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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by linkadge on December 27, 2008, at 21:31:46
Hi, I've noticed that there are a number of people who seem to survive depression through a regiment of medication cycling.
Many doctors seem to stray away from this idea instead looking for a single medication that is going to continuously treat symptoms.
When I say med cycling, I mean a handful of medications (maybe 5 or so) that have theraputic effect for a limited amount of time which can be peridocially interchanged to maintain a euthemic state. It could also mean medication pulsing, or taking medications on an as needed basis.
I think there may be some biochemcial basis for why this seems to work for some people. Perhaps different medications activate or supress different neural cicutry which may or may not be needed at a given time.
Perhaps interhcanging two antidepressants with different mechanisms of action can prevent tollerance to either agent.
Perhaps different neurotransmitter systems promote different forms of neuronal placiticty which are needed at different times.
For instance, certain SSRI's beneift me for a period of about 2-3 weeks after which apathy sets in. At this point I can reduce the SSRI dose and augment with atomoxatine or methyphenidate. After this, I might switch back to the SSRI alone with a full benefit. At some point I might switch to a third medication and then back to the original.
Not that I am encouraging self medication or the like, but has anybody found that sometimes they only feel well when they are able to systematically transition between certain medications.
Posted by linkadge on December 27, 2008, at 21:40:25
In reply to Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:31:46
You might throw other things into the mix such as periodic sleep deprivation, exericse, caffine PRN, etc.
I know that opponents would say that you need to take something consistently for your brain to adjust, but maybe thats exactly what your brain needs. I.e. a consistent change. Something to pull it in a different direction whenever it starts to get in a rut. You know, mixing it up a bit. Anybody?
Linkadge
Posted by linkadge on December 27, 2008, at 21:44:07
In reply to Re: Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:40:25
For instance, I read a study in which mice were fed an alternating regime of venlafaxine and an ampakine. Basically the study concluded that feeding either agent alone lead to a temporary induction of BDNF (as did the combinaiton) but the alternation of either agent lead to a more sustained induction.
Linkadge
Posted by SLS on December 28, 2008, at 7:55:17
In reply to Re: Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:40:25
One of my doctors had a patient that he cycled between Nardil and Parnate with continual success.
Intuitively, one might think of homeostasis as the goal. My guess is that most of the antidepressant drugs are working upstream from the loci in the brain that are the ultimate sources of depressive states. These downstream loci of pathology origin might require that a homeostasis exists within them to function properly. However, the brain is so plastic and capable of having gene activity change, that one cannot guarantee that the cascade of events leading from the upstream drug action to the downstream origin of pathology will remain static.
It would seem that cycling between drugs might be necessary in a minority of otherwise treatment resistant individuals. I am doubtful that this is a productive treatment for the majority, though. I was under the impression that cycling between different antidepressants or pulsing the same antidepressant leads to treatment resistance.
Perhaps cycling drugs will become a more viable alternative once more is understood about the phenomenology of depression so as to be able to choose which drugs to add and subtract at any given point in treatment.
- Scott
Posted by Phillipa on December 28, 2008, at 10:52:57
In reply to Re: Theraputic med cycing, posted by SLS on December 28, 2008, at 7:55:17
Kind of reminds me of being bored a bored brain. Phillipa
Posted by ricker on December 28, 2008, at 14:08:15
In reply to Re: Theraputic med cycing, posted by Phillipa on December 28, 2008, at 10:52:57
I think this is a viable option for treatment resistant cases. Obviously, the need for med "cycling" in a stable patient is not necessary.
But yes, I strongly agree there is something to be said for multiple meds with intermittent dosing.
I'm not comparing this to the standard "augmenting" practice, but rather a unorthodox med delivery system.
The problem with this method lies with the patients ability to properly self diagnose and administration of the cocktail.
For myself, some of my finest moments are captured when "switching from one to another. I usually don't taper so those 3, 4 or 5 days of breakthrough provide enough evidence to support your theory of med cycling.
Regards, Rick
Posted by Valero on December 28, 2008, at 14:47:31
In reply to Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:31:46
Yes, I'd certainly agree with this theory, been doing it for years myself. I'd not speculate on the bio chemistry aspect, but possibly a natural predisposition to a depressive temperament which can be "cheated" out of " default mode" by cycling drug types and combo's. The permutations are virtual endless for those with the talent and inclination to pursue this strategy. The easy availability of on-line meds. certainly make it easier, as I'd guess that many MD's. wouldn't go along with it .
One regime that I'm fond of is:
Tramadol 2-4 weeks
Tianeptine 1-2 weeks ( + chlorzepate)
Moclobemide 4-6 weeks ( + zolpidem)Approx. 12 weeks to full circle.
V.
Posted by bulldog2 on December 30, 2008, at 9:15:41
In reply to Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:31:46
> Hi, I've noticed that there are a number of people who seem to survive depression through a regiment of medication cycling.
>
> Many doctors seem to stray away from this idea instead looking for a single medication that is going to continuously treat symptoms.
>
> When I say med cycling, I mean a handful of medications (maybe 5 or so) that have theraputic effect for a limited amount of time which can be peridocially interchanged to maintain a euthemic state. It could also mean medication pulsing, or taking medications on an as needed basis.
>
> I think there may be some biochemcial basis for why this seems to work for some people. Perhaps different medications activate or supress different neural cicutry which may or may not be needed at a given time.
>
> Perhaps interhcanging two antidepressants with different mechanisms of action can prevent tollerance to either agent.
>
> Perhaps different neurotransmitter systems promote different forms of neuronal placiticty which are needed at different times.
>
> For instance, certain SSRI's beneift me for a period of about 2-3 weeks after which apathy sets in. At this point I can reduce the SSRI dose and augment with atomoxatine or methyphenidate. After this, I might switch back to the SSRI alone with a full benefit. At some point I might switch to a third medication and then back to the original.
>
>
> Not that I am encouraging self medication or the like, but has anybody found that sometimes they only feel well when they are able to systematically transition between certain medications.
>
>
>
>
>
>I currently use neurontin 2-3 times a week for depression and anxiety. During vacation used every day without loss of efficacy. This way I can use it this way indefinitely without loss of efficacy. I think knowing I can look forward to three good days a week helps me out on the other days.
Posted by SLS on December 30, 2008, at 9:30:58
In reply to Re: Theraputic med cycing, posted by bulldog2 on December 30, 2008, at 9:15:41
> I currently use neurontin 2-3 times a week for depression and anxiety. During vacation used every day without loss of efficacy. This way I can use it this way indefinitely without loss of efficacy. I think knowing I can look forward to three good days a week helps me out on the other days.
How about using Lyrica every day? It might be worth a try. Like Neurontin, it is an antagonist ligand of the alpha2delta subunit of the calcium channel.
- Scott
Posted by bulldog2 on December 30, 2008, at 10:36:46
In reply to Re: Theraputic med cycing » bulldog2, posted by SLS on December 30, 2008, at 9:30:58
> > I currently use neurontin 2-3 times a week for depression and anxiety. During vacation used every day without loss of efficacy. This way I can use it this way indefinitely without loss of efficacy. I think knowing I can look forward to three good days a week helps me out on the other days.
>
>
> How about using Lyrica every day? It might be worth a try. Like Neurontin, it is an antagonist ligand of the alpha2delta subunit of the calcium channel.
>
>
> - Scott
>
>The posts on neurontin and lyrica seem to indicate that the ad effects of these meds poop out after 6 months or less when used every day.
Posted by Phillipa on December 30, 2008, at 21:21:50
In reply to Re: Theraputic med cycing, posted by bulldog2 on December 30, 2008, at 10:36:46
Are you planning on using everyday or just weekends as then there wouldn't be a problem. Phillipa
Posted by shasling on January 3, 2009, at 0:53:18
In reply to Theraputic med cycing, posted by linkadge on December 27, 2008, at 21:31:46
I heard of many docters who believe this,the brain doesent want foreign substances in there,when it figures out how to adapt to it chances are your med dose,or even the med itself will become less effective.
I have read many times where a doc will cycle a patients medications,i myself believe the same thing,i cycle my meds according to effect,and keep what i call a aresanal journal of what meds help,listen to my body and work with my doc,when i first started and stayed on a single med constatly i was bed ridden and although still having a giant road ahead,im certainly far from whhere i was on that single med.I agree
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