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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Jay2112 on December 28, 2022, at 17:36:46
Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
Jay
Posted by undopaminergic on December 29, 2022, at 9:57:33
In reply to Bipolar and constipation, posted by Jay2112 on December 28, 2022, at 17:36:46
> Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
>
> JayI went very rarely (once a week?) when I was on buprenorphine. Opies have that effect. However I also ate less, which I believe is due to kappa-opioid receptor antagonism.
-undopaminergic
Posted by Jay2112 on December 29, 2022, at 23:26:59
In reply to Re: Bipolar and constipation, posted by undopaminergic on December 29, 2022, at 9:57:33
> > Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
> >
> > Jay
>
> I went very rarely (once a week?) when I was on buprenorphine. Opies have that effect. However I also ate less, which I believe is due to kappa-opioid receptor antagonism.
>
> -undopaminergic
>I have to *go* once every 3-4 days, or else I feel wretched!! My amitriptyline, clonidine, and risperidone certainly can back me up. I use Tylenol 1 (OTC here in Canada) for migraines, regulaly, so that is the nail in the coffin. :(
Jay
Posted by SLS on December 30, 2022, at 9:41:46
In reply to Re: Bipolar and constipation » undopaminergic, posted by Jay2112 on December 29, 2022, at 23:26:59
> > > Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
> > >
> > > Jay
> >
> > I went very rarely (once a week?) when I was on buprenorphine. Opies have that effect. However I also ate less, which I believe is due to kappa-opioid receptor antagonism.
> >
> > -undopaminergic
> >
>
> I have to *go* once every 3-4 days, or else I feel wretched!! My amitriptyline, clonidine, and risperidone certainly can back me up. I use Tylenol 1 (OTC here in Canada) for migraines, regulaly, so that is the nail in the coffin. :(
>
> Jay
If you haven't tried the metabolite of amitryptyline, nortryptyline, you might respond equally well, but avoid the anticholinergic side effects (constipation, cognitive and memory difficulties, elevated heart rate). However, finding the right dosage of nortriptyline can be tricky. It is the black sheep of the tricyclics. It has a true therapeutic window / index. Generally, I see low-dosages (50-75 mg/day) and high-dosages (125-150 mg/day) produce a robust antidepressant response, but nothing in between. *Generally*. A blood test to assay blood concentrations of nortriptyline can be used as a guide, but an absolute index.The therapeutic range of nortriptyline is currently quoted lies between 70-170 ng/mL. Formerly, it had been 50-150 ng/mL. At 150 mg/day, my blood level of nortriptyline was 153 ng/mL. However, I am a low-dosage responder. It took two years for me to play out a hunch and reduce the dosage of nortriptyline. I am not a high-dosage responder, after all. I am a low-dosage responder. Right now, 75 mg/day is giving me a better quality of mood that is more stable.
If I recall correctly, you are somewhat improved relative to your untreated baseline. What does your current regime comprise?
- Scott
Posted by Jay2112 on December 30, 2022, at 14:59:18
In reply to Re: Bipolar and constipation » Jay2112, posted by SLS on December 30, 2022, at 9:41:46
> > > > Ok, a not so lovely topic...buttttt...All of these meds cause me major constipation, and as long as I take Omega 3's, every 3-4 days I swallow a good size laxative, do my jobbers, and I feel *amazing*!! Otherwise, I am bunged up for over a week sometimes, and I find my mental health deteriorates. I have tracked this in my journal, and it's true....this is always the same sequence of events. I wish I could get on a long-term antibiotic, with a probiotic, and I wouldn't have this problem! There is one called rifaximin, for IBS, and I am trying to convince my doctor to put me on it.
> > > >
> > > > Jay
> > >
> > > I went very rarely (once a week?) when I was on buprenorphine. Opies have that effect. However I also ate less, which I believe is due to kappa-opioid receptor antagonism.
> > >
> > > -undopaminergic
> > >
> >
> > I have to *go* once every 3-4 days, or else I feel wretched!! My amitriptyline, clonidine, and risperidone certainly can back me up. I use Tylenol 1 (OTC here in Canada) for migraines, regulaly, so that is the nail in the coffin. :(
> >
> > Jay
>
>
> If you haven't tried the metabolite of amitryptyline, nortryptyline, you might respond equally well, but avoid the anticholinergic side effects (constipation, cognitive and memory difficulties, elevated heart rate). However, finding the right dosage of nortriptyline can be tricky. It is the black sheep of the tricyclics. It has a true therapeutic window / index. Generally, I see low-dosages (50-75 mg/day) and high-dosages (125-150 mg/day) produce a robust antidepressant response, but nothing in between. *Generally*. A blood test to assay blood concentrations of nortriptyline can be used as a guide, but an absolute index.
>
> The therapeutic range of nortriptyline is currently quoted lies between 70-170 ng/mL. Formerly, it had been 50-150 ng/mL. At 150 mg/day, my blood level of nortriptyline was 153 ng/mL. However, I am a low-dosage responder. It took two years for me to play out a hunch and reduce the dosage of nortriptyline. I am not a high-dosage responder, after all. I am a low-dosage responder. Right now, 75 mg/day is giving me a better quality of mood that is more stable.
>
> If I recall correctly, you are somewhat improved relative to your untreated baseline. What does your current regime comprise?
>
>
> - Scott
>Hi Scott. I hope you are doing well, and happy pre-new year! lol.
Yes, I am about mod-relatively improved to baseline. "Perfect"...well, never really (constantly) achieved, but that's good, because I am an existentialist human! Even at points in my life where I could have been considered having a mostly non-depressed person, at times, I would get a "whoooosh" of the black dog's presence.
It's the anti-cholinergic affects that promote sleep for me, in amitriptyline. I am thinking of trying a combo of ami and nor triptyline. Just a small bit. But, nortriptyline does have anticholinergic effects, just much less. Nortriptyline did work well at one time for me. But, I MUST take it with heavy mood stabilizers and antipsychotics.I am, for most parts, within a range of stability. I track my mood with moodtraker, an app on droid and apple phones. It's a REALLY good scientific mathimatical tracking app of your daily moods.
p.s. I know you don't believe in herbal remedies
, I am part Indigenous, and they worked well for us for for a very, very long time....particularly CBD, CBG, THC.Best,
Jay
Posted by Jay2112 on December 30, 2022, at 17:09:43
In reply to Re: Bipolar and constipation » SLS, posted by Jay2112 on December 30, 2022, at 14:59:18
Forgot to add:
150mg venlafaxine in am
75mg venlafaxine in pm
150mg pregabalin 3x per day
1mg clonazapam 3x day
200 carbamazepine 3x daily
40mg propranaolol 2 x day
5mg vortioxetine 1x dayPRN risperidone, clonidine, methaprozine
herbals, various, 1-2x per day
Posted by SLS on December 30, 2022, at 21:09:08
In reply to Re: Bipolar and constipation » SLS, posted by Jay2112 on December 30, 2022, at 14:59:18
Hi, Jay.
> p.s. I know you don't believe in herbal remedies
> , I am part Indigenous, and they worked well for us for for a very, very long time....particularly CBD, CBG, THC.
I believe in what works. I really have no bias against any "school of thought" per se (I don't think). Show me. Don't tell me. Show me.I tried a food-allergy rotation diet in 1985 with a doctor Stuart Berger in Manhattan. From what I recall, Berger had studied psychiatry at NYU under an associate professor named Baron Shopsin. Dr. Shopsin was my psychiatrist at the time. When I told Berger who I was seeing as a psychiatrist, he agreed that it wouldn't be a good idea for me to tell him what I was doing. Berger had essentially gone rogue.
Berger became very famous for promoting his ideas on weight loss. He was known as being a TV shrink, wrote regular newspaper columns, made the rounds on TV talk shows, appeared on the news, and wrote several books on weight-loss. He touted his food-allergy explanation for his own dramatic weight-loss. He also wrote a book giving an alternate explanation that described a role of the immune system in weight-gain. Berger had been a really, really big guy who lost enough weight to look gaunt. When he died in 1994, he weighed 365 pounds and was only 40 years old. Still, I was determined to leave no stone unturned.
- Scott
Posted by SLS on December 30, 2022, at 21:39:13
In reply to Re: Bipolar and constipation p.s. » Jay2112, posted by Jay2112 on December 30, 2022, at 17:09:43
> Forgot to add:
>
> 150mg venlafaxine in am
> 75mg venlafaxine in pm
> 150mg pregabalin 3x per day
> 1mg clonazapam 3x day
> 200 carbamazepine 3x daily
> 40mg propranaolol 2 x day
> 5mg vortioxetine 1x day
>
> PRN risperidone, clonidine, methaprozine
>
> herbals, various, 1-2x per day
>I don't have much of a feel for the dosage range for pregabalin, even though I had tried it. It made me feel pretty good during the first two days. It then turned very, very foul on me. I experienced psychic pain and terrible brain-fog. It took at least 2 weeks after stopping it to recover.
For venlafaxine, I have a better feel. In my estimation, no one should stop at 225 mg/day if they can tolerate 300 mg/day. Of course, side effects might re-emerge or get worse temporarily upon a dosage increase. You don't know until you try. I was dosing 150 mg b.i.d. There was no way that I could get away with 300 mg once a day dosing. Withdrawal would set in. Infrequently, doctors will prescribe 375 mg/day.
The one other comment I have involves clonidine. As a presynaptic NE alpha-2 agonist, clonidine reduces the manufacture and release of norepinephrine. Lots of people who never had a single episode of depression went on to become depressed when taking clonidine as an antihypertensive. My grandmother was an example of this. Fortunately, I had expected depression as being a possible reaction to clonidine, and very quickly had her discontinue it. I then made an appointment to see her original doctor. Her depression dissipated within 2-3 days.
Can you describe how vortioxetine affects you? Did you add after establishing venlafaxine?
Thanks.
This one is new to me:
https://www.medicines.org.uk/emc/product/10954/
- Scott
Posted by undopaminergic on December 31, 2022, at 13:24:13
In reply to Re: Bipolar and constipation p.s. » Jay2112, posted by Jay2112 on December 30, 2022, at 17:09:43
> Forgot to add:
>
> 150mg venlafaxine in am
> 75mg venlafaxine in pm
> 150mg pregabalin 3x per day
> 1mg clonazapam 3x day
> 200 carbamazepine 3x daily
> 40mg propranaolol 2 x day
> 5mg vortioxetine 1x day
>
> PRN risperidone, clonidine, methaprozine
>
> herbals, various, 1-2x per day
>You stopped Vyvanse?
-undopaminergic
Posted by Jay2112 on January 2, 2023, at 16:32:09
In reply to Re: Bipolar and constipation p.s., posted by undopaminergic on December 31, 2022, at 13:24:13
> > Forgot to add:
> >
> > 150mg venlafaxine in am
> > 75mg venlafaxine in pm
> > 150mg pregabalin 3x per day
> > 1mg clonazapam 3x day
> > 200 carbamazepine 3x daily
> > 40mg propranaolol 2 x day
> > 5mg vortioxetine 1x day
> >
> > PRN risperidone, clonidine, methaprozine
> >
> > herbals, various, 1-2x per day
> >
>
> You stopped Vyvanse?
>
> -undopaminergic
>I forgot to add, Vyvanse prn 20-40mg.
I found daily dosing eventually not only loses it's effect, and exacerbates my bipolar dx, but leavs me feeling...just...blahhhh..tired, but sometimes way overstimulated..very angry.
So, I use it when I am really low...down in the dumps.
Thanks for asking
Jay
Posted by SLS on January 2, 2023, at 20:13:37
In reply to Re: Bipolar and constipation p.s. » undopaminergic, posted by Jay2112 on January 2, 2023, at 16:32:09
For four decades, the only drug that I could rely on consistently to improve mental energy and allow me to read more than 2-3 sentences word-for-word had been a small amount of caffeinated coffee. I don't know if a substance other than caffeine contributed to the benefit I received from coffee, but it did more for me than any of the psychostimulants I tried, including pemoline. Interestingly, caffeine pills were not as helpful as coffee, even when I took a fraction of a pill. I think the pills contained 100 mg/day. Does that sound right? I had to meter my intake of coffee carefully. Just a small amount - 1/4 a cup - worked wonders. Anything over that left me in a state of fatigue and brain-fog that would last all day.
While it's on my mind, When I was in my early twenties, I noticed that the worst day of the week for me was Sunday. This happened most often following after I stayed out late Saturday night. I didn't wake up Sunday morning until well after my usual wake up time during the rest of the week. It finally occurred to me that this Sunday worsening might be a result of a disturbance in my circadian rhythm. I decided to try an experiment. One night, I came home around 2:00 am. Instead of allowing myself to sleep until 10-11 am, I set my alarm for 6:30 am - the time I awoke every other morning during the week. I simply got out of bed at 6:30, although groggier than usual. I forced myself to get out of bed, turned the lights on, and allowed myself to reach a state of full wakefulness before returning to bed. I remained awake for no longer than 5 minutes before returning to bed. I could then wake up at noon and not experience my usual Sunday slump. It worked every time.
- Scott
Posted by undopaminergic on January 3, 2023, at 11:18:03
In reply to Re: Bipolar and constipation p.s. » Jay2112, posted by SLS on January 2, 2023, at 20:13:37
> Interestingly, caffeine pills were not as helpful as coffee, even when I took a fraction of a pill. I think the pills contained 100 mg/day. Does that sound right?
>Yes, in fact I've never seen a caffeine pill that wasn't 100 mg of the active principle.
> I had to meter my intake of coffee carefully. Just a small amount - 1/4 a cup - worked wonders. Anything over that left me in a state of fatigue and brain-fog that would last all day.
>I've had paradoxical sedative effects of caffeine, especially at higher doses.
As I mentioned in another post (vortioxetine plus caffeine), I need another substance, typically a dopaminergic stimulant, in combination, to allow the caffeine to have a stimulant effect, but apparently vortoxetine can work too.
-undopaminergic
Posted by SLS on January 3, 2023, at 13:07:21
In reply to Re: Bipolar and constipation p.s. » SLS, posted by undopaminergic on January 3, 2023, at 11:18:03
> > Interestingly, caffeine pills were not as helpful as coffee, even when I took a fraction of a pill. I think the pills contained 100 mg/day. Does that sound right?
> >
>
> Yes, in fact I've never seen a caffeine pill that wasn't 100 mg of the active principle.
>
> > I had to meter my intake of coffee carefully. Just a small amount - 1/4 a cup - worked wonders. Anything over that left me in a state of fatigue and brain-fog that would last all day.
> >
>
> I've had paradoxical sedative effects of caffeine, especially at higher doses.
>
> As I mentioned in another post (vortioxetine plus caffeine), I need another substance, typically a dopaminergic stimulant, in combination, to allow the caffeine to have a stimulant effect, but apparently vortoxetine can work too.
>
> -undopaminergic
Did aripiprazole (Abilify) help at all?Abilify, like other D2 antagonists, increases That might add an increase in dopamine release, but mostly at low dosages.
This is what I remember to be guideline for:
2-5 mg/day for depression - presynaptic receptor blockade + Postsynaptic receptor blockade.
10-20 mg/day for bipolar mania.
20-30 mg/day for schizophrenia, schizoaffective disorder, psychosis.
- Scott
Posted by undopaminergic on January 4, 2023, at 4:22:28
In reply to Re: Bipolar and constipation p.s. » undopaminergic, posted by SLS on January 3, 2023, at 13:07:21
> > > Interestingly, caffeine pills were not as helpful as coffee, even when I took a fraction of a pill. I think the pills contained 100 mg/day. Does that sound right?
> > >
> >
> > Yes, in fact I've never seen a caffeine pill that wasn't 100 mg of the active principle.
> >
> > > I had to meter my intake of coffee carefully. Just a small amount - 1/4 a cup - worked wonders. Anything over that left me in a state of fatigue and brain-fog that would last all day.
> > >
> >
> > I've had paradoxical sedative effects of caffeine, especially at higher doses.
> >
> > As I mentioned in another post (vortioxetine plus caffeine), I need another substance, typically a dopaminergic stimulant, in combination, to allow the caffeine to have a stimulant effect, but apparently vortoxetine can work too.
> >
> > -undopaminergic
>
>
> Did aripiprazole (Abilify) help at all?
>No, it did not. But I don't remember trying caffeine with it.
> Abilify, like other D2 antagonists, increases That might add an increase in dopamine release, but mostly at low dosages.
>The above looks like one sentence interrupted in the middle by another sentence. I don't dare to try and interpret it.
> This is what I remember to be guideline for:
>
> 2-5 mg/day for depression - presynaptic receptor blockade + Postsynaptic receptor blockade.
> 10-20 mg/day for bipolar mania.
> 20-30 mg/day for schizophrenia, schizoaffective disorder, psychosis.
>
>
> - Scott
>
>I thought aripiprazole was a direct agonist-antagonist, rather than working via autoreceptors.
-undopaminergic
Posted by SLS on January 5, 2023, at 12:03:10
In reply to Re: Bipolar and constipation p.s. » SLS, posted by undopaminergic on January 4, 2023, at 4:22:28
Sorry, UD.
> > Abilify, like other D2 antagonists, increases That might add an increase in dopamine release, but mostly at low dosages.
My proofreading really sucks. Here is a better portrayal:
Abilify, like other antpsychotics, is a full antagonist at presynaptic D2 autoreceptors. This increases the manufacture and release of dopamine. However, unlike most other antipsychotics, Abilify is a partial agonist at the postsynaptic D2 receptor rather than being a full antagonist there. This supposedly renders Abilify as being a dopamine system stabilizer (DSS). As such, the postsynaptic action of Abilify depends on the intrasynaptic concentration of dopamine. At high dopamine concentrations, Abilify acts as a full antagonist at postsynaptic D2 receptors, thus reducing dopamine activity. However, when the intrasynaptic dopamine concentrations are low, Abilify acts more like an agonist than an antagonist of postsynaptic D2 receptors. Dopamine activity is increased.This most probably explains the following clinical guideline:
2-5 mg/day = treats depression - presynaptic D2 receptor antagonist + postsynaptic receptor agonist.
10-20 mg/day = treats bipolar mania - presynaptic D2 receptor antagonist + postsynaptic receptor antagonist.
20-30 mg/day = treats schizophrenia, schizoaffective disorder, and idiopathic psychosis - presynaptic D2 receptor antagonist + postsynaptic D2 receptor antagonist.
- Scott
This is the end of the thread.
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