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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 JohnQ on April 18, 2002, at 20:07:08
I'm currently on 30mgs per day of Paxil, which works pretty good for my depression (mostly), but I still need a little help on the social side of things. I'm thinking of adding amisulpride, but I'm worried about possible interaction between the two. Should I be??
Posted by jonh kimble on April 18, 2002, at 23:47:11
In reply to Amisulpride + SSRI - Dangerous or not??, posted by JohnQ on April 18, 2002, at 20:07:08
well jon, it seems the people who know alot about amisulpride arent on board right now, but i believe i have heard of people combining prozac with amisulpride, and even if not, i dont see any reason why they couldnt be combined considering amisulpride can be combined with maois which are powerful serotonin drugs. (famous last words) jj any way if i hear any more info ill tell you. by the way, i may have found a presciption free source for amisulpride, but im in the midst of emailing, so ask me again in a bit if you want.
jon
Posted by kregpark@yahoo.com on April 21, 2002, at 16:14:56
In reply to Re: Amisulpride + SSRI - Dangerous or not??, posted by jonh kimble on April 18, 2002, at 23:47:11
Hi Jon
I posted on this for first time above on this board - with paxil - *big mistake* .
I have recently completed 3.5 weeks amisulpride low dose for social anxiety (but mostly dysthymia).
If you did try amisulpride you'd be MUCH safer dropping paxil and adding eldepryl first. As is you are likely very high risk for dystonic reactions, and possible permanent reactions.
Unfortunately this effective medication (very much so in my case) - is also most likely to induce even at the low doses used, movement reactions (orofacial especially) in those most likely to benefit.
I strongly discourage it. If you do try anything, low olanzapine is likely much safer, but still I would tend to discourage it - much as "Old School" has posted - those with affective disorders probably have compromised dopamine systems and are MOST susceptible to these TD like reactions (can be permanent).
Be aware also that many "safety studies" are done in mania or skitzophrenia with these drugs - patients who can tolerate MASSIVE doses of these drugs for years with little or no TD or dystonic reactions - but we are the OPPOSITE, we (SP, bipolar low, affective disorder, etc) have LOW dopamine most likely (especially where shyness, low energy, low self esteem, rejection sensitivity, etc.) exist.
Your Paxil is already lowering dopamine (hence the sexual side effects). You are likely now much more *primed* for dystonic or TD reactions.
Posted by Ken on April 21, 2002, at 18:46:30
In reply to Re: Amisulpride + SSRI - WARNING, posted by kregpark@yahoo.com on April 21, 2002, at 16:14:56
Ray,
(This is also in response to your post replying to, "Amisulpride/Sulpiride - nearest US equivalent? » jonh kimble".) What ("low") dosage of amisulpride were you on exactly? Sounds to me like the dosage you were taking was simply too high for you. Amisulpiride is supposed to actually enhance dopaminergic neurotransmission (due to preferential D2 presynaptic/autoreceptor antagonism) at low (i.e. less than antipsychotic) dosages.
Ken
Posted by kregpark@yahoo.com on April 21, 2002, at 19:43:15
In reply to Re: Amisulpride + SSRI - WARNING » kregpark@yahoo.com, posted by Ken on April 21, 2002, at 18:46:30
Hi Ken -
My dose was 50, then 25, then 12.5, then 6 then 0 starting from 50 and occurring over 3.5 weeks. That as you know is "low dose". 6mg is specs of a small tablet. Those with schitzophrenia can tolerate perhaps 1200mg or 2000mg for years without any problem. Manic patients could be considered in many ways "opposites" of those with SP behaviorally, and the obvious different biochemically is in DA function (high versus low). These potent DA blockers are not appropriate for anyone even at tiny doses.
Amisulpride was, in fact prosexual without question. There was some mild physical (not mental or "alertness") type sedation. There is mixed dopaminergic effect, it is not "purely" a DA agonist even at the "lowest" doses.
There is some limbic selectivity for pro DA activity, but notice on Medline you will see that an initial pro DA effect in VT gives way to --DA after a couple weeks . There is also significant --DA in striatum and who knows where else. Tardive dyskinesia, for example, is thought to be triggered when excessive DA upregulation (>90%) occurs in striatum. DURATION OF USE OF ANTIPSYCHOTIC WAS FOUND IRRELEVANT TO DEVLOPING TD IN THIS VERY RECENT STUDY. Polypharmacy and individual dynamics are huge factors in whether a acute or chronic reaction or disorder will occur. One time use of a low dose is enough to trigger TD if the user is "primed".
Note than some posters here (I saw one today) mention they get EPS from med changes not involving antipsychotics. That is medication sensitivity. It may be innate or the permanent result of injury or drug toxicity.
In terms of movement disorders antipsychotics are the implicator in the huge majority of drug induced cases, although L-DOPA (Parkinson's) is associated with a fair number of problems also. Of course Parkinson's patients are highly senstivity to *any* dopamine blocker.
Perhaps this is a good example. Would you suggest that low dose amisulpride is safe for all Parkinson's patients?
Social Phobia patients have been shown to have reduced DA receptor density in striatum (one of many studies, observations, etc implicating DA dysfunction in those with SP). SP patients also are 5 times more likely to develop Parkinson's in later life.
What is your evidence that low dose amisulpride is "safe" for affective disorder patients?
A few US atypicals (especially Clozaril which could be considered safe but is not much help for affective disorders) - may be relatively safe (ie; olanzapine). However, also look at info on the substitute benzamides. ie; metaclopramide, sulpride, amisulpride, etc. If you look at the track record for these drugs you will see that in polypharmacy especially, used in affective patients they are far from safe.
Amisulpride is quite potent at blocking DA receptors, much moreso than olanzapine. It is an "atypical" - but certainly a different type of "atypical" than the 5ht-blockers which are the USA "atypicals".
That is why amisulpride, a novel and potentially very useful agent, never made it into the US ... it was being reviewed in recent years but it failed to make it due to safety concerns.
Personally I'm surprised Metaclopramide is still available in the USA (or has it been banned since early 2001 - date of my PDR)... ? ... there is plenty of lawsuit activity from patients taking this drug for nausea developing permanent orofascial dyskinesias and dystonias. I doubt it is would be used much anymore except in cancer patients with poor long term prognosis.
Ray
Posted by Ken on April 22, 2002, at 0:51:50
In reply to Re: Amisulpride + SSRI - WARNING, posted by kregpark@yahoo.com on April 21, 2002, at 19:43:15
kregpark@yahoo.com wrote, on April 21, 2002, at 19:43:15:
>What is your evidence that low dose amisulpride is "safe" for affective disorder patients?
I make no such claim one way or the other. My only interest is in learning more about this use of sulpride/amisulpride in dysthymia (since I first learned of it a few weeks ago on this board). Pardon me if I appeared to be 'challenging' you in any way. Thanks for your opinion.
Ken
Posted by kregpark@yahoo.com on April 22, 2002, at 11:54:14
In reply to Re: Amisulpride + SSRI - WARNING, posted by Ken on April 22, 2002, at 0:51:50
Hi Ken,
I think people read this stuff and may act.
I know my case was mismanaged.
I got the idea to try amisulpride here. Info here was incomplete and misleading in some ways.
The movement area (ie; dyskinesias and dystonias) are NO GOOD and NO FUN.
Nobody needs that crap f*****ng up their lives.
And since I had such a reaction which fortunately is getting better - naturally I'm more vocal on this topic.Ray
Posted by SLS on April 22, 2002, at 14:18:50
In reply to Re: Amisulpride + SSRI - WARNING, posted by kregpark@yahoo.com on April 22, 2002, at 11:54:14
Dear Ray,
Thank you for your thorough, concise, and accurate post. It pulled a lot of things together for me. I'm going to reread it a few times. Maybe some of it will stick for a change. :-)
- Scott
This is the end of the thread.
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