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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by SLS on October 11, 2001, at 10:15:06
Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
Any comments are appreciated.
Thanks.
- Scott
Posted by Elizabeth on October 11, 2001, at 11:43:20
In reply to Anybody tried clonidine (Catapres) for depression?, posted by SLS on October 11, 2001, at 10:15:06
> Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
It's worth a try, I think. I've heard of people using it for PTSD symptoms (nightmares in particular) and childhood ADHD (it seems to work well in combination with stimulants for this).
-elizabeth
Posted by JohnX on October 11, 2001, at 15:28:27
In reply to Anybody tried clonidine (Catapres) for depression?, posted by SLS on October 11, 2001, at 10:15:06
> Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
>
> Any comments are appreciated.
>
> Thanks.
>
>
> - ScottScott,
What makes you believe that the alpha-2 antagonism
is causing depression. The alpha-2 receptor causes
inhibition of norepinephrine release. Generally
blocking alpha-2 is an anti-depressant. At high
doses, buspar is a good alpha-2 antagonist and it
is believed by some people that this explains its
high dose anti-depressant activity more so that
its serotonin properties.If anything, I may guess the anti-histamine in
Remeron could make you feel tired and depressed.Clonodine is good for anxiety and impulsiveness
(add) and to help with benzo detox. But its actions
statistically would lean more towards depressing
than anti-depressing (unless its anti-anxiety effect
lifts psychological barriers). Clonodine will
inhibit firing of norepinephrine neurons in the
locus coerulus (LC - (spelled right?) area of the brain.
Generally this relieves anxiety. The alpha-2 antagonism increases
firing in the LCrea. People who
have been traumatized (PTSD) often have messed up
feed back mechanisms in the locus coerulus due
to repeated hyperstimulation. There are some
anti-depressants that reduce firing rates in the
LC , one is wellbutrin, wellbutrin releaves anxiety
for some (like me) but makes others jittery.
Another option would be Tenex (guanfacine), this
is a clean alpha-2 agonist with a longer half-life
than clonodine, but it doesnt block the post
synaptic alpha-1 receptor like clonodine.
Anyways, clonodine and tenex have been shown
to be effective adjuncts to anti-depressants in
people with ADD or PTSD.Hope this helps and is not too confusing.
Unfortunately,
I tend to confuse people with information
overload.-john
Posted by Rakken on October 11, 2001, at 15:58:26
In reply to Re: Anybody tried clonidine (Catapres) for depression? » SLS, posted by JohnX on October 11, 2001, at 15:28:27
I currently take Adderall, DextroStat (for ADD) and clonidine at night. I have been feeling more depressed lately. So I don't think clonidine would help for depression. Although it does have a calming effect which may help for anxiety and ADHD. I could be wrong though. Just my experience.
Posted by judy1 on October 11, 2001, at 18:41:24
In reply to Anybody tried clonidine (Catapres) for depression?, posted by SLS on October 11, 2001, at 10:15:06
Hi Scott!
Like Elizabeth and John mentioned, I found it helpful for my nocturnal PTSD symptoms and also during a pregnancy to get off of klonopin. None of which is relevant to your question. I suppose the key is is the depression underlying anxiety or vice-versa- if anxiety is causing depression then by all means give it a try, it has a really low side-effect profile. Take care, Judy
Posted by MB on October 11, 2001, at 20:12:22
In reply to Re: Anybody tried clonidine (Catapres) for depression? » SLS, posted by Elizabeth on October 11, 2001, at 11:43:20
Aren't there some dangerous side effects of mixing ritilin and clonidine? If so, does that go for the combo of clonidine with all stims or just with ritilin. do you know what I'm refering to, or am I comming out of the blue again (heh heh...)?
> It's worth a try, I think. I've heard of people using it for PTSD symptoms (nightmares in particular) and childhood ADHD (it seems to work well in combination with stimulants for this).
>
> -elizabeth
Posted by Rakken on October 11, 2001, at 21:09:12
In reply to Re: Anybody tried clonidine (Catapres) for depression? » Elizabeth, posted by MB on October 11, 2001, at 20:12:22
From what I understand... Since clonidine lowers blood pressure, if a dose is missed after regular use blood pressure can shoot up. The stimulant med would make the increase more intense. So there is a definite risk. Even without the stimulant med though, it still applies whenever clonidine is being used regularly.
Posted by petter on October 12, 2001, at 1:33:46
In reply to Anybody tried clonidine (Catapres) for depression?, posted by SLS on October 11, 2001, at 10:15:06
> Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
>
> Any comments are appreciated.
>
> Thanks.
>
Hi Scott...I´ve heard some anecdotial story of succesfull augment with Clonidine. I´m not quite sure, but I think the person had a lot of atypical features, in her depression.
I know Clonidine can alliviate some symptoms in social phobia.
By the way Scott: How is you´r Ziprasidone working?Sincerely
Petter.
>
> - Scott
Posted by SLS on October 12, 2001, at 1:48:21
In reply to Re: Anybody tried clonidine (Catapres) for depression? » SLS, posted by JohnX on October 11, 2001, at 15:28:27
> > Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
> >
> > Any comments are appreciated.
> What makes you believe that the alpha-2 antagonism is causing depression?It is simply an empirical observation.
Idazoxan produced a worsening of my depression for the entire 3 or 4 months I was taking it. This drug is an investigational NE alpha-2 antagonist, and is often used as a biological probe to quantitize the function of these receptors. I’ve tried Remeron twice. I tried it about 5 years ago and again this past week. My depression became markedly worse within 24 hours of taking the first dose of 15.0mg and 7.5mg. respectively. The first trial was initiated immediately following one of moclobemide, which had exacerbated my depression horribly. I was unwilling to put myself through something like that again, so I discontinued the Remeron after 2 days. This past week, I was unwilling to let it go beyond a day. It took a full 36 hours after a 7.5mg dose for my mood to return to baseline following the exacerbation.
> The alpha-2 receptor causes inhibition of norepinephrine release. Generally blocking alpha-2 is an anti-depressant.Generally, people don’t fail to respond to 40 or so antidepressants. One might entertain the idea that the properties of those drugs that are to be effective in my case will deviate substantially from – and might even be in opposition to – those that others find helpful.
> At high doses, buspar is a good alpha-2 antagonist and it is believed by some people that this explains its high dose anti-depressant activity more so that its serotonin properties.
> If anything, I may guess the anti-histamine in Remeron could make you feel tired and depressed.I am pretty sure that it is not the antihistaminergic properties of Remeron that is responsible for the worsening of my depression. This experience is quite a bit different from sedation, and nothing like the effect that Benadryl has on me. In addition, idazoxan is devoid of histaminergic receptor blockade. I felt neither sedated nor fatigued. I just felt oppressed.
> Another option would be Tenex (guanfacine), this is a clean alpha-2 agonist with a longer half-life than clonodine, but it doesnt block the post synaptic alpha-1 receptor like clonodine.
Thanks, Bob. I’ll keep guanfacine in mind.
> Anyways, clonodine and tenex have been shown to be effective adjuncts to anti-depressants in people with ADD or PTSD.
This is encouraging. When my doctors at the NIMH performed some psychometric and personality inventory examinations, they found that I tested unusually high in the “prisoner of war” category for someone suffering from bipolar disorder.
Regarding buspirone, I am guessing that its ability to act as a 5-HT1a partial agonist might be most important when used as an augmentor to antidepressants.
> Hope this helps and is not too confusing. Unfortunately, I tend to confuse people with information overload.
I do better taking small bites. Too many words on a page are overwhelming to me. Sometimes, I feel particularly piggish for placing on a page so many of my own. I might be acting under the false notion that most people find reading easier than I do.
Thanks again.
- Scott
There are probably studies that contradict this, but…
Psychoneuroendocrinology 2000 Oct;25(7):741-52Multihormonal responses to clonidine in patients with affective and psychotic symptoms.
Mokrani M, Duval F, Diep TS, Bailey PE, Macher JP.
Research Center for Applied Neuroscience in Psychiatry (FORENAP), Centre Hospitalier, 68250, Rouffach, France.
The neuroendocrine responses to the alpha(2)-adrenoreceptor agonist clonidine (CLO) (0.35 mg if body weight < 65 kg or 0.375 mg if body weight > or =65 kg, PO) were studied in a large group of subjects: 134 drug-free inpatients--with either DSM-IV schizophrenia (SCZ, n=31), schizoaffective disorder (SAD, n=16), or major depressive episode (MDE, n=87) - and 22 hospitalized controls (HCs). Comparison with a previous placebo test performed in a subgroup of 92 subjects (46 MDEs, 20 SCZs, 8 SADs, and 18 HCs) showed that CLO induced a significant increase of growth hormone, prolactin (PRL) and thyrotropin (TSH) levels but no significant change in adrenocorticotropin and cortisol release. According to diagnostic categories, we found significantly lower GH stimulation in MDEs and in SADs compared to HCs or to SCZs. In addition, we found significantly lower CLO induced PRL and TSH stimulations in paranoid SCZ patients compared to controls and disorganized SCZ patients. Taken together, these results suggest a hyposensitivity of noradrenergic alpha(2)-receptors in patients with affective symptoms.
PMID: 10938452 [PubMed - indexed for MEDLINE]
Posted by Elizabeth on October 12, 2001, at 10:37:04
In reply to Re: Anybody tried clonidine (Catapres) for depression? » Elizabeth, posted by MB on October 11, 2001, at 20:12:22
> Aren't there some dangerous side effects of mixing ritilin and clonidine?
I don't think there's been any research into this, and given how frequently the mix is given to children, I'd like to see such research. I suspect that there may be some risk, but no more than the risk of giving tricyclics to children.
-elizabeth
Posted by SLS on October 12, 2001, at 10:38:24
In reply to Re: Anybody tried clonidine (Catapres) for depression?, posted by petter on October 12, 2001, at 1:33:46
> > Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
> >
> > Any comments are appreciated.
> >
> > Thanks.
> >
>
>
> Hi Scott...
>
> I´ve heard some anecdotial story of succesfull augment with Clonidine. I´m not quite sure, but I think the person had a lot of atypical features, in her depression.
> I know Clonidine can alliviate some symptoms in social phobia.
>
> By the way Scott: How is you´r Ziprasidone working?
>
> Sincerely
>
> Petter.
Hi Petter.I am still taking ziprasidone (Geodon) 40mg. I am thinking about reducing it to 20mg. I can not fully evaluate its antidepressant effects on me because my sleep has been so disturbed. I developed insomnia about a week ago, which I attribute to the addition of Geodon. Because I have experienced sleep deprivation, it is difficult to assess how much of an improvement is due to the ziprasidone versus the temporary positive effects that sleep deprivation has on me.
I always have hope.
Is ziprasidone called Zeldox in your country?
- Scott
Posted by Elizabeth on October 12, 2001, at 10:43:21
In reply to Re: Anybody tried clonidine (Catapres) for depression?, posted by SLS on October 12, 2001, at 1:48:21
> Generally, people don’t fail to respond to 40 or so antidepressants. One might entertain the idea that the properties of those drugs that are to be effective in my case will deviate substantially from – and might even be in opposition to – those that others find helpful.
Well said. I agree. I think that it might be worthwhile for you to try clonidine or guanfacine.
> Regarding buspirone, I am guessing that its ability to act as a 5-HT1a partial agonist might be most important when used as an augmentor to antidepressants.
It has AD activity on its own when used at high doses (45-90 mg/day). There are also clinical trials of gepirone (a related drug) for depression presently being run in the US, FWIW. I've seen a couple of trials of it and they looked promising.
-elizabeth
Posted by petter on October 12, 2001, at 14:15:30
In reply to Re: Anybody tried clonidine (Catapres) for depression? » petter, posted by SLS on October 12, 2001, at 10:38:24
> > > Drugs like Remeron that block NE alpha-2 receptors seem to make my depression worse. I'm wondering if a drug like clonidine would help. It does the opposite of Remeron. It stimulates NE alpha-2 receptors.
> > >
> > > Any comments are appreciated.
> > >
> > > Thanks.
> > >
Hi Scott...Yes, Ziprasidone is called Zeldox here. You are greate in struggeling. I am also very impressed about your medical knowledge.
I´m sure this is not new for you: But have your depression enough atypical features, for responding to an MAOI + Litium?
What about to get more mileage from your present meds is add Bupropion or Amatadine or Pramipexol??
By the way, Scott: Witch part in U.S are you living in? if you don´t mind I´m asking. I guess you have better weather than we here in Sweden have for the present. I also have some SAD symptoms, it´s get worse, when the days gets shorter.
Sincerely
Petter
Posted by MB on October 14, 2001, at 15:00:07
In reply to clonidine and stimulants » MB, posted by Elizabeth on October 12, 2001, at 10:37:04
> > Aren't there some dangerous side effects of mixing ritilin and clonidine?
>
> I don't think there's been any research into this, and given how frequently the mix is given to children, I'd like to see such research.< snip >
Yeah, I hear ya. I think they should really know for sure what the risks are (within reason, of course; you can't be 100% exhaustive) before they try stuff on kids...so I'd like to see some research being done on this too. There probably just isn't any money to be made in setting up a big double-blind, controlled experiment on meds that are already approved (is there? I can't think of any).
Posted by Elizabeth on October 15, 2001, at 9:56:17
In reply to Re: clonidine and stimulants » Elizabeth, posted by MB on October 14, 2001, at 15:00:07
> Yeah, I hear ya. I think they should really know for sure what the risks are (within reason, of course; you can't be 100% exhaustive) before they try stuff on kids...so I'd like to see some research being done on this too.
I agree. There has been quite a bit of research showing that stimulants are safe for kids to use, but little into clonidine or the combination of stimulants and clonidine.
> There probably just isn't any money to be made in setting up a big double-blind, controlled experiment on meds that are already approved (is there? I can't think of any).
I suspect that the drug companies could cut some type of deal with the federal government whereby they would get the patent extended if they did research on the drug's use in kids. This doesn't work too well with drugs such as clonidine (and, I *think*, guanfacine (Tenex)) which are already off-patent. Perhaps some drug house will come up with a "me too" drug, test it in children (with incentives from the govt.), and market it as the only alpha-adrenergic autoreceptor agonist that's proven safe in kids (hopefully including some research on mixing it with stimulants, too).
One thing I can say for sure: the combination works like a charm, especially for kids with behavior problems related to ADHD, and clonidine alleviates some of the side effects of stimulants (such as appetite suppression and insomnia). I'm less convinced about clonidine by itself: I think a lot of doctors want to try it before stimulants because it's not a controlled substance, even though stimulants are proven to be effective and better tolerated, and their safety in children is well-documented too.
One example of a safety issue: if a kid misses a dose of Ritalin, at worst he'll get into some trouble at school and maybe be a hassle for his teacher. If he misses a dose of clonidine, he could have dangerous rebound hypertension.
-elizabeth
Posted by JillG on November 30, 2003, at 12:10:47
In reply to Re: Anybody tried clonidine (Catapres) for depression? » SLS, posted by JohnX on October 11, 2001, at 15:28:27
Are clonidine and guanfacine (Tenex) alternatives for each other or are they generally taken together?
This is the end of the thread.
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