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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by delna on November 17, 2012, at 1:26:52
Hi Scott and anyone reading this message who can please help:
I really need your in depth knowledge to solve something. But only if you feel up to it.
I'll first ask my question before bombarding you with details.
I am looking to find out
"What do sulpiride (at low dose of 50mg) and Geodon share in common which is rare and not shared by many drugs including stimulants. Or perhaps they jut act in a different area of the brain than other drugs. Where could that be?The background:
I don't know if you recall me and my obsession with Geodon. It is the only drug that had a sustained effect and made me 100% normal. Functional- with a job, a life and the will to live. Its the activating property of Geodon that was a miracle for me. And at 60mg, it also stabilized me. Then it worsened a preexisting nerve hypersensitivity and in spite of high dose of gabapentin 3600mg the pain kept breaking through. Eventually the pain got out of hand and I was forced to give it up. I tried everything for the pain, including nerve blocks but nothing worked.
I tried other things but nothing helped. Parnate also failed. So I tried to mimic Geodon by replicating the known positive binding sites. I remember getting lots of advise here on trying ways to mimic the receptor binding but that failed.To mimic Geodon, various drugs were tried;
-The activating property of Geodon is apparently due to activity at 5HT-2C. Prozac is the only other drug with such strong binding at this site. (stahl).
I tried Prozac with no activation and no improvement of depression
-The other unique receptor in Geodon is 5HT-1A
Buspar shares this binding. I took 30mg of Buspar, for ages with no benefit
Geodon also has strong activity at NA receptors. This seemed to account for the energizing property of Geodon according to books. But I don't think this was the case for me. Because all the NA and DA enhancers are not a patch on the activation I had on Geodon. By that I mean that stimulants just prop me up like a rag doll, held up by strings. I'm still brain dead where as with Geodon and initially with Sulpiride, a light switched on in my brain. Both helped depression and drive. My brain was awakened and I felt like living.As of now I am taking the sulphide which has more or less pooped out and am managed of several drugs that potently effect NA and/or DA receptors: To stay wake, (just about) this is what I take daily. (But none lift depression or wake my brain up and make me feel like living):
Ritalin 40mg,
Dexedrine 20mg,
Provigil 400mg,
Effexor 150mg, (seemed useless so reduced to 37.5 just to prevent OCD from coming back)
Bupropion 450mg,
Reboxetine 8mg (NARI)
Raising these doses really does not help. Its like I'm attacking the wrong pathway. I have also wondered if I am absorbing these drugs at all! There was a time when 2.5mg Ritalin make me manic (in a bad way) and I would be destabilized long after I stopped.Then my usual drugs
Effexor (for OCD)
Lamictal 200mg
Klonopin 2mg (for nerve pain)I was so low before the addition of Sulpiride I attempted suicide but managed to screw that up. Just before giving me ECT, Sulpiride 50mg was added to the combination above and what a dramatic effect it had! I felt fine a lot like Geodon- I had energy, I was not blah and my brain woke up. And the depression lifted.
Unfortunately 2 weeks in, my mood went haywire. I discovered that my prolactin had shot up. Sulpirides efficacy is negatively affected by high prolactin, which in itself ruins mood and energy. It took ages to bring prolactin down (I am on 20mg bromocriptine for that) but Sulpiride has not regained its initial effects, ever. It seems to have pooped out, which is common I believe. It still has a minimal but significant effect and is one of the most activating drugs in my regime. Id be willing to remove a stimulant but not the Sulpiride .Without it, the stimulants are incapable of doing much to help me stay awake and able to do minimal things. I tried replacing it with ability (due to the awful weight gain) but that was a failure.
While Geodon has binding at 5ht-7, low dose Sulpiride doesnt. But I have not tried 5ht-7 enhancement
I am convinced there is something involving DA disinhibition in a certain part of the brain where stimulants dont act.Or maybe I just need to try Latuda....
I am going to try the minocycline but I really have a feeling this is more to do with my drugs not being the most effective.
Please excuse my inaccurate scientific words. I'm not 'all there'
Posted by SLS on November 17, 2012, at 6:43:07
In reply to Zipra/Sulpr link? Scott? ALERT:mention of *S* word, posted by delna on November 17, 2012, at 1:26:52
Abilify and Latuda are good choices according to the most current literature. If you feel that you need an energy boost, I would first establish Abilify, Lamictal, and Wellbutrin, and then consider adding minocycline afterwards.
Sulpiride might poop out because dopamine D2 presynaptic receptors eventually upregulate and reduce the synthesis and release of dopamine, thus reversing the initial increase in DA release.
Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade. If Abilify doesn't work, then Latuda makes a good second choice.
-------------------------------------
Effexor: 300 mg/day (Perhaps substitute Cymbalta for pain symptoms)
Wellbutrin: 300-450 mg/day
Lamictal: 200 mg/day
Abilify: 2.0-10.0 mg/day
Ritalin: 40 mg/day (Focalin might be better)
Klonopin: 2.0 mg/day
gabapentin: 900 mg/day
-------------------------------------
- Scott
Posted by SLS on November 17, 2012, at 7:01:54
In reply to Zipra/Sulpr link? Scott? ALERT:mention of *S* word, posted by delna on November 17, 2012, at 1:26:52
With minocycline, I respond better to 200 mg/day than to 100 mg/day. You must take 100 mg twice a day.
I forgot to mention that gabapentin will help with pain as well as anxiety. Also, because of its antiglutamate activity, it can make the Lamictal and minocycline work better.
Another substance that demonstrates efficacy in treating both unipolar and bipolar depression is N-acetylcysteine (NAC). It, too, can help with reducing the overactivety of glutamate neurons. NAC might not work immediately. It often takes a few months to produce significant results.
- Scott
Posted by Delna on November 17, 2012, at 8:08:39
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word » delna, posted by SLS on November 17, 2012, at 6:43:07
> Abilify and Latuda are good choices according to the most current literature. If you feel that you need an energy boost, I would first establish Abilify, Lamictal, and Wellbutrin, and then consider adding minocycline afterwards.
>
> Sulpiride might poop out because dopamine D2 presynaptic receptors eventually upregulate and reduce the synthesis and release of dopamine, thus reversing the initial increase in DA release.
> Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade.If Abilify doesn't work, then Latuda makes a good second choice.
>
> -------------------------------------
>
> Effexor: 300 mg/day (Perhaps substitute Cymbalta for pain symptoms)
>
> Wellbutrin: 300-450 mg/day
>
> Lamictal: 200 mg/day
>
> Abilify: 2.0-10.0 mg/day
>
> Ritalin: 40 mg/day (Focalin might be better)
>
> Klonopin: 2.0 mg/day
>
> gabapentin: 900 mg/day
>
> -------------------------------------
>
>
> - Scott
Hi Scott,
thanks a lot for your reply!You said:
"Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade. "Did you mean lurasidone and ziprasidone have action at 5HT7? Or Lurasidone & Sulpiride?
I have not seen anything that talks about sulpiride and 5ht7 so if you've read that somewhere, that maybe the answer ! Because I am sure that Ziprasidone has action at 5HT7 and if sulpiride does as well, thats what links them!! Can you please tell me where you read about sulpiride and 5HT7?Then latuda would be worth a shot. It may really work!
I tried Abilify. It was really uselss.
My doctor wants me to take 400mg minocycline, then add mementine. That also acts on glutamate. Gabapentin is way too sedating. I could only tolerate it whilst on Geodon, when nothing could r oversedate me.
Thanks again,
Your input is so helpful!
D
Posted by Phillipa on November 17, 2012, at 8:54:03
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word » SLS, posted by Delna on November 17, 2012, at 8:08:39
Also would lyrica & the cymbalta help with nerve pain? Also did you check the archieves for the old thread where the discussion occurred. Didn't you also go to NYC to see a doc? Memory is coming back slowly. Phillipa
Posted by delna on November 17, 2012, at 10:17:14
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word, posted by Phillipa on November 17, 2012, at 8:54:03
> Also would lyrica & the cymbalta help with nerve pain? Also did you check the archieves for the old thread where the discussion occurred. Didn't you also go to NYC to see a doc? Memory is coming back slowly. Phillipa
Hi Phillipa,
Neither helped the pain. Gabapentin did but I had to keep escalating the dose. Finally was at 3600mg. I saw many doctors in NY but no one can help with the pain that gets worse on Geodon. So Geodon is not an option.
D
Posted by SLS on November 17, 2012, at 11:27:37
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word » SLS, posted by Delna on November 17, 2012, at 8:08:39
Hi Delna.
http://www.ncbi.nlm.nih.gov/pubmed/19337725
:-)
- Scott
--------------------------------------------
> > Abilify and Latuda are good choices according to the most current literature. If you feel that you need an energy boost, I would first establish Abilify, Lamictal, and Wellbutrin, and then consider adding minocycline afterwards.
> >
> > Sulpiride might poop out because dopamine D2 presynaptic receptors eventually upregulate and reduce the synthesis and release of dopamine, thus reversing the initial increase in DA release.
> > Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade.
>
> If Abilify doesn't work, then Latuda makes a good second choice.
> >
> > -------------------------------------
> >
> > Effexor: 300 mg/day (Perhaps substitute Cymbalta for pain symptoms)
> >
> > Wellbutrin: 300-450 mg/day
> >
> > Lamictal: 200 mg/day
> >
> > Abilify: 2.0-10.0 mg/day
> >
> > Ritalin: 40 mg/day (Focalin might be better)
> >
> > Klonopin: 2.0 mg/day
> >
> > gabapentin: 900 mg/day
> >
> > -------------------------------------
> >
> >
> > - Scott
>
>
> Hi Scott,
> thanks a lot for your reply!
>
> You said:
> "Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade. "
>
> Did you mean lurasidone and ziprasidone have action at 5HT7? Or Lurasidone & Sulpiride?
> I have not seen anything that talks about sulpiride and 5ht7 so if you've read that somewhere, that maybe the answer ! Because I am sure that Ziprasidone has action at 5HT7 and if sulpiride does as well, thats what links them!! Can you please tell me where you read about sulpiride and 5HT7?
>
> Then latuda would be worth a shot. It may really work!
>
> I tried Abilify. It was really uselss.
>
> My doctor wants me to take 400mg minocycline, then add mementine. That also acts on glutamate. Gabapentin is way too sedating. I could only tolerate it whilst on Geodon, when nothing could r oversedate me.
>
> Thanks again,
> Your input is so helpful!
> D
>
Posted by Delna on November 17, 2012, at 11:43:23
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word » Delna, posted by SLS on November 17, 2012, at 11:27:37
> Hi Delna.
>
> http://www.ncbi.nlm.nih.gov/pubmed/19337725
>
> :-)
>
>
> - Scott
>
>
> --------------------------------------------
>
>
> > > Abilify and Latuda are good choices according to the most current literature. If you feel that you need an energy boost, I would first establish Abilify, Lamictal, and Wellbutrin, and then consider adding minocycline afterwards.
> > >
> > > Sulpiride might poop out because dopamine D2 presynaptic receptors eventually upregulate and reduce the synthesis and release of dopamine, thus reversing the initial increase in DA release.
> > > Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade.
> >
> > If Abilify doesn't work, then Latuda makes a good second choice.
> > >
> > > -------------------------------------
> > >
> > > Effexor: 300 mg/day (Perhaps substitute Cymbalta for pain symptoms)
> > >
> > > Wellbutrin: 300-450 mg/day
> > >
> > > Lamictal: 200 mg/day
> > >
> > > Abilify: 2.0-10.0 mg/day
> > >
> > > Ritalin: 40 mg/day (Focalin might be better)
> > >
> > > Klonopin: 2.0 mg/day
> > >
> > > gabapentin: 900 mg/day
> > >
> > > -------------------------------------
> > >
> > >
> > > - Scott
> >
> >
> > Hi Scott,
> > thanks a lot for your reply!
> >
> > You said:
> > "Yes, Latuda and Sulpiride both exhibit 5-HT7 receptor blockade. "
> >
> > Did you mean lurasidone and ziprasidone have action at 5HT7? Or Lurasidone & Sulpiride?
> > I have not seen anything that talks about sulpiride and 5ht7 so if you've read that somewhere, that maybe the answer ! Because I am sure that Ziprasidone has action at 5HT7 and if sulpiride does as well, thats what links them!! Can you please tell me where you read about sulpiride and 5HT7?
> >
> > Then latuda would be worth a shot. It may really work!
> >
> > I tried Abilify. It was really uselss.
> >
> > My doctor wants me to take 400mg minocycline, then add mementine. That also acts on glutamate. Gabapentin is way too sedating. I could only tolerate it whilst on Geodon, when nothing could r oversedate me.
> >
> > Thanks again,
> > Your input is so helpful!
> > D
> >
>
>Hi Scott,
Thanks for the link. I can only see an abstract about amisulpiride but not sulpride.
Posted by SLS on November 17, 2012, at 14:54:26
In reply to Re: Zipra/Sulpr link? Scott? ALERT:mention of *S* word » SLS, posted by Delna on November 17, 2012, at 11:43:23
> Thanks for the link. I can only see an abstract about amisulpiride but not sulpride.
I apologize. I can't find anything regarding sulpiride and 5-HT7 receptors on Medline/Pubmed. I checked the PDSP database, and amisulpride is much more potent at the 5-HT7 receptor than is sulpiride. I was probably confusing D4 receptor blockade.
- Scott
This is the end of the thread.
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