Posted by Adam on November 19, 1999, at 10:12:30
In reply to To: adam, posted by johnb on November 18, 1999, at 23:43:12
Actually, my suggestion was not to use sertraline but Serzone (nefazodone) as an augmentation. It seems a specific serotonergic response
(stimulation of postsynaptic 5-HT1a receptors) is what you're after, and Serzone, being an SSRI of sorts would boost serotonin in the synapse
while simultaneously protecting against potential sexual side effects (via 5-HT2 antagonism). Perhaps Remeron (mirtazapine) might be an even
better choice in some respects (blocks both 5-HT2 and 5HT3), but its effect on serotonin potentiation is indirect.I'm not criticizing this augmentation strategy (buspirone + pindolol), I just don't understand it completely, and wish to ask further questions
(the idea interests me too, as far as dealing with OCD while taking an MAOI). Buspirone is a partial 5-HT1a agonist while pindolol is a complete
presynaptic 5-HT1a antagonist. As far as what "partial" and "complete" mean pharmacologically, I'm making a guess that this has to do with
binding affinities for the receptor (delta Gs of binding or however pharmacologists express this). If there is a significant difference in
binding kinetics between the two, why shouldn't pindolol swamp any initial benefits you might get from from early presnaptic 5-HT1a agonism? Why
would there be any potentiation via that pathway? Would it be better to start off with buspirone and follow with pindolol?Also, how does buspirone potentiate clonazepam? I should know this, as I knew someone who took it for years, but I'm not familiar with this
drug's mechanism of action.As for using selegiline to counteract drug-induced cognative deficits: I have a bit of a theory regarding this, that might A) be total B.S., or
B) be worth thinking about. See the "Memory" thread above. I guess it may depend on what cognative deficits you are trying to counteract.Thanks in advance to you or whoever takes the time to answer these questions. Like I said, I've wondered how to target the serotonin system while
taking an MAOI (and, like I said, deal with some issues involving OCD) without it leading to serotonin syndrome. I'm not sure if any currently
available strategy would work or be safe, but maybe buspirone and/or pindolol might be worth looking into.> ccAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 component, or the very expensive 5HT3 antagonist, Ondansetron.
>
> Regarding Selegiline, I was primarily thinking of that, 5 mg tid dosing, to further address Clonazepam cognitive side effects, as well as to enhance sexual arousal, stimulation, and time to orgasm. I'm still only partially recovered from Marplan induced anorgasmia.
>
> Thanks.
>
> JohnBAdam,
>
> I think you almost have the theory down, just a bit of a twist. Actually, agonize (activate) both presynaptic and postsynaptic 5HT1A (by the 5HT1A agonist Buspirone)in the presence of the presynaptic 5HT1A antagonist Pindolol. Result is a rapid and posibly potentiated effect of Buspirone, as well as augmentation of the anxyiolytic effects of Clonazepam. As both Pindolol and Buspirone do not affect 5HT2 (at least not to any significant degree), there's really no 5HT2 antagonism to guard against with an SSRI such as Sertraline. However, Sertraline could certainly be augmentation therapy for my social phobia, possibly potentiated or at leasted hastened in its effect by Pindolol, by I'd like to stay away from its weight gain side effects. Actually, I'd like to stay away from SSRI's, SNRI's, and MAOI's altoghether. Further, I'm fairly sensitive to sexual dysfunction caused by ehanced in 5HT2, particularly 5HT2A. However, the nausea side effect of higher dose Buspar (45-90 mg/day), may be mitigated by low dose mirtazapine, which has a small 5HT3 comp
poster:Adam
thread:15364
URL: http://www.dr-bob.org/babble/19991108/msgs/15532.html