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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by JohnX2 on February 18, 2002, at 15:30:52
I may be starting Serzone again as it is
the only medicine besides Topamax that alleviates
really bad tension headaches and I am having
an impossible time tapering off this last 1 mg
of Klonopin.Funny, I found Topomax alleviated
my myofacial pain that Klonopin seemed to be
doing and swiftly weened Klonopin from 6 mg to
2 mg, but from 1 mg downward the headaches have
been unbearable.So I'm thinking of maybe restarting Serzone.
It totally eliminated these headaches before, and
I may be able to take it if only for a short while
to chip off this last mg of Klonopin. The major
issue is that Serzone caused in the past very
bad cognitive dysfunction and it was a bit scary
to operate my car.So my question is if people have tried augmenting
serzone with other meds to help with cognitive
side effects? Any other ADs or stims?Thanks for any feedback.
-John
Posted by jay on February 18, 2002, at 17:35:12
In reply to tools to offset Serzone cognitive issues?, posted by JohnX2 on February 18, 2002, at 15:30:52
>
> I may be starting Serzone again as it is
> the only medicine besides Topamax that alleviates
> really bad tension headaches and I am having
> an impossible time tapering off this last 1 mg
> of Klonopin.
>
> Funny, I found Topomax alleviated
> my myofacial pain that Klonopin seemed to be
> doing and swiftly weened Klonopin from 6 mg to
> 2 mg, but from 1 mg downward the headaches have
> been unbearable.
>
> So I'm thinking of maybe restarting Serzone.
> It totally eliminated these headaches before, and
> I may be able to take it if only for a short while
> to chip off this last mg of Klonopin. The major
> issue is that Serzone caused in the past very
> bad cognitive dysfunction and it was a bit scary
> to operate my car.
>
> So my question is if people have tried augmenting
> serzone with other meds to help with cognitive
> side effects? Any other ADs or stims?
>
> Thanks for any feedback.
>
> -JohnJohn,
Have you thought about going a 'low-dose' Serzone? That was the only way I could take it.
I also find the tricyclic (the brand name only, strange as it is) for Nortriptyline in the 25mg or so range helps with cognitive performance. I found the stims made me feel 'dumb' at times, mostly because they made me so anxious, I couldn't think straight.
Good luck,
Jay
Posted by Ritch on February 18, 2002, at 21:35:10
In reply to Re: tools to offset Serzone cognitive issues? » JohnX2, posted by jay on February 18, 2002, at 17:35:12
> >
> > I may be starting Serzone again as it is
> > the only medicine besides Topamax that alleviates
> > really bad tension headaches and I am having
> > an impossible time tapering off this last 1 mg
> > of Klonopin.
> >
> > Funny, I found Topomax alleviated
> > my myofacial pain that Klonopin seemed to be
> > doing and swiftly weened Klonopin from 6 mg to
> > 2 mg, but from 1 mg downward the headaches have
> > been unbearable.
> >
> > So I'm thinking of maybe restarting Serzone.
> > It totally eliminated these headaches before, and
> > I may be able to take it if only for a short while
> > to chip off this last mg of Klonopin. The major
> > issue is that Serzone caused in the past very
> > bad cognitive dysfunction and it was a bit scary
> > to operate my car.
> >
> > So my question is if people have tried augmenting
> > serzone with other meds to help with cognitive
> > side effects? Any other ADs or stims?
> >
> > Thanks for any feedback.
> >
> > -John
>
> John,
>
> Have you thought about going a 'low-dose' Serzone? That was the only way I could take it.
>
> I also find the tricyclic (the brand name only, strange as it is) for Nortriptyline in the 25mg or so range helps with cognitive performance. I found the stims made me feel 'dumb' at times, mostly because they made me so anxious, I couldn't think straight.
>
> Good luck,
>
> JayJohn, What do you think about just adding Nortripytline instead of Serzone? I didn't get any *confusion* with it, and it even helped focus better than Wellbutrin. And, since it is a TCA-you shouldn't get worsened neuropathic pain. Just a guess. If the NT dose is low-enough you might be "out of the threshold" enough not to worry about hypomania-but possibly "in there" for analgesia and improved focus.
Just another idea,
Mitch
Posted by Rick on February 18, 2002, at 22:34:33
In reply to Re: tools to offset Serzone cognitive issues? » JohnX2, posted by jay on February 18, 2002, at 17:35:12
This is my main problem with Serzone (plus Klonopin + Provigil), too, especially memory.
Jay - What do you consider a low dose?
John - How much are you taking?
Rick
Posted by Mr. Scott on February 18, 2002, at 23:09:28
In reply to Re: tools to offset Serzone cognitive issues?, posted by Ritch on February 18, 2002, at 21:35:10
How about trazodone + Nortryptaline? create your own serzonelike creation with two other meds.
By the way I've heard amitrptyline and Nortryptaline (it's metabolite) are the best TCA's for pain. I heard that this is because they affect membranes like tegretol, but I'm basically relaying theory here.
Scott
Posted by JohnX2 on February 19, 2002, at 2:22:09
In reply to Re: tools to offset Serzone cognitive issues? » JohnX2, posted by jay on February 18, 2002, at 17:35:12
Thanks for the suggestions.
I've really been curious about a TCA.
This is strange....
I get a PROFOUND anti-depressant/mood stablization
effect when I take a nice dose of the
anti-histamine chlorpheniramine maleate. I mean
it totally wipes out most of my problems.
I just don't understand and am starting to believe
that part of my problems may be allergies.Anyways, I looked into these anti-histamines and
found that they are strongly linked into NMDA
transmission. So the TCA's also have some anti-histamine
like properties which might make them a good candidate
for me.At 25 mg, what is Nortriptyline like? Do you sense
anti-histamine like side effects?Thanks for taking the trouble to give feedback.
-John> >
> > I may be starting Serzone again as it is
> > the only medicine besides Topamax that alleviates
> > really bad tension headaches and I am having
> > an impossible time tapering off this last 1 mg
> > of Klonopin.
> >
> > Funny, I found Topomax alleviated
> > my myofacial pain that Klonopin seemed to be
> > doing and swiftly weened Klonopin from 6 mg to
> > 2 mg, but from 1 mg downward the headaches have
> > been unbearable.
> >
> > So I'm thinking of maybe restarting Serzone.
> > It totally eliminated these headaches before, and
> > I may be able to take it if only for a short while
> > to chip off this last mg of Klonopin. The major
> > issue is that Serzone caused in the past very
> > bad cognitive dysfunction and it was a bit scary
> > to operate my car.
> >
> > So my question is if people have tried augmenting
> > serzone with other meds to help with cognitive
> > side effects? Any other ADs or stims?
> >
> > Thanks for any feedback.
> >
> > -John
>
> John,
>
> Have you thought about going a 'low-dose' Serzone? That was the only way I could take it.
>
> I also find the tricyclic (the brand name only, strange as it is) for Nortriptyline in the 25mg or so range helps with cognitive performance. I found the stims made me feel 'dumb' at times, mostly because they made me so anxious, I couldn't think straight.
>
> Good luck,
>
> Jay
Posted by JohnX2 on February 19, 2002, at 12:18:03
In reply to Re: tools to offset Serzone cognitive issues?, posted by Ritch on February 18, 2002, at 21:35:10
I'm confused about the nortriptyline idea?The pain I am experienced is not neuropathic
per se. i.e it is not tingling in my extremities.
Unless i don't understand the definition of
neuropathic pain. The pain I experience is a
REALLY bad pressure build up in my head. I'm
starting to think this may be histamine related
as strong anti-histamine doses aleviate it.
I've taken every anti-depressant beside tricyclics
and also every anti-convulsants. 4 things fix
this pain: Klonopin, Topamax, Serzone, and very
strong doses of anti-histamines. This problem
became severe the same year I started to develop
bad allergies in Austin, so I'm thinking my
explosion of mood issues may be related. Just
my latest thought. Also the chronic head pain can change
dramatically as I travel across the country.Its not totally obvious why Serzone works, it
just does. Are you guys suggesting a possible add-on of
Nortriptyline to Serzone to offset the cognitive
decline? I've thought about taking TCAs just to
see if their anti-histamine properties would help
fix my problem anyways.Thanks for any feedback.
-John
> > >
> > > I may be starting Serzone again as it is
> > > the only medicine besides Topamax that alleviates
> > > really bad tension headaches and I am having
> > > an impossible time tapering off this last 1 mg
> > > of Klonopin.
> > >
> > > Funny, I found Topomax alleviated
> > > my myofacial pain that Klonopin seemed to be
> > > doing and swiftly weened Klonopin from 6 mg to
> > > 2 mg, but from 1 mg downward the headaches have
> > > been unbearable.
> > >
> > > So I'm thinking of maybe restarting Serzone.
> > > It totally eliminated these headaches before, and
> > > I may be able to take it if only for a short while
> > > to chip off this last mg of Klonopin. The major
> > > issue is that Serzone caused in the past very
> > > bad cognitive dysfunction and it was a bit scary
> > > to operate my car.
> > >
> > > So my question is if people have tried augmenting
> > > serzone with other meds to help with cognitive
> > > side effects? Any other ADs or stims?
> > >
> > > Thanks for any feedback.
> > >
> > > -John
> >
> > John,
> >
> > Have you thought about going a 'low-dose' Serzone? That was the only way I could take it.
> >
> > I also find the tricyclic (the brand name only, strange as it is) for Nortriptyline in the 25mg or so range helps with cognitive performance. I found the stims made me feel 'dumb' at times, mostly because they made me so anxious, I couldn't think straight.
> >
> > Good luck,
> >
> > Jay
>
>
>
> John, What do you think about just adding Nortripytline instead of Serzone? I didn't get any *confusion* with it, and it even helped focus better than Wellbutrin. And, since it is a TCA-you shouldn't get worsened neuropathic pain. Just a guess. If the NT dose is low-enough you might be "out of the threshold" enough not to worry about hypomania-but possibly "in there" for analgesia and improved focus.
>
> Just another idea,
>
> Mitch
Posted by Ritch on February 19, 2002, at 13:01:29
In reply to Re: tools to offset Serzone cognitive issues? » Ritch, posted by JohnX2 on February 19, 2002, at 12:18:03
>
> I'm confused about the nortriptyline idea?
>
> The pain I am experienced is not neuropathic
> per se. i.e it is not tingling in my extremities.> Unless i don't understand the definition of
> neuropathic pain. The pain I experience is a
> REALLY bad pressure build up in my head. I'm
> starting to think this may be histamine related
> as strong anti-histamine doses aleviate it.
> I've taken every anti-depressant beside tricyclics
> and also every anti-convulsants. 4 things fix
> this pain: Klonopin, Topamax, Serzone, and very
> strong doses of anti-histamines. This problem
> became severe the same year I started to develop
> bad allergies in Austin, so I'm thinking my
> explosion of mood issues may be related. Just
> my latest thought. Also the chronic head pain can change
> dramatically as I travel across the country.
>
> Its not totally obvious why Serzone works, it
> just does. Are you guys suggesting a possible add-on of
> Nortriptyline to Serzone to offset the cognitive
> decline? I've thought about taking TCAs just to
> see if their anti-histamine properties would help
> fix my problem anyways.
>
> Thanks for any feedback.
>
> -JohnJohn, I just mentioned it because it did help my ADHD when I was taking it and Serzone caused really bad confusion. The "pain" thing was more of a side issue. I doubt if it could make it *worse*. SSRI's definitely increase pain for me, in my case arthralgia. Tricyclic antidepressants all have antihistaminic effects--more or less. Doxepin was even used as a topical cream for hives (I don't know if it is still marketed as such or not). You mentioned bad allergies. Have you had a comprehensive allergy sensitivity test? Maybe you could find something rather ordinary that is aggravating you and take an allergy shot once a month.
Mitch
Posted by JohnX2 on February 19, 2002, at 15:20:51
In reply to Re: tools to offset Serzone cognitive issues? » JohnX2, posted by Ritch on February 19, 2002, at 13:01:29
Thanks for the info.
I think I'll have an allergy workup and
discuss the options with my doctor.
I know that Histamine can really mess with
a particular type of NMDA receptor and
serotonin 5-ht2 antagonists (Serzone) also are linked
into these receptors. Gaba mediates histamine
release also, so these all may be intertwined.
Maybe there is a connection.
Just a thought.I read an interesting article a while back
postulating that for a lot of people the
antihistamine effect in TCAs were responsible
for enabling the antidepressant.Best regards,
John> >
> > I'm confused about the nortriptyline idea?
> >
> > The pain I am experienced is not neuropathic
> > per se. i.e it is not tingling in my extremities.
>
> > Unless i don't understand the definition of
> > neuropathic pain. The pain I experience is a
> > REALLY bad pressure build up in my head. I'm
> > starting to think this may be histamine related
> > as strong anti-histamine doses aleviate it.
> > I've taken every anti-depressant beside tricyclics
> > and also every anti-convulsants. 4 things fix
> > this pain: Klonopin, Topamax, Serzone, and very
> > strong doses of anti-histamines. This problem
> > became severe the same year I started to develop
> > bad allergies in Austin, so I'm thinking my
> > explosion of mood issues may be related. Just
> > my latest thought. Also the chronic head pain can change
> > dramatically as I travel across the country.
> >
> > Its not totally obvious why Serzone works, it
> > just does. Are you guys suggesting a possible add-on of
> > Nortriptyline to Serzone to offset the cognitive
> > decline? I've thought about taking TCAs just to
> > see if their anti-histamine properties would help
> > fix my problem anyways.
> >
> > Thanks for any feedback.
> >
> > -John
>
>
>
> John, I just mentioned it because it did help my ADHD when I was taking it and Serzone caused really bad confusion. The "pain" thing was more of a side issue. I doubt if it could make it *worse*. SSRI's definitely increase pain for me, in my case arthralgia. Tricyclic antidepressants all have antihistaminic effects--more or less. Doxepin was even used as a topical cream for hives (I don't know if it is still marketed as such or not). You mentioned bad allergies. Have you had a comprehensive allergy sensitivity test? Maybe you could find something rather ordinary that is aggravating you and take an allergy shot once a month.
>
> Mitch
Posted by JohnX2 on February 19, 2002, at 15:49:17
In reply to tools to offset Serzone cognitive issues?, posted by JohnX2 on February 18, 2002, at 15:30:52
hmm....I found a link between medicines that block
serotonin 5ht-2 receptors and histamine turnover.
(Of course I can always find a link for anything).
I don't know if this somehow explains why Serzone
is ridding me of these aweful headaches as well
as the anti-histmine chlorpheniramine maleate.
This link discusses olanzapine (Zyprexa), which
I am taking but have not found as effective as
Serzone was for these facial neuralgia symtoms.I found some interesting articles discussing how
anti-histamines can increase NMDA and hence dopamine
production in the limbic area of the brain. The
thing I find from taking this chlortrimeton is that
in massive doses it totally stabilizes my mood,
reenables stimulants to work, starts a nasal drip
(unclogs my sinuses), and totally cures in a
very interesting way this long standing feeling
of inner restlessness. But I have to take a whopper
of a dose (note the anti-histamine HAS NO decongestant).
So I think I should see an allergist.Pharmacol Exp Ther 1999 Feb;288(2):590-6 (ISSN: 0022-3565)
Morisset S; Sahm UG; Traiffort E; Tardivel-Lacombe J; Arrang JM; Schwartz JC
Unite de Neurobiologie et Pharmacologie Moleculaire (U.109) de Institut National de la Sante et de la
Recherche Medicale, Paris, France.
Clozapine and olanzapine behave as weak H3-receptor antagonists in vitro with Ki values around 1 and
50 microM, respectively. Despite these modest apparent affinities, both compounds given orally to mice,
nearly doubled steady-state tele-methylhistamine levels in brain, with ED50 values as low as 1 and 3
mg/kg, respectively, an effect comparable to those of potent H3-receptor antagonists. This effect
corresponded to an enhancement of histamine turnover rate from 45 to 73 ng/g/h as measured in the
case of olanzapine using the pargyline test. Other antipsychotics displaying, such as clozapine and
olanzapine, high 5-hydroxytryptamine (5-HT)2A receptor antagonist potency, i.e., risperidone,
thioridazine, seroquel, and iloperidone, also enhanced markedly tele-methylhistamine levels. This effect
was 1) additive with that of a pure H3-receptor antagonist, ciproxifan, 2) mimicked by a 5-HT2A receptor
antagonist, ketanserin, 3) reversed by a 5-HT2A receptor agonist, DOI, 4) not shared by antipsychotics
with low affinity for the 5-HT2A receptor, i.e., haloperidol, sulpiride, raclopride, or remoxipride that, on the
contrary, tended to reduce tele-methylhistamine levels. We conclude that in contrast to "typical"
antipsychotics, "atypical" antipsychotics stimulate histamine neuron activity via blockade of the 5-HT2A
receptor in vivo. This effect does not appear to account for their reduced extrapyramidal side-effects but
may underlie their pro-cognitive properties.>
> I may be starting Serzone again as it is
> the only medicine besides Topamax that alleviates
> really bad tension headaches and I am having
> an impossible time tapering off this last 1 mg
> of Klonopin.
>
> Funny, I found Topomax alleviated
> my myofacial pain that Klonopin seemed to be
> doing and swiftly weened Klonopin from 6 mg to
> 2 mg, but from 1 mg downward the headaches have
> been unbearable.
>
> So I'm thinking of maybe restarting Serzone.
> It totally eliminated these headaches before, and
> I may be able to take it if only for a short while
> to chip off this last mg of Klonopin. The major
> issue is that Serzone caused in the past very
> bad cognitive dysfunction and it was a bit scary
> to operate my car.
>
> So my question is if people have tried augmenting
> serzone with other meds to help with cognitive
> side effects? Any other ADs or stims?
>
> Thanks for any feedback.
>
> -John
Posted by JohnX2 on February 19, 2002, at 16:45:56
In reply to Re: tools to offset Serzone cognitive issues? » Ritch, posted by Mr. Scott on February 18, 2002, at 23:09:28
Thanks, Trileptal, a newer form of Tegetrol made
the pressure in my head worse. Bummer.This pressure thing in my head is weird, gets
responses the doctors don't understand, and
still confounds us.-John
> How about trazodone + Nortryptaline? create your own serzonelike creation with two other meds.
>
> By the way I've heard amitrptyline and Nortryptaline (it's metabolite) are the best TCA's for pain. I heard that this is because they affect membranes like tegretol, but I'm basically relaying theory here.
>
> Scott
Posted by JohnX2 on February 19, 2002, at 16:55:52
In reply to Re: tools to offset Serzone cognitive issues? » Ritch, posted by Mr. Scott on February 18, 2002, at 23:09:28
> How about trazodone + Nortryptaline? create your own serzonelike creation with two other meds.
>This is an interesting combination.
Trazodone is a more potent alpha-1 antagonist.
Are you going after the urinary retention?This doesn't sound like a bad combo if I can
keep the anti-muscarinic side effects from
killing me.A little more research into histamine-1 blockade
indicates that it faciliates the release of
serotonin. Does this imply that allergies can
diminish serotonin release? Anyways one of
Trazodones metabolites is something called mCPP.
This is a direct agonist of the serotonin receptor.
So basically all bets are off as to what the
presynaptic receptor is doing. Then the medicine
blocks the postsypantic 5ht-2 receptor. Maybe
all this gets around a foobar histamine system.
Interesting. If I could get Serzone or Trazodone
to work I would be home free.-John
> By the way I've heard amitrptyline and Nortryptaline (it's metabolite) are the best TCA's for pain. I heard that this is because they affect membranes like tegretol, but I'm basically relaying theory here.
>
> Scott
Posted by JohnX2 on February 19, 2002, at 17:08:20
In reply to tools to offset Serzone cognitive issues?, posted by JohnX2 on February 18, 2002, at 15:30:52
Ok, here is what I think may help:
- a medicine with anti-histamine h1 blocking
properties (Trazodone, Nortriptyline, Remeron??)
- a serotonin agonist Trazodone/Serzone (mCPP)
- 5ht-2 antagonist (documented good for tension
headaches)
- potentially something to offset dizziness from
Serzone or Trazodone (Nortiptyline?)
- something to make me less nauseus on Serzone
(Remeron could do this and I tolerate it).So what do we think? I still say there is an
allergic connection that I ought to investigate
and I see lots of evidence of tie ins between
histamine receptors/serotonin. Anyways I believe
Topamax, a Gaba med is helping part of my problem
but perhaps I could get a final AD nudge and rid
myself of this myofacial pain completely.How bad is Trazodone alone?
How had is low dose Nortriptyline alone?I generally tolerate anti-histamines really well
(not too drowsy).Serzone, an noradrenergic blocker (alpha-1
antagonist) made me really sedated and affected
my motor skills making it difficult for me to
operate my car. Plus there is some sort of FDA
warning to be concerned about. I also really hated
the start up nausea. Is a dash of Remeron ok to
deal with nausea? Maybe too much crap here.oooh, what to do. I need to get back to work soon
and i really need to end this saga.-John
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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