Posted by SLS on October 2, 2000, at 10:48:49
In reply to Re: to amisulpride users, posted by AndrewB on October 1, 2000, at 13:20:31
Dear Sigolene,
I must apologize if I guessed wrong regarding your gendre.
Are you male or female?
Sorry.
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Hi Andrew.
> > I would go back down to 50mg for at least a week to see what happens> > First step is to try amisulpride at 150mg. for 7 days. Maybe you require a higher dose. Some people do I think. I don't think you need to explore to low end. I don't think people experience nothing at 50 yet have a response at 25.
The reason I would rather have someone in Sigolene's situation go down first rather than up in dosage is in an effort to avoid inducing an upregulation of the presynaptic membrane, just in case the effective dosage window lies beneath 100mg. If such an upregulation were to occur, she might become less likely to respond to amisulpride quickly at the lower dosage. After upregulation, there would need to be a higher concentration of amisulpride available to bind to the increased number of autoreceptors. With amisulpride (not so much with sulpiride), at the higher dosage now necessary to occupy sufficient presynaptic autoreceptors to effect the negative feedback loop, I believe that too many postsynaptic receptors will become blocked so as to prevent an antidepressant response to occur. Amisulpride is now acting more like an antipsychotic and less like an antidepressant. After a few weeks at too high a dosage, it might take a full two weeks after dosage reduction for the presynaptic membranes to settle back down via downregulation to nominal levels. Prior to downregulation, the supersensitive membrane will not allow the lower dosage of amisulpride to effect the negative feedback loop, and an antidepressant response becomes less likely to occur, even if it is the right dosage. Now, you need to test this new level of presynaptic sensitivity for at least one week more.
If Sigolene goes down in dosage first without results, she can probably go immediately to 150-200mg without adverse sequale. This algorithm would save a month and accomplish the same thing.
This was my rationale for suggesting reducing the dosage first.
* One clue as to Sigolene's dopaminergic tone might be if she experiences an exacerbation of depression (worse than baseline) after discontinuing the amisulpride. If she does, perhaps sulpiride, or low-dose Zyprexa or Risperdal, combined with Mirapex would work. I would also like to see an MAOI come into the picture. Maybe Wellbutrin. Definitely amineptine. Crap.
See ya'
- Scott
poster:SLS
thread:45579
URL: http://www.dr-bob.org/babble/20000926/msgs/45652.html