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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by ed_uk on June 29, 2005, at 10:32:50
OK, this is an interesting drug. Cyproheptadine is a potent sedating antihistamine which blocks 5-HT2 (2a and 2c) receptors. It's also said to act as a calcium channel blocker. Cyproheptadine has an anticholinergic effect.
So.......what could we use it for????
***Insomnia - could be a useful alternative to other sedating antihistamines. Like Seroquel and Remeron, it blocks 5-HT2 receptors - may enhance the quality of sleep. It's half life is said to be 6-9 hours.
***Antipsychotic induced akathisia - can be a useful treatment.......especially if it's not possible to reduce the dose or switch to a different drug.
***Could it be a useful treatment for anxiety? Perhaps......other 5-HT2 antagonists have been claimed to be anxiolytic.
***Might it be a useful treatment for depression? I do think it might be a useful adjunct to ADs in a few patients. I've read that 5-HT2 antagonism can sometimes add to the AD effect of conventional ADs.
On the other hand, there are case reports of cyproheptadine induced relapses in patients who have been successfully treated with ADs.
Cyproheptadine-induced depressive relapse.........
This is not the only case report! There are several others but they don't have abstracts.
***Cyproheptadine is sometimes an effective treatment for SSRI-induced anorgasmia.
There are numerous case reports - see PubMed.
***Schizophrenia - might improve cognition?
***Schizophrenia - might be a useful adjunct - does it improve negative symptoms?
Might not reduce symptoms - but can it treat EPS?
***Might cyproheptadine be a useful treatment for SSRI-induced apathy? Zyprexa, atypical AP, is claimed to be a useful treatment for SSRI apathy. One of the (many) pharmacological properties of Zyprexa is 5-HT2 antagonism. This property is shared by cyproheptadine. Stimulation of 5-HT2 receptors has been implicated in causing apathy - I don't know how much evidence there is to support this statement though.
***Which SSRI side effect might be relieved by cyproheptadine, a 5-HT2a/5-HT2c antagonist???
'Indeed, SSRIs act mainly by increasing the serotonin level in the synapse, thus leading to a non specific activation of all pre- and post-synaptic serotonin receptors. Among them, 5-HT2A/2C receptors have been involved in some of the unwanted effects of SSRI: agitation, anxiety, insomnia, sexual disorders, etc. The inhibition of these receptors could be thus beneficial for patients treated with SSRI.'
***Can cyproheptadine treat nightmares in PTSD??
***Might cyproheptadine reduce aggression?
http://www.dr-bob.org/tips/split/Cyproheptadine-for-aggress.html
***Might cyproheptadine reduce the serotonergic side effects of MAOI? .......myoclonus is an example.
http://www.dr-bob.org/tips/split/Cyproheptadine-for-myoclon.html
***What is the effect of cyproheptadine on cortisol - a stress hormone?
***Might cyproheptadine treat SSRI-induced sweating?
***Cyproheptadine has been used as a treatment for the serotonin syndrome.
***What else does cyproheptadine do???
1. It increases appetite and causes weight gain
2. It treats mild allergies - it's an antihistamine.
3. It reduces itching in people with skin disorders such as eczema and urticaria.
4. It's claimed to be an effective treatment for migraine - not much evidence AFAIK.
5. It's been used to treat the symptoms of carcinoid syndrome eg. diarrhea.
6. It's been used to treat benign essential blepharospasm.***Cyproheptadine and masturbating cats! See....
....................................................................................................................................
So what's GOOD about cyproheptadine?
1. It's CHEAP :-)
2. It's available without a prescription in some countries.
3. It has multiple uses.
4. RE sleep, it's probably safer than using an AP.
5. It's a very old drug - there's extensive experience with its use.
.......and what's BAD about cyproheptadine?
1. It's not been studied *in detail* for any psychiatric indication.
2. It's often very sedating. If you're anything like me it will probably knock you out. Sedating antihistamines always knock me out!
3. Regualar use of cypro is likely to make you quite fat! Prepare to padlock the fridge - you might start craving food.
4. As is the case with other antihistamines, unpleasant psychiatric side effects have occasionally been reported.
~Ed
PS. I think Linkadge took cypro. Tell us more Link? I think you said it helped you sleep while you were on an SSRI but then you started to feel more depressed.
Posted by ed_uk on June 29, 2005, at 11:18:58
In reply to Lets discuss cyproheptadine (Periactin)! Linkadge?, posted by ed_uk on June 29, 2005, at 10:32:50
Posted by Bobby on June 29, 2005, at 14:46:06
In reply to Lets discuss cyproheptadine (Periactin)! Linkadge?, posted by ed_uk on June 29, 2005, at 10:32:50
I use to take Periactin when working out to gain weight---it makes you as hungry as a horse.
Posted by jay on June 29, 2005, at 17:48:23
In reply to Jay, I think you've tried cyproheptadine too? (nm), posted by ed_uk on June 29, 2005, at 11:18:58
Ed...we can get the drug over-the-counter here in Canada. I have tried it, and wasn't impressed at all. I used it in many combos, by itself also...and maybe I've used meds so long that I am 'immune' to some, but this stuff seemed to do zilch. Serzone was the only 5ht2 antagonist that let me sleep good and gave back my sex drive while on Prozac. Zyprexa also helped with a bit of the sexual dysfunction, but had major side effects on my blood sugar levels, and just didn't feel 'right' on the stuff.
So, that is just this 'reporter's' story..but suggest others try it also.
Best,
Jay
Posted by linkadge on June 29, 2005, at 19:37:45
In reply to Re: Jay, I think you've tried cyproheptadine too? » ed_uk, posted by jay on June 29, 2005, at 17:48:23
I found that cyproheptadine was good for a few things.
It is a good antianxiety (esp for physical anxiety), that terrable feeling like your brain is attacking your body.
I have found that yes it can induce depression sometimes, but at other times it seems to be a very helpful antidepressant.
I think that SSRI's mainly work via HPA axis stimulation. The reason cypro may lead to depressive relaspe is probably due to its effects on sleep. It improves the quality of sleep, makes you sleep really deep. It enhances melatonin production. When I was on SSRI's, the only times I felt really goood was when they totally disrupted my sleep. No nighmares/thrashing in sleep = no response.
The 5-ht2c antagonism can lead to increased appetite, but also increase dopamine release in the NAA.
I think the immediate drop in cortisol can depress you, but it may act to regulate HPA axis more like TCA's in the long run.
It helped with migrane, and it helped with SSRI induced akathesia/apathy/hyperactivity.
Unfortunately it is too much antihistamine/anticholinrgic compared to antiserotonin, so you do get a lot that you don't want.
I find it usefull, and always keep some with me. I don't use it on a regular basis. It also helps with SSRI anorgazmia, but sometimes the effect is not immediate, and you need to take it for a few days to have returned sex drive.
I also found it does have antipsychotic qualities.
Its not a wonder med, but its good to take it a few times to see what it does for you.
Its funny, if you take it for a long time, and then suddenly discontinue, you almost get an LSD like effect.
I did something really weird. I took it alone for a week, then suddenly stoped it and then took celexa. I must have had a lot of rebound 5-ht2a/c stimulation which produced a lot of funky visual crap. I was scared to approach the railway lights because they looked like evil knights staring into my soul.
I would really like to find a potent/selective 5-ht2a antagonist.
Linkadge
Posted by ed_uk on June 29, 2005, at 21:31:22
In reply to Re: Jay, I think you've tried cyproheptadine too? » ed_uk, posted by jay on June 29, 2005, at 17:48:23
Jay,
It sounds rubbish! I won't be trying it, antihistamines make me feel dreadful!
Kind regards
~Ed
PS. Thank you for posting your experience :-)
Posted by ed_uk on June 29, 2005, at 21:42:21
In reply to Re: Jay, I think you've tried cyproheptadine too?, posted by linkadge on June 29, 2005, at 19:37:45
Hi Link!
Thank you for your detailed reply :-)
>I found that cyproheptadine was good for a few things.
In your experience, how does it compare with sedating antihistamines that are not 5-HT2 antagonists?
>It enhances melatonin production.......
Do you have any articles?
>When I was on SSRI's, the only times I felt really goood was when they totally disrupted my sleep.
You seem to respond well to sleep deprivation!
>Unfortunately it is too much antihistamine/anticholinrgic compared to antiserotonin, so you do get a lot that you don't want.
How sedating did you find it? Did you get a dry mouth?>I also found it does have antipsychotic qualities.
Can you give an example? I didn't realise you had any psychotic symptoms.
>Its funny, if you take it for a long time, and then suddenly discontinue, you almost get an LSD like effect.
What sort of visual effects did it produce when you stopped?
Kind regards
~Ed
Posted by Racer on June 30, 2005, at 0:02:56
In reply to Re: Jay, I think you've tried cyproheptadine too? » linkadge, posted by ed_uk on June 29, 2005, at 21:42:21
I've been on cyproheptidine, as has my cat and numerous horses I've known. It's used pretty extensively in veterinary medicine these days. Here are a few of my notes on it:
1. I've taken it for AD induced anorgasmia, and it's worked for me. Take a tablet, about two hours later I can roll around and scream with the best of them. And, about the time I'm done screaming, I'm ready to fall asleep -- which is a bit of a relief, since I'm often one of those who is up all night after sex, ready to run around the block a few times. The sleepiness doesn't hit at the same time as the orgasmatron, for which I am profoundly grateful.
If I take it regularly, though, for this reason, it will decrease the effectiveness of my AD. {shrug} I'm middle aged and married -- not like I have a sex life anyway...
2. My cat takes it for appetite enhancement and to help with itchiness. He's not in love with getting the pills -- I don't bother with the vet's prescription for him, just give him mine -- and I'm not in love with the way it knocks him out. It helps a lot with the itch, but doesn't actually help all that much with the appetite. (Appetite is only intermittently a problem with him. He's old, sick, and goes off his feed now and then.) When he's getting it regularly, he spends even more time sleeping, and doesn't seem to feel up to doing much. Now, again -- he's 17, so he isn't exactly a whirlwind of activity, but it still worries me a bit when he's so very lethargic.
3. It's used in horses for a variety of conditions, including Cushing's disease and a lot of anxiety related behavior problems. For Cushing's, it's the second choice drug, with pergolide the first. The problem with pergolide, though, is that it's expensive when you get to doses for 1200 pound patients, so cyproheptidine is the first choice for most of us. The studies of cyproheptidine in equine Cushing's are equivocal at best, but in combination with clinical experience among vets I know, cyproheptidine seems to improve the condition in slightly less than half the horses it's tried in. Pergolide is much more effective, in most horses, but cyproheptidine is effective enough in enough horses that it's worth trying first when cost is an issue.
The "big thing" a few years back with horses was something called "photic head-shaking" which is just what it sounds like: some horses shake their heads in response to bright light, very much like some people who sneeze when they walk out into the sun. Now, it's hard to know how much is behavior, and how much is physical, especially since there's that whole thing that happens when something that starts off as a physical reaction becomes a behavior, if that makes sense. You know, like if you don't get after a horse who's naughty because you think it's physical, he'll learn to do that naughty thing because he can get away with it. Anyway, cyproheptidine helps a lot of horses with the whole photic headshaking thing. For some of them, it probably is by its anti-histimine action. For those horses, if they were getting runny noses when they hit the light, drying that up will help a lot with the behavior. For others -- probably the majority that I saw with PHS, frankly -- I'd bet it's more the anxiolytic effects of the drug. Some horses -- more than most of us would like to admit -- get pretty neurotic under contemporary conditions. They learn all sorts of weird behaviors, from playing with their tongues, to stereotypic movements, to behavior that seems motivated by a need for reassurance. If you ask me, PHS is sometimes an allergy like problem, but more often a horse asking for reassurance that he can't get away with naughtiness. (Sounds weird, but makes sense with a lot of horses. Most horses need to know who's in charge -- it may seem as though they're trying to be in charge, but most would much rather someone else is in charge. They just want to know who it is.)
Anyway, my experience with cyproheptidine is overwhelmingly good. I keep some around, for a variety of reasons -- although not for horses right now -- and always recommend it for AD related sexual side effects.
Hope that helps.
Posted by linkadge on June 30, 2005, at 6:42:49
In reply to Re: Jay, I think you've tried cyproheptadine too? » linkadge, posted by ed_uk on June 29, 2005, at 21:42:21
>In your experience, how does it compare with sedating antihistamines that are not 5-HT2 antagonists?
I always took it at night. It always puts me to sleep, but not sure to what I owe that effect.
Do you have any articles?Do a google search on cyproheptadine + melatonin,
I read an anti-aging article on how cypro induced melatonin release. Most blockers of 5-ht2a will, like Remeron.How sedating did you find it? Did you get a dry mouth?
No dry mouth, not sure about sedation, I took it at night.
Can you give an example? I didn't realise you had any psychotic symptoms.No, not major psychosis. I have some borderline symptoms like fear of radio waves, and fear of going near working microwaves. Sometimes I think that something/someone is stealing my thoughts.
Not too out of controll. Nothing that the antidopaminergic effect of high dose vitamin C won't defunk. Periactin, like zyprexa has some efficacy in defunking some of these unexplained symptoms, that were many times severly exasparated by AD's.
What sort of visual effects did it produce when you stopped?Mainy things popping out at me. Loss of depth barriers, Ie something many meteres away could seem to be right in my face. Also stange loosening of association barriers. ie everything (trees, cars, phone, clock) would seem human.
Linkadge
Posted by ed_uk on June 30, 2005, at 10:45:26
In reply to More anecdotal experience (got looonnnggg) » ed_uk, posted by Racer on June 30, 2005, at 0:02:56
Hi Racer!
Thanks for your detailed and interesting reply :-)
Are you a vet?>Take a tablet, about two hours later I can roll around and scream with the best of them.
:-O What dose did you find most effective?
>The sleepiness doesn't hit at the same time as the orgasmatron, for which I am profoundly grateful.
Love the word orgasmatron!
>If I take it regularly, though, for this reason, it will decrease the effectiveness of my AD.
Does it increase your appetite?
>some people who sneeze when they walk out into the sun.......
That's me!
Kind regards
~Ed
PS. Now I know why you're called Racer :-)
Posted by Racer on June 30, 2005, at 12:54:38
In reply to Re: More anecdotal experience (got looonnnggg) » Racer, posted by ed_uk on June 30, 2005, at 10:45:26
> Hi Racer!
>
> Thanks for your detailed and interesting reply :-)You're very welcome. Thank you for your compliments.
> Are you a vet?
No, nor do I play one on TV... Just someone with a collection of animals. Oh, yeah, and worked with horses for a long time, mostly as a trainer/riding instructor. That means that, not only do I have a lot of experience with various horses with various health issues, I also get to gossip with other trainers and with the vets.
Vets, by the way, are a great way to learn a lot. Much better than doctors for humans. I guess it's because the human doctors figure they can say, "Take this medication as directed" and be done with it. Vets figure they have to help the owners be part of the treatment team, so they tend to explain the treatment plan much better. They tell the owner all sorts of things to look for, since the animal involved can't say, 'you know, my tummy hurts' or anything like that. They also explain what the medication will do, so that there's less chance of the owner "forgetting" about a drug that might be a pain to administer. (One of my horses will eat pills that you offer him by hand -- he's a little dim -- but most require that you grind it up, then dissolve in water, then mix with feed, and often you even have to add something sticky, like molasses. It really is a pain, and very few people use pill ballers these days.) Bottom line is, vets are a great source of information.
>
> >Take a tablet, about two hours later I can roll around and scream with the best of them.
>
> :-O What dose did you find most effective?I think I took the standard 4mg. Don't need it these days, with Cymbalta/Wellbutrin. The Cymbalta caused a bit of anorgasmia at first, but that wore off, even before the Wellbutrin.
>
> >If I take it regularly, though, for this reason, it will decrease the effectiveness of my AD.
>
> Does it increase your appetite?Not that I've noticed, but I take it as needed, and not that often.
>
> Kind regards
>
> ~Ed
>
> PS. Now I know why you're called Racer :-)Tell me? I called myself that because I never had money to buy a nice horse, usually rode off-the-track thoroughbreds -- the bargain basement of the horse world, but I like 'em!
Posted by ed_uk on June 30, 2005, at 16:29:51
In reply to Re: More anecdotal experience (got looonnnggg) » ed_uk, posted by Racer on June 30, 2005, at 12:54:38
Hi Racer,
>Vets, by the way, are a great way to learn a lot.
Maybe I should start seeing a vet!
~Ed
Posted by rod on June 30, 2005, at 17:23:00
In reply to Lets discuss cyproheptadine (Periactin)! Linkadge?, posted by ed_uk on June 29, 2005, at 10:32:50
Hi
I alredy posted it in a other thread.
But I will repeat the most important things Periactine does to me.
I dont take it on a regular basis. Just if I feel apathic and fatigued and have to accomplish a task which requires attention and energy, I take it. Within 30 mins or so it starts working. Mildly stimulating, anti fatigue, mind refeshing. Provides mental focus to do stuff. sharpens my mind a bit.
Also decreases numbness and has a pro libido effect.
But it is, for me, not really sedating (maybe a bit), not really anticholinergic (dumbing or dry mouth), nor does it increase appetite further. maybe Nortriptyline already ocupied my 2C receptor and Periacin does not add any noticeable blockade, because its alredy "knocked out". maybe.
Only bothering side effect is after repeated administration, I get sore corners of the mouth!? strange. I can remember that some nutritional deficits can couse this, but I am not aware of any "anti vitamin" action of Pericatin. I guess this has some other reasons.
just my 2 cents (or 3 =) )
bye
Roland
Posted by ed_uk on June 30, 2005, at 18:08:35
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by rod on June 30, 2005, at 17:23:00
Hi Roland,
>Mildly stimulating, anti fatigue, mind refeshing. Provides mental focus to do stuff. sharpens my mind a bit.
Do you get the same effect when you take other antihistamines? A few people do find them stimulating.
Thank you for your reply :-)
~Ed
Posted by rod on June 30, 2005, at 18:43:29
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka » rod, posted by ed_uk on June 30, 2005, at 18:08:35
> Hi Roland,
>
> >Mildly stimulating, anti fatigue, mind refeshing. Provides mental focus to do stuff. sharpens my mind a bit.
>
> Do you get the same effect when you take other antihistamines? A few people do find them stimulating.
>well. I havent tried many of them.
I once have taken a combination of Loratadin and Pseudoephedrin. Yes that ways stimulating, but I guess because of the Pseudoephedrin.
And Hydroxyzin (Atarax). But this was only mildly sedating. NO stimlation as far as I can remember.
And Diphenhydramine. But its more sedating than stimulating. Also has some positive effect on my conditioin. Sound weired, but I experience it as having a very mild stimulating effect, which gets overlapped with an sedative effect. its both, somehow. but sedation is stronger.
hmmm and many years ago I took one occasionaly (I guess it was also Loratadine)
But cant remember such a reaction. But I was around 14 when i took it, for mild hay fever.Yes, I know some people (especially younger ones? correct?) can have this kind of "paradox" reaction.
bye
Roland
Posted by ed_uk on June 30, 2005, at 20:31:53
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka » ed_uk, posted by rod on June 30, 2005, at 18:43:29
Hi Roland :-)
>Yes, I know some people (especially younger ones? correct?) can have this kind of "paradox" reaction.
Yes, mainly children :-) Thank you for sharing your experiences Roli :-P
Kind regards
~Ed
Posted by Declan on July 1, 2005, at 22:18:56
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka » rod, posted by ed_uk on June 30, 2005, at 20:31:53
OK, Linkadge finds that it's good for deepening sleep. Roland (I think) finds it stimulating. Anything that can deepen the quality of sleep is interesting. Anyone apart from Link find that it's good this way for sleep?
Declan
Posted by Brainbeard on September 25, 2009, at 14:52:41
In reply to Lets discuss cyproheptadine (Periactin)! Linkadge?, posted by ed_uk on June 29, 2005, at 10:32:50
I'm interested in cyproheptadine because of its 5HT2A/C-antagonism, which indirectly boosts dopamine and noradrenaline, as well as promoting deep stage sleep and having anxiolytic effects.
I've been looking on the internet for quite some time to find its binding profile. Eventually, I found this: http://docs.google.com/gview?a=v&q=cache:2UDBSpj0PeQJ:www.lycaeum.org/research/researchpdfs/3722.pdf+Young+binding+profile+of+cyproheptadine&hl=nl&gl=nl&sig=AFQjCNHDjW8WDAk-kS6JbhJpXCF747qf_A
According to this study, cyproheptadine's 5HT2-antagonism is in the same range as its antimuscarinic and antihistaminergic properties, which is roughly a receptor affinity of 5 Ki (the lower the Ki value, the higher the affinity). The Ki for 5HT2A receptors is about 20 times higher than the Ki for 5HT2C receptors (http://www.google.nl/search?hl=nl&safe=active&client=firefox-a&rlz=1R1GGIC_nl___NL345&q=Ki+cyproheptadine+5-HT2A+5-HT2C+receptors%22&btnG=Zoeken&meta=, see text of first search result.)
This would mean that cyproheptadine is a weaker antihistaminergic than amitriptyline, but a stronger 5HT2A-antagonist. Which makes it quite an interesting drug, in my opinion.
Posted by SLS on September 25, 2009, at 15:33:31
In reply to Re: Lets discuss cyproheptadine (Periactin)!, posted by Brainbeard on September 25, 2009, at 14:52:41
Baron Shopsin, MD at NYU recommended that I try Periactin in 1986. I never knew what to make of this suggestion, as it was the last thing he ever said to me. The guy was brilliant.
- Scott
Posted by zzzz7 on September 25, 2009, at 21:12:53
In reply to Lets discuss cyproheptadine (Periactin)! Linkadge?, posted by ed_uk on June 29, 2005, at 10:32:50
I found it interfered with cognition in the same way Namenda did, though not as badly as Lamictal.
Posted by jasmineneroli on September 25, 2009, at 21:21:12
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by zzzz7 on September 25, 2009, at 21:12:53
I would think it would increase appetite like crazy - much like Remeron, which I was on in 2003 and it made me want to eat 24/7!!
Posted by desolationrower on September 26, 2009, at 3:20:34
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by jasmineneroli on September 25, 2009, at 21:21:12
well its even used for anorexics. i'd suggest taking it, sex (optional), then sleep. the short t1/2 is alos why its good for at night. but taking it in the day is going to make weight gain likely
-d/r
Posted by West on October 1, 2009, at 14:59:20
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by desolationrower on September 26, 2009, at 3:20:34
My experiences have been two-sided.
It helped produce a qualitatively deeper sleep than hypnotics while on ssris. At the same time it stopped the ssri working, thus worsening depression.
You might expect that from a drug described as antiserotonergic. Like too much of what's available, It's a toss-up.
Posted by Brainbeard on October 1, 2009, at 16:37:01
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by West on October 1, 2009, at 14:59:20
> It helped produce a qualitatively deeper sleep than hypnotics while on ssris. At the same time it stopped the ssri working, thus worsening depression.
>
> You might expect that from a drug described as antiserotonergic.Not quite. SSRI's are indirectly anti-serotonergic in their own ways. Long-term SRI treatment downregulates 5HT2A/C-receptors, which comes close to 5HT2A/C-antagonism. I've never heard that strong antiserotonergic drugs like mirtazapine (Remeron) or ziprasidon (Geodon) or Risperdal (all strong 5HT2A-antagonists) negate the antidepressant effectiveness of SSRI's. In fact, many of the older tricyclic antidepressants have both pro-serotonergic (SRI) and antiserotonergic (5HT2A-antagonism) actions, and the mix seems to work quite well. Stephen Stahl argues that SRI + 5HT2A-antagonism is a good combination.
So there might be an other reason why cyproheptadine can counter the antidepressant effect of an SSRI. There have been made some suggestions higher up in this thread.
Posted by West on October 2, 2009, at 5:22:50
In reply to Re: Lets discuss cyproheptadine (Periactin)! Linka, posted by Brainbeard on October 1, 2009, at 16:37:01
> > It helped produce a qualitatively deeper sleep than hypnotics while on ssris. At the same time it stopped the ssri working, thus worsening depression.
> >
> > You might expect that from a drug described as antiserotonergic.
>
> Not quite. SSRI's are indirectly anti-serotonergic in their own ways. Long-term SRI treatment downregulates 5HT2A/C-receptors, which comes close to 5HT2A/C-antagonism. I've never heard that strong antiserotonergic drugs like mirtazapine (Remeron) or ziprasidon (Geodon) or Risperdal (all strong 5HT2A-antagonists) negate the antidepressant effectiveness of SSRI's. In fact, many of the older tricyclic antidepressants have both pro-serotonergic (SRI) and antiserotonergic (5HT2A-antagonism) actions, and the mix seems to work quite well. Stephen Stahl argues that SRI + 5HT2A-antagonism is a good combination.
>
> So there might be an other reason why cyproheptadine can counter the antidepressant effect of an SSRI. There have been made some suggestions higher up in this thread.
>
>'stopped the ssri working' is interchangable with return of depression, since the ssri treats it.
I'll go and read through the thread now!
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