often take 2 - 6 weeks to develop. It probably makes sense to co-administer a faster-acting anxiolytic in the beginning.
- Scott
Posted by pat c. on November 4, 2001, at 14:19:34
In reply to Re: Gepirone and Atypical Depression » pat c., posted by SLS on November 4, 2001, at 10:27:45
One of the top doctors at NY Psychiatric (don't want to name him) told me that the first trial showed that people with atypical depression had 40% positive response to Gepirone.
It blew his mind, and he has been doing this for decades.
He said that Bristol Meyers Squibb was crazy for selling it to Organon.
Now they're doing another trial, I guess for Organon.
Pat
Posted by Cam W. on November 4, 2001, at 15:28:01
In reply to Re: Gepirone and Atypical Depression » pat c., posted by SLS on November 4, 2001, at 10:27:45
Scott - I seem to recall (although very unclearly) that there was some hold-up with gepirone release in Europe. Do you remember what the problem was? - Cam
Posted by SLS on November 6, 2001, at 10:46:59
In reply to Re: Gepirone and Atypical Depression » SLS, posted by pat c. on November 4, 2001, at 14:19:34
> One of the top doctors at NY Psychiatric (don't want to name him) told me that the first trial showed that people with atypical depression had 40% positive response to Gepirone.
>
> It blew his mind, and he has been doing this for decades.
>
> He said that Bristol Meyers Squibb was crazy for selling it to Organon.
>
> Now they're doing another trial, I guess for Organon.
>
> Pat
>
Hi Pat.Thanks for the information.
I would be interested to speak to some people up at Columbia myself. I know some of the doctors up there, including Fred Quitkin.
If you wouldn't mind, I would be grateful for you to correspond with me directly for further discussions.
For me, it is probably very unfortunate that gepirone and the other azapirones are extensively metabolized in the body to 1-PP, a potent NE alpha-2 receptor antagonist. Of course, this is probably a good thing for the vast majority of people. Idazoxan and mirtazepine, both alpha-2 antagonists, make my depression substantially worse. I'm worried that my taking gepirone will lead to a similar exacerbation.
http://www.acnp.org/g4/GN401000109/CH107.html
"An additional mechanism that might contribute is the metabolism of the azapirones to 1-(2-pyramidal)-piperazine (1-PP), which achieves brain concentrations tenfold higher than the parent component (13); 1-PP is an a2-adrenergic antagonist, a drug class that has been hypothesized to have antidepressant properties (see below). In one clinical study, 1-PP plasma levels were significantly correlated with improvement in depressive symptoms in patients treated with buspirone (79)."
Take care.
- Scott
Posted by SLS on November 6, 2001, at 10:49:16
In reply to Re: Gepirone and Atypical Depression » SLS, posted by pat c. on November 4, 2001, at 14:19:34
Oops. Forgot.
- Scott
Posted by pat c. on November 6, 2001, at 16:29:22
In reply to Re: Gepirone and Atypical Depression » pat c., posted by SLS on November 6, 2001, at 10:46:59
Yeh, Quitkin told me about McGrath's first study on Gepirone.
Quitkin was amazed by McGrath's findings that
Giperone had a 40%+ success rate.I guess McGrath is doing another study now.
Pat
Posted by SLS on November 6, 2001, at 18:49:29
In reply to Re: Gepirone and Atypical Depression » SLS, posted by pat c. on November 6, 2001, at 16:29:22
> Yeh, Quitkin told me about McGrath's first study on Gepirone.
>
> Quitkin was amazed by McGrath's findings that
> Giperone had a 40%+ success rate.
>
> I guess McGrath is doing another study now.
>
> Pat
Hi Pat.I saw Pat McGrath last year. Wonderful guy. Perhaps I'll give him a call.
Thanks.
- Scott
Posted by jrbecker on August 20, 2002, at 12:52:35
In reply to Re: Gepirone and Atypical Depression » pat c., posted by SLS on November 6, 2001, at 18:49:29
I'm currently in the Columbia Univ phase III study. According to the head researcher (shall go un-named), gepirone will be on the market 8-12 months from now, so presumably, somewhere around summer 2003 (when and if approved -- looks very hopeful that it will though).
Fairly excited for this drug myself. Seems like it will be an advantageous addition to the treatment arsenal (especially for atypical depressive sufferers). I'll let you know any progress as it comes up.
Posted by pc on August 21, 2002, at 20:50:57
In reply to Re: Gepirone and Atypical Depression, posted by jrbecker on August 20, 2002, at 12:52:35
Yes. Please let me know if this helps your atypical depression. I suffer from atypical depression and the only stuff that's helped me has been Nardil and Klonopin. I don't take Nardil any more, because of the side effects, especially the weight gain and I also built up tolerance to it. Klonopin is addictive, and I would like to get off that as well. I'm only on 0.75 mg right now, but I also take 4800 mg of Neurontin.
Anyway, I have had e-mail discussions with Dr. McGrath, who I guess you've worked with. I used to see Dr. Quitkin, but I moved to FL. I heard that Gepirone has a high success rate amongst atypical depressants -- over 60%, so I can't wait to try it.
God bless.
Pat
Posted by jrbecker on August 22, 2002, at 13:24:00
In reply to Re: Gepirone and Atypical Depression » jrbecker, posted by pc on August 21, 2002, at 20:50:57
pat-
I'll let you know how it goes. I start the treatment phase tomorrow. Of course, there's only a 1/3 chance I'll get the gepirone treatment since it's being tested against both Paxil and placebo.
Although rumors have been positive coming back from the study, I am trying not to be too overly-optimistic about this drug. My hunch is that it will be unlikely that anybody who has very severe depressive symptoms will choose this treatment over the SSRIs/MAOIs. It's basically a close cousin to Buspar (which I've taken and didnt find effective against my depression). HOWEVER, all of the data has shown that gepirone has much more AD efficacy than buspar. And it is mildly stimulating, another plus for for some atypical depressives. Moreover, it will most likely have negligible weight gain, somnolescence, and sexual side effects (big yes!). So for moderate atypical types, it sounds right up our alley.I've always thought my depression was somewhat mild to moderate, so I've never wanted to go the way of MAOIs despite being unsatisfied with most SSRIs.
Couple of questions for you now:1)Never tried Klononpin. What's it like, any AD effect?
2)Do you have soft biploar 2 symptoms or is this or anxiety? Have occassionally used Neurontin, although I usually only take 100-200mg three times daily. Only finds it knocks me out and might even be making my depression worse at times. Can't believe you're able to handle that high of a dosage. As an atypical sufferer, doesn't this make your already hypersomnolescence symptomology worse?
> Yes. Please let me know if this helps your atypical depression. I suffer from atypical depression and the only stuff that's helped me has been Nardil and Klonopin. I don't take Nardil any more, because of the side effects, especially the weight gain and I also built up tolerance to it. Klonopin is addictive, and I would like to get off that as well. I'm only on 0.75 mg right now, but I also take 4800 mg of Neurontin.
>
> Anyway, I have had e-mail discussions with Dr. McGrath, who I guess you've worked with. I used to see Dr. Quitkin, but I moved to FL. I heard that Gepirone has a high success rate amongst atypical depressants -- over 60%, so I can't wait to try it.
>
> God bless.
>
> Pat
>
Posted by pc on August 25, 2002, at 9:03:26
In reply to Re: Gepirone and Atypical Depression, posted by jrbecker on August 22, 2002, at 13:24:00
Hi.
Klonopin is quite effective against GAD, social phobia and even panic attacks. It is questionable whether it fights depression. I don't think it does directly, but indirectly it might, because it provides relief for the other problems. These other problems (i.e GAD, social phobia, panic) can cause one to be depressed. However, "major" depression has established a foothold in my atypical depression over the last couple of years (out of the 16) and Klonopin and Neurontin haven't been able to fully combat it. Neurontin, I believe, has antidepressant properties. It cetaintly is a good mood stabilizer which also fights GAD, panic and social phobia.
I'm not bipolar, because I don't have the manic symptons. Neurontin does make me tired, but not overly so.
Pat
Posted by jrbecker on March 25, 2003, at 15:52:54
In reply to Re: Gepirone and Atypical Depression » jrbecker, posted by pc on August 25, 2002, at 9:03:26
Today I talked with my old doc at NY Psych institute about any recent involvements in the Gepirone debacle. He mentioned that the study has nine more weeks to go before they are closing it for new subjects. If the results are positive, then it will probably be another 3-5 months before Organon will submit the results to the FDA.
I asked if there was any preliminary rumors about how the current study (gepirone v. paxil) is going. Unfortunately, there seems to be no real news. However, Organon has initiated two other gepirone studies recently which might mean something positive.
Back to guessing timelines, my doc guessed that if it does make it to market, the soonest would be early spring '04.
Posted by patc on March 25, 2003, at 19:04:22
In reply to Re: Gepirone update, posted by jrbecker on March 25, 2003, at 15:52:54
That sucks.
My atypical depression is raging, and
I refuse to go back on MAOIs.Neurontin and Klonopin are barely holding me together.
Pat
> Today I talked with my old doc at NY Psych institute about any recent involvements in the Gepirone debacle. He mentioned that the study has nine more weeks to go before they are closing it for new subjects. If the results are positive, then it will probably be another 3-5 months before Organon will submit the results to the FDA.
>
> I asked if there was any preliminary rumors about how the current study (gepirone v. paxil) is going. Unfortunately, there seems to be no real news. However, Organon has initiated two other gepirone studies recently which might mean something positive.
>
> Back to guessing timelines, my doc guessed that if it does make it to market, the soonest would be early spring '04.
>
>
Posted by jrbecker on March 25, 2003, at 22:33:31
In reply to Re: Gepirone update » jrbecker, posted by patc on March 25, 2003, at 19:04:22
pat -
how the heck do you get by with just taking klonopin and neurontin? Doesn't any AD provide some relief? Or is sunny Florida providing its own mood effect, ha. Actually, I just returned from a trip to key west recently and thought it was the best mood lift I've had all year.
JB
Posted by patc on March 26, 2003, at 14:04:55
In reply to Re: Gepirone update » patc, posted by jrbecker on March 25, 2003, at 22:33:31
As you know atypical depression is a mix of anxiety (social phobia/GAD/panic) and depression.
Wellbutrin and other stimulants cause too much anxiety. Serotonin-reuptake inhibitors, trycyclics and anti-psychotics don't help. Nardil is the only thing that's really helped, but I will not deal w/ the weight gain. Plus, it pooped out. I had no luck w/ Parnate, and Seligiline is too stimulative. What's left?The Miami sun helps a little, but not when I'm inside working all day. Granted, if I was in NYC I'd would be screwed. But at least I be part of the Gepirone study at Columbia.
Pat
> pat -
>
> how the heck do you get by with just taking klonopin and neurontin? Doesn't any AD provide some relief? Or is sunny Florida providing its own mood effect, ha. Actually, I just returned from a trip to key west recently and thought it was the best mood lift I've had all year.
>
> JB
>
>
Posted by jrbecker on March 26, 2003, at 20:33:22
In reply to Re: Gepirone update » jrbecker, posted by patc on March 26, 2003, at 14:04:55
Pat,
I'm really surprised to hear that no AD at all (with the exception of nardil) has no usefulness to you. Being a fairly treatment-resistant atypical-type myself, I certainly know where you're coming from though. Do you suffer from a profound sense of anhedonia or just the other atypical symptoms of overeating/oversleeping, etc.?
Does a very low dosage of an SSRI provide at least some mood lift...or are side effects a problem still? I'm quite sensitive to most meds myself. Some are either too stimulating or untolerable due to side effects at regular dosage levels. But I have found undeniable benefits from taking just low dosages of some meds (e.g., Effexor 37.5mg, Celexa 10-20mg).
Last question...I'm curious why you're holding such a candle for gepirone. Quitkin, McGrath, and Stewart's 1st study results were certainly impressive, but many others doubt that it will not be that great of an antidepressant. Perhaps the best benefit of the drug will just be that it has the lowest incidence of side effects of most modern ADs. Care to add any knowledge to the debate?
JB
PS- be thankful you're in Miami. It was brutal up here this winter.
> As you know atypical depression is a mix of anxiety (social phobia/GAD/panic) and depression.
> Wellbutrin and other stimulants cause too much anxiety. Serotonin-reuptake inhibitors, trycyclics and anti-psychotics don't help. Nardil is the only thing that's really helped, but I will not deal w/ the weight gain. Plus, it pooped out. I had no luck w/ Parnate, and Seligiline is too stimulative. What's left?
>
> The Miami sun helps a little, but not when I'm inside working all day. Granted, if I was in NYC I'd would be screwed. But at least I be part of the Gepirone study at Columbia.
>
> Pat
>
>
>
> > pat -
> >
> > how the heck do you get by with just taking klonopin and neurontin? Doesn't any AD provide some relief? Or is sunny Florida providing its own mood effect, ha. Actually, I just returned from a trip to key west recently and thought it was the best mood lift I've had all year.
> >
> > JB
> >
> >
>
>
Posted by patc on March 26, 2003, at 22:06:33
In reply to Re: Gepirone update » patc, posted by jrbecker on March 26, 2003, at 20:33:22
I don't know what anhedonia is.
All I know is I having been dealing with this disease for 17 years (now age 37) and no drugs have put a dent in this atypical depression, except Nardil and Klonopin. Perhaps, Neurontin helps a little. The latest stage of the disease involves heavy depression.
SSRIs have all failed and I tried them all.
The boys up in Colombia think Gepirone is very effective ag/ atypical depression. I think Quitkin told me McGrath said 50%+ success on Gepirone and that BMS was "crazy" to sell it to Organon. 50%+ success has to be close to Nardil.
Wellbutrin is great for depression, but I get the worst anxiety attacks. The agitation is killer.
Pat
> Pat,
>
> I'm really surprised to hear that no AD at all (with the exception of nardil) has no usefulness to you. Being a fairly treatment-resistant atypical-type myself, I certainly know where you're coming from though. Do you suffer from a profound sense of anhedonia or just the other atypical symptoms of overeating/oversleeping, etc.?
>
> Does a very low dosage of an SSRI provide at least some mood lift...or are side effects a problem still? I'm quite sensitive to most meds myself. Some are either too stimulating or untolerable due to side effects at regular dosage levels. But I have found undeniable benefits from taking just low dosages of some meds (e.g., Effexor 37.5mg, Celexa 10-20mg).
>
> Last question...I'm curious why you're holding such a candle for gepirone. Quitkin, McGrath, and Stewart's 1st study results were certainly impressive, but many others doubt that it will not be that great of an antidepressant. Perhaps the best benefit of the drug will just be that it has the lowest incidence of side effects of most modern ADs. Care to add any knowledge to the debate?
>
> JB
>
> PS- be thankful you're in Miami. It was brutal up here this winter.
>
>
> > As you know atypical depression is a mix of anxiety (social phobia/GAD/panic) and depression.
> > Wellbutrin and other stimulants cause too much anxiety. Serotonin-reuptake inhibitors, trycyclics and anti-psychotics don't help. Nardil is the only thing that's really helped, but I will not deal w/ the weight gain. Plus, it pooped out. I had no luck w/ Parnate, and Seligiline is too stimulative. What's left?
> >
> > The Miami sun helps a little, but not when I'm inside working all day. Granted, if I was in NYC I'd would be screwed. But at least I be part of the Gepirone study at Columbia.
> >
> > Pat
> >
> >
> >
> > > pat -
> > >
> > > how the heck do you get by with just taking klonopin and neurontin? Doesn't any AD provide some relief? Or is sunny Florida providing its own mood effect, ha. Actually, I just returned from a trip to key west recently and thought it was the best mood lift I've had all year.
> > >
> > > JB
> > >
> > >
> >
> >
>
>
Posted by jrbecker on March 27, 2003, at 9:48:23
In reply to Re: Gepirone update » jrbecker, posted by patc on March 26, 2003, at 22:06:33
3/25/2003
- Methods for treating psychological disorders using bioactive metabolites of gepirone (Assignee -- Fabre-Kramer Pharmaceuticals, Inc.)
Abstract: Bioactive gepirone metabolites, such as 3-OH gepirone -1-piperazinyl]butyl]-2,6- piperidinedione), and their pharmaceutically acceptable salts and hydrates, can be used to alleviate psychological disorders or the symptoms thereof.
U.S. Patents via NewsEdge Corporation : Abstract: Bioactive gepirone metabolites, such as 3-OH gepirone (4,4,-dimethyl-3-hydroxy-1-[4- [4-(2-pyrimidinyl)-1-piperazinyl]butyl]-2,6- piperidinedione), and their pharmaceutically acceptable salts and hydrates, can be used to alleviate psychological disorders or the symptoms thereof. The use of these compounds provides advantages over other therapeutic azapirones as they possess superior bioavailability, faster onset of action, and more stable plasma levels when administered to a mammal.Ex Claim Text: A method of alleviating depression or anxiety or symptoms thereof in a mammal comprising administering an effective amount of a gepirone metabolite, or a pharmaceutically acceptable salt or hydrate thereof, to the mammal, wherein the gepirone metabolite is 3-OH gepirone or 3,5-dihydroxy gepirone.
Patent Number: 6534507
Issue Date: 2003 03 18
Posted by douxmari on April 21, 2006, at 7:59:46
In reply to Re: Gepirone update, posted by jrbecker on March 27, 2003, at 9:48:23
so, what is with this gepirone? any news? and it was twice refused by FDA - is it any good?
Posted by patc on April 22, 2006, at 19:20:35
In reply to Re: Gepirone update, posted by douxmari on April 21, 2006, at 7:59:46
> so, what is with this gepirone? any news? and it was twice refused by FDA - is it any good?
NY Psychiatric says it was a bust
have you heard about any new drugs that work for atypical depression?
Posted by SLS on April 23, 2006, at 9:33:07
In reply to Re: Gepirone update » douxmari, posted by patc on April 22, 2006, at 19:20:35
> > so, what is with this gepirone? any news? and it was twice refused by FDA - is it any good?
>
> NY Psychiatric says it was a bustThat's too bad.
It would have been interesting had they used it to augment an SSRI. Unfortunately, no one ever thinks to study an investigational as an adjunct. Gepirone is probably a cleaner drug than buspirone.
- Scott
Posted by jrbecker on April 23, 2006, at 23:14:42
In reply to Re: Gepirone update, posted by SLS on April 23, 2006, at 9:33:07
> > > so, what is with this gepirone? any news? and it was twice refused by FDA - is it any good?
> >
> > NY Psychiatric says it was a bust
>
> That's too bad.
>
> It would have been interesting had they used it to augment an SSRI. Unfortunately, no one ever thinks to study an investigational as an adjunct. Gepirone is probably a cleaner drug than buspirone.
>
>
> - Scott
>
As of last week, Fabre-Kramer still plans to submit an amendment of the original NDA to the FDA sometime this summer. A six month response period would follow.
This is the end of the thread.
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