![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
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
Posted by jujube on November 3, 2004, at 19:20:59
In reply to Re: no more Cymbalta for now » jujube, posted by KaraS on November 3, 2004, at 19:09:33
> > 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
>
>Kara,
Thanks for the warning. I wasn't aware that the site sold meds without a prescription. Hope you find something that works soon.
Take care.
Tamara
Posted by KaraS on November 4, 2004, at 15:55:36
In reply to Re: no more Cymbalta for now » KaraS, posted by jujube on November 3, 2004, at 19:20:59
z,
I wanted to make sure that you caught the post below about narcolepsy/sleep issues. The title might not lead you there so if you didn't open it up, you might not catch it.It's the post by dove:
"hypocretin/dopamine/nore/serotonin/histamine/sleep"
Kara
Posted by zeugma on November 4, 2004, at 19:51:24
In reply to Zeugma - check out post below, posted by KaraS on November 4, 2004, at 15:55:36
> z,
> I wanted to make sure that you caught the post below about narcolepsy/sleep issues. The title might not lead you there so if you didn't open it up, you might not catch it.
>
> It's the post by dove:
>
> "hypocretin/dopamine/nore/serotonin/histamine/sleep"thank you kara. it is timely. i see my pdoc tomorrow. My condition has worsened on Ritalin, and I am going to take 30 mg tomorrow and that will be it.
All I could think of on the bus ride home today was that caffeine pills would serve my cause better than Rit. I did try the 30-30 dosing today, and have not experienced the crash, but unfortunately the med, like most I have tried, has not helped my condition at all. It's a dilemma I'm sure you can empathize with all too well: the 'clean' meds do not work, and the ones that do help come with a train of side effects that end up being worse than the actual disorder.
nortriptyline helps some of my symptoms and has acceptable side effects (although the xerostomia is no joke and my dentist should love me for being a regular customer :)). klonopin lets me show my face to the outside world.
but i feel half asleep all the time, and that is scary, not to mention unacceptable to most employers.
i will let you know what happens tomorrow.
-z>
> Kara
>
Posted by KaraS on November 4, 2004, at 23:37:00
In reply to Re: Zeugma - check out post below » KaraS, posted by zeugma on November 4, 2004, at 19:51:24
> > z,
> > I wanted to make sure that you caught the post below about narcolepsy/sleep issues. The title might not lead you there so if you didn't open it up, you might not catch it.
> >
> > It's the post by dove:
> >
> > "hypocretin/dopamine/nore/serotonin/histamine/sleep"
>
> thank you kara. it is timely. i see my pdoc tomorrow. My condition has worsened on Ritalin, and I am going to take 30 mg tomorrow and that will be it.
>
> All I could think of on the bus ride home today was that caffeine pills would serve my cause better than Rit. I did try the 30-30 dosing today, and have not experienced the crash, but unfortunately the med, like most I have tried, has not helped my condition at all. It's a dilemma I'm sure you can empathize with all too well: the 'clean' meds do not work, and the ones that do help come with a train of side effects that end up being worse than the actual disorder.
>
> nortriptyline helps some of my symptoms and has acceptable side effects (although the xerostomia is no joke and my dentist should love me for being a regular customer :)). klonopin lets me show my face to the outside world.
>
> but i feel half asleep all the time, and that is scary, not to mention unacceptable to most employers.
>
> i will let you know what happens tomorrow.
>
> -z>
> > Kara((((z)))),
Really sorry (and surprised) to hear that. I didn't think that Ritalin was helping as much as you'd like but I didn't get the impression that it was doing nothing either. I will wait to hear what comes out of your doctor's appointment tomorrow.
Maybe we'll try Parnate together. Won't that be fun?
Kara
Posted by zeugma on November 5, 2004, at 19:40:12
In reply to Re: no more Cymbalta for now » zeugma, posted by KaraS on November 3, 2004, at 19:18:11
> >> 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've always been underweight. Provigil, strangely, made me gain weight. I think it has to do with the orexins that are deficient in my brain. I tried to write an explanation at the post you guided me to.
> I haven't completely abandoned MAP but if reboxetine could do the job without the weight gain, then it might be worth the shot.
>
It could be. No EPS or TD to worry about, either. >
> > > > > 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.
> > > >
> > That's a commendable aim. I thought I was killing two birds with one with the nortriptyline/methylphenidate combination. As my pdoc said, though, I seem to have killed one bird- the narcolepsy, not the ADD. Ritalin does not really work for my ADD, and it creates anger and impulsivity during the crash- which is pretty serious considering I often work while the crash happens. I'm doing the 30:30 mg dosing now, in an attempt to forestall this. I took only the 30 mg dose in the am today, and even without anyone to direct the anger against, the crash is pretty bad- I lose the small amount of coordination I have, I fumble with my wallet and everything spills out, I get this 'trance'-like feeling that is not pleasant. Ritalin does not make this disappear. It makes the 'trance' a momentary event. That is the 'wakefulness' effect. It is not a feeling of increased energy at all. It is feeling in a trance less often. It's so odd.> > 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?
Yes, I think it can cause EPS, but at least that is reversible.>
> Also, what about the suggestion of tianeptine? Is that not very well thought of either?
>
Is tianeptine another of those French drugs that causes spontaneous orgasms? That sounds like a reason to to think well of it :)
>
> > > > 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
>
> No miracle. Hopefully the 30-30 schedule will help, at least a little. It does help with the narcolepsy.By the way, are you seriously thinking of Parnate now?
-z
>
>
Posted by gromit on November 6, 2004, at 1:22:25
In reply to resuming the thread » KaraS, posted by zeugma on November 5, 2004, at 19:40:12
> Is tianeptine another of those French drugs that causes spontaneous orgasms? That sounds like a reason to to think well of it :)
Hold the phone, can you name some other drugs that might have that effect? I think I have a greater chance of capturing bigfoot than having an orgasm.
And it's not like I'm not trying. Every night I wait in the woods, I have set up an elaborate system of Wile E. Coyote style traps. Yet every night the damned thing eludes me.
It's ok, my wife thinks I'm weird and not funny too. I should probably stop drinking I guess. Maybe I should create a new account now...
Rick
Posted by Cecilia on November 6, 2004, at 3:27:00
In reply to Re: resuming the thread, posted by gromit on November 6, 2004, at 1:22:25
I tried tianeptine for 7 weeks-no spontaneous orgasms, in fact no effects of any kind, good or bad. Maybe it only works in France. Cecilia
Posted by KaraS on November 6, 2004, at 17:11:28
In reply to Re: tianeptine, posted by Cecilia on November 6, 2004, at 3:27:00
> I tried tianeptine for 7 weeks-no spontaneous orgasms, in fact no effects of any kind, good or bad. Maybe it only works in France. Cecilia
Sorry to hear that tianeptine wasn't very helpful for you, Cecilia. I don't think overall that it has that good of a track record.
That was just a joke by zeugma about the spontaneous orgasms from it. There's another French drug, Amineptine, that really could produce that effect in some people and that was the reference for the joke.
Here's some info on Amineptine from biopsychiatry.com if you're interested:
"Amineptine (Survector) is a clean-ish, (relatively) selective dopamine reuptake blocker. Higher doses promote dopamine release too. Amineptine is pro-sexual and liable occasionally to cause spontaneous orgasms. It is a mild but pleasant psychostimulant and a fast-acting mood-brightener. Unlike other tricyclics, it doesn't impair libido or cognitive function. Unlike typical stimulants and other activating agents, it may actually improve sleep architecture. Scandalously, amineptine isn't licensed and marketed in Britain and America. For it is feared it might have "abuse-potential". FDA pressure recently led to its withdrawal in Europe too. This drove it onto the pharmaceutical grey market, discomfiting doctors and patients alike."
Posted by KaraS on November 6, 2004, at 18:47:35
In reply to resuming the thread » KaraS, posted by zeugma on November 5, 2004, at 19:40:12
> I've always been underweight. Provigil, strangely, made me gain weight. I think it has to do with the orexins that are deficient in my brain. I tried to write an explanation at the post you guided me to.
Yes, I read that. I understand. I have had some prolonged periods in my life where I couldn't eat because of extreme anxiety. That's just as bad as having to worry about weight gain.
> > > >
> > > > > 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.> >
> >
I have a friend who just started on low-dose Seroquel for anxiety (as an addition to Wellbutrin). I have not said much to him about the possible side effects but I have wanted to. I wanted to check out how valid my concerns are first. I am also afraid that my mother's doctor is going to prescribe Seroquel for her. I wish he would prescribe a small amount of doxepin or maprotiline instead. How much should I worry about the cardio effects on a woman in her mid-70s though?
> >
> > > > > > 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 is a consideration for the future. It's not my first choice now though. I'm leaning towards starting on Parnate. I've been depressed and dysfunctional for far too long now. It's time to go for the gusto I think.
> > > > >
> > > That's a commendable aim. I thought I was killing two birds with one with the nortriptyline/methylphenidate combination. As my pdoc said, though, I seem to have killed one bird- the narcolepsy, not the ADD.I thought it was the other way around.
>> Ritalin does not really work for my ADD, and it creates anger and impulsivity during the crash- which is pretty serious considering I often work while the crash happens. I'm doing the 30:30 mg dosing now, in an attempt to forestall this. I took only the 30 mg dose in the am today, and even without anyone to direct the anger against, the crash is pretty bad- I lose the small amount of coordination I have, I fumble with my wallet and everything spills out, I get this 'trance'-like feeling that is not pleasant. Ritalin does not make this disappear. It makes the 'trance' a momentary event. That is the 'wakefulness' effect. It is not a feeling of increased energy at all. It is feeling in a trance less often. It's so odd.
I can only imagine since I haven't experienced anything like it. It doesn't sound like you are able to be upfront about any of this with the people you work with or for. That must make it all the more difficult.
> > > 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.Yes, it's always to soon to say for sure until a med has been around for a long time and tested out in the real world.
> Is tianeptine another of those French drugs that causes spontaneous orgasms? That sounds like a reason to to think well of it :)
I'm sure there are worse side effects but, actually, I would need that particular side effect now like I'd need a hole in my head.
> > > > 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
> >
>
> By the way, are you seriously thinking of Parnate now?Yes, very seriously. I just left my doctor a message to that effect. It's one of the most powerful ADs there is and it might have the potential to reduce the density of the DA autoreceptors. All indicators seem to be pointing in that direction now. I'm terrified to try it though for many reasons - the biggest of which is that it seems like it's one of the strongest, most comprehensive ADs. If this doesn't work, what hope would I have left?
What did you and your doctor decide your next move should be?
Kara
Posted by zeugma on November 7, 2004, at 13:07:13
In reply to Re: resuming the thread » zeugma, posted by KaraS on November 6, 2004, at 18:47:35
> > I've always been underweight. Provigil, strangely, made me gain weight. I think it has to do with the orexins that are deficient in my brain. I tried to write an explanation at the post you guided me to.
>
>
> Yes, I read that. I understand. I have had some prolonged periods in my life where I couldn't eat because of extreme anxiety. That's just as bad as having to worry about weight gain.
>
> > > > >
> > > > > > 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.> >
> > >
>
>
> I have a friend who just started on low-dose Seroquel for anxiety (as an addition to Wellbutrin). I have not said much to him about the possible side effects but I have wanted to. I wanted to check out how valid my concerns are first. I am also afraid that my mother's doctor is going to prescribe Seroquel for her. I wish he would prescribe a small amount of doxepin or maprotiline instead. How much should I worry about the cardio effects on a woman in her mid-70s though?
>
I don't know, honestly. I don't think a low dose of doxepin would be dangerous. About seroquel: I think it is one of the safest AP's. But I think it is irrational to prescribe an AP for anxiety, unless there is a bipolar condition involved. Wellbutrin is a bad choice itself for someone with anxiety, although I take it that the anxiety is a s/e of the WB and not a preexisting condition. But again, I don't know that much about the dangers of Seroquel. Still, I think it's bad practice to prescribe an AP for an AD side effect. You should by all means tell your friend about your concerns.
>
> > >
> > > > > > > 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 is a consideration for the future. It's not my first choice now though. I'm leaning towards starting on Parnate. I've been depressed and dysfunctional for far too long now. It's time to go for the gusto I think.
>
I'll address this further down some more, but if depression is your biggest problem now, it makes more sense to try an AD than Abilify.
>
> > > > > >
> > > > That's a commendable aim. I thought I was killing two birds with one with the nortriptyline/methylphenidate combination. As my pdoc said, though, I seem to have killed one bird- the narcolepsy, not the ADD.
>
> I thought it was the other way around.
>
Well, so did I. Strattera helped my ADD, but at the cost of intolerable s/e. Provigil also helped my ADD, to a much greater extent than Strattera, but again at an intolerable cost. Ritalin does increase my responsiveness. I mean this in the sense that sleep specialists do: it is easier to get a reaction from me on Ritalin than when not medicatated, just as it's easier to rouse someone from stage 1 sleep than from stage 4.It is interesting that on the website Stanford University's center for sleep research, Strattera has been added to the list of narcolepsy meds. This is in keeping with my observations, that Strattera reduced cataplectic attacks to zero, until I added Klonopin. Of course it is not a stimulant, and worsens EDS, but it is a very powerful REM suppressor, in keeping with its affinity for the NE transporter.
I had an episode of hypnagogic hallucinations last night, during the 'trough' period for nortriptyline to take effect. I think the Ritalin helped, because I was awake enough to not look at the hallucinatory content (i.e., I 'closed my eyes' during the dream). So I think that Ritalin makes me more wakeful, although I'm still fatigued and the heightened 'responsiveness' may actually aggravate my ADD, by speeding my reaction time, in contrast to Provigil, which slowed it. It's a complicated situation I have here.
>
> I can only imagine since I haven't experienced anything like it. It doesn't sound like you are able to be upfront about any of this with the people you work with or for. That must make it all the more difficult.
>
> Well, people last year saw me crash on caffeine and Strattera, but those crashes made me virtually speechless, and so I said nothing. Crashing on ritalin causes the anger I mentioned before, and I have been so alarmed about the feelings of those around me, as well as for my job itself, that I have explained my condition to several colleagues. I am hoping that the 30 mg Ritalin LA am, plus 30 mg LA pm, will keep my methylphenidate levels high enough for a long enough time that this effect doesn't happen.> > > > 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.
>
> Yes, it's always to soon to say for sure until a med has been around for a long time and tested out in the real world.Well, I think Abilify can cause marked akathasia, but it is only a partial agonist of the D2 receptor, and while partial agonists by their nature have ambiguous effects (compare with buspirone), I do think that it is safer from a TD pov than anything other than clozapine. Clozapine, by the way, is an option, although (get this) it requires weekly blood monitoring. I would think that it would be an option for anyone with severe, treatment-resistant depression. But not a pleasant one. Maybe less pleasant than ECT. But its efficacy is striking.>
> > Is tianeptine another of those French drugs that causes spontaneous orgasms? That sounds like a reason to to think well of it :)
>
> I'm sure there are worse side effects but, actually, I would need that particular side effect now like I'd need a hole in my head.
>
Well, I doubt you need to worry about that one then. I think that statement is an index of your level of depression :( I hope you can find something soon that helps. I've probably asked this before, but are you experiencing complete anhedonia?[about Parnate]
>
> Yes, very seriously. I just left my doctor a message to that effect. It's one of the most powerful ADs there is and it might have the potential to reduce the density of the DA autoreceptors. All indicators seem to be pointing in that direction now. I'm terrified to try it though for many reasons - the biggest of which is that it seems like it's one of the strongest, most comprehensive ADs. If this doesn't work, what hope would I have left?
>Well, I understand your reluctance. One thing that may (or may not) console you is that MAOI's are NOT considered the most broadly effective AD's by everyone, although this is highly disputed. Most meta-analyses suggest that amitriptyline and clomipramine are the most effective of all AD's. ECT is supposed to be the most effective of all treatments. One study I read suggested that nortriptyline, if kept in a plasma level range of 90-130 ng/mL, is as effective as ECT.
All of these drugs have idiosyncracies that makes response a highly individual matter, although some effects, such as Strattera's anticataleptic effect, would probably qualify as universal given the close association between NE reuptake inhibition and REM suppression. (Dreaming, by the way, can occur in the absence of REM, although cataplexy can't. There is a particular anatomical reason for this that would take this parenthesis beyond the bounds of relevance.) There is also the matter of the therapeutic relationship between pdoc and patient. If this is suboptimal, it may interfere with your response.
> What did you and your doctor decide your next move should be?
I am doing the dosing change. He also told me that my response to meds was more typical of a narcolepsy than a pure ADD patient. This helps me in that it clarifies aspects of my diagnosis. My next move is to meet with my ADD coach this week. These, I understand, are not drastic moves. But there are no obvious, drastic moves that i can see right now.
-z
>
> Kara
>
>
>
>
Posted by KaraS on November 8, 2004, at 0:14:16
In reply to Re: resuming the thread » KaraS, posted by zeugma on November 7, 2004, at 13:07:13
>>...about the dangers of Seroquel. Still, I think it's bad practice to prescribe an AP for an AD side effect. You should by all means tell your friend about your concerns.
I think I'm going to post something here to see what kind of feedback I get on the issue of using Seroquel or Amisulpride for anxiety/depression respectively. Risk vs benefit.
> > > > > That's a commendable aim. I thought I was killing two birds with one with the nortriptyline/methylphenidate combination. As my pdoc said, though, I seem to have killed one bird- the narcolepsy, not the ADD.
> >
> > I thought it was the other way around.
> >
> Well, so did I. Strattera helped my ADD, but at the cost of intolerable s/e. Provigil also helped my ADD, to a much greater extent than Strattera, but again at an intolerable cost. Ritalin does increase my responsiveness. I mean this in the sense that sleep specialists do: it is easier to get a reaction from me on Ritalin than when not medicatated, just as it's easier to rouse someone from stage 1 sleep than from stage 4.
>
> It is interesting that on the website Stanford University's center for sleep research, Strattera has been added to the list of narcolepsy meds. This is in keeping with my observations, that Strattera reduced cataplectic attacks to zero, until I added Klonopin. Of course it is not a stimulant, and worsens EDS, but it is a very powerful REM suppressor, in keeping with its affinity for the NE transporter.Yet the Strattera did end up making you tired eventually...
> I had an episode of hypnagogic hallucinations last night, during the 'trough' period for nortriptyline to take effect. I think the Ritalin helped, because I was awake enough to not look at the hallucinatory content (i.e., I 'closed my eyes' during the dream). So I think that Ritalin makes me more wakeful, although I'm still fatigued and the heightened 'responsiveness' may actually aggravate my ADD, by speeding my reaction time, in contrast to Provigil, which slowed it. It's a complicated situation I have here.If I understand this correctly, the "fix" for one problem may have a detrimental effect on the other so you're trying to find some kind of balance that you can function on - and your next test is to see if Ritalin LA 60 mg. will be the answer?
> > I can only imagine since I haven't experienced anything like it. It doesn't sound like you are able to be upfront about any of this with the people you work with or for. That must make it all the more difficult.
> >
> > Well, people last year saw me crash on caffeine and Strattera, but those crashes made me virtually speechless, and so I said nothing. Crashing on ritalin causes the anger I mentioned before, and I have been so alarmed about the feelings of those around me, as well as for my job itself, that I have explained my condition to several colleagues. I am hoping that the 30 mg Ritalin LA am, plus 30 mg LA pm, will keep my methylphenidate levels high enough for a long enough time that this effect doesn't happen.Telling some of your colleagues must have been a relief. I hope that they were understanding and supportive.
> > > > > 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.
> >
> > Yes, it's always to soon to say for sure until a med has been around for a long time and tested out in the real world.
>
> Well, I think Abilify can cause marked akathasia, but it is only a partial agonist of the D2 receptor, and while partial agonists by their nature have ambiguous effects (compare with buspirone), I do think that it is safer from a TD pov than anything other than clozapine. Clozapine, by the way, is an option, although (get this) it requires weekly blood monitoring. I would think that it would be an option for anyone with severe, treatment-resistant depression. But not a pleasant one. Maybe less pleasant than ECT. But its efficacy is striking.>An AP and once a week labs - definitely last resort. Good to know there are other options I guess.
>I think that statement is an index of your level of depression :( I hope you can find something soon that helps. I've probably asked this before, but are you experiencing complete anhedonia?
I have had a rough couple of days. Definitely anhedonic now but overall I have not been. Hope this doesn't last because I really feel terrible now. I think it's related to some recent events and that it will change once some things calm down.
> [about Parnate]
> >
> > Yes, very seriously. I just left my doctor a message to that effect. It's one of the most powerful ADs there is and it might have the potential to reduce the density of the DA autoreceptors. All indicators seem to be pointing in that direction now. I'm terrified to try it though for many reasons - the biggest of which is that it seems like it's one of the strongest, most comprehensive ADs. If this doesn't work, what hope would I have left?
> >
>
> Well, I understand your reluctance. One thing that may (or may not) console you is that MAOI's are NOT considered the most broadly effective AD's by everyone, although this is highly disputed. Most meta-analyses suggest that amitriptyline and clomipramine are the most effective of all AD's.Really? Good old Elavil? You're the second one recently to bring up Anafranil. Why do the best ADs have to cause weight gain? I still have it in my mind that Parnate is the next thing to try for me. I like the idea that the serotonergic activity isn't unopposed. Do you believe I'm thinking about this correctly given my condition?
ECT is supposed to be the most effective of all treatments. One study I read suggested that nortriptyline, if kept in a plasma level range of 90-130 ng/mL, is as effective as ECT.
I would love to try nort again if I could do something about the tachycardia. I loved the energy I had on it. What about Pindolol with it?
> All of these drugs have idiosyncracies that makes response a highly individual matter, although some effects, such as Strattera's anticataleptic effect, would probably qualify as universal given the close association between NE reuptake inhibition and REM suppression.Didn't know that. With REM suppression, can the sleep be adequate or restorative?
(Dreaming, by the way, can occur in the absence of REM, although cataplexy can't. There is a particular anatomical reason for this that would take this parenthesis beyond the bounds of relevance.) There is also the matter of the therapeutic relationship between pdoc and patient. If this is suboptimal, it may interfere with your response.
>
> > What did you and your doctor decide your next move should be?
>
> I am doing the dosing change. He also told me that my response to meds was more typical of a narcolepsy than a pure ADD patient. This helps me in that it clarifies aspects of my diagnosis.You've suspected this for quite some time now, no?
My next move is to meet with my ADD coach this week. These, I understand, are not drastic moves. But there are no obvious, drastic moves that i can see right now.
>Maybe tweaking is what you need to try now while you work on the nonmed therapy.
Kara
This is the end of the thread.
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