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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Dr. Fischer-Terworth on March 13, 2011, at 5:50:35
Hi,
has anyone an idea about that? I have OCD
(separation anxiety-related, checking and
compulsive reassurance seeking) and I've been responding well to tranylcypromine 40 mg/d for many years. The MAOI helped for minor depressive
symptoms and very well for OCD and anxiety. Because of sleep disorder and mood swings (maybe kind of little hypomanic) agomelatine 25 mg/d was added. With the MAOI on 40 mg the YBOCS-Score
for OCD was about 6 to 8, nearly remission (
10-15 on 30 mg/d).
The agomelatine helped to improve sleep and mood, makes me calm in some way and to enjoy things more that were boring in the "mood crisis".
At the beginning I thought it also helps with
OCD, as 5-HT2c receptor antagonism is also a
feature of some SSRI like Fluoxetine.
But, however, over the months I think that OCD has worsened (YBOCS:15).Can it be that the 5-HT2c antagonism is not good
for OCD as negatively affecting serotonergic
transmission?I'd appreciate to read some answers and idea.
Many thanks,
Christian FT
Posted by Phillipa on March 13, 2011, at 11:08:19
In reply to Agomelatine and Tranylcypromine for OCD, posted by Dr. Fischer-Terworth on March 13, 2011, at 5:50:35
Are you a medical Doctor or PHD? Do you want to combine these meds? As I don't feel this would be safe. Just an opinion. Phillipa
Posted by Dr. Fischer-Terworth on March 13, 2011, at 12:29:29
In reply to Re: Agomelatine and Tranylcypromine for OCD » Dr. Fischer-Terworth, posted by Phillipa on March 13, 2011, at 11:08:19
Hi Philippa,
I have a PhD in psychology and I am also a OCD patient. A medical doctor has recommended the combination and I've discussed it with him. For me the combo is safe after taking it together
for 6 months- but you are right: There
are no studies having dealt with the subject
safety of co-administrated MAOIs and agomelatine.Christian
Are you a medical Doctor or PHD? Do you want to combine these meds? As I don't feel this would be safe. Just an opinion. Phillipa
Posted by sigismund on March 13, 2011, at 13:15:22
In reply to Agomelatine and Tranylcypromine for OCD, posted by Dr. Fischer-Terworth on March 13, 2011, at 5:50:35
>At the beginning I thought it also helps with
OCD, as 5-HT2c receptor antagonism is also a
feature of some SSRI like Fluoxetine.
But, however, over the months I think that OCD has worsened (YBOCS:15).>Can it be that the 5-HT2c antagonism is not good
for OCD as negatively affecting serotonergic
transmission?I am not clear about OCD, but I think you are right. That would be my guess too.
Posted by sigismund on March 13, 2011, at 14:12:49
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by sigismund on March 13, 2011, at 13:15:22
I wonder if the two together would be a bit much?
Posted by linkadge on March 13, 2011, at 17:53:38
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by Dr. Fischer-Terworth on March 13, 2011, at 12:29:29
A 5-ht2c antagonist could theoretically increase OCD like behavior. Although fluoxetine is a 5-ht2c antagonist, it is also a SSRI. In other words, the net effect is 5-h5t2c agonism (I believe). Most SSRIs are 5-ht2c agonists, and there are case reports of drugs like cyproheptadine (combined 5-ht2a/c antagonists) causing relapse in OCD patients on SSRIs. Also, there are reports of 5-ht2a/c agonists like tryptamine, mescaline etc. rapidly improving OCD symptoms.
Another (theoretical) possiblility is potentiation of 5-ht1a mediated neurotransmission and possible serotonin syndrome. If you haven't experienced this yet, the risk seems low. However, since certain sertonergic antagonists (like antipsychotics) can increase 5-ht1a mediated effects when combined with SSRIs, the risk with combination with agomelatine is a possbililty.
You might find that simply taking periodic breaks from the agomelatine (or reducing the dose) is sufficent to regain the anti-ocd effect.
Linkadge
Posted by Franz on March 25, 2011, at 12:27:28
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by linkadge on March 13, 2011, at 17:53:38
> A 5-ht2c antagonist could theoretically increase OCD like behavior. Although fluoxetine is a 5-ht2c antagonist, it is also a SSRI. In other words, the net effect is 5-h5t2c agonism (I believe). Most SSRIs are 5-ht2c agonists, and there are case reports of drugs like cyproheptadine (combined 5-ht2a/c antagonists) causing relapse in OCD patients on SSRIs. Also, there are reports of 5-ht2a/c agonists like tryptamine, mescaline etc. rapidly improving OCD symptoms.
>
> Another (theoretical) possiblility is potentiation of 5-ht1a mediated neurotransmission and possible serotonin syndrome. If you haven't experienced this yet, the risk seems low. However, since certain sertonergic antagonists (like antipsychotics) can increase 5-ht1a mediated effects when combined with SSRIs, the risk with combination with agomelatine is a possbililty.
>
> You might find that simply taking periodic breaks from the agomelatine (or reducing the dose) is sufficent to regain the anti-ocd effect.
>
> LinkadgeI am confused. Why use agomelatine (which I am trying with some problems like short sleep, nightmares, etc.) if fluoxetine is also a 5-ht2c antagonist?. Is it because of the side effects?
Fluoxetine looks like escitalopram+agomelatine and much cheaper. Why are we taking newer and expensive drugs?.
Thanks
Posted by linkadge on March 26, 2011, at 19:01:51
In reply to Re: Agomelatine and Tranylcypromine for OCD » linkadge, posted by Franz on March 25, 2011, at 12:27:28
Well fluoxetine is a very potent SSRI in comparison to its 5-ht2c effects. Also, contrary to its 5-ht2c antaonist effects, fluoxetine usually increases agitation / akathesia.
SSRI action is not desirable for everybody anyhow. So, a relatively selective 5-h2c antagonist is desirable for some.
Linkadge
Posted by sk85 on March 27, 2011, at 14:45:39
In reply to Agomelatine and Tranylcypromine for OCD, posted by Dr. Fischer-Terworth on March 13, 2011, at 5:50:35
>Can it be that the 5-HT2c antagonism is not good
for OCD as negatively affecting serotonergic
transmission?I really don't think that's the case or such generalization can be made. Mirtazapine is also 5-HT2C antagonist and works for OCD as proven by studies. I suffer OCD myself and mirtazapine did slightly improve it and didn't make it worse. I'd rather suspect agomelatine's melatonergic effects which could in some way increase dopamine's effect in particular areas of the brain linked to OCD. But that's also very speculative. And sometimes drugs just do that when you start them, i.e. exacerbate symptoms before improving them. Anafranil made my OCD much worse before significantly improving it.
-Ikaros
Posted by Franz on March 27, 2011, at 16:22:16
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by sk85 on March 27, 2011, at 14:45:39
> >Can it be that the 5-HT2c antagonism is not good
> for OCD as negatively affecting serotonergic
> transmission?
>
> I really don't think that's the case or such generalization can be made. Mirtazapine is also 5-HT2C antagonist and works for OCD as proven by studies. I suffer OCD myself and mirtazapine did slightly improve it and didn't make it worse. I'd rather suspect agomelatine's melatonergic effects which could in some way increase dopamine's effect in particular areas of the brain linked to OCD. But that's also very speculative. And sometimes drugs just do that when you start them, i.e. exacerbate symptoms before improving them. Anafranil made my OCD much worse before significantly improving it.
>
> -IkarosHow long did you have to wait for agomelatine´s good effects?. In almost two weeks I am not getting them. Thanks.
Posted by Dr.Fischer-Terworth on April 3, 2011, at 2:38:20
In reply to Re: Agomelatine and Tranylcypromine for OCD » sk85, posted by Franz on March 27, 2011, at 16:22:16
Hallo,two years ago I noticed by incident that magnesium (300mg) had some beneficial effects on OCD symptoms. First I guessed this could be
imagnination but it is in fact the case because 600 mg Magnesium can reduce compulsive urges
at least to a certain amount.
Now I recognized that adding Magnesium 600 mg to the regimen Tranylcypromine 40 mg+agomelatine 25 mg, it partially may compensate for
the (potential) anti-OCD-effects of agomelatine,
which I attribute to the 5-HT-2c antagonism.It is known that Magnesium it works for depression and it is supposed to be acting via serotonergic pathways although it seems to be unknown which way.As Mg is also a NMDA-antagonist and the NMDA-antagonist Memantine has been used as an augmenter of SSRI in OCD patients being partial responders to SSRI, it might also act that way. Glutamatergic dysfunction (overactivity
in the Thalamus) is associated with OCD (shown at least in children and adolescents) and NMDA-antagonism could also facilitate pro-GABA-ergic effects reducing anxiety.Does anyone have information about magnesiums psychopharmacological profile of action?
Thank you very much for your comments!
Best wishes,Christian
Posted by sk85 on April 3, 2011, at 7:18:11
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by Dr.Fischer-Terworth on April 3, 2011, at 2:38:20
>
> Hallo,
>
> two years ago I noticed by incident that magnesium (300mg) had some beneficial effects on OCD symptoms. First I guessed this could be
> imagnination but it is in fact the case because 600 mg Magnesium can reduce compulsive urges
> at least to a certain amount.
> Now I recognized that adding Magnesium 600 mg to the regimen Tranylcypromine 40 mg+agomelatine 25 mg, it partially may compensate for
> the (potential) anti-OCD-effects of agomelatine,
> which I attribute to the 5-HT-2c antagonism.
>
> It is known that Magnesium it works for depression and it is supposed to be acting via serotonergic pathways although it seems to be unknown which way.As Mg is also a NMDA-antagonist and the NMDA-antagonist Memantine has been used as an augmenter of SSRI in OCD patients being partial responders to SSRI, it might also act that way. Glutamatergic dysfunction (overactivity
> in the Thalamus) is associated with OCD (shown at least in children and adolescents) and NMDA-antagonism could also facilitate pro-GABA-ergic effects reducing anxiety.
>
> Does anyone have information about magnesiums psychopharmacological profile of action?
>
> Thank you very much for your comments!
>
> Best wishes,ChristianI take magnesium 600 mg daily with zinc as a general supplement. But I haven't noticed it being any help for OCD. I have also taken memantine and aswell did not find it helpful. It just might be that OCD can have various different underlying neurochemical forms which all lead to the same end result i.e. OCD symptoms.
-Ikaros
Posted by Phillipa on April 3, 2011, at 19:38:14
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by sk85 on April 3, 2011, at 7:18:11
Take about 300mg mg a day for a different reason regulation if you know what I mean. Magnesium they say is calming and if OCD considered an anxiety disorder maybe that is why? Phillipa
Posted by desolationrower on April 4, 2011, at 0:49:55
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by Dr.Fischer-Terworth on April 3, 2011, at 2:38:20
>
> Hallo,
>
> two years ago I noticed by incident that magnesium (300mg) had some beneficial effects on OCD symptoms. First I guessed this could be
> imagnination but it is in fact the case because 600 mg Magnesium can reduce compulsive urges
> at least to a certain amount.
> Now I recognized that adding Magnesium 600 mg to the regimen Tranylcypromine 40 mg+agomelatine 25 mg, it partially may compensate for
> the (potential) anti-OCD-effects of agomelatine,
> which I attribute to the 5-HT-2c antagonism.
>
> It is known that Magnesium it works for depression and it is supposed to be acting via serotonergic pathways although it seems to be unknown which way.As Mg is also a NMDA-antagonist and the NMDA-antagonist Memantine has been used as an augmenter of SSRI in OCD patients being partial responders to SSRI, it might also act that way. Glutamatergic dysfunction (overactivity
> in the Thalamus) is associated with OCD (shown at least in children and adolescents) and NMDA-antagonism could also facilitate pro-GABA-ergic effects reducing anxiety.
>
> Does anyone have information about magnesiums psychopharmacological profile of action?
>
> Thank you very much for your comments!
>
> Best wishes,ChristianYes, you are right. Like zinc, it can block the calcium flow in NMDA receptors. here is a nice picture http://commons.wikimedia.org/wiki/File:NMDA_receptor.jpg
Most people don't get enough, for mental health as well as regular old body health. blood pressure is another problem from mag deficiency. I notice i get twitchy eye when i don't get enough, like last time i went camping. Improved sleep might affect mental health too, look at this study [1]: most people are mg deficient. when they test depressed people, they have this same sleep pattern. eat your bran, nuts, legumes, cocoa.
-d/r
Effects of a Magnesium Deficient Diet on Sleep Organization in Rats
AbstractThe influence of magnesium, one of the most important cations in the vertebrate body, on the sleep-wakefulness cycle and ECoG patterns in chronically implanted rats recorded during the light period over a 6-hour period was investigated. Two groups of rats were studied. Group 1 (6 rats): after a control period of 2 weeks, the rats were maintained for 9 weeks on a Mg2+-deficient diet. Group 2 (5 rats): after a control period of 2 weeks, the rats were maintained for 7 weeks on a Mg2+-deficient diet followed by 4 weeks on a normal diet (recovery period: weeks 811). Mg2+-deficient diet for 9 weeks induced sleep and ECoG time-dependent alterations. After 67 weeks on a Mg2+-defi-cient diet (n = 11) sleep analysis showed a significant increase of wakefulness (+50%) at the expense of slow wave sleep (24%) but paradoxical sleep was not significantly modified. After 9 weeks of a Mg2+ deficient diet, sleep was desorganized: light sleep and polyspikes occurred indicating an increase in neuronal excitability. When Mg2+ was reintroduced in food and water, sleep organization and ECoG recordings were restored to their original patterns. Our findings which are in line with previous clinical and pharmacological observations provide conclusive arguments for the neuroprotective effect of magnesium ions in neurologic disorders and epileptiform activity. Mg2+ deficiency induces ECoG alterations in the rat which bear some similarities with those seen in neurogenic spasmophilic syndromes in man.
Posted by yearism on September 23, 2013, at 16:57:51
In reply to Re: Agomelatine and Tranylcypromine for OCD » linkadge, posted by Franz on March 25, 2011, at 12:27:28
> > A 5-ht2c antagonist could theoretically increase OCD like behavior. Although fluoxetine is a 5-ht2c antagonist, it is also a SSRI. In other words, the net effect is 5-h5t2c agonism (I believe). Most SSRIs are 5-ht2c agonists, and there are case reports of drugs like cyproheptadine (combined 5-ht2a/c antagonists) causing relapse in OCD patients on SSRIs. Also, there are reports of 5-ht2a/c agonists like tryptamine, mescaline etc. rapidly improving OCD symptoms.
> >
> > Another (theoretical) possiblility is potentiation of 5-ht1a mediated neurotransmission and possible serotonin syndrome. If you haven't experienced this yet, the risk seems low. However, since certain sertonergic antagonists (like antipsychotics) can increase 5-ht1a mediated effects when combined with SSRIs, the risk with combination with agomelatine is a possbililty.
> >
> > You might find that simply taking periodic breaks from the agomelatine (or reducing the dose) is sufficent to regain the anti-ocd effect.
> >
> > Linkadge
>
>
>
> I am confused. Why use agomelatine (which I am trying with some problems like short sleep, nightmares, etc.) if fluoxetine is also a 5-ht2c antagonist?. Is it because of the side effects?
>
> Fluoxetine looks like escitalopram+agomelatine and much cheaper. Why are we taking newer and expensive drugs?.
>
> Thanksthis is all wrong.mcpp which is a typical 5ht2c agonists is used in challenging studies for ocd.ssris dont show an agonist effect on serotonergic receptors.conversely,it has antagonistic effects on ser. receptors in long-term.serotonergic agonism doesnt always mean good clinical results.please read to learn the reliable sources in a careful way!
Posted by Bastiat on October 12, 2013, at 22:43:12
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by yearism on September 23, 2013, at 16:57:51
> > > A 5-ht2c antagonist could theoretically increase OCD like behavior. Although fluoxetine is a 5-ht2c antagonist, it is also a SSRI. In other words, the net effect is 5-h5t2c agonism (I believe). Most SSRIs are 5-ht2c agonists, and there are case reports of drugs like cyproheptadine (combined 5-ht2a/c antagonists) causing relapse in OCD patients on SSRIs. Also, there are reports of 5-ht2a/c agonists like tryptamine, mescaline etc. rapidly improving OCD symptoms.
> > >
> > > Another (theoretical) possiblility is potentiation of 5-ht1a mediated neurotransmission and possible serotonin syndrome. If you haven't experienced this yet, the risk seems low. However, since certain sertonergic antagonists (like antipsychotics) can increase 5-ht1a mediated effects when combined with SSRIs, the risk with combination with agomelatine is a possbililty.
> > >
> > > You might find that simply taking periodic breaks from the agomelatine (or reducing the dose) is sufficent to regain the anti-ocd effect.
> > >
> > > Linkadge
> >
> >
> >
> > I am confused. Why use agomelatine (which I am trying with some problems like short sleep, nightmares, etc.) if fluoxetine is also a 5-ht2c antagonist?. Is it because of the side effects?
> >
> > Fluoxetine looks like escitalopram+agomelatine and much cheaper. Why are we taking newer and expensive drugs?.
> >
> > Thanks
>
> this is all wrong.mcpp which is a typical 5ht2c agonists is used in challenging studies for ocd.ssris dont show an agonist effect on serotonergic receptors.conversely,it has antagonistic effects on ser. receptors in long-term.serotonergic agonism doesnt always mean good clinical results.please read to learn the reliable sources in a careful way!I have a hard time with your statement that in the long-term SSRIs have antagonistic properties on 5-HT receptors. This is vast oversimplification; SSRIs probably do cause down-regulation of some serotonin receptors in the long-term but the truth is we don't actually know the precise mechanism.
However, I also have a hard time seeing how 5-HT2C receptor antagonism would worsen OCD. If anything it should help with OCD but definately not worsen it. Perhaps you are confusing 5-HT2C with 5-HT2A since 5-HT2A receptor agonist (such as psychedelics like psilocybin and LSD) actually have shown relief of OCD. One could argue however that psychedelics also agonize 5-HT2C but the truth is their affinity at 5-HT2C is much less pronounced. I strongly believe that 5-HT2A agonism likely can help reduce OCD but strongly disagree with the statement that 5-HT2C antagonism would worsen it.
Keep in mind that most of this is highly theoretical speculation and the brain is an insanely complex system that happens to have a vastly different structure between individuals.
This is the end of the thread.
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