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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on August 17, 2006, at 17:04:21
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by ed_uk on August 17, 2006, at 16:43:46
Hi Ed.
> I was wondering whether the side effects of fatigue and breathlessness are symptoms of metabolic acidosis. Metabolic acidosis is common with Topamax because it's a carbonic anhydrase inhibitor. Your doc might do a blood test.
Those damned carbonic anhydrase inhibitors will do it to you every time! Thanks. That hadn't occurred to me. Someone else on the board has reported having the same side effects on Topamax.
> >What adverse effects might you expect from this combination?
> Perhaps too much NE reuptake inhibition is bad for depression?> Perhaps this is the problem with reboxetine, and why too high a dose of nortriptyline might be ineffective.
These are good thoughts. I had considered this as a possibility for reboxetine, but not for nortriptyline.
I'm going to try lowering the dosage of Topamax to 50mg. I think it was at this dosage that I first noticed the subtle improvement in mental energy that I experienced, so I might as well go with the minimum effective dosage and see if the side effects subside. At least it will reduce my risk of developing kidney stones.
- Scott
Posted by Phillipa on August 17, 2006, at 20:46:37
In reply to Re: Sibutramine (Meridia) - Day 9 » ed_uk, posted by SLS on August 17, 2006, at 17:04:21
Scott I'm sorry about you life right now it doesn't help a med trial. you know where to reach me if ever you want to talk. Love Phillipa
Posted by jealibeanz on August 17, 2006, at 21:10:04
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by Phillipa on August 17, 2006, at 20:46:37
So this is an SNRI, like Cymbalta or Effexor, right? That explains possible antidepressants effetcs, but I don't understand how this is a weight loss drug. Cymbalta and Effexor are both known to induce large amounts of weight gain in certain populations susceptible to this side effect. Is it in a way like Wellbutrin, which was marketed as likely to help people shed a few? ha, but not me:)
Posted by SLS on August 18, 2006, at 4:26:12
In reply to Re: Sibutramine (Meridia) - Day 11, posted by SLS on August 17, 2006, at 1:41:08
7 days @ 10mg
5 days @ 20mg
No improvement in depression.
Today was less stressful. Sadness and anxiety were significantly less problematic, as I continue to process personal emotional issues.I am becoming less optimistic regarding the likelihood that I may respond favorably to sibutramine. I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
I reduced the dosage of Topamax from 100mg to 50mg in an attempt to reduce side effects. The minimal improvement in mental energy produced by Topamax first appeared at 50mg and was not made greater by increasing the dosage beyond this.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by mayzee on August 18, 2006, at 12:44:09
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 4:26:12
> I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
>
Hi Scott,Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)
Thanks,
mayzee
Posted by SLS on August 18, 2006, at 12:58:46
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 12:44:09
Hi Mayzee.
> > I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
> Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)No.
A monoamine is a type of neurotransmitter, and includes norepinephrine, dopamine, and serotonin.
A monoamine reuptake inhibitor is any drug that blocks the membrane transporter on the sending neuron from recycling the neurotransmitter once it has been released into the synapse. The transporter acts as a sort of vacuum cleaner to allow the sending neuron to clean up after itself. If it is blocked by a reuptake inhibitor, a greater amount of neurotransmitter gets trapped in the synapse, thus increasing the stimlation of the receiving neuron across the synaptic gap.
Drugs in this class include TCAs, SSRIs, SNRIs, and NARIs.
- Scott
Posted by mayzee on August 18, 2006, at 19:59:56
In reply to Re: Sibutramine (Meridia) - Day 12 » mayzee, posted by SLS on August 18, 2006, at 12:58:46
Scott, thanks for the explanation; I didn't know that all those neurotransmitters were monoamines! If you don't mind continuing... so what is the "monoamine oxidase" that's in MAOI (vs. the monoamine you just described to me)?
Hope it's not too annoying to be asked for explanations.
Gratefully,
mayzee
> Hi Mayzee.
>
> > > I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
>
> > Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)
>
> No.
>
> A monoamine is a type of neurotransmitter, and includes norepinephrine, dopamine, and serotonin.
>
> A monoamine reuptake inhibitor is any drug that blocks the membrane transporter on the sending neuron from recycling the neurotransmitter once it has been released into the synapse. The transporter acts as a sort of vacuum cleaner to allow the sending neuron to clean up after itself. If it is blocked by a reuptake inhibitor, a greater amount of neurotransmitter gets trapped in the synapse, thus increasing the stimlation of the receiving neuron across the synaptic gap.
>
> Drugs in this class include TCAs, SSRIs, SNRIs, and NARIs.
>
>
> - Scott
Posted by Phillipa on August 18, 2006, at 20:05:39
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 19:59:56
Scott yes please do. Love Phillipa
Posted by SLS on August 18, 2006, at 20:41:14
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 19:59:56
> Scott, thanks for the explanation; I didn't know that all those neurotransmitters were monoamines! If you don't mind continuing... so what is the "monoamine oxidase" that's in MAOI (vs. the monoamine you just described to me)?
At some point, the neuron must control the amount of the monoamine neurotransmitter it stores and prevent too much from collecting. It therefore uses an enzyme to metabolize and break-down the excess. This enzyme is known as monoamine oxidase. If this enzyme is inhibited by the MAOI drug and prevented from performing its task, the levels of the neurotransmitter are permitted to rise. It is thought that this increase in the availability of monoamine neurotransmitters is important in the mechanism of action of MAOI antidepressants.
There are two forms of the MAO enzyme. There is MAO-A and MAO-B. MAO-A is responsible for metabolizing norepinephrine and serotonin while MAO-B is responsible for metabolizing dopamine. Some MAOI drugs are selective for one type over the other. Emsam (selegiline) is selective for MAO-B at lower dosages, but becomes non-selective at higher dosages. Moclobemide is selective for MAO-A. Some researchers believe that MAO-A is more important for treating depression. A MAOI can be either reversible or irreversible. Most of the MAOIs in current use are irreversible. Once they attach themselves to the MAO enzyme, the enzyme is permanently destroyed. The body must synthesize a new enzyme to replace it. This is why one must wait 2 weeks after discontinuing an irreversible MAOI before beginning another antidepressant. Moclobemide is different. It is reversible. It does not damage the enzyme while it is attached. When the drug concentration decreases, the drug detaches from the enzyme and allows it to function again. Also, other molecules competing for the MAO enzyme can bump into the drug and knock it off. This allows users of moclobemide to eat modest amounts of tyramine without provoking a hypertensive reaction.
- Scott
Posted by mayzee on August 18, 2006, at 21:17:50
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 20:41:14
Scott, thank you again for the explanations. I think I get it!!! I guess most of the stuff I'd read assumed a base knowledge, so didn't explain basics like that.
Now back to your Sibutramine diary!
Wishing you all the best,
mayzee
Posted by Phillipa on August 18, 2006, at 22:00:40
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 20:41:14
Like low dose EMSAM. Moclom whatever is the same? Love Phillipa Scott why not teach online?
Posted by SLS on August 19, 2006, at 6:35:20
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 4:26:12
7 days @ 10mg
6 days @ 20mgNo improvement in depression.
It is getting close to the time when I sometimes experience an antidepressant response to medication.
It is difficult to evaluate sibutramine for anticholinergic side effects since I am also taking nortriptyline. However, the drug is not suppose to have any. My guess is that it does increase heart rate. There might be a tendency for an increase in anxiety, but that is difficult to segregate due to the personal issues I've had to deal with. There may be some reduction in libido, but it has not been abolished as often happens with SSRIs. There is no impairment in sexual function otherwise. Unlike SSRIs, there has not yet been the appearance of apathy and amotivation. Sibutramine seems to be a pretty clean drug.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by ed_uk on August 19, 2006, at 9:18:27
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 6:35:20
Hi Scott
Do you feel any less breathless on the lower dose of Topamax?
Ed
Posted by SLS on August 19, 2006, at 10:30:28
In reply to Re: Sibutramine (Meridia) - Day 13 » SLS, posted by ed_uk on August 19, 2006, at 9:18:27
> Hi Scott
>
> Do you feel any less breathless on the lower dose of Topamax?
I'm not sure yet. I haven't done anything to test myself. I know the risk of kidney stone formation is dosage dependent. What about metabolic acidosis?
- Scott
Posted by SLS on August 19, 2006, at 19:55:43
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 6:35:20
7 days @ 10mg
7 days @ 20mgNo improvement in depression.
Nothing remarkable to report. There has been some appetite suppression, but I have still been eating regularly. This drug makes it easier to exercise portion control.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg- Scott
Posted by ed_uk on August 20, 2006, at 8:13:10
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 10:30:28
Hi Scott
>What about metabolic acidosis?
Yes, I have read that it is dose-dependent.
Ed
Posted by ed_uk on August 20, 2006, at 8:14:36
In reply to Re: Sibutramine (Meridia) - Day 14, posted by SLS on August 19, 2006, at 19:55:43
Hi Scott
I'm sorry you haven't gained any relief yet. How long a trial do you plan to give sibutramine?
Ed
Posted by SLS on August 20, 2006, at 8:59:24
In reply to Re: Sibutramine (Meridia) - Day 14 » SLS, posted by ed_uk on August 20, 2006, at 8:14:36
Hi Ed.
Thanks for the info on the metabolic acidosis.
> I'm sorry you haven't gained any relief yet.I am trying to resign myself to the probability that sibutramine won't work, even though I haven't yet entered the time window for treatment response.
> How long a trial do you plan to give sibutramine?
I haven't given it enough thought. I don't think I will go beyond 6 weeks, though.
- Scott
Posted by SLS on August 21, 2006, at 6:18:34
In reply to Re: Sibutramine (Meridia) - Day 14, posted by SLS on August 19, 2006, at 19:55:43
7 days @ 10mg
8 days @ 20mgNo improvement in depression.
I can still feel a slight cognitive "muddiness". It is annoying.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg- Scott
Posted by Phillipa on August 21, 2006, at 19:26:42
In reply to Re: Sibutramine (Meridia) - Day 15, posted by SLS on August 21, 2006, at 6:18:34
Scott I'm sorry. I know you're suffering. Love Phillipa
Posted by SLS on August 22, 2006, at 6:25:50
In reply to Re: Sibutramine (Meridia) - Day 15, posted by SLS on August 21, 2006, at 6:18:34
7 days @ 10mg
9 days @ 20mgNo improvement in depression.
I increased the dosage of Topamax from 50mg to 100mg. I think I retain a bit more mental energy at the higher dosage.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg- Scott
Posted by Declan on August 22, 2006, at 15:00:51
In reply to Re: Sibutramine (Meridia) - Day 16, posted by SLS on August 22, 2006, at 6:25:50
Hi Scott
Sometime ago, I think you said, that your meds lift you 15% off baseline. So I wonder:
How do you know what your baseline is by now?
And secondly (if it is only 15%), is it worth the bother?
Your depression is not mainly about mood, but cognitive slowing?
When you say 'dysphoria', do you just mean you feel unwell?
I hope this is OK.
Declan
Posted by SLS on August 22, 2006, at 15:42:57
In reply to Re: Sibutramine (Meridia) - Day 16 » SLS, posted by Declan on August 22, 2006, at 15:00:51
> Hi Scott
Hi Declan.
> Sometime ago, I think you said, that your meds lift you 15% off baseline. So I wonder:
> How do you know what your baseline is by now?It is hard to forget not being able to lift a fork of food from the plate to your mouth because you freeze still for not having the energy to complete the motion.
> And secondly (if it is only 15%), is it worth the bother?
I would not be able to function well enough to live independently otherwise.
> Your depression is not mainly about mood, but cognitive slowing?
I use CBT 24/7 in an effort to reduce depressed mood and anxiety. I am left mainly with loss of interest and motivation, anergia, psychomotor retardation, anhedonia, low libido, incoordination and clumsiness, cognitive slowing, memory impairment, and difficulty concentrating.
> When you say 'dysphoria', do you just mean you feel unwell?
It is a sort of depressed mood with a grayness that you just don't want to be in the middle of.
> I hope this is OK.
No problem.
- Scott
Posted by SLS on August 22, 2006, at 17:04:34
In reply to Re: Sibutramine (Meridia) - Day 16, posted by SLS on August 22, 2006, at 6:25:50
7 days @ 10mg
10 days @ 20mgNo improvement in depression.
The depression has actually worsened. I believe that the sibutramine is contributing to this.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg- Scott
Posted by Phillipa on August 22, 2006, at 19:51:19
In reply to Re: Sibutramine (Meridia) - Day 17, posted by SLS on August 22, 2006, at 17:04:34
Oh Scott I'm so sorry. Two more weeks did you say? Love Phillipa
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Dr. Bob is Robert Hsiung, MD,
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