Psycho-Babble Medication Thread 952388

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Re: A thread for SLS

Posted by Justherself54 on June 30, 2010, at 18:55:57

In reply to Re: A thread for SLS » ed_uk2010, posted by SLS on June 30, 2010, at 15:35:59

It's not defeat in my eyes, Scott..it's strength. My thoughts are with you..

 

Re: A thread for SLS » SLS

Posted by Bob on July 1, 2010, at 0:20:05

In reply to Re: A thread for SLS » ed_uk2010, posted by SLS on June 30, 2010, at 15:35:59

> > Hi Scott,
> >
> > Am I right that you're restarting Nardil? I hope it helps. Are you planning on titrating to a higher dose this time?
>
>
> I'm going to target 90mg, which is the same dosage I used the last time. Maybe having lithium on board this time will help. Going back to Nardil this time is, in a way, an admission of defeat.
>
>
> - Scott


By your measure of defeat, I've had countless instances. I seem to have run out of options long ago, and all I see to do now is limp along with treatments that don't work and hope for the best. The best is not very good.

- Bob

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on July 1, 2010, at 21:48:15

In reply to Re: A thread for SLS, posted by ed_uk2010 on June 27, 2010, at 15:26:15

>>So far, we cannot find any evidence for there being a contraindication against doing this. Do you know of any?

> I am not aware of any contra-indication. I suppose it's just a case of there not being any evidence to support the safety of combined use.
---------------------------

Ed,

Sorry for the length of this post.

Scott and I are both interested in adding 25 mg/day of agomelatine (Valdoxan) to 90 mg/day of Nardil.

My previous p-doc would have trusted me to CARFULLY try the addition of agomelatine to my current combo (see below). But, he changed jobs and went to work as a p-doc in the U.S. Veterans Administration. I am not a Veteran, so I no longer have access to him.

My new p-doc is a good doc, but is totally into CYA (cover his butt) and refused my request to add agomelatine. But, Im not going to give up. Please respond to the following:

Can Valdoxan be combined with Nardil (phenelzine), if done carefully under the direct supervision and care of a qualified psychiatrist? In the Valdoxan - Summary of Product Characteristics document, MAOIs are not contraindicated. Also, it is not contraindicated in this document: http://www.ema.europa.eu/humandocs/PDFs/EPAR/valdoxan/H-915-PI-en.pdf

Clearly, there is not any risk of serotonin syndrome, since Valdoxan does not release serotonin.

So, my question comes down to this: Since Valdoxan is an antagonist of post-synaptic 5-HT2c receptors; does the disinhibition (NDDI), resulting in the release of dopamine and norepinephrine in the frontal cortex, cause an unacceptable risk of a hypertensive crisis when 25 mg/day of Valdoxan is added to 90 mg/day of Nardil?

My p-doc is afraid of the risk a of hypertensive crisis. But, I am super safe when adding a med with some risk. I would start by trying ¼ of a 25 mg tablet. I would monitor my blood pressure continually for the first couple of hours, and I would have one of my nifedipine capsules close at hand.

Anecdotally, there are reports of this being done:

http://www.dr-bob.org/babble/20100305/msgs/939363.html

Ed, do you agree with the following paragraph? Beware of the source (see link below).

Notably, although phenelzine inhibits the breakdown of norepinephrine and epinephrine (which in concept should lead to increased levels of these two respective neurotransmitters), it actually typically significantly decreases their overall activity with time via a complex interaction with octopamine. This is the cause of the side effect of orthostatic hypotension commonly seen with phenelzine and the other MAOIs. Importantly, it has been demonstrated that the antidepressant effects of serotonin are actually mediated through norepinephrine. [9] As a result, this depletion of norepinephrine and epinephrine may significantly inhibit the full therapeutic potential of phenelzine and the other MAOIs. For this reason, augmenting with an adrenergic agent such as a norepinephrine reuptake inhibitor (NRI) or releasing agent (NRA) in conjunction may be desirable, though strict professional supervision is advised to minimize the risk of a potentially dangerous drug interaction such as hypertensive crisis.

http://wapedia.mobi/en/Phenelzine

If the above is true, agomelatine would improve the effectiveness of Nardil.

Ed, here is the home page for Valdoxan. Please click around.

http://www.valdoxan.com/

Also, enter the following as a medical professional (which you are). The first four options, counting from left to right, all get you to the same place with good information. The fifth one leads you to the laymans watered down version.

http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx

FWIW, I sent in a Medical Enquiry to Servier, but they did not reply.

Ed, thank you for reviewing this information and providing your accessment. I am particularly interested in agomelatine because, as a BP II ultra rapid cycler, I want to take advantage of the tx of circadian rhythms.

However, I cannot merely replace Nardil with agomelatine, because the latter does not have enough antidepressant horsepower in and of itself. I need my Nardil.

Further, I am fully convinced, based on my reaction to other meds, that Valdoxan without Nardil will cause me to become irritable. This is due to the lack of a serotoninergic component.

My bottom line is that the addition of agomelatine to Nardil is simillar in risk to the careful addition of a p-stim to Nardil. This is done often.

Aside from the potential liver issue, is 25 mg/day of Valdoxan safe to add-on to Nardil?

-- Ron

dx: Bipolar II with ultra rapid cycling, and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil

3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
35 ml of Calsons Bottled Fish Oil
100 mg/day phosphatidylserene
Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins
2000 IU Vitamin E
850 mg/day of Mg 212% of RDA (as 5 grams of MgMalate).
Dark therapy via LowBlueLight glasses (When I remember)


Whats next to add:

25 mg/day agomelatine (if my p-doc wakes up and smells the roses due to my submitted research) {Valdoxan}
300 mg/day of lithum carbonate
CoQ10
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
GTF Chromium
Cromium Picolinate
Cinnamon


 

Re: Agomelatine add-on to Nardil

Posted by Ron Hill on July 1, 2010, at 21:56:16

In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on July 1, 2010, at 21:48:15

One link in my above post is not active. Here it is activated:

Valdoxan - Summary of Product Characteristics

http://www.valdoxan.com/index.php/summary-of-product-characteristics/

-- Ron

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by Bob on July 1, 2010, at 22:37:37

In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on July 1, 2010, at 21:48:15

> >>So far, we cannot find any evidence for there being a contraindication against doing this. Do you know of any?
>
> > I am not aware of any contra-indication. I suppose it's just a case of there not being any evidence to support the safety of combined use.
> ---------------------------
>
> Ed,
>
> Sorry for the length of this post.
>
> Scott and I are both interested in adding 25 mg/day of agomelatine (Valdoxan) to 90 mg/day of Nardil.
>
> My previous p-doc would have trusted me to CARFULLY try the addition of agomelatine to my current combo (see below). But, he changed jobs and went to work as a p-doc in the U.S. Veterans Administration. I am not a Veteran, so I no longer have access to him.
>
> My new p-doc is a good doc, but is totally into CYA (cover his butt) and refused my request to add agomelatine. But, Im not going to give up. Please respond to the following:
>
> Can Valdoxan be combined with Nardil (phenelzine), if done carefully under the direct supervision and care of a qualified psychiatrist? In the Valdoxan - Summary of Product Characteristics document, MAOIs are not contraindicated. Also, it is not contraindicated in this document: http://www.ema.europa.eu/humandocs/PDFs/EPAR/valdoxan/H-915-PI-en.pdf
>
> Clearly, there is not any risk of serotonin syndrome, since Valdoxan does not release serotonin.
>
> So, my question comes down to this: Since Valdoxan is an antagonist of post-synaptic 5-HT2c receptors; does the disinhibition (NDDI), resulting in the release of dopamine and norepinephrine in the frontal cortex, cause an unacceptable risk of a hypertensive crisis when 25 mg/day of Valdoxan is added to 90 mg/day of Nardil?
>
> My p-doc is afraid of the risk a of hypertensive crisis. But, I am super safe when adding a med with some risk. I would start by trying ¼ of a 25 mg tablet. I would monitor my blood pressure continually for the first couple of hours, and I would have one of my nifedipine capsules close at hand.
>
> Anecdotally, there are reports of this being done:
>
> http://www.dr-bob.org/babble/20100305/msgs/939363.html
>
> Ed, do you agree with the following paragraph? Beware of the source (see link below).
>
> Notably, although phenelzine inhibits the breakdown of norepinephrine and epinephrine (which in concept should lead to increased levels of these two respective neurotransmitters), it actually typically significantly decreases their overall activity with time via a complex interaction with octopamine. This is the cause of the side effect of orthostatic hypotension commonly seen with phenelzine and the other MAOIs. Importantly, it has been demonstrated that the antidepressant effects of serotonin are actually mediated through norepinephrine. [9] As a result, this depletion of norepinephrine and epinephrine may significantly inhibit the full therapeutic potential of phenelzine and the other MAOIs. For this reason, augmenting with an adrenergic agent such as a norepinephrine reuptake inhibitor (NRI) or releasing agent (NRA) in conjunction may be desirable, though strict professional supervision is advised to minimize the risk of a potentially dangerous drug interaction such as hypertensive crisis.
>
> http://wapedia.mobi/en/Phenelzine
>
> If the above is true, agomelatine would improve the effectiveness of Nardil.
>
> Ed, here is the home page for Valdoxan. Please click around.
>
> http://www.valdoxan.com/
>
> Also, enter the following as a medical professional (which you are). The first four options, counting from left to right, all get you to the same place with good information. The fifth one leads you to the laymans watered down version.
>
> http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx
>
> FWIW, I sent in a Medical Enquiry to Servier, but they did not reply.
>
> Ed, thank you for reviewing this information and providing your accessment. I am particularly interested in agomelatine because, as a BP II ultra rapid cycler, I want to take advantage of the tx of circadian rhythms.
>
> However, I cannot merely replace Nardil with agomelatine, because the latter does not have enough antidepressant horsepower in and of itself. I need my Nardil.
>
> Further, I am fully convinced, based on my reaction to other meds, that Valdoxan without Nardil will cause me to become irritable. This is due to the lack of a serotoninergic component.
>
> My bottom line is that the addition of agomelatine to Nardil is simillar in risk to the careful addition of a p-stim to Nardil. This is done often.
>
> Aside from the potential liver issue, is 25 mg/day of Valdoxan safe to add-on to Nardil?
>
> -- Ron
>
> dx: Bipolar II with ultra rapid cycling, and mild OCPD
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 90 mg/day Nardil
>
> 3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)
> 35 ml of Calsons Bottled Fish Oil
> 100 mg/day phosphatidylserene
> Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins
> 2000 IU Vitamin E
> 850 mg/day of Mg 212% of RDA (as 5 grams of MgMalate).
> Dark therapy via LowBlueLight glasses (When I remember)
>
>
> Whats next to add:
>
> 25 mg/day agomelatine (if my p-doc wakes up and smells the roses due to my submitted research) {Valdoxan}
> 300 mg/day of lithum carbonate
> CoQ10
> NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
> GTF Chromium
> Cromium Picolinate
> Cinnamon
>
>
>


Agomelatine is not available in the US, right?

 

Re: Agomelatine add-on to Nardil » Bob

Posted by Ron Hill on July 2, 2010, at 0:01:42

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by Bob on July 1, 2010, at 22:37:37

> Agomelatine is not available in the US, right?

Bob,

You are correct. In the U.S., Novartis has conducted six Phase III trials as an antidepressant. However, the results were less than stellar.

Therefore, Novartis is conducting more Phase III tests prior to submission to the U.S. FDA. Novartis expects agomelatine to be available in the U.S. sometime in 2012.

But, in answer to what I think is the heart of your question, the U.S. FDA allows the import of overseas medications in three month lots. Any p-doc can order a three months supply of an overseas medication, like Valdoxan (i.e.; agomelatine). Then, in three months the p-doc can order another three months supply, and-on-and-on.

-- Ron

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by inanimate peanut on July 2, 2010, at 1:16:05

In reply to Re: Agomelatine add-on to Nardil » Bob, posted by Ron Hill on July 2, 2010, at 0:01:42

Please keep us posted if/as you try this. I'm really interested in it as a potential add-on to Parnate. I was making the choice between trying Valdoxan or nortriptyline first and decided the evidence was obviously stronger for the nortrip at this point along with the fact that the Valdoxan I found was $90-$180 depending on dose. Valdoxan is high on my list if nortrip fails, though, so I will follow your journey with interest.

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by Bob on July 2, 2010, at 1:22:46

In reply to Re: Agomelatine add-on to Nardil » Bob, posted by Ron Hill on July 2, 2010, at 0:01:42

> > Agomelatine is not available in the US, right?
>
> Bob,
>
> You are correct. In the U.S., Novartis has conducted six Phase III trials as an antidepressant. However, the results were less than stellar.
>
> Therefore, Novartis is conducting more Phase III tests prior to submission to the U.S. FDA. Novartis expects agomelatine to be available in the U.S. sometime in 2012.
>
> But, in answer to what I think is the heart of your question, the U.S. FDA allows the import of overseas medications in three month lots. Any p-doc can order a three months supply of an overseas medication, like Valdoxan (i.e.; agomelatine). Then, in three months the p-doc can order another three months supply, and-on-and-on.
>
> -- Ron
>


Ron-

Wow, 6 phase III trials? It sounds like the efficacy is questionable. I don't understand how drug after drug like this one get approved in
Europe but then don't make it to approval over here.

I wasn't aware that a 3-month supply could be obtained from my doctor like that. Thanks for the info.

-Bob

 

Re: Agomelatine add-on to Nardil » inanimate peanut

Posted by Ron Hill on July 2, 2010, at 2:03:13

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by inanimate peanut on July 2, 2010, at 1:16:05

> Please keep us posted if/as you try this.
----------------

Inanimate Peanut,

Will do.

I see my p-doc on 7/7/10 to present my research. Nowhere, absolutely NOWHERE, have I found any statement saying that agomelatine and MAOI's are contraindicated.

But, a lot of p-docs run the red flag up the pole and plug their ears when the patient says the all dangerous word; MAOI. MAOIs demand respect and wisdom, but they are powerful meds; albeit with a lot of side effects.

Clearly, adding agomelatine with Nardil has risk. But, if done very carefully, a prudent patient and p-doc can use very small doses with rigorous blood pressure monitoring to determine a safe dosage (if any). The combination clearly needs to be treated with respect, in the same way that adding a pstim to an MAOI must be treated with respect.

As I'm sure you know, Parnate is typically more prone to producing a hypertensive crisis than Nardil. So, even if I do find success combining agomelatine with Nardil, that does not mean it can safely be combined with Parnate.

Nice talking to you, IP. I will post if I am allowed to give the combination a trial.

-- Ron

 

Re: Agomelatine add-on to Nardil » Bob

Posted by Ron Hill on July 2, 2010, at 3:00:52

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by Bob on July 2, 2010, at 1:22:46

> Wow, 6 phase III trials? It sounds like the efficacy is questionable.

I gave the wrong impression. Three of the trials clearly showed efficacy. For example, one study showed that agomelatine has as a similar antidepressant effect as the trial comparisons, Paxil and Zoloft. The other three Phase III trials were more questionable, as stated here:

http://wapedia.mobi/en/Agomelatine#1.

<Start Quote>

Although some controlled studies in humans have shown that agomelatine is as effective as the SSRI antidepressants paroxetine and sertraline in the treatment of major depression [8] , there are unpublished randomised controlled trials which have failed to show that agomelatine is more effective than placebo [9] [9] . Agomelatine appears to cause fewer sexual side effects and discontinuation effects than sertraline and paroxetine. Additionally, possibly because of its action on melatonin receptors, agomelatine appears to improve sleep quality, with no reported daytime drowsiness [7] . Agomelatine has demonstrated anxiolytic properties [10] . Its efficacy in generalized anxiety disorder has been assessed by Stein et al (2008) who reported it significantly more effective than placebo treatment. [11]

<Stop Quote>


>I don't understand how drug after drug like this one get approved in Europe but then don't make it to approval over here.

It was difficult to get it approved in the EU as well:

http://wapedia.mobi/en/Agomelatine

<Start Quote>

Agomelatine was discovered and developed by the European pharmaceutical company Servier Laboratories Ltd. Servier continued to develop the drug and conduct phase III trials in the European Union. In March 2005 Servier submitted agomelatine to the European Medicines Agency (EMEA) under the trade names Valdoxan and Thymanax. [12] On 27 July 2006 the Committee for Medical Products for Human Use (CHMP) of the EMEA recommended a refusal of the marketing authorisation of Valdoxan/Thymanax (agomelatine). The major concern was that efficacy had not been sufficiently shown. The CHMP had no special concerns about the side effects. [12] In September 2007, Servier submitted a new marketing application for Valdoxan (agomelatine) to the EMEA. [13] On 20 November 2008, Valdoxan was given a positive opinion, with restrictions, [14] by the EMEA [13] , and was subsequently given marketing authorisation in the European Union on 20 February 2009. [15] Release dates for agomelatine will depend on marketing arrangements in the individual countries of the EU.

In March 2006, Servier announced it had sold the rights to market agomelatine in the United States to Novartis. [16] Agomelatine is currently undergoing phase III clinical trials in the US. [17]

Novartis currently lists the drug as scheduled for submission to the FDA no earlier than 2012.

<Stop Quote>

I feel sure agomelatine will be approved in the U.S.

Keep in mind that I am interested in agomelatine for its potential treatment of circadian rhythm problems in hopes that it will reduce the severity of my bipolar II ultra rapid cycling (15 day cycle; 9 days in full remission and 6 days in debilitating depression. The 15 day cycle repeats over and over and ... without end).

Nardil is my heavy-hitter antidepressant, and I must keep it on board. The puny amount of antidepressant effect that I expect to be contributed by agomelatine will be just gravy on my Nardil meat and potatoes.

> I wasn't aware that a 3-month supply could be obtained from my doctor like that. Thanks for the info.

You bet.

-- Ron

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on July 2, 2010, at 4:49:36

In reply to Re: A thread for SLS, posted by ed_uk2010 on June 27, 2010, at 15:26:15

Ed,

I'm sure you would do this without me stating it, but I'll mention it anyway. {Can you say OCPD?}

After you enter the following link as a medical professional, click on the links along the header. The good information are presented in links on the pages that come up after clicking on the header options.

http://www.valdoxan.co.uk/landing.aspx?redirect=/frequently-asked-questions-about-Valdoxan.aspx

Sorry to be anal. I just wanted to make sure you found the good stuff. {Can you say OCPD?}

-- Ron

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on July 2, 2010, at 5:30:56

In reply to Re: A thread for SLS, posted by ed_uk2010 on June 27, 2010, at 15:26:15

Ed,

Add to previous post from me to you.

Opps! Links at the bottom of pages, as well. From an OCPD pt, over-and-out.

-- Ron

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by ed_uk2010 on July 2, 2010, at 17:36:29

In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on July 1, 2010, at 21:48:15

Hi Ron,

>Can Valdoxan be combined with Nardil (phenelzine), if done carefully under the direct supervision and care of a qualified psychiatrist?

There is no evidence to support the safety of this combination, nor is there any evidence to support its efficacy. It simply hasn't received any study whatsoever. There are no reports of interactions.

>Since Valdoxan is an antagonist of post-synaptic 5-HT2c receptors; does the disinhibition (NDDI), resulting in the release of dopamine and norepinephrine in the frontal cortex, cause an unacceptable risk of a hypertensive crisis when 25 mg/day of Valdoxan is added to 90 mg/day of Nardil?

I can only make an educated guess. My guess is that there is no increased risk of hypertension with this combination. MAOI-associated hypertensive crisis is believed to occur due to peripheral adrenergic stimulation when interacting drugs/foods have been administered. It is not due to dopamine or NE being released in the frontal cortex.

>I would start by trying ¼ of a 25 mg tablet. I would monitor my blood pressure continually for the first couple of hours, and I would have one of my nifedipine capsules close at hand.

Starting with a low dose of agomelatine would be very sensible. Limited (in vitro) evidence suggests that Nardil inhibits various drug-metabolising enzymes, including CYP 1A2. Agomelatine is metabolised predominantly by CYP 1A2. If Nardil does indeed inhibit CYP 1A2, exposure to agomelatine would be substantially increased. This could lead to an increased risk of adverse effects from agomelatine eg. daytime drowsiness, nausea and possibly liver dysfunction. I would certainly recommend liver function tests prior to and during treatment with agomelatine. The initial pre-treatment test would be vital to establish a baseline.

>............If the above is true, agomelatine would improve the effectiveness of Nardil.

Possibly. I find it very difficult to say whether combined use is likely to be beneficial. If agomelatine metabolism was inhibited by Nardil, constant high levels of agomelatine may further disrupt circadian rhythms. The 5-HT2c antagonism may be beneficial but I'm not sure that the benefit would be robust.

In summary, I would only recommend this combination if other options have not been effective. So... I guess you are a candidate for treatment! Cautiously, of course.

By the way, are you sure that the Keppra is helping? Evidence of Keppra's efficacy in psych disorders is very limited.....and it seems to cause psychiatric adverse reactions quite frequently in its own right. Pehaps you should consider dropping the Keppra before adding any further medications? In some cases, complex polypharmacy can lead to more problems than it solves.

Best regards,

Ed

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by inanimate peanut on July 2, 2010, at 18:54:45

In reply to Re: Agomelatine add-on to Nardil » inanimate peanut, posted by Ron Hill on July 2, 2010, at 2:03:13

I wasn't aware that Parnate use made you more prone to a hypertensive crisis than Nardil use. Do you know why that is?

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on August 15, 2010, at 0:14:12

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by ed_uk2010 on July 2, 2010, at 17:36:29

Ed,

Just a brief follow up.

About two weeks ago, I added 25 mg of Valdoxan (agomelatine) to my combo (combo listed below). No increase in blood pressure, and I really like the med. It feels like a mild antidepressant with a moodstablizer. But, the main thing is it's a great tx for circadian rhythm dysfunction and, therefore, a great tx for bipolar disorder.

500 mg/day of Keppra is very beneficial to me. However, 1000 mg/day causes depression.

-- Ron

dx: Bipolar II with ultra rapid cycling, and mild OCPD

600 mg/day oxcarbazepine (Trileptal)
200 mg/day lamotrigine (Lamictal)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
25 mg/day Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)

45 ml of Carlsons Bottled Fish Oil
100 mg/day phosphatidylserene
Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins; NO VANADIUM!!
2000 IU Vitamin E
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate).
Dark therapy via LowBlueLight glasses (When I remember)


Whats next to add?:

300 mg/day of lithum carbonate
CoQ10
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
GTF Chromium
Cromium Picolinate
Cinnamon



---------------------------
> Hi Ron,
>
> >Can Valdoxan be combined with Nardil (phenelzine), if done carefully under the direct supervision and care of a qualified psychiatrist?
>
> There is no evidence to support the safety of this combination, nor is there any evidence to support its efficacy. It simply hasn't received any study whatsoever. There are no reports of interactions.
>
> >Since Valdoxan is an antagonist of post-synaptic 5-HT2c receptors; does the disinhibition (NDDI), resulting in the release of dopamine and norepinephrine in the frontal cortex, cause an unacceptable risk of a hypertensive crisis when 25 mg/day of Valdoxan is added to 90 mg/day of Nardil?
>
> I can only make an educated guess. My guess is that there is no increased risk of hypertension with this combination. MAOI-associated hypertensive crisis is believed to occur due to peripheral adrenergic stimulation when interacting drugs/foods have been administered. It is not due to dopamine or NE being released in the frontal cortex.
>
> >I would start by trying ¼ of a 25 mg tablet. I would monitor my blood pressure continually for the first couple of hours, and I would have one of my nifedipine capsules close at hand.
>
> Starting with a low dose of agomelatine would be very sensible. Limited (in vitro) evidence suggests that Nardil inhibits various drug-metabolising enzymes, including CYP 1A2. Agomelatine is metabolised predominantly by CYP 1A2. If Nardil does indeed inhibit CYP 1A2, exposure to agomelatine would be substantially increased. This could lead to an increased risk of adverse effects from agomelatine eg. daytime drowsiness, nausea and possibly liver dysfunction. I would certainly recommend liver function tests prior to and during treatment with agomelatine. The initial pre-treatment test would be vital to establish a baseline.
>
> >............If the above is true, agomelatine would improve the effectiveness of Nardil.
>
> Possibly. I find it very difficult to say whether combined use is likely to be beneficial. If agomelatine metabolism was inhibited by Nardil, constant high levels of agomelatine may further disrupt circadian rhythms. The 5-HT2c antagonism may be beneficial but I'm not sure that the benefit would be robust.
>
> In summary, I would only recommend this combination if other options have not been effective. So... I guess you are a candidate for treatment! Cautiously, of course.
>
> By the way, are you sure that the Keppra is helping? Evidence of Keppra's efficacy in psych disorders is very limited.....and it seems to cause psychiatric adverse reactions quite frequently in its own right. Pehaps you should consider dropping the Keppra before adding any further medications? In some cases, complex polypharmacy can lead to more problems than it solves.
>
> Best regards,
>
> Ed

 

Re: Agomelatine add-on to Nardil » Ron Hill

Posted by ed_uk2010 on August 15, 2010, at 7:06:30

In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on August 15, 2010, at 0:14:12

Hi Ron,

Glad that agomelatine is helping. Will you stay at 25mg? I imagine you are paying a lot for it even at this dose. Which country has it come from? UK?

>500 mg/day of Keppra is very beneficial to me. However, 1000 mg/day causes depression.

What symptoms does it help? Have you tried 250mg per day? eg. 125mg BID.

>300 mg/day of lithum carbonate

Have you tried lithium before? I can't remember.

 

Re: Agomelatine add-on to Nardil » inanimate peanut

Posted by Ron Hill on August 16, 2010, at 16:50:03

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by inanimate peanut on July 2, 2010, at 18:54:45

> I wasn't aware that Parnate use made you more prone to a hypertensive crisis than Nardil use. Do you know why that is?
-----------------------------------
inanimate peanut,

I do not know the answer, but someone else on the board might know.

-- Ron

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on August 16, 2010, at 18:05:25

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by ed_uk2010 on August 15, 2010, at 7:06:30

Ed,

> Glad that agomelatine is helping.

Thanks. I forget if I said it above, but Valdoxan (agomelatine) is tx for my circadian rhythms which, in turn, is an effective tx of my bipolar II disorder and my associated ultra rapid cycling. I'm only two weeks into my Valdoxan trial, so it's too soon to predict the long-term effectiveness. But, so far, it "feels" very good.

> Will you stay at 25mg?

I hope I won't need 50 mg/night due to the cost.

> I imagine you are paying a lot for it even at this dose.

Not bad for a new medication, but expensive because my insurance company does not pay for meds that are not U.S. FDA approved. 28 tabs of 25 mg each costs $90 plus $7 shipping.

> Which country has it come from? UK?

My p-doc and I obtain three months supply per order from an on-line pharmacy in accordance with U.S. FDA rules. I don't know which country the pharmacy gets it from, but they arrive sealed in the original Valdoxan boxes. The on-line pharmacy is very trustworthy but, of course, I can't give the URL on this site.

>> 500 mg/day of Keppra is very beneficial to me. However, 1000 mg/day causes depression.

> What symptoms does it help?

Moodstabilization and antidepressant. The latter surprised me. But according to my mood tracking chart, it's true.

> Have you tried 250mg per day? eg. 125mg BID.

Yes, but the antidepressant effect is reduced.

> > 300 mg/day of lithium carbonate

> Have you tried lithium before? I can't remember.

Yes, I took it for many moons about 10 years ago. It provides mood stabilization at about 600 mg/day. But, AED's are the better moodstabilizers for me as a Bipolar II. Lithobid never provided any antidepressant effect for me. I want to add 300 mg/day primarily for its neurotrophic benefits.

 

Re: Agomelatine add-on to Nardil » ed_uk2010

Posted by Ron Hill on August 16, 2010, at 20:10:15

In reply to Re: Agomelatine add-on to Nardil » Ron Hill, posted by ed_uk2010 on August 15, 2010, at 7:06:30

Ed and PB Archives:

For the record, Valdoxan (agomelatine) start-up side effects consisted of difficulty going to sleep, choppy sleep throughout the night, sleeping close to the surface of wakefulness, and nightmares.

These side effects subsided for me within the first four days.

As I write this, I am two weeks into my Valdoxan trial, and I am sleeping very well. I wake only to use the restroom, and I quickly fall back to sleep.

-- Ron


dx: Bipolar II with ultra rapid cycling, and mild OCPD

600 mg/day oxcarbazepine (Trileptal)
200 mg/day lamotrigine (Lamictal)
500 mg/day Keppra (levetiracetam)
90 mg/day Nardil (phenelzine)
25 mg/day Valdoxan (agomelatine)
3.75 mg/day Deplin (taken with 2500 mcg/day of sublingual methyl B-12, and 12.5mg/day of sublingual P-5-P)

45 ml of Carlsons Bottled Fish Oil
100 mg/day phosphatidylserene
Centrum Chewable Multi-vitamins; Only 100% of all the usual vitamins; NO VANADIUM!!
2000 IU Vitamin E
850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate).
Dark therapy via LowBlueLight glasses (When I remember)


Whats next to add?:

300 mg/day of Lithobid
CoQ10
NAC, + 8 to 10 glasses of water, + Acetyl-L-Carnitine, + Alpha-Lipoic Acid, + Vitamin C
GTF Chromium
Cromium Picolinate
Cinnamon


-- Ron

 

Re: Agomelatine add-on to Nardil

Posted by Diego11 on April 18, 2012, at 6:35:58

In reply to Re: Agomelatine add-on to Nardil » ed_uk2010, posted by Ron Hill on July 1, 2010, at 21:48:15

Hi, I wonder, If anyone here has tried this combination with Nardil ?

I am just taking 75mg of Nardil and with 25mg of Valdoxan(agomelatine) and l am planning to go up to 50 mg. My doctor assumes that this combo would help me better sleeping and also help to raise/improve my low blood pressure and also he believes that agomelatine to get me the same stimulant effect as on beginning of treatment(it would supposedly help me to activate and get me back energy feeling).

I also wonder, if there is any psychological study/research about possibility of treatment option with Agomelatine + Nardil ?


Thank you in advance for any advice or comments for this thread...

 

1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11 » Diego11

Posted by Ron Hill on April 27, 2012, at 3:33:36

In reply to Re: Agomelatine add-on to Nardil, posted by Diego11 on April 18, 2012, at 6:35:58

> Hi, I wonder, If anyone here has tried this combination with Nardil?

> I am just taking 75mg of Nardil and with 25mg of Valdoxan(agomelatine) and l am planning to go up to 50 mg.

> My doctor assumes that this combo would help me better sleeping and also help to raise/improve my low blood pressure and also he believes that agomelatine to get me the same stimulant effect as on beginning of treatment(it would supposedly help me to activate and get me back energy feeling).

-------------------------
Diego11,

I have been taking Valdoxan (agomelatine) with Nardil (phenelzine) and the rest of my combo for about 2 years with excellent results.

What is your dx? What are you attempting to treat; depression? Are you taking any other medications besides Nardil and Valdoxan? If so, what are they?

It is just my opinion, but I think you should stay at 25 mg/night of Valdoxan for more time to see if 25 is enough. I suspect 25 will do it for you. However, Id recommend that you increase your Nardil to 90 mg/day. Technically, the literature says that the effective dosage of Nardil is 1 mg of Nardil per kg of body weight. But, 90 mg/day is the dosage that often works best for patients in general.

Your p-docs belief that Valdoxan provides a stimulant effect is contrary to Section 4.8 Undesirable Effects in the Valdoxan Prescribing Information document. Section 4.8 lists somnolence, not stimulation, as a common Undesired Effect. Valdoxan caused daytime sleepiness (somnolence) for me and, therefore, I added 20 mg/day of generic Dexedrine Spanules to overcome the daytime sleepiness. Here is the link to the Valdoxan Prescribing Information document:

http://www.servier.co.uk/pdfs/Valdoxan_SPC.pdf

Further, here is the Valdoxan web site:

http://www.servier.co.uk/products/valdoxan/Professional/Home.aspx

I can not overstate my thankfulness for Valdoxan. This medication took away my bipolar ultra rapid cycling and gave me back my life. Here is a brief discussion of my ordeal and how Valdoxan solved the problem.

About 16 years ago, an inept p-doc misdiagnosed me as ADHD and put me on Ritalin and Paxil. Since I'm bipolar, the meds caused me to become an ultra rapid cycler with a cycle of 15 days; consisting of 6 days of debilitating hellacious depression, followed by 9 days of normal mood.

The ultra rapid cycling never stopped. As soon as my 9 normal days were over, my six days of depression would start; and on-and-on non-stop for 14 years.

During the 14 years I tried various medications in an attempt to stop my ultra rapid cycling. Nothing worked until the first part of August in 2010 when I added 25 mg/night of Valdoxan (agomelatine).

When I added Valdoxan to my existing combo, my ultra rapid cycling stopped along with the related depression and hypomania.

Since I began taking Valdoxan roughly two years ago, I have been in full remission, with the caveat that in addition to taking all of my meds, I must also take my vitamins and supplements.

If I do not take my vitamins and supplements daily, I become depressed. No ultra rapid cycling, but a moderate depression consisting primarily of amotivation.

Below is a list of my meds, and my vitamins and supplements.

-- Ron


Medications:

200 mg/day lamotrigine
http://us.gsk.com/products/assets/us_lamictal.pdf

600 mg/day oxcarbazepine
http://www.pharma.us.novartis.com/product/pi/pdf/trileptal.pdf

500 mg/day Keppra
http://www.keppra.com/pc/global/Keppra_Full_PI.pdf

90 mg/day Nardil
http://www.pfizer.com/files/products/uspi_nardil.pdf

20 mg/day Dexedrine spanules
http://www.gsksource.com/gskprm/htdocs/documents/DEXEDRINE-PI-MG.PDF

7.5 mg/day Deplin
http://www.deplin.com/

25 mg/day Valdoxan (agomelatine)
http://www.servier.co.uk/products/valdoxan/


Vitamins and Supplements:

5000 mcg/day of sublingual methylcobalamin
http://www.iherb.com/Source-Naturals-MethylCobalamin-Cherry-Flavored-5-mg-60-Tablets/1461?at=0

25 mg/day of sublingual P-5-P
http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-Sublingual-120-Tablets/1038?at=0

850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
http://www.iherb.com/Source-Naturals-Magnesium-Malate-1-250-mg-360-Tablets/19154?at=0

One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
http://www.iherb.com/Garden-of-Life-Raw-One-for-Men-75-UltraZorbe-Vegan-Caps/18251?at=0

60 ml/day (= ¼ cup) of Bottled Fish Oil
http://www.iherb.com/Carlson-Labs-The-Very-Finest-Fish-Oil-Orange-Flavor-16-9-fl-oz-500-ml/7799?at=0

200 mg/day phosphatidylserene
http://www.iherb.com/Source-Naturals-Phosphatidyl-Serine-100-100-mg-60-Capsules/1454?at=0

2000 IU/day Vitamin D-3
http://www.iherb.com/Source-Naturals-Vitamin-D-3-1000-IU-200-Tablets/1216?at=0

600 mcg/day Chromium Picolinate
http://www.iherb.com/Nature-s-Way-Chromium-Picolinate-200-mcg-100-Capsules/1879?at=0

200 mcg/day GTF Chromium
http://www.iherb.com/Nature-s-Way-GTF-Chromium-Polynicotinate-100-Capsules/1918?at=0

1000 mg/day Cinnamon
http://www.iherb.com/Solgar-Full-Potency-Herbs-Cinnamon-100-Veggie-Caps/12156?at=0

600 mg/day N-Acetyl-L-cysteine (NAC)
http://www.iherb.com/Jarrow-Formulas-N-A-C-Sustain-600-mg-100-Bilayer-Tablets/135?at=0

250 mg/day Acetyl-L-Carnitine
http://www.iherb.com/Jarrow-Formulas-Acetyl-L-Carnitine-250-250-mg-120-Capsules/175?at=0

300 mg/day Alpha-Lipoic Acid
http://www.iherb.com/Jarrow-Formulas-Alpha-Lipoic-Sustain-300-with-Biotin-300-mg-120-Bilayer-Tablets/24411?at=0

500 mg/day L-Arginine
http://www.iherb.com/Jarrow-Formulas-Arginine-1000-1000-mg-100-Easy-Solv-Tablets/146?at=0

200 mg/day Co-Q10
http://www.iherb.com/Jarrow-Formulas-Co-Q10-200-200-mg-60-Capsules/224?at=0

2 g Vitamin C
http://www.iherb.com/Allergy-Research-Group-Nutricology-Pure-Vitamin-C-100-Capsules/3449?at=0

8 to 10 glasses of water


Article
http://biogaba.com/images/nutrients_botanicals_stress.pdf


 

Re: 1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11 » Ron Hill

Posted by SLS on April 27, 2012, at 5:31:23

In reply to 1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11 » Diego11, posted by Ron Hill on April 27, 2012, at 3:33:36

Hi Ron.

It was very generous of you to post this.

At what times during the day do you take the amphetamine? Are you satisfied with the results?

Nice seeing you.


- Scott

> > Hi, I wonder, If anyone here has tried this combination with Nardil?
>
> > I am just taking 75mg of Nardil and with 25mg of Valdoxan(agomelatine) and l am planning to go up to 50 mg.
>
> > My doctor assumes that this combo would help me better sleeping and also help to raise/improve my low blood pressure and also he believes that agomelatine to get me the same stimulant effect as on beginning of treatment(it would supposedly help me to activate and get me back energy feeling).
>
> -------------------------
> Diego11,
>
> I have been taking Valdoxan (agomelatine) with Nardil (phenelzine) and the rest of my combo for about 2 years with excellent results.
>
> What is your dx? What are you attempting to treat; depression? Are you taking any other medications besides Nardil and Valdoxan? If so, what are they?
>
> It is just my opinion, but I think you should stay at 25 mg/night of Valdoxan for more time to see if 25 is enough. I suspect 25 will do it for you. However, Id recommend that you increase your Nardil to 90 mg/day. Technically, the literature says that the effective dosage of Nardil is 1 mg of Nardil per kg of body weight. But, 90 mg/day is the dosage that often works best for patients in general.
>
> Your p-docs belief that Valdoxan provides a stimulant effect is contrary to Section 4.8 Undesirable Effects in the Valdoxan Prescribing Information document. Section 4.8 lists somnolence, not stimulation, as a common Undesired Effect. Valdoxan caused daytime sleepiness (somnolence) for me and, therefore, I added 20 mg/day of generic Dexedrine Spanules to overcome the daytime sleepiness. Here is the link to the Valdoxan Prescribing Information document:
>
> http://www.servier.co.uk/pdfs/Valdoxan_SPC.pdf
>
> Further, here is the Valdoxan web site:
>
> http://www.servier.co.uk/products/valdoxan/Professional/Home.aspx
>
> I can not overstate my thankfulness for Valdoxan. This medication took away my bipolar ultra rapid cycling and gave me back my life. Here is a brief discussion of my ordeal and how Valdoxan solved the problem.
>
> About 16 years ago, an inept p-doc misdiagnosed me as ADHD and put me on Ritalin and Paxil. Since I'm bipolar, the meds caused me to become an ultra rapid cycler with a cycle of 15 days; consisting of 6 days of debilitating hellacious depression, followed by 9 days of normal mood.
>
> The ultra rapid cycling never stopped. As soon as my 9 normal days were over, my six days of depression would start; and on-and-on non-stop for 14 years.
>
> During the 14 years I tried various medications in an attempt to stop my ultra rapid cycling. Nothing worked until the first part of August in 2010 when I added 25 mg/night of Valdoxan (agomelatine).
>
> When I added Valdoxan to my existing combo, my ultra rapid cycling stopped along with the related depression and hypomania.
>
> Since I began taking Valdoxan roughly two years ago, I have been in full remission, with the caveat that in addition to taking all of my meds, I must also take my vitamins and supplements.
>
> If I do not take my vitamins and supplements daily, I become depressed. No ultra rapid cycling, but a moderate depression consisting primarily of amotivation.
>
> Below is a list of my meds, and my vitamins and supplements.
>
> -- Ron
>
>
> Medications:
>
> 200 mg/day lamotrigine
> http://us.gsk.com/products/assets/us_lamictal.pdf
>
> 600 mg/day oxcarbazepine
> http://www.pharma.us.novartis.com/product/pi/pdf/trileptal.pdf
>
> 500 mg/day Keppra
> http://www.keppra.com/pc/global/Keppra_Full_PI.pdf
>
> 90 mg/day Nardil
> http://www.pfizer.com/files/products/uspi_nardil.pdf
>
> 20 mg/day Dexedrine spanules
> http://www.gsksource.com/gskprm/htdocs/documents/DEXEDRINE-PI-MG.PDF
>
> 7.5 mg/day Deplin
> http://www.deplin.com/
>
> 25 mg/day Valdoxan (agomelatine)
> http://www.servier.co.uk/products/valdoxan/
>
>
> Vitamins and Supplements:
>
> 5000 mcg/day of sublingual methylcobalamin
> http://www.iherb.com/Source-Naturals-MethylCobalamin-Cherry-Flavored-5-mg-60-Tablets/1461?at=0
>
> 25 mg/day of sublingual P-5-P
> http://www.iherb.com/Source-Naturals-Coenzymated-B-6-25-mg-Sublingual-120-Tablets/1038?at=0
>
>
>
> 850 mg/day of Mg 212% of RDA (as 5 grams of Mg Malate)
> http://www.iherb.com/Source-Naturals-Magnesium-Malate-1-250-mg-360-Tablets/19154?at=0
>
>
>
> One Multi-vitamin/day; Only 100% of all the usual vitamins; Look for good chelations. NO VANADIUM!!
> http://www.iherb.com/Garden-of-Life-Raw-One-for-Men-75-UltraZorbe-Vegan-Caps/18251?at=0
>
>
>
> 60 ml/day (= ¼ cup) of Bottled Fish Oil
> http://www.iherb.com/Carlson-Labs-The-Very-Finest-Fish-Oil-Orange-Flavor-16-9-fl-oz-500-ml/7799?at=0
>
>
>
> 200 mg/day phosphatidylserene
> http://www.iherb.com/Source-Naturals-Phosphatidyl-Serine-100-100-mg-60-Capsules/1454?at=0
>
>
>
> 2000 IU/day Vitamin D-3
> http://www.iherb.com/Source-Naturals-Vitamin-D-3-1000-IU-200-Tablets/1216?at=0
>
> 600 mcg/day Chromium Picolinate
> http://www.iherb.com/Nature-s-Way-Chromium-Picolinate-200-mcg-100-Capsules/1879?at=0
>
>
>
> 200 mcg/day GTF Chromium
> http://www.iherb.com/Nature-s-Way-GTF-Chromium-Polynicotinate-100-Capsules/1918?at=0
>
> 1000 mg/day Cinnamon
> http://www.iherb.com/Solgar-Full-Potency-Herbs-Cinnamon-100-Veggie-Caps/12156?at=0
>
>
>
> 600 mg/day N-Acetyl-L-cysteine (NAC)
> http://www.iherb.com/Jarrow-Formulas-N-A-C-Sustain-600-mg-100-Bilayer-Tablets/135?at=0
>
> 250 mg/day Acetyl-L-Carnitine
> http://www.iherb.com/Jarrow-Formulas-Acetyl-L-Carnitine-250-250-mg-120-Capsules/175?at=0
>
> 300 mg/day Alpha-Lipoic Acid
> http://www.iherb.com/Jarrow-Formulas-Alpha-Lipoic-Sustain-300-with-Biotin-300-mg-120-Bilayer-Tablets/24411?at=0
>
> 500 mg/day L-Arginine
> http://www.iherb.com/Jarrow-Formulas-Arginine-1000-1000-mg-100-Easy-Solv-Tablets/146?at=0
>
> 200 mg/day Co-Q10
> http://www.iherb.com/Jarrow-Formulas-Co-Q10-200-200-mg-60-Capsules/224?at=0
>
> 2 g Vitamin C
> http://www.iherb.com/Allergy-Research-Group-Nutricology-Pure-Vitamin-C-100-Capsules/3449?at=0
>
> 8 to 10 glasses of water
>
>
> Article
> http://biogaba.com/images/nutrients_botanicals_stress.pdf
>
>
>

 

Dex Spanules » SLS

Posted by Ron Hill on April 27, 2012, at 6:45:41

In reply to Re: 1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11 » Ron Hill, posted by SLS on April 27, 2012, at 5:31:23

> At what times during the day do you take the amphetamine?

In the morning. I take the generic version of Dex spanules, so it is slow release.

> Are you satisfied with the results?

Yep. As you know, Dex is the safest pstim to take with an MAOI. Plus, dex has a smooth action.

But, the exciting news is your level of wellness.

Yippee Skippie!!!!

-- Ron

 

Re: Dex Spanules

Posted by SLS on April 27, 2012, at 7:08:10

In reply to Dex Spanules » SLS, posted by Ron Hill on April 27, 2012, at 6:45:41

> > At what times during the day do you take the amphetamine?
>
> In the morning. I take the generic version of Dex spanules, so it is slow release.
>
> > Are you satisfied with the results?
>
> Yep. As you know, Dex is the safest pstim to take with an MAOI. Plus, dex has a smooth action.
>
> But, the exciting news is your level of wellness.
>
> Yippee Skippie!!!!
>
> -- Ron


<grin>

Thanks.


- Scott

 

Re: 1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11

Posted by lawgrindmeintoground on May 4, 2012, at 18:55:41

In reply to 1) Attn: Bipolar Ultra Rapid Cyclers, 2) Diego11 » Diego11, posted by Ron Hill on April 27, 2012, at 3:33:36

Perhaps it's because I don't get talk to a lot of other bipolar people, but oh my goodness that's a lot of vitamins! I take a b-complex and a multi-vitamin which has most of what you listed in it. Do you find that any of those help? [And I'm assuming the cinnamon is in capsule form, not a teaspoon, haha.] I'm a rapid cycler, too, but mine are usually a couple hours between swings, believe it or not.


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