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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by floatingbridge on August 13, 2011, at 21:48:53
Hi I am attempting a comparison of some of the AP's out there.
I am looking for something that is tranquilizing, but does not
block dopamine (all those d2 and d3 things). At least too
much.Any that effect kappa agonism however slightly. (Or maybe
that is nuts.)Risperidone is sedating, which I like but I feel weighted and cranky, not great for depression. I have three more weeks at a low dosage to go. However, my anxiety is up, and I do not wish to increase my benzodiazepine intake.
At this point, I am researching.
(Abilify and seroquel were no-gos for me.)
Amisulpride and sulpride have appeared on the radar.
I admit to finding these comparisons difficult to do.
Any input regarding mechanisms of effect would be
appreciated, or a profile that might suit my complaints; MDD, anxiety the most plaintive.Thanks.
Posted by Christ_empowered on August 13, 2011, at 22:06:30
In reply to AP mechanisms of effect: Amisulpiride, sulpiride, posted by floatingbridge on August 13, 2011, at 21:48:53
I'm not entirely sure (I get those 2 drugs mixed up), but I think a low dose of amisulrpide is used for depression and people with mostly negative symptoms of schizophrenia. Mildly stimulating, I guess kind of like low-dose Abilify, but w/o the akathisia.
If you're going to be importing pills, flupentixol is worth looking at, too. Nothing special in high doses--EPS, TD, all that--but very low doses are somewhat "activating." Its still a neuroleptic, so it can apparently be used for depression and anxiety w/o setting off mania. I don't think it even causes akathisia in the lower doses used for mood disorders, but I'm not sure.
Good luck!
Posted by Phillipa on August 13, 2011, at 23:47:53
In reply to Re: AP mechanisms of effect: Amisulpiride, sulpiride, posted by Christ_empowered on August 13, 2011, at 22:06:30
FB think it could be the Emsam? Just a thought. Gonna research Sunny Love Phillipa
Posted by floatingbridge on August 14, 2011, at 2:41:43
In reply to Re: AP mechanisms of effect: Amisulpiride, sulpiride, posted by Christ_empowered on August 13, 2011, at 22:06:30
Thanks CE.
I'll look. I'm rethinking jettisoning the whole thing. I think the 'crankiness' I feel is is a low akathisia. Which is both a relief to realize and a disappointment.
At least when I call the doc on Monday, I can use that serviceable term. When I saw him I said I felt cranky but that could be because I have enough energy to feel cranky. Just a guess.
But I had felt better cutting my dose back in anticipation of stopping. Now the cranky is back.
Can one feel sedated and akathisia at the same time?
> I'm not entirely sure (I get those 2 drugs mixed up), but I think a low dose of amisulrpide is used for depression and people with mostly negative symptoms of schizophrenia. Mildly stimulating, I guess kind of like low-dose Abilify, but w/o the akathisia.
>
> If you're going to be importing pills, flupentixol is worth looking at, too. Nothing special in high doses--EPS, TD, all that--but very low doses are somewhat "activating." Its still a neuroleptic, so it can apparently be used for depression and anxiety w/o setting off mania. I don't think it even causes akathisia in the lower doses used for mood disorders, but I'm not sure.
>
> Good luck!
Posted by bleauberry on August 14, 2011, at 8:36:15
In reply to AP mechanisms of effect: Amisulpiride, sulpiride, posted by floatingbridge on August 13, 2011, at 21:48:53
I can't really comment on mechanisms because from what I have seen they don't do a good job of predicting how well, or not well, a med will work with any particular person. There are too many other unknowns about these meds, as well as individual biochemistry, for me to put a whole lot of faith in the mechanisms we are aware of.
That said, there are only 2 APs I favor. Zyprexa or amisulpride. Sometimes abilify. Zyprexa is the king as far as I am concerned. The other me-too copycats don't come close. imo. Amisulpride is unique in that the mechanism can be adjusted depending on the size of the dose. Higher doses are more AP-like, while lower doses are more stimulant-like, and you can find a middle window that is mix of both. I found it calming yet somewhat energizing. Its antidepressant and dysthymia effects are well known. From my own personal experience with it, I would say it was a mild antidepressant, stronger on anhedonia than anything else, and somehow increased my appetite and weight a little bit which was good. That was unexpected because it doesn't have any mechanisms I am aware of that should do that (back to the mechanisms thing). Weight gain is not a common issue with it. Of course, I'm only talking a couple pounds.
Risperdal I think, with depression patients anyway, imo has its best potential at very low doses in combination with antidepressants that hit both serotonin and norepinephrine. It seems to combine well with paxil or milnacipran in overseas studies. I have never heard of it doing a good job all by itself. Which is in contrast to zyprexa or amisupride, where I have heard plenty of stories of them doing good all by themselves.
So anyway that's my 2 cents worth. Zyprexa or amisulpride,
It also needs to be revisited why an AP in the first place? I mean, if anxiety is the issue, there are a lot better things that don't even require a doctor or a prescription.
Posted by floatingbridge on August 14, 2011, at 16:25:58
In reply to Re: AP mechanisms of effect: Amisulpiride, sulpiride, posted by Christ_empowered on August 13, 2011, at 22:06:30
CE,
I am so tired of med trials. When do you think you start lamictal? I would be very interested in your report. The/my depression is just awful.
Posted by Phillipa on August 14, 2011, at 19:16:03
In reply to Lamictal » Christ_empowered, posted by floatingbridge on August 14, 2011, at 16:25:58
FB it is? I thought improving? So going to take lamictal? Love Phillipa
Posted by floatingbridge on August 14, 2011, at 19:29:50
In reply to Re: Lamictal » floatingbridge, posted by Phillipa on August 14, 2011, at 19:16:03
> FB it is? I thought improving? So going to take lamictal? Love Phillipa
Hi Phillipa,
Who knows? Still desperately searching a cure for desperation. I mean, things are better than they were a month ago, that's for sure.
I am dissappointed by what seems another med trial failure.
Everything takes so long. I am not big on patience, considering I feel like I have been abiding so long.
Jeez, last year, if I had been on 2mg Xanax per day, well, it would have been far more effective. Now, I don't know. The ante has been upped somehow. But I can't just take more Xanax. I think it was upped to 2mg just to get the
withdrawals to stop.That experience did something to me. I am like a shell. I had troubles before, and probably, google back three years and my posts read exactly the same. But I took way less Xanax.
And I am better than a month ago, but I am not getting the same response to Emsam like the first time. I'm up to 9mg now. Not the smallest benign hypomania.
Therapy? Exercise.
I'm not changing my meds for the next three weeks unless the doc suggests it. So just research.
Posted by Christ_empowered on August 14, 2011, at 19:48:48
In reply to Re: Lamictal » Phillipa, posted by floatingbridge on August 14, 2011, at 19:29:50
hey fb,
I finally got the package from India 2-3 days ago. I'm only on 25mgs/day, so there's really nothing to report. I certainly don't have the Rash of Death at this point, so that's good. I feel more active, more alert, but that could also be going to 15mgs Abilify, although today I took 30 because I had this awful sense of unease, the kind of anxiety that makes you want to stay in your room and shut out the world. The 30mgs worked, so I'm more sociable and less crazed. Awesome.
I think Lamictal would be reasonable for you. I mean, it shouldn't cause mood instability like reuptake inhibitors, it apparently can help anxiety (PTSD, I think), and if nothing else, it could keep future episodes of depression at bay. That's always a good thing.
I will say that this dose titration schedule is crazy. Its going to take me 1 month to get to my target dose. However, people sometimes get some improvements at lower doses, so I'll just have to see if it helps before I hit 200mgs.
You should do something nice for yourself...get a light chemical peel (or do one at home) or something. Just a thought.
Posted by Dinah on August 14, 2011, at 20:52:01
In reply to Re: Lamictal » Phillipa, posted by floatingbridge on August 14, 2011, at 19:29:50
I've found it generally unwise to try for a benign hypomania. The result may all too often be the nastier sort. Although I confess I've done it at times when I felt I had to.
Are you sure your agitation isn't attributable to the increased Ensam dose? If you are planning to quit Risperdal, maybe you could put it aside instead, and try again when you don't have any other med changes going on?
It's hard to judge any one medication when you have more than one change going on.
Posted by Phillipa on August 14, 2011, at 21:01:08
In reply to Re: Lamictal » floatingbridge, posted by Dinah on August 14, 2011, at 20:52:01
FB agree with Dinah and know what you mean by reading posts from three years ago as I can say the same about myself. Yes it's frustrating. Hypomania would be nice been low for so long and the anxiety eats at me. Peace without things consistently going wrong with help. To the others around me also. I know you know what I mean. Love Phillipa ps you are considering stopping resperidol? I don't think I knew that
Posted by floatingbridge on August 14, 2011, at 21:50:45
In reply to Re: Lamictal, posted by Phillipa on August 14, 2011, at 21:01:08
Yeah, I know that there isn't a benign hypomania. Stability is the long range goal. I was giving into a little self-pity.
I will speak to pdoc and try not to be the annoying calling patient. Thinking about putting the risperdal aside is a good idea. I find finalities so appealing for a number of reasons. However, I did discuss this with my husband who has agreed about the late day agitation (w/o complaint). It's good to have an outside witness.
Thanks you all.
CE, good luck. A month isn't too bad for a target dose (listen to me, Miss Patience), is it? I've got my fingers crossed.
Posted by floatingbridge on August 14, 2011, at 22:13:02
In reply to Re: Lamictal » floatingbridge, posted by Dinah on August 14, 2011, at 20:52:01
Really, I am so hypervigilant. It drives me and anyone treating me nuts :-/
I hope some doctors and providers understand this. How difficult it can be for an anxious person to stay steady.
I took my risperdal as agreed and have been. I suppose it's *only* three weeks. At a low dose I can ditch he said if it doesn't begin to show benefits....
I thought it would help right away.... Silly old bear.
Posted by Phillipa on August 15, 2011, at 19:44:38
In reply to On being an anxious patient » Dinah, posted by floatingbridge on August 14, 2011, at 22:13:02
FB it should shouldn't it as time tried the baby dose hung over whole next day? Love Phillipa
This is the end of the thread.
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