Posted by SLS on November 4, 2014, at 23:36:47
In reply to Re: Restarted Abilify - Feeling better. » SLS, posted by phidippus on November 4, 2014, at 13:56:09
> >At no time have I tried taking a 5-HT1a partial agonist in the absence of DA partial agonism, so I can't parse the importance of either mechanism.
> Have you tried augmenting the 5ht1a agonism with another 5ht1a agonist? Pindolol? Buspar?
I haven't tried any of these. I did try Viibryd, though. Regarding Buspar, I am reluctant to try any drug that blocks NE alpha-2 receptors. My depression has been made significantly worse when trying such a drug (idazoxan, mirtazapine, lurazidone). Unfortunately, the metabolite of Buspar, 1-PP, does this. Perhaps 1-PP serves to promote antidepressant effects for most people.
> Are there any other agents that do DA partial agonism?
Cariprazine should be available soon. It is more potent at D3 receptors than is Abilify. It is also a 5-HT1a partial agonist. It also acts to reduce the activity of 5-HT2 receptors. I might try it if I don't continue to improve.
http://en.wikipedia.org/wiki/Cariprazine#Pharmacodynamics
> > I have not tried Brintellix
> What was remarkable about Brintellix was that it started working fairly quickly, most predominately as an anxiolytic, then its antidepressant effects became apparent. I think this may be owed to its 5ht1a full agonism. Unfortunately, Brintellix caused me to cycle and I could not take it anymore.
What was the nature of your cycle? Mania? OCD?
> > nefazodone
> What an odd duck.
I know.
> Wouldn't you be worried about liver toxicity?
Yes, but the incidence of fulminant liver failure is rather low. According to the black-box warning, the incidence of severe liver damage is approximately 1 in every 250,000 to 300,000 patient-years.
> >Luvox
> I can tell you it works wonders for OCD and its been studied in the treatment of psychotic depression (even as monotherapy). Its action on sigma receptors is novel but may owe to its efficacy as an anxiolytic and antidepressant.
I think you are right about this.
> > However, at this juncture, I am not inclined to discontinue Parnate in order to try them.
> What are you running at? 60%? 40%?
I have stabilized at about 40% relative to baseline. That is quite a bit. I am thinking of returning to work if I can maintain this improvement.
> I feel strongly you should be reconsidering the Parnate. Are you afraid switching it out will lead to crushing depression?
Yes. I am pretty sure I would lose most of my current improvement. I would probably be left at 15%. I can barely survive independently at that level.
> > What if they screw up?
> What are you afraid will happen?
Brain damage.
> > The idea is nice, but the reality is less than impressive for depression.
> Don't they adjust the implant while you're awake so you'll know if its working before they close your skull?
Yes, but by that point, the damage might already be done. Before undergoing DBS, I would want to see more established rates of efficacy. I would also want to see a consensus on what brain structures to target. Finally, I would want to see the establishment of case profiles that have the most and least rates of response.
> > I would first try intranasal ketamine. It is convenient, inexpensive, and effective.
> I have spoken with so many people who have tried intranasal ketamine to know its efficacy. It hasn't worked for any of them
That sucks.
> IV Ketamine seems to work very well, however.
Yes. They are able to adjust more precisely the amount of ketamine to administer. This is critical to produce an improvement in depression. There is a rather narrow dosage "sweet spot" or therapeutic window for ketamine treatment.
http://mediasite.video.ufl.edu/Mediasite/Play/4a46e8f9a6f84560aadacc408f77f6b51d
* See the end of the video for Q and A by John Krystal.
I am doubtful that this therapeutic window is taken into consideration with most people when they use intranasal delivery. Titration must be performed painstakingly to optimize a response (dosage x frequency).
> For a list of those clinics, check this out:
>
> http://www.ketamineadvocacynetwork.org/46-2/
>
> The only drawback is the cost-insurance usually doesn't cover it.That's quite a drawback.
> > Optimism?
>
> On a scale of 1 to 10, how would you rate your depression, 1 being the most depressed and 10 being the least depressed?4 (40%)
> > I really can't account for it.
> I think you found some things to live for.
One of the major motivators for me to remain alive is that I know what it is like to live without depression. I hold tightly my memories of remission.
> I am also convinced you are not as depressed as you think you are.
You might be right. However, I think that my illness must be judged as a function of my untreated baseline rather than during a temporary improvement. Professors at university programs and researchers at the NINH, NIH have called my condition "horrendous" and "very sick." My doctor at the NIH called my efforts at remaining alive as being "heroic". This has been vindicating. I am uncomfortable disclosing these things, but they do represent professional and objective impressions.
> What about this neuroscience stuff? You seem to have a knack for it. Why not make a living out of it?
I'd be happy just to be able to make a living selling cars.
> That's what I'm doing ;)
Do it! You've got the smarts for it. I look forward to watching you learn.
:-)
Thanks again.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1072466
URL: http://www.dr-bob.org/babble/20141017/msgs/1073223.html