Psycho-Babble Medication | about biological treatments | Framed
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Re: ...Q for SLS et. al. regarding ...

Posted by SLS on October 31, 2006, at 8:36:41

In reply to Re: ...Q for SLS et. al. regarding ... SLS, posted by michael on October 30, 2006, at 16:33:12

> > ...You know, several people have used a combination of amisulpride and selegiline for dysthymia with some success. I would be curious as to how combining Emsam with Abilify might be. In case I fail to think of it later, I thought I might mention it now.

> Above you mention Abilify - I was just curious what your thoughts/opinions/observations might be regarding Abilify vs. Sulpiride (low dose - 50 mg - 150 mg / day)?

It's hard to say. One explanation behind the antidepressant effect of sulpiride is its preferential antagonism of presynaptic autorecteptors, leading to an increase in the production and release of dopamine. Its affinity is less than dopamine, and thus does not affect postsynaptic receptors at low dosages. Abilify works differently. Its affinity is considerably higher than dopamine. Some of its energizing effect might be due to its tendency to stimulate postsynaptic receptors when levels of dopamine are low. However, it also stimulates 5-HT1a receptors and blocks 5-HT2a receptors, the combination of which could also contribute to an antidepressant effect.

> Sounds as if Abilify might tend to be more stimulating/activating?

I think this is certainly true early in treatment. I have known people to become somewhat manic on Abilify.

> Anyway, just wondering if you might have any thoughts on the relative potentials, or pros & cons, of Abilify vs. Sulpiride.

One negative aspect of sulpiride (and amisulpride) is its tendency to raise prolactin levels. This doesn't occur in everyone, and is probably not as much of a problem at the lower dosages, but you might want to test for prolactin if you decide to go with sulpiride. I would start at 50mg. With Abilify, you might experience anxiety and insomnia or akathisia-like side effects during the first week or two of treatment. This usually dissipates, but I have seen it suggested to use propranalol or lorazepam temporarily during this period to make things easier if necessary. I would go straight to 10mg.

I have seen amisulpride + Adderal + selegiline work nicely for dysthymia. I imagine sulpiride could just as easily be substituted for the amisulpride. I would leave out the selegiline at first.

> Good luck w/Emsam - I hope you can get the red tape straightend out, and that it turns out to be your unexpected "Silver Bullet"!

Thanks. I am expecting nothing more than a matrix of patches of red skin, but I guess it doesn't make sense to pass-over this drug. You just never know. Actually, it might possibly make me dysphoric. I think the parent drug (selegiline) is a NE reuptake inhibitor. Some NE drugs make me feel worse.

- Scott




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