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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 cadburyhesychasm on October 11, 2019, at 13:20:05
Do you think following the theory of 5-ht1b heteroreceptor activation attenuating aggression, vortioxetine might work for my intermittent explosive behaviour (destruction of property, screaming, official diagnosis schizoaffective but just rage and depression). Is it a partial agonist at that receptor, meaning the dose must be kept low or it starts to have antagonist instead of activating effects? if so what dose do you think might be suitable to keep the receptor activated sufficiently?
Any knowledge or info on the subject? thanks a lot
Posted by linkadge on October 11, 2019, at 16:09:40
In reply to Trintellix for rage disorder?, posted by cadburyhesychasm on October 11, 2019, at 13:20:05
It's possible that it could help. Both 5-ht1a and 5-ht1b agonists can have anti-aggressive properties. However, lithium (a presynaptic 5-ht1b autoreceptor antagonist) also has anti-aggressive properties.
In higher doses, a 5-ht1b agonist could suppress serotonergic function.
Antidepressants (esp SSRIs) can sometimes have anti-aggressive effects. However, for serious anger issues, you may also need an anticonvulsant on board.
Linkadge
Posted by SLS on October 11, 2019, at 20:20:41
In reply to Trintellix for rage disorder?, posted by cadburyhesychasm on October 11, 2019, at 13:20:05
Hi, Cadburyhesychasm.
> Do you think following the theory of 5-ht1b heteroreceptor activation attenuating aggression, vortioxetine might work for my intermittent explosive behaviour (destruction of property, screaming, official diagnosis schizoaffective but just rage and depression). Is it a partial agonist at that receptor, meaning the dose must be kept low or it starts to have antagonist instead of activating effects? if so what dose do you think might be suitable to keep the receptor activated sufficiently?
Linkadge gave very informed and insightful answers - as usual. I wasn't aware that lithium blocks 5-ht1b autoreceptors. That might explain the many reports over the years that describe increased serotonin release with lithium.
Of the anticonvulsants, carbamazepine (Tegretol) is the one that I have seen described most often as being effective for Intermittent Explosive Disorder, rage, and aggression. It made a big difference for a friend of mine. However, I think you should take a look at oxcarbazepine (Trileptal) first. It is a sister drug of carbamazepine, but is less sedating and does not require regular blood tests to monitor for agranulocytosis. There are fewer studies of oxcarbazepine, but some of them have reported good results.
My friend stopped taking his carbamazepine because he didn't want to spend money on it anymore. His wife had to go to court to get a restraining order.
- Scott
Posted by rjlockhart37 on October 11, 2019, at 23:28:17
In reply to Re: Trintellix for rage disorder?, posted by linkadge on October 11, 2019, at 16:09:40
never take wellbutrin, it can cause irrtibility, and somewhat rage because of elevated norpehirhphrine, same to reboxetine
depakote also is a good anti-aggressive medication, i don't know the medical structure how it works, but i knew people that were on it long time ago at hospital for anger episodes or they got mad real quick and raged
Posted by Christ_empowered on October 12, 2019, at 9:50:04
In reply to Re: Trintellix for rage disorder?, posted by rjlockhart37 on October 11, 2019, at 23:28:17
id go for trileptal, lamictal, maybe possibly a mid-to-high dose ssri, maybe buspar in there somewhere...
skip depakote, if you can. labs, hair loss, and...yeah. its rough stuff.
i took trileptal+lamictal, and...it calmed me down considerably. my problems were mood related and such, but i can -definitely- see how the antiseizure drugs (and other drugs) could simmer down some rage.
are you prescribed a tranquilizer/antipsychotic? i read somewhere that, at least in animal studies, it looks like taking lamictal with an antipsychotic somehow reduces the D2 receptor changes one sees in long term exposure. just...throwing that out there.
hope this helps. :-)
Posted by Lamdage22 on October 12, 2019, at 15:37:15
In reply to Trintellix for rage disorder?, posted by cadburyhesychasm on October 11, 2019, at 13:20:05
Has psychotherapy been tried? If it was me I would like to get to the bottom of why I am angry.
Posted by cadburyhesychasm on October 12, 2019, at 16:58:18
In reply to Re: Trintellix for rage disorder?, posted by Lamdage22 on October 12, 2019, at 15:37:15
thanks everyone, ive started brintellix on a very low dose 5mg and feel better already somehow. it gives me the vibrant colours and strange fuzz of a mild aripiprazole tablet, though arip was a catastrophe for me re hypersexuality.
im taking it with risperdal and depakote, ive been on those two meds since quitting arip finally. trileptal lamictal and other meds have been tried more than once with strange reactions to thought process.i would also like to know about the optimum dose of trintellix regarding aggression if one could hazard a guess.
lamdage, most doctors have told me psychotherapy is not for me and i failed it once. many have offered schizoaffective as a diagnosis which i disagree given lack of frank psychotic symptoms of hallucinations, ive settled with an idea of my own that the rage attacks are probably due to frontal/orbitofrontal failure or damage, developmental or acquired. i appreciate any thoughts on my guess also.
Posted by cadburyhesychasm on October 14, 2019, at 11:15:30
In reply to Re: Trintellix for rage disorder?, posted by cadburyhesychasm on October 12, 2019, at 16:58:18
Posted by Lamdage22 on October 14, 2019, at 16:12:42
In reply to became very hostile. had to stop trintellix. (nm), posted by cadburyhesychasm on October 14, 2019, at 11:15:30
I'm sorry. Maybe Linkadge's and Scott's suggestion?
Posted by bleauberry on October 18, 2019, at 15:15:44
In reply to Trintellix for rage disorder?, posted by cadburyhesychasm on October 11, 2019, at 13:20:05
Rage disorder is very common in Lyme disease. It even has a name. Lyme Rage. You can calm it down with a variety of meds and herbs. But it takes experimentation to find out which ones work for you satisfactorily without intolerable side effects.
Lyme is epidemic. Most sick patients never recall a tick bite or a rash and erroneous testing is the norm. Most psychiatric patients have no idea what a huge role lyme plays in psychiatry.
I'm not guessing you have lyme. Though you very well might. Science says your odds are 3 out of 10, my doctors say your odds are 9 out 10. Take your pic. That's a lot of people with lyme who don't know they have lyme and are treating it as psychiatric instead. I don't know you, don't know your symptoms, never examined you, never questioned you, and don't know your history. Only that there is a lot of rage you would like to see go away. And that while many people consider rage and irritation to be unexplained mysteries, I don't.
"What every Mental Health Specialist should know about psychiatry and lyme and tick born illnesses"...most don't know any of this.
Calming it down is only the first part of a 2 step process. The second step is to remove the thing that is causing it all in the first place. Which probably falls within the realm of systemic inflammation, brain inflammation and unknown toxicity. We don't have good enough testing to figure any of that out. We have to use educated guesses, hunches, instincts and anecdotal evidence to guide our decisions. In the end, everything new we do is an experiment.
I've seen unexplained rage in several people throughout my life that cleared up with antibiotics for Lyme. That takes a skilled doctor with extracurricular training from I.L.A.D.S. to make the diagnosis and effectively treat. They are called Lyme Literate Medical Doctors (LLMDs) and they often improve patients who have been poorly managed by more mainstream doctors.
An LLMD brought me to remission from 20 years of treatment resistant depression, bipolar, schizoaffective disorder and anxiety/rage/irritation. The psych drugs helped cut the edge up until that time, but it was antibiotics and herbs that ultimately did the work, not the psych meds. Those are merely for immediate symptoms, not for a cure.
Even without a lyme diagnosis, or even with skepticism that is has anything to do with lyme, you can still attack the inflammation and toxicity with herbs and supplements. That alone should help noticeably.
Whether any particular med will work for you or not is anybody's guess.
Posted by phidippus on November 30, 2019, at 18:46:41
In reply to became very hostile. had to stop trintellix. (nm), posted by cadburyhesychasm on October 14, 2019, at 11:15:30
Have you tried Lithium?
Phidippus
Posted by SLS on December 1, 2019, at 10:28:00
In reply to Trintellix for rage disorder?, posted by cadburyhesychasm on October 11, 2019, at 13:20:05
> Do you think following the theory of 5-ht1b heteroreceptor activation attenuating aggression, vortioxetine might work for my intermittent explosive behaviour (destruction of property, screaming, official diagnosis schizoaffective but just rage and depression). Is it a partial agonist at that receptor, meaning the dose must be kept low or it starts to have antagonist instead of activating effects? if so what dose do you think might be suitable to keep the receptor activated sufficiently?
>
> Any knowledge or info on the subject? thanks a lot
You might want to look into anticonvulsants, particularly Trileptal (oxcarbazepine) and Tegretol (carbamazepine). Of the two, Tegretol is the most studied, but has more side effects than Trileptal, including agranulocytosis, for which regular blood tests are required.
- Scott
This is the end of the thread.
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