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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on August 25, 2012, at 17:15:23
In reply to Re: Starting minocycline » SLS, posted by Iansf on August 25, 2012, at 13:59:35
> One thing I'm not clear on is whether minocycline is meant to be taken continuously as with antidepressants or if it's a one-time intervention.
I would guess that we are looking at using minocycline as a long-term treatment. I have not encountered anything that would indicate otherwise. Currently, there is a study of minocycline in the treatment of bipolar depression using dosages between 100 - 300 mg/day for 8 weeks. I can only hope that they coadminister Lamictal to some of the participants.
http://clinicaltrials.gov/ct2/show/NCT01514422
> Is the theory that there is an underlying systemic infection that needs to be cleared up?
No.
> Or is it that the characteristics of minocycline happen to affect brain chemistry apart from its antibiotic properties?
Yes. I listed some of them in the following post:
http://www.dr-bob.org/babble/20120803/msgs/1023257.html
I am impatient. I am tempted to increase my dosage of minocycline from 100 mg to 150 mg, but I haven't spoken to my doctor about this. I'm just curious to see how much better I can feel at the higher dosage. I don't want to get stuck if I remain underdosed for months.
- Scott
Posted by SLS on August 25, 2012, at 17:21:18
In reply to i'm dying to try this med....., posted by Jeroen on August 25, 2012, at 14:17:21
> i'm dying to try this med.....
>
> not dying but sufferingWhat is it about minocycline that you feel is important to treat your case in particular?
I'm sorry you are suffering so much. It's not fair.
- Scott
Posted by Phillipa on August 25, 2012, at 21:02:10
In reply to Re: i'm dying to try this med..... » Jeroen, posted by SLS on August 25, 2012, at 17:21:18
Scott for simple perioral dermatitis dosing was 75mg twice a day. And most take l00mg twice a day for skin. So I see no reason not to raise it. Just watch for dizziness and headache. Phillipa
Posted by SLS on August 25, 2012, at 21:05:22
In reply to Re: i'm dying to try this med..... » SLS, posted by Phillipa on August 25, 2012, at 21:02:10
> Scott for simple perioral dermatitis dosing was 75mg twice a day. And most take l00mg twice a day for skin. So I see no reason not to raise it. Just watch for dizziness and headache. Phillipa
I didn't know that. Thanks for the heads-up.
- Scott
Posted by Slabicki on August 25, 2012, at 22:16:50
In reply to i'm dying to try this med....., posted by Jeroen on August 25, 2012, at 14:17:21
Hi Jeroen,
I'm sorry to hear that you are suffering right now.
Do you mind sharing what are your symptoms?
What medications have you tried?
Certanly. Minocycline gives us hope.
Please keep us posting.Slabicki
Posted by Jeroen on August 26, 2012, at 3:56:28
In reply to Re: i'm dying to try this med.....Jeroen, posted by Slabicki on August 25, 2012, at 22:16:50
Thanks Slabicky
Posted by SLS on September 1, 2012, at 0:24:52
In reply to Re: Starting minocycline., posted by SLS on August 23, 2012, at 20:34:43
> > Feeling better.
>
> Feeling even better...Feeling even better than that...
Right now, I am feeling pretty good. I enjoyed my night out with some friends, and sang a few songs at the karaoke bar. I did not have to push myself to do anything. I had sufficient mental energy, concentration, and memory function such that I did not stumble over lyrics. I still had a tendency to stare into space, motionless at times. This is probably some residual psychomotor retardation that I hope disappears as I continue to improve. Food tastes better, music sounds better, woman look better, etc. My mind is still fairly slow, and not quite active enough to engage in conversation. There is still a degree of numbness, and I just don't seem to have much to say. My social anxiety is diminishing. I feel more confident in myself, and am more likely to be assertive. My metabolism is increasing and I am losing weight, despite my taking in the same number of calories. My appetite is somewhat reduced, but I still eat out of boredom. I am going to make a concerted effort to take advantage of the reduced appetite and try to eat less. I exercise better judgment in making decisions. That the world feels more real to me now helps facilitate this. I feel like I am beginning to rejoin society. Without depression, the world seems like a very different place.
- Scott
Posted by Tomatheus on September 1, 2012, at 10:04:04
In reply to Re: Starting minocycline. » SLS, posted by SLS on September 1, 2012, at 0:24:52
Scott,
It's great to hear that you're noticing ongoing improvement from the minocycline that you're taking. I think it's wonderful that your life seems to be improving in a lot of different ways with your depression under much more control than it's been under in the past. I wish you continued success with the medication.
Tomatheus
Posted by SLS on September 4, 2012, at 13:15:57
In reply to Starting minocycline., posted by SLS on August 14, 2012, at 9:23:51
My doctor acceded to my request to increase my dosage of minocycline from 100 mg/day to 200 mg/day. I would like to convert a partial response into a full remission.
The current clinical trials of minocycline in the treatment of depression use dosages between 100 - 400 mg/day. I felt it was important to explore a higher dosage now rather than to risk remaining underdosed for an extended period of time. The improvement that I am experiencing is not enough for me to return to work or school, although it has been enough for me to go out more and socialize. I know what "magic" feels like. I believe that I am just on the cusp of a robust antidepressant response. I can be such a dumb optimist sometimes. I keep failing to respond adequately to treatment. You would think I would have learned my lesson by now.
My current treatment regime:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 300 mg/day
Abilify 10 mg/day
minocycline 200 mg/dayIf I do indeed respond robustly to the addition of minocycline, I would like to attempt to discontinue Abilify. Besides offending my sense of vanity by causing me to gain 50 pounds, it has raised my triglycerides to over 400 mg/dL.
Hoping and praying...
- Scott
Posted by Tomatheus on September 4, 2012, at 13:45:00
In reply to Re: Starting minocycline., posted by SLS on September 4, 2012, at 13:15:57
Good luck, Scott. I really hope that you get the kinds of benefits that you're hoping for from your dose increase.
Tomatheus
Posted by SLS on September 4, 2012, at 14:02:15
In reply to Re: Starting minocycline. » SLS, posted by Tomatheus on September 4, 2012, at 13:45:00
> Good luck, Scott. I really hope that you get the kinds of benefits that you're hoping for from your dose increase.
>
> Tomatheus
Thanks for being so supportive. It is VERY much appreciated.I will continue to post of my progress - good or bad.
- Scott
Posted by Phillipa on September 4, 2012, at 21:10:49
In reply to Re: Starting minocycline., posted by SLS on September 4, 2012, at 13:15:57
Scott congrats and don't be afraid remember how Ron Hill finally found the right combo? Phillipa
Posted by SLS on September 5, 2012, at 7:15:10
In reply to Re: Starting minocycline. » Tomatheus, posted by SLS on September 4, 2012, at 14:02:15
My initial reaction to the higher dosage (200 mg/day) of minocycline has been a mixture of good and bad. I feel somewhat more depressed. My affect is flat. However, my cognitive impairments are less severe. My memory is better and my thinking is not as slow. Hopefully, this is a prelude to a more robust antidepressant response.
- Scott
Posted by SLS on September 9, 2012, at 3:00:56
In reply to Re: Starting minocycline., posted by SLS on September 5, 2012, at 7:15:10
> My initial reaction to the higher dosage (200 mg/day) of minocycline has been a mixture of good and bad. I feel somewhat more depressed. My affect is flat. However, my cognitive impairments are less severe. My memory is better and my thinking is not as slow. Hopefully, this is a prelude to a more robust antidepressant response.
I had a couple of good days, but things have since leveled off to a degree of improvement that I find disappointing. Minocycline is very obviously helping me, but I just don't know if it will get me more than 50% well; a level at which I anticipate being able to return to work. I will give this a few more days. If there are no signs of further recovery, I will add back prazosin. I was hoping to avoid taking prazosin because it reduces my libido.
Exercising patience is a real pain in the _ss.
- Scott
Posted by Tomatheus on September 9, 2012, at 14:36:42
In reply to Re: Starting minocycline., posted by SLS on September 9, 2012, at 3:00:56
Scott,
I'm sorry to hear that the degree of improvement that you've been experiencing as of late with minocycline has been disappointing. I think it's good that you're being patient, despite the fact that it can be a real pain, and I also think it's good that you're giving your current regimen a few more days. If you do reintroduce prazosin to your medication regimen, I really hope that it will combine well with minocycline.
Best of luck to you,
Tomatheus
Posted by SLS on September 10, 2012, at 18:29:02
In reply to Re: Starting minocycline. » SLS, posted by Tomatheus on September 9, 2012, at 14:36:42
> Scott,
>
> I'm sorry to hear that the degree of improvement that you've been experiencing as of late with minocycline has been disappointing. I think it's good that you're being patient, despite the fact that it can be a real pain, and I also think it's good that you're giving your current regimen a few more days. If you do reintroduce prazosin to your medication regimen, I really hope that it will combine well with minocycline.
>
> Best of luck to you,Thanks.
I was pleasantly surprised today. I felt better than I have since beginning minocycline treatment three weeks ago. I am very glad that I exercised some patience and didn't run back to prazosin so quickly. I think we're getting close to that magical feeling that happens when you emerge from depression as the light fills the darkness and your mind operates with energy and clarity.
How are you coming along?
- Scott
Posted by Tomatheus on September 10, 2012, at 22:11:29
In reply to Re: Starting minocycline. » Tomatheus, posted by SLS on September 10, 2012, at 18:29:02
Scott,
Thank you for sharing the good news about the way you're coming along on minocycline. I'm happy that as of today, you're feeling the best that you've felt since you started minocycline. I hope that you're right that a strong response is likely around the corner for you, and I certainly hope that you will at least continue to experience the benefits that you're experiencing up to this point in time.
Although I'm not feeling nearly as bad as I was feeling when my depressive symptoms were at their worst, I haven't been doing too well lately. I was noticing some improvements on the supplement Sytrinol (which somebody on another site recommended to me) for about a week before that response gave way a few days ago. To see if I could recapture some of the benefits that I was initially noticing from taking the Sytrinol, I increased the dose yesterday. I would say that I seem to be noticing a little something from the dose increase (a slight increase in energy, a slight boost in concentration, and a slight reduction in hypersomnia), but overall I would say that my response is rather weak -- and definitely weaker than my initial response from when I started Sytrinol. In addition to Sytrinol, the supplements that I'm taking are folic acid (which is to combat anxiety that emerged after I took aminoguanidine), coenzyme q10, Korean ginseng, liquid vitamin B12, and liquid SAM-e. Other than the folic acid, the supplements that I take are for the management of my depressive symptoms (diminished energy, psychomotor retardation, hypersomnia, difficulty concentrating, and anhedonia), but even together, the supplements that I'm taking don't seem to be doing much.
At this point, I'm considering adding phosphatidlycholine to my regimen of medications and supplements. The phosphatidylcholine would hopefully help with my cognitive impairment, which along with my anxiety and psychosis, emerged shortly after I took aminoguanidine. Unfortunately, I have good reason to think that the phosphatidylcholine might also have a detrimental effect on my depressive symptoms (particularly the diminished energy and psychomotor retardation). Still, I think that I will take this supplement and plan to possibly increase my SAM-e intake and also possibly my Starbucks hot cocoa intake, because SAM-e and Starbucks hot cocoa have historically been some of the most helpful tools that I've had in combating my depressive symptoms. SAM-e tablets no longer seem to do much of anything for me, and a liquid version of the supplement helps me significantly on a rather short-term basis, but I would like to test this idea that I have that phosphatidylcholine might help to give SAM-e some new life. My idea that phosphatidylcholine might sort of reactivate the SAM-e is based on the fact that when I last took phosphatidylcholine (and also when I last took DMAE, which is another cholinergic supplement), my cognition seemed to improve, but my depressive symptoms seemed to get worse. This was more consistent with the way that I felt when I responded well to SAM-e, which was prior to the time that I took aminoguanidine, which is what I think probably brought on my cognitive impairment (along with my psychosis and my anxiety) in the first place. Of course, time will tell whether or not my idea about phosphatidylcholine giving SAM-e new life will have any merit to it. I think that the odds actually favor me being wrong with this idea, but it's something that I want to test.
Another treatment that I may try soon is low-dose nalxtrexone, possibly along with an MAOI such as Rhodiola rosea or moclobemide. Slabicki from these boards said that she had good results for quite a while from taking low-dose naltrexone in addition to moclobemide, and her response to moclobemide monotherapy was similar to mine (a strong, but very short-lived response), so I'm hoping that I might see some results from trying low-dose naltrexone with an MAOI.
Well, I think that what I've written above basically sums up where my treatment is at right now and where I'm thinking about possibly taking it. If you have any suggestions for me, I'd be interested in hearing them.
Let's hope that the response that you noticed today will be the beginning of better days ahead for you. And of course, let's hope that better days will be ahead for all on Psycho-Babble, myself included.
Tomatheus
Posted by AlexCanada on September 11, 2012, at 5:23:17
In reply to Re: Starting minocycline. » Tomatheus, posted by SLS on September 10, 2012, at 18:29:02
Hey Scott. Good to hear you are improving.
Do you feel minocycline may be working for you due to it's effect on Norepinephrine or other factors?
> > Scott,
> >
> > I'm sorry to hear that the degree of improvement that you've been experiencing as of late with minocycline has been disappointing. I think it's good that you're being patient, despite the fact that it can be a real pain, and I also think it's good that you're giving your current regimen a few more days. If you do reintroduce prazosin to your medication regimen, I really hope that it will combine well with minocycline.
> >
> > Best of luck to you,
>
> Thanks.
>
> I was pleasantly surprised today. I felt better than I have since beginning minocycline treatment three weeks ago. I am very glad that I exercised some patience and didn't run back to prazosin so quickly. I think we're getting close to that magical feeling that happens when you emerge from depression as the light fills the darkness and your mind operates with energy and clarity.
>
> How are you coming along?
>
>
> - Scott
>
>
Posted by SLS on September 11, 2012, at 6:21:30
In reply to Re: Starting minocycline. » SLS, posted by AlexCanada on September 11, 2012, at 5:23:17
> Hey Scott. Good to hear you are improving.
Thanks.
:-)
> Do you feel minocycline may be working for you due to it's effect on Norepinephrine or other factors?Gosh. It's so hard to know for sure. I am guessing that there is more than one effect that is contributing to my therapeutic response. I know that minocycline amplifies the antidepressant effect of desipramine. It might work with other TCAs as well. Researchers have found that it also has anti-glutamatergic properties via receptor downregulation. These might amplify the antidepressant effects of Lamictal, a glutamate release inhibitor. Even its anti-inflammatory properties might contribute, as drugs with this effect have shown antidepressant activity in rats. In fact, there is a study currently underway that is designed to see if the addition of aspirin to minocycline works better for bipolar depression than minocycline alone. These treatments are to be compared to placebo. Although it might not produce new nerve cells (neurogenesis), minocycline does protect new cells from damage (neuroprotection) by suppressing microglia activity. Microglia have a nasty habit of producing neurotoxic pro-inflammatory modulators.
There comes a time when I say the heck with theory. To some degree, we act as blind guinea pigs for one another. So far, this guinea pig is happy with the results of my minocycline investigation. It is important to note that I am taking Lamictal. Theory here is helpful in that it might indicate to someone who is not responding to minocycline therapy that adding Lamictal would "unlock" its therapeutic potential or vice-versa.
Currently:
Parnate 80 mg/day
Nortriptyline 150 mg/day
Lamictal 200 mg/day
Lithium 300 mg/day
Abilify 10 mg/day
Minocycline 200 mg/dayI found that minocycline works better for me at 200 mg/day than it did at 100 mg/day. Most of the current studies of minocycline to treat depression use 200 mg/day or higher. It should be dosed twice a day.
I was able to discontinue prazosin, which produced a significant antidepressant effect for me. My next move will be to attempt to discontinue Abilify. I am less confident that I will able to do this without relapsing. I might need its dopamine system stabilizing (DSS) properties. However, it is logical to try this due to the metabolic side effects Abilify produces. I have gained 50 pounds over the course of several years and my triglycerides are way too high. Abilify is the likely culprit.
Do you feel that noradrenergic (NE) hypofunction is a component of your illness?
- Scott
Posted by AlexCanada on September 12, 2012, at 11:17:37
In reply to Re: Starting minocycline. » AlexCanada, posted by SLS on September 11, 2012, at 6:21:30
> > Do you feel minocycline may be working for you due to it's effect on Norepinephrine or other factors?
>
> Gosh. It's so hard to know for sure. I am guessing that there is more than one effect that is contributing to my therapeutic response. I know that minocycline amplifies the antidepressant effect of desipramine. It might work with other TCAs as well. Researchers have found that it also has anti-glutamatergic properties via receptor downregulation. These might amplify the antidepressant effects of Lamictal, a glutamate release inhibitor. Even its anti-inflammatory properties might contribute, as drugs with this effect have shown antidepressant activity in rats. In fact, there is a study currently underway that is designed to see if the addition of aspirin to minocycline works better for bipolar depression than minocycline alone. These treatments are to be compared to placebo. Although it might not produce new nerve cells (neurogenesis), minocycline does protect new cells from damage (neuroprotection) by suppressing microglia activity. Microglia have a nasty habit of producing neurotoxic pro-inflammatory modulators.I have tried Lamictal before and it seemed promising in terms of improving my mood initially, I was starting to enjoy things a little bit but it very quickly was negatively impacting my already poor cognition and I'd also feel empty headed and very dull. I never felt more dumb on any medication than I did on lamictal and even my short term memory was severely compromised. Constantly forgetting things moment by moment.
Do you know which other meds may have anti-glutamatergic action? Lamictal seemed promising but I just could not handle the infamous side effects. The ''Lamictal Stupid'' effect that is well documented online.
A very prominent doctor here in Canada stated glutamine could be one possible factor in my melancholic depression but he never specified anything on the issue and I am no longer able to reach him as he is not my main doctor.
Minocycline, might it be a viable option for augmenting an SSRI such as Zoloft which I am currently taking (and so far feeling very dull, blunted, flat, as I am on day 6 of 25mg) or an SNRI (such as Savella or others?). Or is it more suited to augment TCAs? Because I'm not sure if I'll be trying a TCA any time soon.
> There comes a time when I say the heck with theory. To some degree, we act as blind guinea pigs for one another. So far, this guinea pig is happy with the results of my minocycline investigation. It is important to note that I am taking Lamictal. Theory here is helpful in that it might indicate to someone who is not responding to minocycline therapy that adding Lamictal would "unlock" its therapeutic potential or vice-versa.
>
> Currently:
>
> Parnate 80 mg/day
> Nortriptyline 150 mg/day
> Lamictal 200 mg/day
> Lithium 300 mg/day
> Abilify 10 mg/day
> Minocycline 200 mg/day
>
> I found that minocycline works better for me at 200 mg/day than it did at 100 mg/day. Most of the current studies of minocycline to treat depression use 200 mg/day or higher. It should be dosed twice a day.
>
> I was able to discontinue prazosin, which produced a significant antidepressant effect for me. My next move will be to attempt to discontinue Abilify. I am less confident that I will able to do this without relapsing. I might need its dopamine system stabilizing (DSS) properties. However, it is logical to try this due to the metabolic side effects Abilify produces. I have gained 50 pounds over the course of several years and my triglycerides are way too high. Abilify is the likely culprit.
>
> Do you feel that noradrenergic (NE) hypofunction is a component of your illness?I think it very well could be a missing link. Considering NRIs etc can supposedly have benefits to cognition, memory, drive, motivation, energy, things which I very often lack especially on the cognitive side. When my mind is more active and does not feel so cognitively blocked off and I am able to have some flowing stream of thought often other things become easier as well. In the past I did not respond well to Effexor, Wellbutrin, among others though. Effexor rapidly caused my condition to worsen but those were early days when aside from strong melancholic dep I was also dealing with severe ''out of nowhere'' anxiety, anxiety without reason, and intense burning pains in my head. I was never able to give effexor and certain other similar meds a long enough trial due to the worsening of my symptoms. Anxiety would strongly manifest itself yet in theory Norepinephrine info seems like it may help greatly.
Perhaps I have too much norepinephine? And very low dopamine and seratonin. I don't know. Dopamine based meds have worked wonders (ritalin/dexedrine/parnate etc) in the past. These days I have much tolerance to ritalin.
My anxiety these days is usually very low and has always been very secondary compared to my melancholic depression but much of this low anxiety might be due to how dulled and cognitively impaired i am right now.
Posted by SLS on September 17, 2012, at 8:20:26
In reply to Re: Starting minocycline. » SLS, posted by AlexCanada on September 12, 2012, at 11:17:37
> My anxiety these days is usually very low and has always been very secondary compared to my melancholic depression but much of this low anxiety might be due to how dulled and cognitively impaired i am right now.
That's a very insightful connection you make between cognitive impairment and the anxiety that can emerge as a result of being hypofunctional in a busy world. It is difficult not to become anxious when one is asked to perform at a level beyond their capabilities.
I wonder if using low-dose lithium treatment would help in combination with antidepressants. Adding lithium to Parnate had been a favorite strategy 30 years ago. Of course, adding it to TCAs was a common treatment. Lithium might act as a buffer against excessive NE and GLU activity via receptor modulation produced by inhibiting second messenger cascades.
- Scott
Posted by SLS on September 17, 2012, at 8:21:54
In reply to Re: Starting minocycline. » AlexCanada, posted by SLS on September 17, 2012, at 8:20:26
Minocycline is still working...
...better and better.
- Scott
Posted by Tomatheus on September 17, 2012, at 15:00:19
In reply to Re: Starting minocycline., posted by SLS on September 17, 2012, at 8:21:54
Posted by brynb on September 17, 2012, at 15:05:49
In reply to Re: Starting minocycline., posted by SLS on September 17, 2012, at 8:21:54
> Minocycline is still working...
>
> ...better and better.
>
>
> - Scott
>Wow, that's awesome! I think I mentioned I have an Rx (from my derm). I'd love to bring this up to my pdoc.
Posted by rovers95 on September 18, 2012, at 15:57:32
In reply to Re: Starting minocycline., posted by SLS on September 17, 2012, at 8:21:54
> Minocycline is still working...
>
> ...better and better.
>
>
> - Scott
>
>Okay, whilst it is difficult for me to discern what represents a response from what is a 'high' from eating a few carbs, I seem to be doing a lot better. I am now at 100mg and whilst I was quite flat friday to sunday, in the last few couple of days I have good spells that suggest considerable improvement.
Obviously, I have issues in other areas (binge eating, diet)that need addressing. I was considering suggesting an SSRI (zoloft) or using 5htp to see if this would help this side of my treatment.
Scott, would be interesting to know what made you try minocycline...apart from running out of ideas! Is your pdoc using with others? Are they having similar success and do you know of anyone who has been on this long term?
Cheers, Rover
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