![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by bob on March 12, 2000, at 23:25:58
In reply to What's Your Educated Guess?, posted by anonymous on March 12, 2000, at 20:13:28
I'd still call it depression. Being depressed doesn't mean just feeling sad -- given your circumstances, you may feel any number of things ... anger, especially due to self-loathing, being one.
As for taking an AD and feeling worse because of it, I just went through a phase like that myself. I knew I had had my ups and downs over the past few years, but I was like teflon -- they just didn't stick because I had stopped caring about myself and my life so long ago. My meds and my talk therapy finally got me to a place, tho, where I started to care again ... and yes, the first thing I saw was how royally f*ck*d up my life is. It hurt like hell -- worse than any pain I had had in a decade or more. Now, I've numbed up somewhat again. I know the pain is still out there and it needs to be dealt with ... I need to get through that pain to get to a better place.
The same is probably true of your anger.
You didn't mention whether you were in any talk therapy besides the meds. I'd urge you to do so. You might be able to find a med that can take away the anger, but it won't take away all the behaviors you have learned due to that anger. Think of it this way: you can put some Neosporin(+Pain Relief!) on an infected cut to kill the infection and sooth the hurt--but if you keep cutting yourself, all the Neosporin in the world isn't going to help you stop.
You may still have some dark days ahead of you, but you're taking action to bring in the light. Take pride in that! That first step takes a helluva lot of guts.
And never forget that you will always have people here in Babbleland who have been there--who ARE there--and who'll stand by you and support you.
be well,
bob
Posted by kazoo on March 13, 2000, at 1:03:12
In reply to Re: What's Your Educated Guess?, posted by bob on March 12, 2000, at 23:25:58
Nota bene: it is our IMPERFECTIONS that make us beautiful.
Anger is a form of energy; direct it toward something positive
and you'll be alright.Re. the "Educated Guess": "We don't need no EDUKAYSHUN..." (a Floydian Slip)
kazoo (to you)
Posted by Noa on March 13, 2000, at 6:04:13
In reply to Re: What's Your Educated Guess?, posted by kazoo on March 13, 2000, at 1:03:12
I agree talk therapy in combo with meds can help.
What meds are you on? What have you been on? How long have you had your symptoms? Are there specific areas of your life you need help with?
I have been on a long and arduous "quest" for the right combo of medications. It aint been easy. But this place (Babble) has given me lots of hope to keep trying.
Posted by KarenB on March 13, 2000, at 10:46:42
In reply to What's Your Educated Guess?, posted by anonymous on March 12, 2000, at 20:13:28
Greetings Anonymous,
I too have spent a lifetime hating myself and being mad as hell, in my case because of undiagnosed Bipolar II disorder, since early childhood. I can remember my first cases of physical depression and mania as early as age six.
When I am depressed, every ounce of energy is sucked from my body and mind. In this case I have hated myself for being "lazy and ineffective." When I have had mildly violent outbursts (mostly verbal) I have hated myself for being mean and have been utterly shocked at my own behavior. I tried talk therapy and worked though a lot of pain (Dad's alcoholism, etc.), rather successfully and still felt like crap. Then I hated myself for not getting better.
I don't know what is wrong, in your case - it could be many things BUT the thing that has given me hope and helped me to stop hating myself is this: Knowing that there is definitely something chemically imbalanced in my brain, knowing I am not responsible for making it that way and taking much of my recovery into my own hands. Research! You know, with the internet, you have a wealth of information in your own home. Find out which neurotransmitters are whacked. This is an incredibly painful process for most, finding the right meds but it is worth it. If you have been on seratonin reuptake drugs (SSRIs) and they haven't worked, they are most likely not working on the real problem. Mine, for example, is Dopamine. When I take drugs that inhibit the reuptake of dopamine, I feel like a human being...and, I've got to tell you, that feels good.
Best of health to you. Fight for your sanity and wellness - it is possible.
KarenB
Posted by Elizzy on March 13, 2000, at 18:57:06
In reply to Re: What's Your Educated Guess?, posted by KarenB on March 13, 2000, at 10:46:42
Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
Thanks for your help :) This board is really great.
lizzy
Posted by Lee on March 14, 2000, at 20:00:46
In reply to medication poop-out/reply to KarenB, posted by Elizzy on March 13, 2000, at 18:57:06
> Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
>
> Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
>
> Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
>
> Thanks for your help :) This board is really great.
> lizzy
Mine poop too, except only 2 mos!Once I got 50mg samples, thought they were 100, and got really depressed because I wasn't taking 2. Some say ritalin helps see Jan 20 posting, but that may poop out, too.
Posted by Scott L. Schofield on March 15, 2000, at 10:06:30
In reply to medication poop-out/reply to KarenB, posted by Elizzy on March 13, 2000, at 18:57:06
> Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
> >
> > Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
> >
> > Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
> >
> > Thanks for your help :) This board is really great.
> > lizzy
> Mine poop too, except only 2 mos!Once I got 50mg samples, thought they were 100, and got really depressed because I wasn't taking 2. Some say ritalin helps see Jan 20 posting, but that may poop out, too.
The Ritalin (methylphenidate) would be a good choice. Many people here say good things about it. It is just one of several options available as strategies to prevent or resolve the SSRI poop-out. Other stimulants may also help. I have seen numerous people respond well to a combination of Wellbutrin with either an SSRI or Effexor. The side benefit of any of these augmentation alternatives is that they often mitigate the sexual side effects that usually appear with SSRI treatment. Zoloft + Wellbutrin seems to work well. I know someone who is doing very well using a combination of Effexor and Wellbutrin. She did not respond adequately to either one by itself. Using the school of thought that JohnL has recently described, that she experienced a partial response to each drug monotherapeutically is clinically significant, and was used as the basis for choosing the combination.Adding pindolol (Visken) or lithium are also strategies that have helped some people. Although there are conflicting results from investigations testing the efficacy of adding pindolol to SSRIs in treatment-resistant cases, more confidence has been placed on its use in cases where there has been a partial antidepressant response. Adding lithium in low dosages (300mg - 600mg) sometimes works wonders. These dosages are high enough to illicit a response in depression, but are too low to treat bipolar disorder, especially mania.
If it were me, I would probably choose Wellbutrin first, then add or change to Ritalin.
Good luck.
- Scott
-------------------------------------
J Clin Psychiatry 1996 Feb;57(2):72-6
Methylphenidate augmentation of serotonin selective reuptake inhibitors: a case series.
Stoll AL, Pillay SS, Diamond L, Workum SB, Cole JO
Psycho-pharmacology Unit, Division of Psychiatry, Brigham and Women's Hospital, Boston, MA 02115, USA.
BACKGROUND: The serotonin selective reuptake inhibitors (SSRIs) are effective in treating major depressive episodes. However, for the subgroups of patients who remain refractory to therapy, augmentation strategies can improve the efficacy of these agents. METHOD: We report the results of an open trial of methylphenidate to augment SSRIs in the treatment of five consecutive cases of DSM-III- R diagnosed major depression. RESULTS: Self-reported symptom reduction was achieved rapidly in all cases, with methylphenidate dosages ranging from 10 to 40 mg/day. Symptom remission was independent of the presence of attention-deficit/hyperactivity disorder. Also, the beneficial effects of the methylphenidate-SSRI combination appeared to be robust and sustained. No patients abused or misused methylphenidate. CONCLUSION: The empirical use of methylphenidate added to ineffective or only partially effective SSRI treatment appeared to be a rapid, safe, and efficacious alternative to existing augmentation strategies for the treatment of major depression. Prospective controlled studies are required to confirm or refute these findings.------------------------------------
Posted by Scott L. Schofield on March 15, 2000, at 10:11:33
In reply to Re: What's Your Educated Guess?, posted by KarenB on March 13, 2000, at 10:46:42
> Mine, for example, is Dopamine. When I take drugs that inhibit the reuptake of dopamine, I feel like a human being...
I have suspected the same for myself for quite some time (17 years). Which DA-reuptake inhibitors have you used? Have you ever tried amineptine (Survector) or nomifensin (Merital)?
I need help.
> and, I've got to tell you, that feels good.
I bet.
Stay well.
- Scott
Posted by KarenB on March 15, 2000, at 19:46:23
In reply to Re: What's Your Educated Guess?, posted by Scott L. Schofield on March 15, 2000, at 10:11:33
Scott,
Funny you should mention Amineptine, because a combination of that and Sulpiride are what did the trick for me, finally, after many, many years of suffering. Unfortunately, Amineptine has been discontinued and Sulpiride is not available here in the US. Starting last night, I am taking Nortriptyline and will add Topamax soon, as a mood stabilizer. I am hopeful...
You stay well too.
Karen
Posted by Scott L. Schofield on March 16, 2000, at 7:35:17
In reply to Re: Educated Guess?/Amineptine, posted by KarenB on March 15, 2000, at 19:46:23
> Funny you should mention Amineptine, because a combination of that and Sulpiride are what did the trick for me, finally, after many, many years of suffering. Unfortunately, Amineptine has been discontinued and Sulpiride is not available here in the US. Starting last night, I am taking Nortriptyline and will add Topamax soon, as a mood stabilizer. I am hopeful...
Amineptine + sulpiride is a brilliant combination. My complements to the chef. (Who be he?)
There are those who claim that the antidepressant properties of Wellbutrin (bupropion) are due to its ability to inhibit the reuptake of dopamine (DA). My gut instinct tells me that this is not the case. I think it is more likely that it works because it may influence noradrenergic (norepinephrine, NE) pathways. I see people describe an "energizing" effect when using Wellbutrin more so than a mood-brightening effect. I just don't get the impression that Wellbutrin is that consistently robust in reducing anhedonia or increasing spontaneous motivation (the desire to do a whole bunch of different stuff). However, I would certainly give it a shot. As I've written before, I know someone who is doing well using a combination of Effexor (venlafaxine) and Wellbutrin. She claims that it is the Effexor that is responsible for contributing the mood-brightening effect, with the reduction in anhedonia and increase in motivation. She describes this motivational improvement as being "the wanna do's".
Personally, I think that the pro-dopaminergic effects of Effexor are underestimated. I would consider adding Effexor to nortriptyline, and then Wellbutrin to these two drugs if necessary. I am pretty confident that it would be a safe cocktail to try, and would cover quite a few pharmacological mechanisms at the same time. Wellbutrin makes me feel worse, so I've pretty much crossed it off my list. I'm playing around with the idea of getting a hold of amisulpiride (a blood relation to sulpiride) from Europe. I am even considering augmenting my treatment with one of the DA + NE drugs like mazindol (Mazinor). Most of these drugs are currently being used in the management of obesity. Have you ever heard of this being done?
Of course, if you have the potential for mania, you would want to establish a prophylactic mood-stabilizer regime before messing around with this stuff. What is the reason for the addition of Topamax (topiramate)?
Good luck.
Please keep me posted as to what recipies your chef comes up with.
Thanks.
- Scott
Posted by Kathy on March 16, 2000, at 8:31:11
In reply to medication poop-out/reply to KarenB, posted by Elizzy on March 13, 2000, at 18:57:06
Hi. I can so relate to your experience of ssri's fading out after a few month and having to keep raising the dose, etc. It seems like a never ending battle. I have been at this game for 20 years, had some periods where I was not on anything, and then realized that I needed some relief. Right now I just weaned off of celexa because after gradually increasing the dose over a years time to 40-50 mg. it was not working. It made me exhausted. I had ritalin added which helped but that effect fluctuates from day to day also. Right now I am on neurontin 600 mg. 3 times a day, and ritalin 15-20 mg 3 times a day, which seems to be okay for right now. I dont know what the next step will be. If I can function on these meds without falling into the black pit, I will continue as is . If not, I think I will probably try an maoi, since that is the only type of med I have yet to try. I have atypical bipolar ll, and I am totally exhausted and have low motivation,and can sleep all day, if not for the ritalin. The fatigue and exhaustion is a symptom of the depression .I can get very angry and agitated on the flip side, but never manic like with highs. The neurontin helps quite a bit, but does not help with energy. It helps with anger and agitation. I still have to see if it will help with preventing a huge drop into the black pit. The ritalin actually helps with my flat mood and energy level. Too bad I cant just take 1 pill a day. Its good to hear from those of you who have experienced such a poop out with meds such as I have experienced. Kathy
Posted by AndrewB on March 16, 2000, at 10:58:16
In reply to Re: Educated Guess?/Amineptine, posted by Scott L. Schofield on March 16, 2000, at 7:35:17
A couple comments I wanted to add here.......
SSRI poop out can also be caused by dopamine depletion. For more info. see Dr. Bob's Tips section. Signs to look for in dopamine depletion are: fatigue, mental fatigue (poor memory, poor concentration), sleepiness, apathy, anhedonia. Remedies include dopamine activity enhancers, ideally D2-D3 receptor enhancers, such as the amino acid dopamine precurosor Tyrosine, the D2 agonist Bromocryptine, amisulpride and Mirapex.
Scott, it's my impression also that Wellbutrin has mainly NE activity. I have tried or am using Wellbutrin, Reboxetine, amineptine , Mirapex, and amisulpride so I should be able to tell the difference between NE and dopamine action. I've read contradicting info. on Wellbutrin's supposed dopamine effects so maybe academia is not in agreement on what Wellbutrin actually acts on (and to what degree). By the way Scott, thank you for your imformative (and entertaining) posts, I've learned a lot from you over the months.
Final note, I've been on the combo of amisulpride and Mirapex (also take reboxetine) for 10 days. Good effect, all of amisulpride's effects have been enhanced; euthymia, the anxiolytic effect, the motivation and energy. Too early to tell if this will work long term though, as you noted a while back Scott, dopamine agonists may tend to poop out. Amisulpride and Mirapex are the combination of a presynaptic D2-D3 antagonist with a (postsynaptic) D2-D3 agonist. I guess this enhances dopaminergic activity sort of like plugging the dike and filling the pond.
AndrewB
Posted by KarenB on March 16, 2000, at 11:16:26
In reply to Re: Educated Guess?/Amineptine, posted by Scott L. Schofield on March 16, 2000, at 7:35:17
Scott,
The "chef" was a just-out-of-medical-school family practice doctora (female doctor) in the Philippines, where I lived five years. She was bipolar herself and was the first to properly diagnose me (I am atypical BipolarII). I am having a difficult time with my new doc wanting to try anything unconventional. Like, when I told him I was unresponsive to SSRI's, he prescribed Serzone, saying it was "different." Well, it certainly didn't FEEL different and I went off it on my own after 1 week of feeling both insane and sluggish at the same time. If I would have known it was an SSRI, I would have balked but I didn't know until after I started taking it.
Wellbutrin, for me, lifts my body but not my mind. I feel energized to do SOMETHING but can't figure out what it is and just don't care, anyway. It creates in me some kind of revved up depression.
Nortriptyline, so far (two days) is feeling pretty good. I have a hard time getting up in the morning but once I do, I feel good (my mood) and seem to have enough energy to do what I need to do. I know they say to wait three weeks or so to see the results but it has been my experience that if something is not right, I know it immediately. Like the Serzone, for instance.
The Topamax will be for mood stabilization but doc wants to add one med at a time, so I will be starting that in a couple of weeks.
I would love to try amisulpride but my insurance will not cover overseas ordering and we are not overflowing with cash right now. If I can't find anything available here in the US, I'll be forced to look outside. I had been ordering Amineptine and Sulpiride from the Philippines until Amineptine was discontinued just recently. I am still scurrying about, trying to buy up leftover stock to cover myself should the US meds not work out.
I hate this "trying new meds" thing, don't you? Without proper medication, I am a real vegetable. On the right meds, I kind of like who I am. I have two small boys, ages two and four, who rely on me as well. I want to be all I can be for them.
Be well,
Karen
Posted by AndrewB on March 16, 2000, at 12:41:27
In reply to Re: Scott/Amineptine, posted by KarenB on March 16, 2000, at 11:16:26
J Clin Psychiatry 1995 Sep;56(9):395-401
Bupropion: a review of its mechanism of antidepressant activity.
Ascher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, Golden RN, Martin P, Potter WZ,
Richelson E, et alDepartment of Neurology/Psychiatry, Burroughs Wellcome Co., Research Triangle Park, N.C., USA.
BACKGROUND: The mechanism of action of the novel antidepressant bupropion remains unclear after many years of study. A review of
the relevant biochemical, in vivo brain microdialysis, electrophysiologic, behavioral, and clinical data clarifies what is known about this
unique compound and suggests possible modes of action. METHOD: A panel of 11 experts was convened for a conference to discuss
bupropion's mechanism of antidepressant activity. Four of the panelists presented current research findings, followed by a discussion.
RESULTS: (1) Biochemical studies suggest down-regulation of postsynaptic beta-adrenoceptors and desensitization of the
norepinephrine-stimulated adenylate cyclase in the rat cortex occur only after chronic administration of very high doses of bupropion. (2) In
vivo brain microdialysis studies demonstrate that, after chronic administration, there is an enhancement of bupropion-induced increases in
extracellular dopamine in the nucleus accumbens. (3) Electrophysiologic data show that with acute dosing, bupropion reduces the firing rates
of noradrenergic neurons in the locus ceruleus. The firing rates of dopaminergic neurons are reduced by bupropion in the A9 and A10 areas of
the brain, but only at very high doses, and bupropion does not alter the firing rates of serotonergic neurons in the dorsal raphe. (4)
Behavioral studies show that the most active metabolite of bupropion, hydroxybupropion (306U73), appears to be responsible for a large
part of the compound's effects in animal models of antidepressant activity. (5) Clinical studies indicate that bupropion enhances noradrenergic
functional activity as reflected by an increased excretion of the hydroxy metabolite of melatonin, while at the same time producing a
presumably compensatory decrease in norepinephrine turnover. In one study, bupropion elevated plasma levels of the dopamine metabolite
homovanillic acid in nonresponders, but not in responders. CONCLUSION: The mechanism of action of bupropion appears to have an
unusual, not fully understood, noradrenergic link. The bupropion metabolite hydroxybupropion probably plays a critical role in bupropion's
antidepressant activity, which appears to be predominantly associated with long-term noradrenergic effects. The mild central nervous system
activating effects of bupropion appear to be due to weak dopaminergic mechanisms. There is some evidence that dopamine may contribute to
bupropion's antidepressant properties. Antidepressant effects of bupropion are not serotonergically mediated.
Posted by KarenB on March 16, 2000, at 23:23:34
In reply to Re: What's Your Educated Guess?, posted by Scott L. Schofield on March 15, 2000, at 10:11:33
Scott,
This nomifensin (Merital) you mention: Have you tried it? Is it available in the US?
I did several searches today and didn't come up with much, as it was mostly in German.Thanks!
Karen
Posted by vega on March 17, 2000, at 1:39:57
In reply to medication poop-out/reply to KarenB, posted by Elizzy on March 13, 2000, at 18:57:06
> Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
>
> Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
>
> Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
>
> Thanks for your help :) This board is really great.
> lizzyI have never found a single antidepressant to be
adequate. Wellbutrin alone is activating for the
first week or so, as is Prozac, but any AD
activity it may have is insufficient. I have
taken Elavil and Wellbutrin; Prozac and Wellbutrin;
Celexa and Wellbutrin; Paxil and Wellbutrin;
Serzone and Wellbutrin; Remeron and Wellbutrin and
Ritalin; Remeron and Wellbutrin and Ritalin and
Adderall;and now Celexa and Wellbutrin and Ritalin
and Adderall. I have a personal scale from 0 to
10. 0 is dead. 1/2 is very heavily contemplating
suicide, steering yourself in a surreal way
through the day. A full 1 is just dragging
yourself through the day. Normal for the
"nonpathological population" is 4,5,6; 7 is high
energy, productive, generally satisfying. Most
people at 7 would play their hand. 7 and 8 are
the levels of hypomania. Someone once said that
the goal, in terms of mood and productivity, is a
controlled hypomania. At 8 symptoms of mania may
start to appear. You're walking on the edge.
9 is frank mania at its most controlled level.
The structure of your life is crumbling, you may
loose everything. At ten you are either under
control in a hospital or prison or swiftly heading
toward death.
Without any AD I am usually at a 1. A serotonin
active drug takes me to 2. Add Wellbutrin, I'm up
to a 3, the bottom of my 3,4,5 personal range. Top
that with Ritalin and/or Adderall, and I'm generally
content to play the hand at 4 or 5. EXCEPT for the
sexual effects of the serotonergic drug. Orgasm
becomes extremely difficult. So I switch to Remeron
and Wellbutrin, Ritalin and Adderall, and function
at a 4 or 5 for about 3 months, when I crash, start
taking Celexa, Wellbutrin, Ritalin and Adderall,
and SAM-e, and if I catch it early, in a few days
I'm on my way up.
Posted by michael on March 17, 2000, at 4:20:30
In reply to Re: Educated Guess?/Poop Out, posted by AndrewB on March 16, 2000, at 10:58:16
> A couple comments I wanted to add here.......
>
> SSRI poop out can also be caused by dopamine depletion. For more info. see Dr. Bob's Tips section. Signs to look for in dopamine depletion are: fatigue, mental fatigue (poor memory, poor concentration), sleepiness, apathy, anhedonia. Remedies include dopamine activity enhancers, ideally D2-D3 receptor enhancers, such as the amino acid dopamine precurosor Tyrosine, the D2 agonist Bromocryptine, amisulpride and Mirapex.
>
> Scott, it's my impression also that Wellbutrin has mainly NE activity. I have tried or am using Wellbutrin, Reboxetine, amineptine , Mirapex, and amisulpride so I should be able to tell the difference between NE and dopamine action. I've read contradicting info. on Wellbutrin's supposed dopamine effects so maybe academia is not in agreement on what Wellbutrin actually acts on (and to what degree). By the way Scott, thank you for your imformative (and entertaining) posts, I've learned a lot from you over the months.
>
> Final note, I've been on the combo of amisulpride and Mirapex (also take reboxetine) for 10 days. Good effect, all of amisulpride's effects have been enhanced; euthymia, the anxiolytic effect, the motivation and energy. Too early to tell if this will work long term though, as you noted a while back Scott, dopamine agonists may tend to poop out. Amisulpride and Mirapex are the combination of a presynaptic D2-D3 antagonist with a (postsynaptic) D2-D3 agonist. I guess this enhances dopaminergic activity sort of like plugging the dike and filling the pond.
>
> AndrewB
Andrew -Just wondering if you've had any experience w/selegiline?
Posted by AndrewB on March 17, 2000, at 11:28:47
In reply to Re: Educated Guess?/Poop Out, posted by michael on March 17, 2000, at 4:20:30
Michael,
I've just tried Seligiline at a low dose, 5 and 10 mg.s. I didn't get a response. Many people however don't respond at the lower dosages.
Posted by Scott L. Schofield on March 17, 2000, at 13:26:00
In reply to Scott - Nomifensin, posted by KarenB on March 16, 2000, at 23:23:34
> This nomifensin (Merital) you mention: Have you tried it? Is it available in the US?
> I did several searches today and didn't come up with much, as it was mostly in German.
Hi Karen.
* Nomifensine (Merital) was available briefly in the mid 1980’s for the indication of depression. It was marketed in many countries, including the U.S. Nomifensine strongly inhibits the reuptake of both dopamine and norepinephrine, and promotes the release of dopamine as well. When reports of hemolytic anemia (exploding red blood-cells) associated with its use began to show up, the drug manufacturer (Hoescht-Roussel) withdrew it from market. It is still used today as a biological tool in the study of the central nervous system.When I tried Nomifensine, I began to respond to it at about the two-week mark. The antidepressant effect, although robust, only lasted for about three days. Amineptine is another drug that potently inhibits the reuptake of dopamine. I am very interested to know if anyone has tried both drugs, and how they reacted to each of them.
I am very angry and frustrated that amineptine has been bullied out of the world market. It was a first-line treatment in French psychiatry for twenty years with little question of its efficacy. It was at the top of my list of things to try until it was withdrawn just this past year. It seems to be the best antidepressant match for my illness profile – a retarded depression.
* Two spellings, “nomifensine” and “nomifensin” are used in medical literature, with the former being the more common.
- Scott
----------------------------------------
Acta Psychiatr Scand 1991 Dec;84(6):552-4
Dopaminergic hypothesis for retarded depression: a symptom profile for predicting therapeutical responses.
Rampello L, Nicoletti G, Raffaele R
Institute of Neurology, University of Catania, Italy.
We assessed the therapeutical efficacy of various antidepressants (amineptine, minaprine and clomipramine) in patients affected by retarded depression. All patients exhibited symptoms of retardation, including hypokinesia, anergia, reduction of speech, increased salivation, hypersomnia, Parinaud's syndrome, reduced sexual activity, slowness, hypomimia, orthostatic hypotension, dysphagia and drowsiness. Antidepressant drugs were administered for a 6-week period in a randomized double-blind vs placebo design. The rank order of clinical effectiveness (amineptine much greater than minaprine greater than clomipramine greater than placebo) paralleled the specificity of antidepressants as dopaminomimetic agents. These results support the view that a reduced dopaminergic transmission contributes to the pathophysiology of retarded depression.
Posted by michael on March 17, 2000, at 14:20:42
In reply to Re: Educated Guess?/Poop Out, posted by AndrewB on March 16, 2000, at 10:58:16
> A couple comments I wanted to add here.......
>
> SSRI poop out can also be caused by dopamine depletion. For more info. see Dr. Bob's Tips section. Signs to look for in dopamine depletion are: fatigue, mental fatigue (poor memory, poor concentration), sleepiness, apathy, anhedonia. Remedies include dopamine activity enhancers, ideally D2-D3 receptor enhancers, such as the amino acid dopamine precurosor Tyrosine, the D2 agonist Bromocryptine, amisulpride and Mirapex.
>
> Scott, it's my impression also that Wellbutrin has mainly NE activity. I have tried or am using Wellbutrin, Reboxetine, amineptine , Mirapex, and amisulpride so I should be able to tell the difference between NE and dopamine action. I've read contradicting info. on Wellbutrin's supposed dopamine effects so maybe academia is not in agreement on what Wellbutrin actually acts on (and to what degree). By the way Scott, thank you for your imformative (and entertaining) posts, I've learned a lot from you over the months.
>
> Final note, I've been on the combo of amisulpride and Mirapex (also take reboxetine) for 10 days. Good effect, all of amisulpride's effects have been enhanced; euthymia, the anxiolytic effect, the motivation and energy. Too early to tell if this will work long term though, as you noted a while back Scott, dopamine agonists may tend to poop out. Amisulpride and Mirapex are the combination of a presynaptic D2-D3 antagonist with a (postsynaptic) D2-D3 agonist. I guess this enhances dopaminergic activity sort of like plugging the dike and filling the pond.
>
> AndrewB
Hey Andrew,I was just wondering if you're in the US, and also if you've got a doc who's willing to work with you, w/respect to these different meds? Or if you're striking out, somewhat, on your own?
Sounds like you're making some pretty good progress. It seems to me like serotonin gets a lot more focus than dopamine. However, it seems like the dopamine connection might be more relevent, or at least as relevent, in terms of looking at the fatigue aspects, and dysthymia... Especially if these meds give doc's alternatives to explore that possibility, w/o resorting to the dreaded stimulants (please excuse the sarcasm).
Thanks for all the feedback, and info.
michael
Posted by Colleen on March 18, 2000, at 0:41:09
In reply to Re: medication poop-out/reply to KarenB, posted by vega on March 17, 2000, at 1:39:57
I just pooped out on my drugs and I am crashing very hard. I'm taking 300 Effexor Xr, 400 Wellbutrin and 2mg Risperdal. My doctor is taking me off of the Effexor and wants to try me on serzone. I really understand everyone's frustrations. I've been battleing depression for 20 years now and have been on every kind of AD you can think of except for the MAO. It's nice to know that I'm not alone.
> > Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
> >
> > Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
> >
> > Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
> >
> > Thanks for your help :) This board is really great.
> > lizzy
>
> I have never found a single antidepressant to be
> adequate. Wellbutrin alone is activating for the
> first week or so, as is Prozac, but any AD
> activity it may have is insufficient. I have
> taken Elavil and Wellbutrin; Prozac and Wellbutrin;
> Celexa and Wellbutrin; Paxil and Wellbutrin;
> Serzone and Wellbutrin; Remeron and Wellbutrin and
> Ritalin; Remeron and Wellbutrin and Ritalin and
> Adderall;and now Celexa and Wellbutrin and Ritalin
> and Adderall. I have a personal scale from 0 to
> 10. 0 is dead. 1/2 is very heavily contemplating
> suicide, steering yourself in a surreal way
> through the day. A full 1 is just dragging
> yourself through the day. Normal for the
> "nonpathological population" is 4,5,6; 7 is high
> energy, productive, generally satisfying. Most
> people at 7 would play their hand. 7 and 8 are
> the levels of hypomania. Someone once said that
> the goal, in terms of mood and productivity, is a
> controlled hypomania. At 8 symptoms of mania may
> start to appear. You're walking on the edge.
> 9 is frank mania at its most controlled level.
> The structure of your life is crumbling, you may
> loose everything. At ten you are either under
> control in a hospital or prison or swiftly heading
> toward death.
> Without any AD I am usually at a 1. A serotonin
> active drug takes me to 2. Add Wellbutrin, I'm up
> to a 3, the bottom of my 3,4,5 personal range. Top
> that with Ritalin and/or Adderall, and I'm generally
> content to play the hand at 4 or 5. EXCEPT for the
> sexual effects of the serotonergic drug. Orgasm
> becomes extremely difficult. So I switch to Remeron
> and Wellbutrin, Ritalin and Adderall, and function
> at a 4 or 5 for about 3 months, when I crash, start
> taking Celexa, Wellbutrin, Ritalin and Adderall,
> and SAM-e, and if I catch it early, in a few days
> I'm on my way up.
>
>
Posted by AndrewB on March 18, 2000, at 8:21:56
In reply to Andrew - Q, posted by michael on March 17, 2000, at 14:20:42
> Hey Andrew,
>
> I was just wondering if you're in the US, and also if you've got a doc who's willing to work with you, w/respect to these different meds? Or if you're striking out, somewhat, on your own?
>
I live in the US. I have a psych willing to prescribe overseas med.s (i.e. amisulpride). I have also struck out on my own at times.> Sounds like you're making some pretty good progress. It seems to me like serotonin gets a lot more focus than dopamine. However, it seems like the dopamine connection might be more relevent, or at least as relevent, in terms of looking at the fatigue aspects, and dysthymia... Especially if these meds give doc's alternatives to explore that possibility, w/o resorting to the dreaded stimulants (please excuse the sarcasm).
>
Amen, I agree with what you just said.
Posted by Cindy W on March 18, 2000, at 19:34:50
In reply to Re: medication poop-out/reply to KarenB, posted by Colleen on March 18, 2000, at 0:41:09
> I just pooped out on my drugs and I am crashing very hard. I'm taking 300 Effexor Xr, 400 Wellbutrin and 2mg Risperdal. My doctor is taking me off of the Effexor and wants to try me on serzone. I really understand everyone's frustrations. I've been battleing depression for 20 years now and have been on every kind of AD you can think of except for the MAO. It's nice to know that I'm not alone.
>
>
>
>
>
>
> > > Whoa -- a lightbulb just went off in my head when I read your message. I've been on SSRIs -- and they work great for about three months, then they stop working and we increase the dose and the blues dissolve again after two weeks. Then three months later the meds poop out again. (Repeat that process till I reach the max dosage of Zoloft, Celexa, whatever, then switch to a new SSRI.)
> > >
> > > Recently my dr. switched me to Effexor (Wellbutrin had no effect), and while I don't feel like crying 24/7, I do still feel apathetic, lazy and like Human Slug Girl.
> > >
> > > Have you (or anyone else?) had similar reactions? How do you know what the problem is? The seratonin stuff works for a while, but eventually gives out, so do you think there's another brain feel-good thingy that's out of whack?
> > >
> > > Thanks for your help :) This board is really great.
> > > lizzy
> >
> > I have never found a single antidepressant to be
> > adequate. Wellbutrin alone is activating for the
> > first week or so, as is Prozac, but any AD
> > activity it may have is insufficient. I have
> > taken Elavil and Wellbutrin; Prozac and Wellbutrin;
> > Celexa and Wellbutrin; Paxil and Wellbutrin;
> > Serzone and Wellbutrin; Remeron and Wellbutrin and
> > Ritalin; Remeron and Wellbutrin and Ritalin and
> > Adderall;and now Celexa and Wellbutrin and Ritalin
> > and Adderall. I have a personal scale from 0 to
> > 10. 0 is dead. 1/2 is very heavily contemplating
> > suicide, steering yourself in a surreal way
> > through the day. A full 1 is just dragging
> > yourself through the day. Normal for the
> > "nonpathological population" is 4,5,6; 7 is high
> > energy, productive, generally satisfying. Most
> > people at 7 would play their hand. 7 and 8 are
> > the levels of hypomania. Someone once said that
> > the goal, in terms of mood and productivity, is a
> > controlled hypomania. At 8 symptoms of mania may
> > start to appear. You're walking on the edge.
> > 9 is frank mania at its most controlled level.
> > The structure of your life is crumbling, you may
> > loose everything. At ten you are either under
> > control in a hospital or prison or swiftly heading
> > toward death.
> > Without any AD I am usually at a 1. A serotonin
> > active drug takes me to 2. Add Wellbutrin, I'm up
> > to a 3, the bottom of my 3,4,5 personal range. Top
> > that with Ritalin and/or Adderall, and I'm generally
> > content to play the hand at 4 or 5. EXCEPT for the
> > sexual effects of the serotonergic drug. Orgasm
> > becomes extremely difficult. So I switch to Remeron
> > and Wellbutrin, Ritalin and Adderall, and function
> > at a 4 or 5 for about 3 months, when I crash, start
> > taking Celexa, Wellbutrin, Ritalin and Adderall,
> > and SAM-e, and if I catch it early, in a few days
> > I'm on my way up.
> >
Sorry to hear you "pooped out" on Effexor. I'm taking Effexor now. How long were you taking Effexor? Tried Serzone in the past, and found it very helpful (just remember to hang in there if you have mood swings or whatever the first couple of weeks...this passes). Best wishes!
Posted by jd on March 18, 2000, at 20:34:48
In reply to Re: Educated Guess?/Poop Out, posted by michael on March 17, 2000, at 4:20:30
I hate to be a "cheerleader" for a particular med, but whenever the subject of poop-out comes up I want to at least mention naltrexone (Revia). There's been much talk about it on this site and it seems to have a good track record as an augmenting medication with people who lose the effectiveness of SSRIs after a few months!
--jd
Posted by ChrisK on March 19, 2000, at 6:35:49
In reply to Re: Poop-out naltrexone, posted by jd on March 18, 2000, at 20:34:48
I started taking Naltrexone for its intended purpose of reducing my alcohol cravings. It worked fine for that but it also had the added benefit of augmenting my AD's. I think it is definitely worth a try whenever poop-out is a problem.
This is the end of the thread.
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