Posted by SLS on August 7, 2008, at 14:48:38
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Bob on August 7, 2008, at 12:15:08
> > Stevan Stahl:
> > "Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
> > - Scott
> Interstingly, I checked your chart of psych meds, and Geodon doesn't list 5HT2c as one of it's characteristics. Is this an oversight?
It wasn't at the time. :-)
They discover new properties of psychotropics all the time. I guess I ought to add this to the chart. Thanks for pointing that out.