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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by bulldog2 on April 26, 2010, at 9:15:28
So far I have had a decent response to clomipramine 50mg. However there are a couple areas that I would like to improve. Clom. does increase prolactin which means a decrease in dopamine which I do not like. Also I do not know how potent an antagonist it is at 5htc2. So what can I add to this med.
1. I was thinking of mirapex to bring down prolactin. I'm not sure about dostinex because of heart damage.
2. In the other thread nortriptyline gets high grades for 5htc2 antagonism. However I don't know about adding nortriptyline to clomipramine.
Any other thoughts? Ritalin or adderall to clomipramine etc?
Posted by SLS on April 26, 2010, at 12:10:14
In reply to Turbocharging Clomipramine- Any Suggestions?, posted by bulldog2 on April 26, 2010, at 9:15:28
Does decreased dopamine increase prolactin, or does increased prolactin decrease dopamine? I thought that it was the former.
Lithium at dosages between 300-600mg?
- Scott
Posted by bulldog2 on April 26, 2010, at 13:41:43
In reply to Re: Turbocharging Clomipramine- Any Suggestions?, posted by SLS on April 26, 2010, at 12:10:14
> Does decreased dopamine increase prolactin, or does increased prolactin decrease dopamine? I thought that it was the former.
>
> Lithium at dosages between 300-600mg?
>
>
> - Scott
>Is this a therapeutic dose? Why do you recommend lithium?
Thanks
Bulldog2
Posted by SLS on April 26, 2010, at 15:35:05
In reply to Re: Turbocharging Clomipramine- Any Suggestions?, posted by bulldog2 on April 26, 2010, at 13:41:43
> > Lithium at dosages between 300-600mg?
> Is this a therapeutic dose?
As an adjunct to standard antidepressants, low dosages of lithium can work miracles. Evidence for this has been collected for over three decades. The early investigations were performed using tricyclics. However, investigations with SSRIs have yielded encouraging results as well.
> Why do you recommend lithium?
Mostly because you are taking a serotonergic tricylic. Among other things, lithium is thought to exert pro-serotonergic effects that are perhaps synergistic with reuptake inhibition. I believe it acts as a 5-HT1b autoreceptor antagonist. Perhaps lithium acts as a serotonin release enhancer - I really don't know.
- Scott
----------------------------------
Psychiatry Res. 2002 Aug 30;111(2-3):117-24.
Interaction of lithium with 5-HT(1B) receptors in depressed unipolar patients treated with clomipramine and lithium versus clomipramine and placebo: preliminary results.Januel D, Massot O, Poirier MF, Olié JP, Fillion G.
Unité de Pharmacologie Neuro-Immuno-Endocrinienne, Institut Pasteur, Paris, France. djanuel@freesurf.fr
AbstractLithium is commonly used in combination with antidepressant drugs as a treatment for refractory depression; less often, it is used in non-resistant depression. The aim of this study was to examine the interaction of lithium with 5-HT(1B) receptors in 10 non-resistant unipolar depressed patients treated with clomipramine+lithium (C+L) vs. clomipramine+placebo (C+P). A mediation of the serotonergic system has been proposed in the literature to explain the clinical effect of lithium. Indeed, in a previous study of healthy human blood platelets, we demonstrated the interaction of lithium with adenylate cyclase activity coupled to 5-HT(1B) receptors. The functional activity of these receptors was measured by studying the inhibitory effect of L694,247, a 5-HT(1B) receptor agonist, on the adenylate cyclase activity determined by the production of cAMP. Using the same technique in the present study, we found that lithium significantly reduced the inhibition of adenylate cyclase activity induced by 5-HT(1B) receptor activation. This result confirms the specific interaction of lithium with 5-HT(1B) receptors. Moreover, a correlation between the percentage of 5-HT(1B) receptor-dependent adenylate cyclase inhibition and the clinical benefit of lithium was established, suggesting 5-HT(1B) receptors may be a target for the therapeutic effect of lithium.
Posted by Brainbeard on May 24, 2010, at 11:44:40
In reply to Turbocharging Clomipramine- Any Suggestions?, posted by bulldog2 on April 26, 2010, at 9:15:28
Nortriptyline is not much of a 5HT2C-antagonist as far as I know - but how much do I really know? It is a moderate 5HT2A-antagonist. Its mother drug, amitriptyline, is a 5HT2C-inverse agonist, which comes down to being a 5HT2C-antagonist if I've understood correctly.
I've never been quite attracted to Mirapex because of the reports of compulsive gambling and hypersexuality, as well as the nasty side-effect of sleep attacks in the middle of activity (riding a bike or driving a car).
For reducing prolactin, you could also try piribedil=Trivastal, Serviers subtle and possibly fun D2-agonist. Or lisuride, LSD's non-hallucinogenic cousin - a drug currently being debated on this forum which may have anxiolytic and antidepressant properties in its own right..
Ritalin, Adderall: watch your blood pressure.
Personally I would add at least a bit of an SSRI to counter constipation, but you may not suffer from that side-effect at all.
This is the end of the thread.
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