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Re: amisulpride answers

Posted by Leighwit on May 22, 2001, at 13:46:24

In reply to Re: amisulpride answers, posted by IanSFO on May 21, 2001, at 18:08:22

Ian,

Thanks! I thought I'd heard the correlation before (between Remeron and weight gain) but I thought my recollection was wrong. The recommendation was in response to my post about quitting an AD because of weight gain side effects, and needing to replace it as an augmentation to Wellbutrin. I made many too assumptions about the response.

In my case, it's now off the list. Thanks again,

Laurie

> If you're concerned about weight gain, I'm surprised you're considering adding Remeron to Wellbutrin. Though not everybody taking Remeron gains weight, a lot of people do, primarily because it has the potential to make you ravenously hungry. Purportedly it has fewer side effects at higher doses than at lower ones, but I don't think that's 100% guaranteed. A friend of mine has added more than 30 pounds of weight in just a few months.
>
>
> > Hi Andrew,
> >
> > Thanks for a great post; one full of useful info in a sociable & compassionate tone (which of course, is no surprise coming from you.)
> >
> > I think I'll ask my Pdoc about ordering amisulpride to add to Wellbutrin. (She ordered Reboxetine for me, so this shouldn't be a problem).
> >
> > I was using a small dose of Celexa (10-20 mg.) to minimize the side effects of Wellbutrin as well as to improve its AD performance. It was working very well for me. I took it to alleviate the irritablity side effect; the fact that it also improved the performance of Wellbutrin was an unexpected surprise, and icing on the cake. It's amazing to me, that something taken alone (I took Celexa alone at max dose in the past) can be virtually worthless, yet the same drug when used to augment another, can produce a big gain.
> >
> > Unfortunately, I experienced severe weight gain from the Celexa (Celexa isn't considered high risk for weight gain, but my endocrinologist is certain Celexa was the culprit in my case, and finally, my Pdoc concurred). I discontinued it three weeks ago, and have finally stopped what was a continuous weight gain. My Pdoc said that whether or not a metabolism can recover from adverse changes brought on by some of these drugs is currently unknown, but being studied.
> >
> > Someone else here suggested Remeron w/Wellbutrin. Guess I'll give both amisulpride and Remeron more serious attention & consideration before my appt. next week. Have you personally used amisulpride as an adjunct to another drug? As I recall (but my memory stinks these days) you had positive experiences with Reboxetine,yes?
> >
> > Laurie/Leighwit
> >
> > >
> > > Hi out there!
> > >
> > > I've been taking amisulpride for close to 2 years with good results for dysthymia, concentration problems and social anxiety (sociability). It doesn't work for everybody, but of the dozens of responses I have received on it, it seems to work in slightly over 50% of the treatment resistant patients who have tried it. By treatment resistant I mean those who have tried SSRIs and sometimes numerous other ADs without good results. Sometimes the results are miraculous.
> > >
> > > Amisulpride isn't right for everyone, but if I had a atypical depression that included symptoms such dysthymia, anhedonia, apathy, negative ruminations, low self esteem, poor concentration, fatigue or social anxiety - it is a good drug to start with in general. It has been extensively studied and been shown very effective for dysthymia. It has a very low incidence of side effects in males. It also can be combined safely, apparently, with all other ADs and, furthermore, will not cause drug to drug interactions. I am aware of no exceptions to this.
> > >
> > > All this being said, I am not a proponent of amisulpride, per se. I wouldnít want anybody to pin there hopes on one medicine. I however am a proponent of atypical depressives, dysthymics, and those with social anxiety, who have tried traditional strategies, to look outside the box and to consider various options which basically improve the function of select parts of the dopaminergic system. This is based on my interpretation of the evidenceout there. That is, parts of the dopaminergic system can be central, and indeed may be the final loci, of depression, motivation, and social anxiety.
> > >
> > > This does not mean taking a dopaminergic, i.e. wellbutrin, will solve your problem. The system is complicated with many feedback mechanisms. In healthy individualsthese feedback mechanisms allow the system to be kept in balance. but in people with mental problems the same feedback mechanisms can frustrate a doctorís attempts to alter the long-term function of the dopaminergic system. This scenario has led the greater part of the medical community to conclude that dopaminergics donít have a place in disorders of depression and anxiety.
> > >
> > > However, at the risk of sounding like an expert in possession of rare knowledge, I believe that effective dopaminergic strategies do exist and are vastly underutilized. The reasons these strategies arenít used more are multifold: some of the drugs are not available in the US (i.e. amisulpride), some drugs are relatively new (i.e. mirapex), and finally the dopaminergic strategy is likely to involve polypharmacy. Drugs involved in such polypharmacy may include dopaminergics or drugs that act indirectly on the dopaminergic system. For example, mirapex may be used as an add -on to an SSRI (SSRIS act indirectly on the dopaminergic system and this may explain there ultimate effectiveness). Selegiline and amphetamines, while sometimes anxiety producing alone, when combined with amisulpride can increase motivation without increasing anxiety. Mementine when combined amphetamine provide long term relief of depression while increasing motivation and self-esteem, obviating the oh -so-common poop-out of amphetamines.
> > >
> > > Answers to specific questions:
> > >
> > > *Amisulpride is not available in the U.S. now but will be available here in about two years. The reason for the delay may possibly be explained by the French drug makerís (Sanofi-Synthelabo) lack of history (lack of in-house capabilities)in getting drugs approved for the market. My doctor has been following the US apporoval process and believes amisulpride offers unique therapuetic opportunities.
> > >
> > > *Mirapex can be used where amisulpride has failed. There is some indication that mirapex will work for many of those that amisulpride doesnít help and visa versa.
> > >
> > > *Prolactin levels can be expected to increase with use of amisulpride. The amount they increase will vary by individual. My levels are slightly increased. For males, this usually does not result in any side effects. But sexual side effects in males can occur due to this. Possible remedies are to slighlty decrease the dosage or to add-on bromocriptine. BTW. prolactin levels increases are commom with the use of many Ads.
> > >
> > > For women it is another story. Their prolactin level increases are generally more pronounced and about 50% of women will experience loss of menses, disrupted menses or breast swelling because of this. One case study showed that use of bromocriptine (which lowers prolactin) would remove these side effects without diminishing the effect of sulpiride (a drug very much analogous to amisulpride). Women who benefit from amisulpride but have these side effects should seriously consider taking bromocriptine as an add-on. With Geodon now available, women probabl yshould consider it as there first option low dose anti-psychotic rather than amisulpride.
> > >
> > > Many women have tried amisulpride, Karen B. being one. She has written many posts describing her mostly positive experience with it but also she describes her loss of menses.
> > >
> > > Doses of amisulpride probably are the same whether one is taking another AD such as an SSRI or taking it alone. 50mg., once a day is the standard dose. Occasionally 25mg. or 75mg. may be better. 100 mg. would be rarely be better.
> > >
> > > You can try St. Johnís Wort. I tried it without benefit. JohnL liked the combo of St. Johns and Amisulpride. Make sure your SJW dose is high enough though (900mg to 1500mg?).
> > >
> > > Best wishes,
> > >
> > > AndrewB
> > >
> > >


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poster:Leighwit thread:62389
URL: http://www.dr-bob.org/babble/20010522/msgs/63914.html