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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 satsumas on July 17, 2008, at 12:59:06
Hi folks,
I'm considering trying Tianeptine. At this point, given what has failed, it's either that, or Nardil, or trying Pristiq (efx definitely works for me, but the side effects are not ideal and i'm pretty much over all S/NRIs since they all work well at first but then poop out).I'm in a bit of a crisis right now and getting mood back up ASAP is a big goal. No job, many personal losses over the past few months, and each day that goes by that i'm not well is another near waste of my talent and of my life!
So while i'm interested in trying tianeptine, if it will take too long to determine whether it's effective or not, i may just go the Nardil or Pristiq route. I know nardil takes at least a month to kick in, and efx has always worked fast so assume pristiq will work at least as fast, but then i'm stuck with an SNRI again.
Question for tianeptine users: how long did it take before tianeptine kicked in? When it did kick in, was your response obvious and effective, especially if you were deeply depressed before you started (sucidal ideation, laying in bed all day).
Thanks
Posted by Quintal on July 17, 2008, at 13:18:08
In reply to How long for an adequate tianeptine trial?, posted by satsumas on July 17, 2008, at 12:59:06
Tianeptine worked from the first day. If you look at Servier's website (http://www.servier.com/pro/Neurosciences/Stablon/Stablon.aspx?id=628) they have the statistics comparing tianeptine with fluoxetine, showing improvement in the first week. Last month I was severely depressed and tianeptine brought about a near complete remission within six days.
http://www.dr-bob.org/babble/20080617/msgs/835336.html [Posting as Horned One]Q
Posted by Sigismund on July 17, 2008, at 15:36:35
In reply to How long for an adequate tianeptine trial?, posted by satsumas on July 17, 2008, at 12:59:06
>Question for tianeptine users: how long did it take before tianeptine kicked in?
Half an hour....but it got better after a few days. I think you would know quickly enough whether it suited you or not. And it might not. It might aggravate your anxiety.
>When it did kick in, was your response obvious and effective,Yes, enough for people other than me to comment on how I seemed better.
>especially if you were deeply depressed before you started (sucidal ideation, laying in bed all day).It wasn't that bad for me, not that depressed, but I wasn't in a good state either.
Just give it 2 weeks. You will know by then. It didn't get better for me than it was after a few days.
Posted by satsumas on July 17, 2008, at 15:38:43
In reply to Re: How long for an adequate tianeptine trial? » satsumas, posted by Sigismund on July 17, 2008, at 15:36:35
I should follow-up. Did anyone try any dose escalation? Heard that tianeptine can be used at much higher dosages without much worry about toxicity, and that many people conclude it doesn't working without trying a higher dose.
Any experience?
Posted by Sigismund on July 17, 2008, at 15:40:28
In reply to Re: How long for an adequate tianeptine trial?, posted by satsumas on July 17, 2008, at 15:38:43
I took 2 tablets at a time now and again.
I took 4 a day for a bit.
That was it.
Posted by Quintal on July 17, 2008, at 16:12:25
In reply to Re: How long for an adequate tianeptine trial?, posted by satsumas on July 17, 2008, at 15:38:43
I've taken up to 62.5mg a day (5 tablets) on occasion, but more often 3-4 tablets depending on how I'm feeling. I've found I can tailor the dose to my mood as I need it. Some days I only take two tablets.
Q
Posted by Phillipa on July 17, 2008, at 17:14:40
In reply to Re: How long for an adequate tianeptine trial?, posted by Quintal on July 17, 2008, at 16:12:25
Q can it replace a benzo? Phillipa
Posted by Quintal on July 18, 2008, at 5:52:35
In reply to Re: How long for an adequate tianeptine trial? » Quintal, posted by Phillipa on July 17, 2008, at 17:14:40
Not directly in the way that something like Lyrica might. It could help you deal with anxiety better though.
Q
Posted by SLS on July 18, 2008, at 5:53:40
In reply to Re: How long for an adequate tianeptine trial?, posted by Quintal on July 17, 2008, at 16:12:25
> I've taken up to 62.5mg a day (5 tablets) on occasion, but more often 3-4 tablets depending on how I'm feeling. I've found I can tailor the dose to my mood as I need it. Some days I only take two tablets.
Don't fix what isn't broken, certainly.
The brain, as well as the rest of the body, relies on homeostasis. To habitually change the dosage of an antidepressant is to never allow the brain to equilibrate. To avoid fluctuations in your depression, I would recommend at least trying to remain on the minimum effective dosage of tianeptine that keeps you stable. That probably means to start at the 4 tablets a day and let it "sink in" for 3 weeks.
Pulsing antidepressant dosages often leads to treatment resistance.
- Scott
Posted by Quintal on July 18, 2008, at 9:28:15
In reply to Re: How long for an adequate tianeptine trial? » Quintal, posted by SLS on July 18, 2008, at 5:53:40
Thank you for your advice. My depression fluctates anyway, that's why I adjust the dose. If you ever try tianeptine you might find, like me, that it works in a different way to other antidepressants, and I don't just mean the mechanism. Tianeptine can be taken as required. I don't think SSRIs or any other conventional class of antidepressants can be used in this way. For me tianeptine belongs in the same 'class' as benzos, opiates and amphetamines in that I can usually guage how much I need to acheive the desired effect. I've never alterd the dose of any other antidepressant like this, bar Parnate, and there's reason for that.
As far as homeostatis is concerned, I think that might actually be a contributing factor in antidepressant 'poop-out', and thereby treatment resistance. The body eventually adapts to a steady, controlled dose of a foreign substance (possibly a toxin) over time. The fact that the brain can eventually reach equillibrium undermines the efficacy of sleeping tablets, painkillers, benzos and I believe antidepressants too. I sometimes think it's actually the switch between antidepressants, and the resulting disruption, that restores an antidepressant response (at least initially) in some people who have experienced antidepressant poop-out. Keeps the brain on its toes.
Q
Posted by SLS on July 18, 2008, at 11:56:11
In reply to Re: How long for an adequate tianeptine trial? » SLS, posted by Quintal on July 18, 2008, at 9:28:15
Hi Quintal.
Thanks for such a thoughtful response.
Tianeptine is one of the few major antidepressants that I have not tried. I know nothing of its personality.
> Thank you for your advice. My depression fluctates anyway, that's why I adjust the dose. If you ever try tianeptine you might find, like me, that it works in a different way to other antidepressants, and I don't just mean the mechanism. Tianeptine can be taken as required. I don't think SSRIs or any other conventional class of antidepressants can be used in this way. For me tianeptine belongs in the same 'class' as benzos, opiates and amphetamines in that I can usually guage how much I need to acheive the desired effect. I've never alterd the dose of any other antidepressant like this, bar Parnate, and there's reason for that.
Very interesting. That's a great analogy between drug classes.
> As far as homeostatis is concerned, I think that might actually be a contributing factor in antidepressant 'poop-out', and thereby treatment resistance.
I've heard this before, and I am still undecided. Your point is well taken, and it is an important issue. It's funny, but one of our posters, Noa, first presented this idea several years ago. I was struck by it, and it does make sense. Of course, making sense does not guarantee that the conclusion arrived at is accurate.
> The body eventually adapts to a steady, controlled dose of a foreign substance (possibly a toxin) over time. The fact that the brain can eventually reach equillibrium undermines the efficacy of sleeping tablets, painkillers, benzos and I believe antidepressants too.
There is no doubt that antidepressants extend the time before relapse. SSRIs seem to be the antidepressants most likely to poop-out. Yet, Nardil will poop out for some people, too. Perhaps there is a counterproductive drift in gene expression that is responsible for this. That is really what it comes down to.
Taking into consideration the putative mechanism of action of tianeptine being the reverse of SSRIs, I often wonder if "pushing" the system in either direction results in the same thing, namely, to force adjustments to be made in dynamics such that the resultant state represents a reset of gene expression. The resultant compensatory events produce a new phenotype that more approximates the ratios normally designed by the genotype. It is like the neurons saying, "Ok, we've been pushed out of our homeostatic zone [by an antidepressant]. Now, lets compensate to bring the system back into equilibrium. I guess we should use the original blueprints (genes) to arrive at the position we were originally designed to be at." Absolute numbers are different, but ratios are the same.
What do I know? This might be a very silly idea.
> I sometimes think it's actually the switch between antidepressants, and the resulting disruption, that restores an antidepressant response (at least initially) in some people who have experienced antidepressant poop-out. Keeps the brain on its toes.
This is sound reasoning, but doesn't explain the decades for which many people have been stabilized on an antidepressant, only to relapse upon an attempt to discontinue treatment. NIMH saw this with clorgyline, an MAOI antidepressant when the drug became no longer available, and patients relapsed within weeks to a few months after discontinuation. However, the fact that Nardil poop-out can be remediated by stopping the drug for three months and then restarting it is in agreement with your notion of keeping the brain on its toes. It is also in agreement with mine. The idea is to provoke the brain into compensating for a change in equilibrium, perhaps by using new set points of gene expression that are higher or lower, but that are at nominal ratios. This idea is really pretty complex in the details, but simple in concept.
What other ideas do you have regarding the neuroscience of affective disorders? Inquiring minds want to know.
:-)
- Scott
Posted by Phillipa on July 18, 2008, at 20:02:31
In reply to Re: How long for an adequate tianeptine trial? » Phillipa, posted by Quintal on July 18, 2008, at 5:52:35
Q got some lyrica here what is a starting dose sent to me by another. Thanks Phillipa
Posted by Sigismund on July 18, 2008, at 20:10:20
In reply to Re: How long for an adequate tianeptine trial? » Quintal, posted by SLS on July 18, 2008, at 11:56:11
My experience with tianeptine was very positive, but it changed over time to become less so.
People sometimes say that tianeptine makes them feel some kind of anxiety, and though I didn't feel that to begin with, it became a problem after a year.
This was not poopout, as I understand it, and was not even the opposite.
The good part was that (so long as I titrated) there was NO discontinuation syndrome.
I have wondered if this change in effect over time had, with me, anything to do with its neuroprotective (whatever they are?) qualities.
Posted by zeugma on July 21, 2008, at 8:23:32
In reply to Re: How long for an adequate tianeptine trial?, posted by Sigismund on July 18, 2008, at 20:10:20
>
> People sometimes say that tianeptine makes them feel some kind of anxiety, and though I didn't feel that to begin with, it became a problem after a year.
>
> This was not poopout, as I understand it, and was not even the opposite.
>
> The good part was that (so long as I titrated) there was NO discontinuation syndrome.
>
> I have wondered if this change in effect over time had, with me, anything to do with its neuroprotective (whatever they are?) qualities.This is a very interesting speculation. Since adrafinil/modafinil also has reputed 'neuroprotective' properties, and I recall you suffered from 'inner tension' on adrafinil, would you say the anxiety is similar in quality?
Posted by Sigismund on July 22, 2008, at 15:36:00
In reply to Re: How long for an adequate tianeptine trial? » Sigismund, posted by zeugma on July 21, 2008, at 8:23:32
>would you say the anxiety is similar in quality?
Not quite.
Both felt good at the start.
When they caused me to feel bad they felt a little different.
I recall Hydergine with Adrafinil was particularly bad......trouble with speaking.
I never liked Adrafinil as much as tianeptine.
Tianeptine actually made me feel nice for a bit (maybe a year), most unusual with psych drugs IME.
It's strange how it became more anxiety provoking, but it was excellent that there was no discontinuation syndrome.
Posted by zeugma on July 25, 2008, at 23:13:57
In reply to Re: How long for an adequate tianeptine trial? » zeugma, posted by Sigismund on July 22, 2008, at 15:36:00
Hi S,
"Trouble with speaking" on hydergine and adrafinil....Those are two drugs with complicated pharmacology. Modafinil does not give me trouble with speaking per se...It just slows down my already extremely slow rate of speech... It is also extremely, for want of a better word, "introverting." And I was already an INTP according the Meyers-Briggs classification system.
This is the end of the thread.
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