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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 Darkness At Noon on July 12, 2007, at 7:37:10
Does anyone have experience augmenting MAOIs (particularly EMSAM) with other meds?
EMSAM has not yet worked for me, though I can still increase the dose and stay on it longer. But it is -- so far -- one of the more tolerable ADs, side-effect-wise, if I don't mind not having a sex life. So I'm looking for augmentation strategies which might work, but not freak out my pdoc.
My pdoc is talking about antipsychotics. I've added several to SSRIs, but they always left my mind groggy.
A number of pdocs appear to advocate stimulants with MAOIs. They haven't helped me with SSRIs or TCAs, but haven't caused problems either. But my pdoc is using the PDR labeling to fend them off, somewhat like holding off vampires with garlic. But that's all theoretical; I can't find references to people actually going hypertensive from adding small amounts.
There are also references to TCAs, at least those with minimal serotonin effect. Anyone ever try MAOI-TCA and survive to read Psycho-Babble?
Thanks for any experiences you can share.
Posted by Phillipa on July 12, 2007, at 12:01:42
In reply to EMSAM / MAOI Augmentation, posted by Darkness At Noon on July 12, 2007, at 7:37:10
Seriously goodle Scott or SLS on the Dr. Bob's google as he went into remission on a TCA and nardil I think. Don't quote me on that . I just think he did. Love Phillipa
Posted by KayeBaby on July 12, 2007, at 14:33:51
In reply to Re: EMSAM / MAOI Augmentation » Darkness At Noon, posted by Phillipa on July 12, 2007, at 12:01:42
I have been on EMSAM 6mg for 12 weeks and it has had very good anti-depressant effects for me with virtually no side effects.
My problem (always it seems) is that it wasn't taking care of my low motivation and energy levels enough. It helped a lot but I still had this nagging problem of wanting to lie around most of the time. Sure hate to complain because I have been quite happy while laying around. :)
I saw my Dr. on the 9th and begged him to add a tiny amount of Dexedrine and bless him! He did. 2.5 mg IR Dex 2x daily. It makes ALL the difference for me and so far no BP problems. My BP was actually a little on the low side for me but I have lost 13 lbs and (mostly) quit smoking.
I feel really well. I am also taking Namenda 5-15 mg per day which I believe has helped restore my sensetivity to stims (along with a few months abtinence and the EMSAM) 2.5mg has NEVER even been noticable to me before and Dex has never felt very stimulating to me.
The Namenda is good for my sleep and a good for anxiety. I like it.
I tried a small amount of Abilify for a few weeks and it seemed to help with few side effects but all in all I think stims are a better choice for me.
Hope this helps.
Kaye
Posted by Honore on July 12, 2007, at 15:01:33
In reply to Re: EMSAM / MAOI Augmentation, posted by KayeBaby on July 12, 2007, at 14:33:51
Hi, KayeBaby. I'm really interested in whatever you can say about Namenda. I really dont' know much about it, other than its usual use. How is it used as a pysch med? what are the usual recommendations, or conditions where it seems effective? what effects does it usually have/ or side effects (as far as you know)?
I'm looking for something to add to Emsam, also, esp if/when I stop abilify, and would like to mention it to my pdoc in my next appointment, if I knew more about it.
Thanks in advance.
Honore
Posted by Sigismund on July 12, 2007, at 16:56:16
In reply to Re more info on nameda as psych med » KayeBaby, posted by Honore on July 12, 2007, at 15:01:33
I'm interested in Namenda too.
(I need a crash course.)
Is this the excitotoxicity thing?
Same as the NMDA thing?
Posted by KayeBaby on July 12, 2007, at 17:27:33
In reply to Re more info on nameda as psych med » KayeBaby, posted by Honore on July 12, 2007, at 15:01:33
> Hi, KayeBaby. I'm really interested in whatever you can say about Namenda.
**I know. I cannot find much on it other than for AD.
>I really dont' know much about it, other than its usual use. How is it used as a pysch med? what are the usual recommendations, or conditions where it seems effective? what effects does it usually have/ or side effects (as far as you know)?**My Dr. said he was putting all of his ADD pt's on it. For cognitive benefits. I have heard of people having great results for OCD. I find it to be great for lowering anxiety without being overly sedating.
I take 2-5mg as needed in the daytime and usually 10mg before bed. Seems to improve my sleep. The lower doses are seem to calm me down and bring my energy levels back up and my focus and mood too. Helps me when I feel scattered.
It blocks glutamante toxicity (not tech explanation) and probably brings GABA up.
It has been used for about 10 years in Europe and seems to be very safe. It is quite mood brightening and libido enhancing (esp. the first few weeks)
> I'm looking for something to add to Emsam, also, esp if/when I stop abilify, and would like to mention it to my pdoc in my next appointment, if I knew more about it.
**what symptom are you having that you need to address?
> Thanks in advance.
>
> Honore
You are very welcome, Honore.
Kaye
Posted by KayeBaby on July 12, 2007, at 17:29:17
In reply to Re: Re more info on nameda as psych med, posted by Sigismund on July 12, 2007, at 16:56:16
> I'm interested in Namenda too.
>
> (I need a crash course.)
>
> Is this the excitotoxicity thing?
>
> Same as the NMDA thing?This is my understanding. I benefitted a good deal fro lyrica and these two drugs seem to share some basic similarities. In a broad sense.
Peace,
Kaye
Posted by Phillipa on July 12, 2007, at 21:26:06
In reply to Re: Re more info on nameda as psych med, posted by KayeBaby on July 12, 2007, at 17:29:17
Lets see if this google works Love Phillipa
Memantine
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Memantine
Systematic (IUPAC) name
1-amino-3,5-dimethyl-adamantane
Identifiers
CAS number 19982-08-2
ATC code N06DX01
PubChem 4054
DrugBank APRD00221
Chemical data
Formula C12H21N
Mol. mass 179.3 g/mol
Pharmacokinetic data
Bioavailability ~100%
Metabolism Hepatic (<10%)
Half life 60–100 hours
Excretion Renal
Therapeutic considerations
Licence data EU US
Pregnancy cat. B2 (Au), B (U.S.)
Legal status S4 (Au), P*M (UK), ℞-only (U.S.)
Routes Oral
Memantine is the first in a novel class of Alzheimer's disease medications acting on the glutamatergic system. Memantine was developed by Merz and licensed to Forest for the U.S. and Lundbeck for selected European and international markets. Memantine is marketed under the brands Axura® and Akatinol® by Merz, Namenda® by Forest and Ebixa® by Lundbeck.Contents [hide]
1 Pharmacology
1.1 Glutamatergic (NMDA receptor)
1.2 Serotonergic (5-HT3 receptor)
1.3 Cholinergic (Nicotinic acetylcholine receptor)
2 Clinical use
2.1 Indications
2.2 Adverse drug reactions
3 See also
4 References
5 External links
[edit] Pharmacology[edit] Glutamatergic (NMDA receptor)
A dysfunction of glutamatergic neurotransmission, manifested as neuronal excitotoxicity, is involved in the etiology of Alzheimer's disease. Targeting the glutamatergic system, specifically NMDA receptors, offers a novel approach to treatment in view of the limited efficacy of existing drugs targeting the cholinergic system.[1]Memantine is a moderate-affinity voltage-dependent uncompetitive antagonist at glutamatergic NMDA receptors.[2] By binding to the NMDA receptor with a higher affinity than Mg2+ ions, memantine is able to inhibit the prolonged influx of Ca2+ ions which forms the basis of neuronal excitotoxicity. The low-affinity of memantine, however, preserves the physiological function of the receptor as it can still be activated by the relatively high concentrations of glutamate released following depolarisation of the presynaptic neuron.
[edit] Serotonergic (5-HT3 receptor)
Memantine acts as an uncompetitive antagonist at the 5HT3 receptor, with a potency similar to that for the NMDA receptor.[3] The clinical significance of this serotonergic activity in the treatment of Alzheimer's disease is unknown.
[edit] Cholinergic (Nicotinic acetylcholine receptor)
Memantine acts as an uncompetetive antagonist at different neuronal nicotinic neuronal receptors (nAChRs) at potencies similar to the NMDA receptor.[4][5] It has been shown that the number of nicotinic receptors in the brain are reduced in Alzheimer's disease, even in the absence of a general decrease in the number of neurons, and nicotinic receptor agonists are viewed as interesting targets for anti-Alzheimer drugs.[6]
[edit] Clinical use[edit] Indications
Although memantine is approved for treatment of moderate to severe Alzheimer's Disease[7] its usage has been recommended against by the UK's National Institute for Clinical Excellence.[8]Memantine has been associated with a moderate decrease in clinical deterioration in Alzheimer's disease.[9] A systematic review of randomised controlled trials found that memantine has a small positive effect on cognition, mood, behaviour, and the ability to perform daily activities in moderate to severe Alzheimer's disease, but an unknown effect in mild to moderate disease.[10]
Memantine is also being tested for Opioid dependence, systemic lupus erythematosus, depression, obsessive compulsive disorder, glaucoma, tinnitus, neuropathic pain, and pervasive developmental disorders.
[edit] Adverse drug reactions
Memantine is generally well-tolerated.[10] Common adverse drug reactions (≥1% of patients) include: confusion, dizziness, drowsiness, headache, insomnia, agitation, and/or hallucinations. Less common adverse effects include: vomiting, anxiety, hypertonia, cystitis, and increased libido.[11][9]
[edit] See also
Alzheimer's disease
Donepezil
Galantamine
Rivastigmine
Exelon
Posted by Jedi on July 13, 2007, at 2:51:58
In reply to EMSAM / MAOI Augmentation, posted by Darkness At Noon on July 12, 2007, at 7:37:10
> Does anyone have experience augmenting MAOIs (particularly EMSAM) with other meds?
>
> There are also references to TCAs, at least those with minimal serotonin effect. Anyone ever try MAOI-TCA and survive to read Psycho-Babble?
>
> Thanks for any experiences you can share.
>Hi,
I've never used EMSAM, so no help there. I have augmented the MAOI Nardil with the TCA nortriptyline. There was no problem with this combination for me. The MAOIs can generally be augmented with the non-serotonergic TCAs. I've augmented Nardil with bupropion, though it is offically contraindicated also. Meds I've used with the MAOIs include clonazepam(Klonopin), quetiapine(Seroquel), diphenhydramine hydrochloride(Benadryl), codeine, and others that do not increase serotonin. When augmenting MAOIs it really helps to have a very good psychopharmacologist, and then do lots of research.
Be well,
Jedi
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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