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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by myco on March 11, 2009, at 15:36:03
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Im always interesting in the idea of augmenting meds to get better or different AD effects. To me this is the most interesting part of the study/use of Psychiatry.
Ive recently read a few studies focusing on the use of Clonidine (an old antihypertensive med that is being re-evaluated for other indications neuropathic pain, ADHD, Tourettes, and as a sleep aid yay!) to potentiate the AD effects of: MAOIs; TCAs; SSRIs, Atypical ADs; Stimulants and some non-AD meds.[1][2]
Clonidine may have effects on Norepinephrine and Seratonin (older studies state SE while Wiki only mentions NE) that are useful as an augmentation tool.
Interestingly, the authors dont focus on possibility of Serotonin syndrome which makes me think that perhaps Serotonin doesnt play a key role with the efficacy of Clonidine (somewhat old studies; Wiki states only NE effect for Clonidine with no mention of SE).
The 2 studies Ive looked at in detail, both well written and easy to grasp for noobs, do use the forced swim test with mice not really a good indication, in my opinion, of what may occur in humans but still lend evidence. The doses seem to be quite high for most of the meds tested but the dosage of Clonidine in all cases is very low (for additive effect) at 0.06mg/kg to 0.1mg/kg (if you weigh 76kg thats ~4.6 to 7.6mg of Clonidine an acceptably small dosage)
Among MAOIs the dosages [2] (used in mice anyway) were massive and I dont think can be extrapolated to human usage (i.e. 8mg/kg of Nardil to show significant effect! yikes). Interestingly though, Moclobemide may show good augmentation pairing with Lithium [2] (havent read the study the authors refer to yet though). Among TCAs and SSRIs [1] the dosages (combined with 0.1mg/kg Clonidine less than 8mg if you weigh 76mg) were again massive (for mice) and the human translation is questionable to me (i.e. human ~300mg Celexa, ~600mg Paxil! for 76kg of weight lol). In the ATYPICAL AD category [1] only Trazodone has a reasonable, to me, human dose (~38mg - ~150mg area with Clonidine). Another study mentions Bupropion potentiated well with Clonidine [1] (Ive yet to read the study they refer to). Stimulants were not at all convincing in combo with Clonidine [1].
Sodoes anyone here have any experience using Clonidine with any AD or non-AD type med with success as an augmentation tool?
Please share your experiences.
Thanks,Myco
1) Bourin et al. 1991. Clonidine as a sensitizing agent in the forced swimming test for revealing antidepressant activity. J Psychiatry Neursci. 16(4): 199-203. (FREE ONLINE - check pubmed)2) Bourin et al. 2002. Clonidine potentiates the effects of tranylcypromine, phenelzine and two analogues in the forced swimming test in mice. J Psychiatry Neursci. 27(3): 178-185. (FREE ONLINE - check pubmed)
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Posted by Phillipa on March 11, 2009, at 21:52:26
In reply to On the use of CLONIDINE as a med AUGMENT., posted by myco on March 11, 2009, at 15:36:03
Myco sweetie no experience but when nursing was used with cocaine withdrawal. Love Phillipa
Posted by myco on March 11, 2009, at 22:04:24
In reply to Re: On the use of CLONIDINE as a med AUGMENT. » myco, posted by Phillipa on March 11, 2009, at 21:52:26
Oh Jan you naughty thing...I didnt know you were a party girl back then lol
:oP
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> Myco sweetie no experience but when nursing was used with cocaine withdrawal. Love Phillipa
Posted by Phillipa on March 11, 2009, at 23:56:01
In reply to Re: On the use of CLONIDINE as a med AUGMENT. » Phillipa, posted by myco on March 11, 2009, at 22:04:24
Myco assuming joking? Something I never did too scared. Love Jan
Posted by myco on March 12, 2009, at 0:13:29
In reply to Re: On the use of CLONIDINE as a med AUGMENT. » myco, posted by Phillipa on March 11, 2009, at 23:56:01
Of course lol i was being cheeky ;o)
> Myco assuming joking? Something I never did too scared. Love Jan
Posted by mav27 on March 12, 2009, at 1:01:16
In reply to On the use of CLONIDINE as a med AUGMENT., posted by myco on March 11, 2009, at 15:36:03
I started taking clonidine a short while back when i was on prozac, it had a really nice relaxing feel to it and also gave me a few good hours sleep but without making me feel tired first so if i didn't want to go to sleep i could still take it without then feeling drowsy ect
My only problem was it was lowering my blood pressure too much (as everything seems to do to me) I was only taking up to 1mg
Posted by desolationrower on March 12, 2009, at 3:57:56
In reply to On the use of CLONIDINE as a med AUGMENT., posted by myco on March 11, 2009, at 15:36:03
high doses of MAOIs are given because if you are doing an acute study you still need to inhibit all of the MAO that is in the body
also you have to convert rat metabolic rate to human, higher doses /kg are needed for smaller animals
-d/r
Posted by myco on March 12, 2009, at 12:49:51
In reply to Re: On the use of CLONIDINE as a med AUGMENT., posted by desolationrower on March 12, 2009, at 3:57:56
d/r
I've read quite a few, well tons actually, of studies involving meds and mice/rats...dosages always seem massive. Like you mention...they don't translate like that into human doses. Do you have any idea, for future reference, how they extrapolate this data for patient usage (i.e. a formula or something for me)? It would help me make sense of tons of articles i've read and laughed at regarding the dose.
myco
> high doses of MAOIs are given because if you are doing an acute study you still need to inhibit all of the MAO that is in the body
>
> also you have to convert rat metabolic rate to human, higher doses /kg are needed for smaller animals
>
> -d/r
Posted by desolationrower on March 12, 2009, at 13:24:45
In reply to Re: On the use of CLONIDINE as a med AUGMENT. » desolationrower, posted by myco on March 12, 2009, at 12:49:51
rule of thumb i use is to divide by 6
-d/r
Posted by yxibow on March 16, 2009, at 1:55:22
In reply to On the use of CLONIDINE as a med AUGMENT., posted by myco on March 11, 2009, at 15:36:03
Clonidine has been used mostly in childhood ADHD, and the like, mainly for rage symptoms. It, and guanfacine should not be started or stopped suddenly as they are heart agents.
Supposedly it may also help tics, although that was not the case for me.
Posted by myco on March 16, 2009, at 11:08:15
In reply to Re: On the use of CLONIDINE as a med AUGMENT., posted by yxibow on March 16, 2009, at 1:55:22
So you tried clonidine for treatment of tics or abnormal involuntary movements?....did you notice any other benefits from it? I'd be interested in its sleep benefit (works for some based on studies ive read) and possibly as an augment to potentiate nardil.
> Clonidine has been used mostly in childhood ADHD, and the like, mainly for rage symptoms. It, and guanfacine should not be started or stopped suddenly as they are heart agents.
>
> Supposedly it may also help tics, although that was not the case for me.
Posted by Vincent_QC on April 20, 2009, at 23:25:06
In reply to Re: On the use of CLONIDINE as a med AUGMENT. » yxibow, posted by myco on March 16, 2009, at 11:08:15
Hi Myco!
I see my Family Doctor today and I suggere to him to try the Clonidine, before I start the Marplan, if i'm accepted... Since my blood pressure is high since my parnate experience and never get to the normal range with time (BP:140-150/80/-90 is now my normal)... The Family Doctor was very open minded to try it on me, because some studies show efficacity as an anti panic agent...and it can help to reduce my blood pressure...The dosages you convert from rat uses into human is A WAY TOO MUCH!!! Normally, Clonidine is begin at 0.1mg dived in two doses, so maximum of 0.2mg/day. That's what my Family Doctor RX to me... Since I do major panic attacks since a couple of weeks, especially since i'm going to the gym and since my heart is all f*ck up, he said that it's an effective dose...
Why he don't give to me the maximum dosage of 0.5mg/day to me? Because he don't know if my blood pressure will be down again to the normal in the near future...it seem that I have a bad reaction with the Parnate and that my body don't want to return to his normal state... Since it's an anti-hypertensive meds who act on the noradrenaline, reducing the amount of it into the brains....it can produce an anti-anxiety effect...this anti anxiety effect is often loose after severals weeks on the Clonidine, but the benzos anxi-anxiety effect also loose his power after a while anyway... so it's the same...the anxi panic effect seem to last, more than on the benzo drugs....that's what the studies show...
I start it this afternoon... I think with the Marplan and the Nardil, it have a minor possible interraction...probably more hypotension orthostatic...but in my case it will help me because the blood pressure is too high...
What I can say on day one on 0.1mg this afternoon and 0.1mg tonight...it's make me feel like i'm more weak physically than usual...remember me the beta blocker effect... I don't feel an anti-anxiety effect and my blood pressure is still high... Maybe I will need a dose increase after 1 month...but anyway I think the Clonidine don't have a full effect on the blood pressure reduction before 2 or 3 weeks... the anti panic affect is more present at the begining of the treatment...anyway it's just a test we do me and the Doctor...
For the sedation, forget it... I don't feel any sedation on it... so I don't think it's a good choice to help with insomnia. Seroquel is probably the only thing that can help, even if it's loose his effect after a while... I plan to stop it soon...I finish my bootle of pills in 20 days...I take 50mg of Seroquel at bedtime... The first month I was sleeping 8 hours in a row on it...the second month maybe 4-5 hours...now it's 2-3 hours in a row...after my sleep time is cut with period where I have to get up, do others things...smooke a cigarette, return in the bed... I don't want to increase at 75mg because I will tend to developp an psychological dependance to this med and I will worse my insomnia problem.
So that's it... Clonidine for an augment agent for AD ??? I'm not sure...but for anti panic and anti hypertension... i'm sure it work... That's important to remember it's an alpha 2 antagonist...so it's not like a beta-blocker... it work on the NE... I don't read anywhere it was working on the SE also... Since the panic attack are often cause by a high level of NE, it can help...who know... I will keep you update...maybe if it's not effective for the blood pressure after 3 weeks, I will call the Doctor to ask for an augmentation of the dosage... For now I can't say more things about it because in other hands I have the appointment with the PDoc soon and maybe I will be accepted for the Marplan importation into the Canada...so the Marplan will take care of lowering my blood pressure also... I don't want to ending by having too much hypotension and fainting.... I have to be carefull for now...
ho and I change again the Valium for the Rivotril...since the Valium is dirty and add extra daytime sedation and cause more depression than anything else, I prefer to take the chance to become again addicted to the Rivotril, but at least, I know the Rivotril don't make me more depress or tired at daytime...that's hard to stop it after a couple of months on it, but it work more well for the anti panic effect...not very well for social phobia... but that's better than nothing ...
The side-effects of 0.2mg of Clonidine... headache, physical fatigue, nausea lasting 30 minutes after taking the pill, lighthead... but that's tolerable... and I monitor my blood pressure 10 minutes ago and it's still high (135/90) but the pulse rate seem to be more low than usual...84, normally it's around 100...
Anyway, Clonidine can't kill me, especialy at this dosage... but forget the 4 mg or 7 mg I read in another post by you I think...the conversion was not good from the rat use and human...I think studies don't use more than 1.5mg/day in human...and at this dosage, the amount of people who drop the studies increase... the target dose seem to be 0,2mg to 0.5mg/day ... and they also say in some others studies that at 0.2mg-0.5mg range, it's a better anti panic agent than the Imipramine at 100mg/day ...
So don't be shy do ask it to the doctor...you will never know if you don't try it...
Good luck mister ;-)
This is the end of the thread.
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