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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by schleprock on August 13, 2012, at 16:20:54
I had very similar bad reactions to a trial of both drugs, and am looking for similarities between the two so that I may eliminate some other possible drugs for the treatment of depression\anxiety. I know both have some effect in increasing prolactin levels, but I'm looking for some more information, assuming it's not too technical. I'm trying to see if I can eliminate some other mood stabilizers and antipsychotics if they share similar mechanisms of action to the aforementioned. My agoraphobia is at an all time high at the moment, and I'm hoping I could just get my pdoc to call in a script so I can get thongs under control.
As I'm sure most of you know, my current meds are 150mg of Nortriptyline and 1.5mg of klonopin.
Posted by phidippus on August 13, 2012, at 22:37:22
In reply to Pharmokinetic similarites between Lithium\Risperal, posted by schleprock on August 13, 2012, at 16:20:54
Agoraphobia is best treated with psychotherapy. If you want more anxiolytic, why not increase your Clonazepam to double the dose?
Eric
Posted by Phillipa on August 13, 2012, at 23:26:10
In reply to Re: Pharmokinetic similarites between Lithium\Risperal » schleprock, posted by phidippus on August 13, 2012, at 22:37:22
Klonopin is strong to me. Phillipa
Posted by SLS on August 14, 2012, at 0:48:14
In reply to Pharmokinetic similarites between Lithium\Risperal, posted by schleprock on August 13, 2012, at 16:20:54
Hi.
Why did you try and how did you react to:
1. lithium
2. risperdoneDo you also have panic attacks?
You might have better luck by adding a drug that is more potent as a serotonin reuptake inhibitor for a more balanced action. Also, I have seen Nardil used in combination with a tricyclic as an experimental treatment of PD with AG. The report indicated positive results. I spent a great deal of time combining Nardil and nortryptyline. If you titrate the dosage of Nardil slowly enough, you might be able to avoid postural hypotension. Retaining the benzodiazepine in your treatment regime is important.
I agree with Eric that psychotherapies like CBT and exposure-therapy are very useful, if not critical, for treating agoraphobia. However, if panic attacks are present, an antidepressant is often employed. Imipramine had been considered the standard treatment for many years for panic disorder with agoraphobia. More recent work indicates that several SRIs work, too. You might be able to optimize your treatment by adding Zoloft to nortriptyline in order to maintain both NE and 5-HT mechanisms. With Zoloft, there would be no need to adjust the dosage of nortriptyline downward. I think sertraline has been well studied for treating PD with AG. It seems to really work. Keep clomipramine somewhere on your list.
> I had very similar bad reactions to a trial of both drugs, and am looking for similarities between the two so that I may eliminate some other possible drugs for the treatment of depression\anxiety.
Can you describe your adverse reactions to each drug?
I'll need to ponder this one. Each drug has multiple properties. Both drugs can attenuate dopaminergic activity, albeit through different mechanisms. That might not explain things, though.
For complex agoraphobia without panic attacks, antidepressants are probably less useful than benzodiazepines. I think a few of the antipsychotics could be useful. I haven't looked into it, though.
- Scott
Posted by schleprock on August 14, 2012, at 9:44:11
In reply to Re: Pharmokinetic similarites between Lithium\Risperal » schleprock, posted by SLS on August 14, 2012, at 0:48:14
If I were to attempt the Zoloft combo, what would the dosage be, approx. how long would it take to kick-in?
Posted by SLS on August 14, 2012, at 19:58:04
In reply to Re: Pharmokinetic similarites between Lithium\Risperal, posted by schleprock on August 14, 2012, at 9:44:11
> If I were to attempt the Zoloft combo, what would the dosage be, approx. how long would it take to kick-in?
Personally, I have found that I need full therapeutic doses of the drugs I combine. I don't believe that combining drugs always allows one to use reduced dosages. The maximum dosage of Zoloft is 200 mg/day. I would consider beginning at 50 mg/day and titrating quickly according to side effects and response. For depression, Zoloft can kick-in within three weeks once a therapeutic dosage is reached. The trouble is, this dosage will be different from person to person. For OCD, it can take 6 or more weeks at 200 mg/day for Zoloft to produce an improvement. Agoraphobia might not respond as quickly as depression does to antidepressant treatment. It might resemble OCD in this respect. I don't know.
I hope you keep posting. I would love to see you respond to this stuff.
- Scott
Posted by phidippus on August 14, 2012, at 21:02:00
In reply to Re: Pharmokinetic similarites between Lithium\Risperal » phidippus, posted by Phillipa on August 13, 2012, at 23:26:10
Isn't that the point?
Eric
Posted by Phillipa on August 14, 2012, at 21:33:55
In reply to Re: Pharmokinetic similarites between Lithium\Risperal » Phillipa, posted by phidippus on August 14, 2012, at 21:02:00
One time years ago it caused me to feel suicidal and I wasn't. Called pdoc said to stop return to xanax and was fine. Phillipa
This is the end of the thread.
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