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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 SalArmy4me on June 14, 2001, at 12:26:46
Before you give up on medical treatment, there is hope for you in newer medications and newer combinations. I found relief in the antipsychotic Ziprasidone (http://www.medsafe.govt.nz/Profs/datasheet/z/zeldoxcap.htm). Here are some more options that you may not have thought of:
Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
Lamotrigine - good side-effect profile; most antidepressant properties of the anticonvulsants.
Carbamazepine - less side effects than Lithium or divalproex sodium.
Topiramate - the newest mood-stabilizer; it promotes weight loss.
Desipramine - the least side-effects of all the Tricyclics; one of the few NRIs except for reboxetine.
High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
Buspirone - an effective antidepressant and anxiolytic at high doses (60-90mg).
Dopamine Agonists - Pramipexole has two studies on it (I took it).
"Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, Remeron + Prozac.
Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (I took pindolol).
Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc.
Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel, ZIPRASIDONE
Provigil - a stimulant that is possibly effective.
Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine at 60 mg.
I hope that gives you hope!
Posted by Elizabeth on June 14, 2001, at 15:53:17
In reply to Medications Options You May Not Know About, posted by SalArmy4me on June 14, 2001, at 12:26:46
Great list, Sal.
> Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
Doesn't cause changes in sleep architecture that are seen with most other ADs.
> Carbamazepine - less side effects than Lithium or divalproex sodium.
Requires periodic blood counts, can cause drowsiness, dizziness, ataxia, etc. Less likely to cause weight gain than Li+ or valproate.
> Topiramate - the newest mood-stabilizer; it promotes weight loss.
...and is often used for just that purpose.
> Desipramine - the least side-effects of all the Tricyclics; one of the few NRIs except for reboxetine.
Nortriptyline is a good alternative for people who find desipramine overly activating.
> High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
I'd add sibutramine, which has similar chemical and pharmacological properties to venlafaxine, but is an order of magnitude more potent.
> Buspirone - an effective antidepressant and anxiolytic at high doses (60-90mg).
The "high doses" part can't be stressed enough.
> Dopamine Agonists - Pramipexole has two studies on it (I took it).
Pramipexole is a relatively selective D3 agonist. It seems to be more effective for our purposes than bromocriptine, amantadine, pergolide, etc.
> "Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, Remeron + Prozac.
A great one that I heard about: Remeron + Effexor + Wellbutrin + Lamictal + Provigil. (overkill??? :-) )
> Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (I took pindolol).
Or thyroid hormones, psychostimulants, low-dose atypical antipsychotics, ...
> Provigil - a stimulant that is possibly effective.
Although not for its official indication (narcolepsy)!
> Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
And safer than their reputation would lead one to believe.
> MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine at 60 mg.
More activating than phenelzine; no propensity for weight gain, and less orthostatic hypotension; probably a less effective anxiolytic (no GABA-ergic effect), may cause anxiety or agitation. Will cause false positives on drug tests for amphetamine (metabolites include the less-desirable levo- isomors of amphetamine and methamphetamine).
-elizabeth
Posted by Kaysey on June 14, 2001, at 18:26:20
In reply to More about Sal's list, posted by Elizabeth on June 14, 2001, at 15:53:17
As always thanks (to both of you) for the valuable information. I have a question that has been addressed before, but the responses have varied. At what (approximate) dosage does the norepinephrine effect 'kick in' for effexor. I have seen everything from 200mg up to over 300 (and that it might be different for effexor vs. bvXR). Ditto that question for the dopamine effect (have seen everything from 250 mg up to 600!). Perhaps this is also something that varies greatly by individual; but is there a designated baseline for each?
Thanks again.
Posted by Elizabeth on June 15, 2001, at 0:07:04
In reply to Re: More about list: question to Sal and Elizabeth, posted by Kaysey on June 14, 2001, at 18:26:20
> As always thanks (to both of you) for the valuable information. I have a question that has been addressed before, but the responses have varied. At what (approximate) dosage does the norepinephrine effect 'kick in' for effexor. I have seen everything from 200mg up to over 300 (and that it might be different for effexor vs. bvXR). Ditto that question for the dopamine effect (have seen everything from 250 mg up to 600!). Perhaps this is also something that varies greatly by individual; but is there a designated baseline for each?
One study compared a group receiving 75 mg to one receiving 375 mg. At the former dose, Effexor appears to have some effects on norepinephrine reuptake but is mainly a serotonin reuptake blocker; at the latter dose, there is a clear-cut norepinephrine effect. One observation has been that the NE effect becomes more relevant at about 1 mg/kg.
Unfortunately, it's hard to measure transporter binding directly in human beings, so most of the information on Effexor's dose-related effects comes from animal research. It's not always the case that animal doses in mg/kg can be translated to human doses.
Dopamine reuptake inhibition occurs to a clinically significant extent only at very high doses that I would expect to be hard to tolerate for most people. It is doubtful that this action contributes much to the efficacy of Effexor.
-elizabeth
Posted by Kaysey on June 15, 2001, at 8:53:13
In reply to Re: More about list » Kaysey, posted by Elizabeth on June 15, 2001, at 0:07:04
> > As always thanks (to both of you) for the valuable information. I have a question that has been addressed before, but the responses have varied. At what (approximate) dosage does the norepinephrine effect 'kick in' for effexor. I have seen everything from 200mg up to over 300 (and that it might be different for effexor vs. bvXR). Ditto that question for the dopamine effect (have seen everything from 250 mg up to 600!). Perhaps this is also something that varies greatly by individual; but is there a designated baseline for each?
>
> One study compared a group receiving 75 mg to one receiving 375 mg. At the former dose, Effexor appears to have some effects on norepinephrine reuptake but is mainly a serotonin reuptake blocker; at the latter dose, there is a clear-cut norepinephrine effect. One observation has been that the NE effect becomes more relevant at about 1 mg/kg.
>
> Unfortunately, it's hard to measure transporter binding directly in human beings, so most of the information on Effexor's dose-related effects comes from animal research. It's not always the case that animal doses in mg/kg can be translated to human doses.
>
> Dopamine reuptake inhibition occurs to a clinically significant extent only at very high doses that I would expect to be hard to tolerate for most people. It is doubtful that this action contributes much to the efficacy of Effexor.
>
> -elizabethThank you Elizabeth. I really need to take the time and look at more journal articles re this subject. As you said, it is difficult to extrapolate results of animal studies to human response. The animals in such studies are usually genetically pure, in a fixed environment, have the same exposures, etc. Certainly not true for us humans!!
It would seem though that the mg/kg measure would be a pretty good indicator--based on that I would need (assuming I could get the adrenergic effect at all) an intake in the upper 200s (getting close to 300), and that seems probable.
Thanks again!
Posted by Elizabeth on June 15, 2001, at 9:22:31
In reply to Re: More about list » Elizabeth, posted by Kaysey on June 15, 2001, at 8:53:13
> Thank you Elizabeth. I really need to take the time and look at more journal articles re this subject. As you said, it is difficult to extrapolate results of animal studies to human response. The animals in such studies are usually genetically pure, in a fixed environment, have the same exposures, etc. Certainly not true for us humans!!
The other thing is that you simply can't assume that the dose will be the same (even the dose per unit weight) because of potential differences in metabolism, uptake into the CNS, etc.
> It would seem though that the mg/kg measure would be a pretty good indicator--based on that I would need (assuming I could get the adrenergic effect at all) an intake in the upper 200s (getting close to 300), and that seems probable.
That's probably a reasonable range, but psych drug effects don't seem to vary so much with people's body size, probably because we're only looking for effects above the neck (central effects, that is). That's why the recommended doses for antidepressants aren't given in mg/kg.
-elizabeth
Posted by sl on June 15, 2001, at 10:27:32
In reply to Medications Options You May Not Know About, posted by SalArmy4me on June 14, 2001, at 12:26:46
> High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
But you have to wait thru the bad side-effects and sedation til you're ready for that high dose. I really wonder how many people would be successfully treated by this stuff if we could just get through the "titrating up" period.
> Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel, ZIPRASIDONEWhat about Zyprexa? That's on my list for things to try if this stuff [I'm on now] is not acceptable. Looking at the pharmacology of the Zyprexa, I'd EXPECT it to have AD effects....am I wrong?
Still learning...
sl
Posted by Judy on June 15, 2001, at 10:47:18
In reply to More about Sal's list, posted by Elizabeth on June 14, 2001, at 15:53:17
> > MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine at 60 mg.
>More activating than phenelzine; no propensity for weight gain, and less orthostatic hypotension
Arrrgggghhhh! Why won't Selegiline work for me???
Nardil is the only AD my depression/dysthymia/anxiety ever completely responded to but I can't tolerate it physically. I took up to 60 mg/day of Selegiline for about 6 months, was blissfully free of side effects, and for one day each week I felt like I was 'getting somewhere' - but I never quite made it over the hump. I begged for an increased dosage or an augmenter but was told it wouldn't be prudent since Selegiline had no track record at that time as an AD and not enough was known about taking higher doses, etc.
My gut instinct is that Selegiline may be part of the answer I've been seeking for 16+ years... maybe the transdermal patch?...but I can't wait the year or more until it's approved (if it ever is). I'm too old and tired to play this AD 'game' anymore. I think I give up.
Posted by Neal on June 15, 2001, at 13:02:15
In reply to Medications Options You May Not Know About, posted by SalArmy4me on June 14, 2001, at 12:26:46
Sal, thanks for posting your list. I think if you post the trade name along with the generic name it'll help those of us who are "medically challenged". What medications are you taking right now (the Ziprasidone?) and what kind of effects are you getting. Thanks. --Neal
Posted by Elizabeth on June 15, 2001, at 17:41:23
In reply to Re: Medications Options You May Not Know About, posted by sl on June 15, 2001, at 10:27:32
> What about Zyprexa? That's on my list for things to try if this stuff [I'm on now] is not acceptable. Looking at the pharmacology of the Zyprexa, I'd EXPECT it to have AD effects....am I wrong?
That's olanzapine. It's an AD augmentor for some people, in particular those who have obsessive suicidal thoughts. For me it is just sedating. And some people feel worse on all antipsychotics (including Zyprexa).
-elizabeth
Posted by Phil on June 15, 2001, at 18:13:20
In reply to Re: Medications Options You May Not Know About, posted by Neal on June 15, 2001, at 13:02:15
> Sal, thanks for posting your list. I think if you post the trade name along with the generic name it'll help those of us who are "medically challenged".
------------
Neal, A link to Dr. Goldberg's site courtesy of Dr. Bob.
http://www.psycom.net/depression.central.drugnames.html
Posted by SalArmy4me on June 15, 2001, at 23:52:06
In reply to Sal's List - Selegiline ?? Sal and Elizabeth, posted by Judy on June 15, 2001, at 10:47:18
Why don't you take a look at moclobemide?
> > > MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine at 60 mg.
>
> >More activating than phenelzine; no propensity for weight gain, and less orthostatic hypotension
>
> Arrrgggghhhh! Why won't Selegiline work for me???
>
> Nardil is the only AD my depression/dysthymia/anxiety ever completely responded to but I can't tolerate it physically. I took up to 60 mg/day of Selegiline for about 6 months, was blissfully free of side effects, and for one day each week I felt like I was 'getting somewhere' - but I never quite made it over the hump. I begged for an increased dosage or an augmenter but was told it wouldn't be prudent since Selegiline had no track record at that time as an AD and not enough was known about taking higher doses, etc.
>
> My gut instinct is that Selegiline may be part of the answer I've been seeking for 16+ years... maybe the transdermal patch?...but I can't wait the year or more until it's approved (if it ever is). I'm too old and tired to play this AD 'game' anymore. I think I give up.
Posted by Judy on June 16, 2001, at 15:44:38
In reply to Re: Sal's List - Selegiline ?? Sal and Elizabeth, posted by SalArmy4me on June 15, 2001, at 23:52:06
> Why don't you take a look at moclobemide?
Thanks, but no can do. I asked for it and my pdoc refused to condone anything not approved in the US.
I was hoping someone would say they'd pushed Selegiline beyond 60 mg or augmented with something and that did the trick.
Posted by SalArmy4me on June 16, 2001, at 19:20:52
In reply to Re: Sal's List - Selegiline? » SalArmy4me, posted by Judy on June 16, 2001, at 15:44:38
Selegiline + Zyprexa
or
Selegiline + Lamictal
This is the end of the thread.
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