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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Alan on May 8, 2000, at 23:01:19
My pdoc wants to try me on small dosages of Seroquel for my depression/anxiety. This would be to replace the SSRI's Tricyclics and Mood stabilizers that have unacceptable side effects (sexual,early awakening, etc.) Wants to start at 25mg and work up from there. Am curious if any of the other antipsychotics are being used successfully this way...
Thanks
Alan
***************************************
Posted by AndrewB on May 9, 2000, at 6:58:15
In reply to SEROQUEL off label usage anyone?, posted by Alan on May 8, 2000, at 23:01:19
> My pdoc wants to try me on small dosages of Seroquel for my depression/anxiety. This would be to replace the SSRI's Tricyclics and Mood stabilizers that have unacceptable side effects (sexual,early awakening, etc.) Wants to start at 25mg and work up from there. Am curious if any of the other antipsychotics are being used successfully this way...
>
> Thanks
> Alan
> ***************************************Alan,
Low doses of antipsychotics can be used for anxiety, depression and even fatigue. Cam mentioned that he was aware of low doses of antipsychotics being used as a bridge to help with anxiety and depression until the patient’s antidepressant kicked in. At very low doses an antipsychotic does not act with the pharmacology of an antipsychotic. I’m not sure that such low doses are going to be used in your situation or whether that is what Cam was describing, but let me explain what happens when antipsychotics are used at very low doses.
Antipsychotics at normal doses block the D2 dopamine receptors and are thus able to minimize the positive symptoms of schizophrenia (i.e. hallucinations). However at very low doses the antipsychotics actually do the opposite, they create greater stimulation of these D2 receptors. Some antipsychotics act on the D3 receptors in the same dose dependent manner. The D2 and D3 receptors are involved in mood, anxiety and fatigue. Sulpiride and amisulpride are two examples of such antipsychotics. At normal doses they are used for schizophrenia but at low doses they are very commonly used for depression, dysthymia, anxiety (especially social anxiety) and, less commonly, for fatigue conditions, like Chronic Fatigue Syndrome. Neither of these antipsychotics is marketed in the US though. That may be a shame because, possibly, the antipsychotics available in the US are not as effective in these low dosage applications. I did see one reference in the Tips section to the successful use of very low doses of the antipsychotics Stelazine and Risperdone (sp?) for fatigue conditions where prior trials with stimulants had failed.
I am looking forward to hearing more from you on how the Seroquel works on treating your condition as you learn more.
Best wishes,
AndrewB
Posted by Alan on May 9, 2000, at 7:37:29
In reply to Re: SEROQUEL off label usage anyone?, posted by AndrewB on May 9, 2000, at 6:58:15
> > My pdoc wants to try me on small dosages of Seroquel for my depression/anxiety. This would be to replace the SSRI's Tricyclics and Mood stabilizers that have unacceptable side effects (sexual,early awakening, etc.) Wants to start at 25mg and work up from there. Am curious if any of the other antipsychotics are being used successfully this way...
> >
> > Thanks
> > Alan
> > ***************************************
>
> Alan,
>
> Low doses of antipsychotics can be used for anxiety, depression and even fatigue. Cam mentioned that he was aware of low doses of antipsychotics being used as a bridge to help with anxiety and depression until the patient’s antidepressant kicked in. At very low doses an antipsychotic does not act with the pharmacology of an antipsychotic. I’m not sure that such low doses are going to be used in your situation or whether that is what Cam was describing, but let me explain what happens when antipsychotics are used at very low doses.
>
> Antipsychotics at normal doses block the D2 dopamine receptors and are thus able to minimize the positive symptoms of schizophrenia (i.e. hallucinations). However at very low doses the antipsychotics actually do the opposite, they create greater stimulation of these D2 receptors. Some antipsychotics act on the D3 receptors in the same dose dependent manner. The D2 and D3 receptors are involved in mood, anxiety and fatigue. Sulpiride and amisulpride are two examples of such antipsychotics. At normal doses they are used for schizophrenia but at low doses they are very commonly used for depression, dysthymia, anxiety (especially social anxiety) and, less commonly, for fatigue conditions, like Chronic Fatigue Syndrome. Neither of these antipsychotics is marketed in the US though. That may be a shame because, possibly, the antipsychotics available in the US are not as effective in these low dosage applications. I did see one reference in the Tips section to the successful use of very low doses of the antipsychotics Stelazine and Risperdone (sp?) for fatigue conditions where prior trials with stimulants had failed.
>
> I am looking forward to hearing more from you on how the Seroquel works on treating your condition as you learn more.
>
> Best wishes,
>
> AndrewB
************************************
Thanks so much Andrew. I think I understand the mechanics now. I'll talk to my pdoc about the other AP's that you mentioned. Sulpiride and Amisulpiride sound interesting but I wonder why the FDA hasn't approved them....already enough AP's to satisfy the market and therefore not high priority? Or are there problems with them that you know of?
Also Stelazine has definitely been mentioned to me (and I to my pdoc) before. He's had experience enough with it to fear TD and the trembling that goes along with it. That's why he wants to play it safe and try the Seroquel first. Do you know of or have first hand experience with the effectiveness of Sulpiride and Amisulpiride for me to push him in order to get it to try?
Any help would be greatly appreciated...
Thanks.
Alan
*****************************************
Posted by AndrewB on May 9, 2000, at 9:11:52
In reply to Re: SEROQUEL off label usage anyone?, posted by Alan on May 9, 2000, at 7:37:29
Alan,
If you email me at andrewb@seanet.com I will send you an information piece on amisulpride for doctors and their patients. I don't know why amisulpride hasn't been submitted for approval in the United States.
Posted by KarenB on May 9, 2000, at 11:31:34
In reply to Re: SEROQUEL off label usage anyone?, posted by AndrewB on May 9, 2000, at 9:11:52
Alan,
I lived in the Philippines and used Sulpiride along with a psychostimulant type antidepressant, Amineptine, (a modified tricyclic) with great results. I have never responded well to SSRIs. My general symptoms are apathetic type depression with chronic fatigue symptoms. Plus some irritability, temper and manic type symptomology and behavior thrown in, but not in any recognizable cycle.
I have since been diagnosed as ADD, innattentive type with HYPOactivity - this sounds more right to me than anything ever has. I am currently on Adderall (an ADD stimulant) and Buspar (wimpy anti anxiety med). I am almost ready to ditch the Buspar and try an AP along with the Adderall because the Sulpiride did work so well for me. But, I will hang in there and give the Buspar a full trial. There are no side effects - I'm just not sure it is doing anything.
I think - and Andrew or one of those guys can correct me if I'm wrong - that Mirapex is supposed to be the closest thing to Sulpiride, chemically, on our shores. I may be giving this a try soon.
Sulpiride was excellent for social phobia, fatigue, and I believe, the prevention of migraines. I RARELY had a headache when on this med with the amineptine.
Good luck. Hope this info helps.
Karen
Posted by Anna P. on May 9, 2000, at 18:05:56
In reply to Re: SEROQUEL? Sulpiride experience..., posted by KarenB on May 9, 2000, at 11:31:34
> Alan,
>
> I lived in the Philippines and used Sulpiride along with a psychostimulant type antidepressant, Amineptine, (a modified tricyclic) with great results. I have never responded well to SSRIs. My general symptoms are apathetic type depression with chronic fatigue symptoms. Plus some irritability, temper and manic type symptomology and behavior thrown in, but not in any recognizable cycle.
>
> I have since been diagnosed as ADD, innattentive type with HYPOactivity - this sounds more right to me than anything ever has. I am currently on Adderall (an ADD stimulant) and Buspar (wimpy anti anxiety med). I am almost ready to ditch the Buspar and try an AP along with the Adderall because the Sulpiride did work so well for me. But, I will hang in there and give the Buspar a full trial. There are no side effects - I'm just not sure it is doing anything.
>
> I think - and Andrew or one of those guys can correct me if I'm wrong - that Mirapex is supposed to be the closest thing to Sulpiride, chemically, on our shores. I may be giving this a try soon.
>
> Sulpiride was excellent for social phobia, fatigue, and I believe, the prevention of migraines. I RARELY had a headache when on this med with the amineptine.
>
> Good luck. Hope this info helps.
>
> KarenKaren, what were your dosages of amineptine and sulpride?
Posted by Janet on May 9, 2000, at 18:36:37
In reply to Re:KAREN B., posted by Anna P. on May 9, 2000, at 18:05:56
I have been on Seroquel for a year and a half. I was put on it while in the hospital for being obsessive/compulsive suicidal. It helps me with the hallucinations I think. I'm on a low dose of 100 mg daily.
Posted by KarenB on May 9, 2000, at 23:06:49
In reply to Re:KAREN B., posted by Anna P. on May 9, 2000, at 18:05:56
Hello Anna,
Did you stop the Tianeptine yet? That one did nothing for me - how did it do for you?
Amineptine was 100mg before getting out of bed in the morning, then 100mg after lunch. Sometimes the second dose was not necessary if my energy level and mood were good.
The Sulpiride was brand name Dogmatil and I don't remember the mg but I took one capsule, 2x a day, along with the Amineptine. The only side effects were minor weight gain that could be kept under control with moderate exercise and complete cessation of menses. I understand this does not happen often but I considered it a great blessing. No more Dogmatil and the monthly cramps are back right on schedule. Yuck.
Karen
Posted by Anna P. on May 10, 2000, at 12:37:28
In reply to Re:Anna - sulpiride dosage, posted by KarenB on May 9, 2000, at 23:06:49
> Hello Anna,
>
> Did you stop the Tianeptine yet?Hello Karen,
I heaven't stop the Tianeptine yet, as I had no choice. My pdoc tried to add the
Topamax to it, because I lost the response, but that didn't work.
I have SAD cycle, and May and June are typically good months for me. So, right now my Tianeptine started to work partially only, and some of my energy returned. It lifted my mind and spirit, but my body feels heavy, and my fatigue didn't leave me.
Things I want to try:
- amineptine plus amisulpride
- tianeptine and amineptine? (I'm a little concerned about combining these two, as both of them are tricyclics)Karen, what do you think?
Posted by KarenB on May 10, 2000, at 13:18:43
In reply to Re:Karen B., posted by Anna P. on May 10, 2000, at 12:37:28
Anna,
Amineptine and Tianeptine are two very, very different drugs in the way my body responds. Tianeptine did absolutely nothing for my energy level - I was tired and lethargic. Amineptine, when used with Sulpiride, was energizing and mood brightening. I had the energy AND the desire to do something about it. The Sulpiride took away those feelings of heaviness and was a great complement to the Amineptine.
The only problem is, Amineptine has been discontinued worldwide. You can still order it from www.cyber-chemist.com in India but no one can tell us how long their supply will be available.
So... I would suggest to you: Adrafinil plus Amisulpride, the combo that JohnL is so happy with. He has symptoms similar to ours and has gotten simply great results.
You have been saying the Tianeptine is not really working for quite a while now. Maybe it's time to make that change...
Good luck:)
Karen
Posted by Anna P. on May 10, 2000, at 20:08:50
In reply to Re:Anna - amineptine, etc., posted by KarenB on May 10, 2000, at 13:18:43
> Thank you, Karen. Can anyone tell me the cheapest site to order
Adrafinil?
I'm also concerned about the Amineptine availability for the long term.
The reason I use Tianeptine for so long is its cardiac safety.
I got the heart and cheast pain after taking Moclobemide, Dexedrine and Cytomel combo.Anna P.
Posted by AndrewB on May 10, 2000, at 22:40:54
In reply to Re:Adrafinil order, posted by Anna P. on May 10, 2000, at 20:08:50
Anna,
Any Polish pharmacies do mail order? I'm looking for a med. out of Russia.
By the way, I think Michael would know the cheapest source of Adrafinil. Note that Modafinil has much the same action as Adrafinil but less side effects. For example, no potential liver toxicity and less sexual side effects.
Posted by SLS on May 11, 2000, at 10:26:51
In reply to Re: SEROQUEL? Sulpiride experience..., posted by KarenB on May 9, 2000, at 11:31:34
Hi Karen.
> I think - and Andrew or one of those guys can correct me if I'm wrong - that Mirapex is supposed to be the closest thing to Sulpiride, chemically, on our shores. I may be giving this a try soon.
Mirapex can certainly produce the same end-results as sulpiride.
Mirapex (pramipexole) is a drug that helps to excite dopaminergic neurons by attaching itself directly to the postsynaptic receptors and stimulating them, thus causing this neuron to fire and send the message on to the next neuron. Mirapex is considered to be an agonist of the receptor. Sulpiride and amisulpride excite dopaminergic neurons in a different way. These drugs, too, bind directly to dopamine receptors. However, they do not stimulate them. While they remain attached to the receptor, they prevent dopamine from stimulating it. Sulpiride and amisulpride are considered to be antagonists of the receptor. The neuron is prevented from “seeing” dopamine. When the presynaptic neuron is convinced that there is not enough dopamine floating around in the synaptic cleft (the gap between the presynaptic and postsynaptic neuron), it makes more and releases more. The increase in the amount of dopamine in the synaptic cleft results in the attachment of dopamine to more postsynaptic receptors, stimulating the nerve to fire more often.Of course, both sulpiride and amisulpride block those dopamine receptors located on the postsynaptic neuron as well. This tends to prevent it from firing. For this reason, these two drugs, considered neuroleptics, are used as antipsychotics. However, sulpiride and amisulpride, unlike the other antipsychotics, bind much, much more strongly to presynaptic receptors than they do to postsynaptic receptors. When used at low dosages, many more presynaptic receptors are blocked (resulting in more dopamine being released) than are postsynaptic receptors. This may be the reason why these two drugs exert antidepressant effects at low dosages, and antipsychotic effects at high dosages.
Some of the other neuroleptics may produce an antidepressant effect, in part, by the same mechanism. If neither sulpiride nor amisulpride are available, Zyprexa and Seroquel might be good choices to try as a substitute.
Amineptine promotes the stimulation of dopaminergic neurons in yet a third way. It prevents the released dopamine from being retrieved by the presynaptic neuron so that it can be used again. Amineptine inhibits the reuptake of dopamine and is thus labeled a reuptake inhibitor. The concentration of dopamine within the synaptic cleft increases, thereby inducing the postsynaptic neuron to fire.
These drugs, when combined, probably act synergistically to promote a prolonged increase in the activity of dopaminergic neurons. On paper, the combination of sulpiride or amisulpride with amineptine is brilliant. Surely, the person who thought of it must be. It is my hope that mazindol (Mazinor), another dopamine reuptake inhibitor, may serve as a substitute for amineptine in these combinations. Unfortunately, things that look good on paper don’t always pan-out.
- Scott
Posted by Anna P. on May 11, 2000, at 11:37:47
In reply to Re: Polish Pharmacies, Anna, posted by AndrewB on May 10, 2000, at 22:40:54
> Anna,
>
> Any Polish pharmacies do mail order? I'm looking for a med. out of Russia.
>
> By the way, I think Michael would know the cheapest source of Adrafinil. Note that Modafinil has much the same action as Adrafinil but less side effects. For example, no potential liver toxicity and less sexual side effects.Andrew,
I know it is really strict in Poland, and you need to have a prescription probably from the local doctor.
They get in Poland French medications such as Tianeptine.
What kind of a medication you are looking for in Russia?Anna P.
This is the end of the thread.
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