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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 doxogenic boy on September 7, 2013, at 15:18:16
Hello to all of you!
Its a long time since last I was here, but I found it helpful to read og post here.
I am now going to tell a success story about a cocktail with high dose tianeptine (Stablon) treatment.
In 2009, I told my medication history 1994 2009, 54 medications here:
http://www.dr-bob.org/babble/20090826/msgs/914853.htmlFrom around August 2004, I had severe anxiety and was suicidally depressed all the time for more than five years. It was the worst five years of my life, and I was convinced I would never be better again.
The turning point came October 25, 2009, when the tianeptine dose was increased to 4 tablets 6 times a day 300 mg daily
At that time I also used:
quetiapine Seroquel: 200 mg morning + 100 mg at noon + 100 mg afternoon + 200 mg evening (600 mg a day)
escitalopram Cipralex: 40 mg in the morning
liothyronine - L-isomer of triiodothyronine (T3) Liothyronin: 10 micrograms in the morning
trimipramine Surmontil: 100 mg evening
lithium Lithionit: 21 mg Li+ morning
clonazepam Rivotril: 1 mg at bedtime (My condition became better when I discontinued the clonazepam)I felt calm and euthymic one hour after a 4 tablets/50 mg dose of tianeptine, so when taking it 6 times a day in about two hour intervals, I thought that effect could continue, and it did! My psychiatrist was happy that we finally found something that worked. The low-dose lithium was discontinued in November 2009.
I started with 25 mg agomelatine (Valdoxan) in March 2010 and increased to 50 mg April 2010. This did also improve my mood.
But there were some problems remaining: Mostly low energy. I thought this was due to the depression, but 25 July, 2011, I tried for the first time to take the whole 600 mg quetiapine dose at bedtime. I felt much better at daytime after that.
It was a big mistake to take quetiapine in four daily doses (starting with 200 mg in the morning) for all those years it made me sedated at daytime.
My medication is now:
tianeptine: 4 tablets 6 times a day, first dose in the morning 300 mg daily (1 tablet is 12,5 mg)
escitalopram: 40 mg in the morning
liothyronine: 20 micrograms in the morning
trimipramine: 100 mg in the evening, a few hours before I go to bed
agomelatine 50 mg in the evening, a few hours before I go to bed
quetiapine: 600 mg at bedtimeBefore I started high dose treatment with tianeptine, my medication always stopped working after some time the longest good period was with citalopram (Cipramil) from 1996 to 1998.
Now have I been using the same daily doses of tianeptine, quetiapine, escitalopram and trimipramine successfully for nearly four years, agomelatine 50 mg since April 2010, and liothyronine 20 micrograms since July 2011 all those six meds with no tolerance build up.
And the strangest thing: I experience few side effects. Could it be that one medication work against the side effects of another in this cocktail?
[I started escitalopram, trimipramine and quetiapine in 2006, liothyronine 2007, tianeptine in 2008 and agomelatine in 2010. I have also had earlier trials of escitalopram and normal dose tianeptine]
Are there any of you that have used the SSRI/tianeptine combination?
See this post with a quote of a german case report where the patient is using first three psychotropic drugs, one of them an SSRI, and later successfully adding tianeptine:
http://www.dr-bob.org/babble/20090826/msgs/914964.htmlI think it is important to start with an SSRI first and then add tianeptine later. If you are starting with tianeptine and thereafter add an SSRI, this can happen:
http://informahealthcare.com/doi/abs/10.1080/13651500410005685-1
Quote:
Paroxetine augmentation to tianeptine treatment causes exacerbation of depressive symptoms: presentation of two casesI hope my cocktail will continue to work for me for many years to come, preferably for the rest of my life. To not making this post too long, I havent brought all the details, but feel free to ask questions. :)
- doxogenic
Posted by Tomatheus on September 7, 2013, at 22:30:41
In reply to My meds are working, posted by doxogenic boy on September 7, 2013, at 15:18:16
Doxogenic boy,
Thank you for letting us know of your success with tianeptine in combination with your other medications. As you're undoubtedly aware, you are taking quite a hefty dose of tianeptine. Did you feel any undesirable effects start to come on around the time you started taking tianeptine?
I'm glad that your combo is working well for you, and I most certainly wish you continued success with it.
T.
Posted by doxogenic boy on September 8, 2013, at 15:54:40
In reply to Re: My meds are working, posted by Tomatheus on September 7, 2013, at 22:30:41
> Doxogenic boy,
>
> Thank you for letting us know of your success with tianeptine in combination with your other medications. As you're undoubtedly aware, you are taking quite a hefty dose of tianeptine. Did you feel any undesirable effects start to come on around the time you started taking tianeptine?
>
> I'm glad that your combo is working well for you, and I most certainly wish you continued success with it.
>Hi.
Thank you for your supportive response. I cant remember any undesirable effects when I started taking tianeptine in combination with the other medicines. The first time I took 50 mg tianeptine in one dose, I felt calm one hour later, and I had a terrible generalized anxiety disorder with a constant high anxiety level (and treatment resistant depression), so the effect for me was amazing.
I cant know for sure, but I think the escitalopram, trimipramine and the quetiapine make the effect of tianeptine more pronounced, because I have tried tianeptine as monotherapy for many years ago, and it didnt work as good as this, although it that time was doses from 25 to 75 mg tianeptine. When I used tianeptine in monotherapy I had some minor side effects, I think it was abdominal pain, but nothing that was intolerable.I wonder if the combo I am using works only for me, or if there are more people out there with treatment resistant anxiety disorders and depression that could benefit from this high dose combination of six psychotropic drugs. Could it be that I coincidentially have found a combo that in total is a new mode of action?
I hope more people can get the possibility to experience the same improvement as me. When I had my last depression, that lasted for five years, I thought about suicide all the time. If it had been allowed with assisted suicide for people with mental disorders here in Norway, as it is in Switzerland, I would probably not have been alive today.
- doxogenic
Posted by Tomatheus on September 8, 2013, at 18:25:45
In reply to Re: My meds are working, posted by doxogenic boy on September 8, 2013, at 15:54:40
Hello again,
Thank you for getting back to me. I think that it might very well be the case that others with treatment-resistant depression and anxiety might respond favorably to the high-dose combination of medications that you've been taking. And I think that it makes sense that you've posted a message here indicating that you seem to be responding well to the high-dose combo that you're taking. I don't think that it's uncommon to come across reports in the medical literature of patient responses to medications or medication combinations that aren't typically tried for a given medical condition, and even though a case report on your response to the medications that you're taking probably won't appear in a medical journal, I think it's helpful to have anecdotes on this site from patients such as yourself who've been responsive to drug combos that might be considered to be unconventional.
I think it would be interesting to see if others with treatment-resistant depression and anxiety might respond well to the combination of medications that you're taking. I tend to think that doctors might generally be at least hesitant to prescribe tianeptine in the dose that you're taking because I don't think that such high doses of the medication have been studied (although I could be wrong), but I do think that the combo that you're taking has the potential to be helpful for others with treatment-resistant depression and/or anxiety.
T.
Posted by doxogenic boy on September 9, 2013, at 10:48:17
In reply to Re: My meds are working » doxogenic boy, posted by Tomatheus on September 8, 2013, at 18:25:45
Hi,
Thank you for your thoughts about this.I will be very happy if more people can benefit from this combo. Escitalopram and tianeptine have in theory the opposite effect of each other on serotonin levels, SSRI vs tianeptine, a serotonin reuptake enhancer, but the brain is complicated, so maybe they work different together? I started with escitalopram (and quetiapine, trimipramine and liothyronine) before tianeptine, maybe it would have had a different and not so good effect if I started with tianeptine and then added escitalopram and the other medicines? (The latest medication I started with, was agomelatine in 2010.)
And I think it should have been more research into combos like this and high-dose tianeptine treatment of treatment resistant depression and/or anxiety. There are some case reports of patients taking extreme doses of tianeptine, that are labeled as "tianeptine abuse", but maybe it isn't - maybe it just is a treatment that works? But then it is important to stop if there is tolerance build up, and it must be a psychiatrist that prescribes it and monitor the patient.
Another thing:
Do you know about how it is with generics in general - are they normally as good as branded drugs? I am soon changing from Stablon to the generic Tianeurax.- doxogenic
Posted by Tomatheus on September 9, 2013, at 12:54:07
In reply to Re: My meds are working » Tomatheus, posted by doxogenic boy on September 9, 2013, at 10:48:17
Doxogenic boy,
Thank you for your reply. My impression of generic drugs is based primarily on various anecdotes that I've read over the years, so I don't have any expert knowledge on the subject, but I'll share my opinion of generic drugs with you. I tend to think that generic drugs are as good as the brand versions in most cases, but that there are some instances where they may not be as effective or may produce some side effects that the brand versions don't. Also, because of individual differences in the ways that medications affect people, a given generic version of a medication may be acceptable for some individuals, but not for others.
One clear-cut example of a generic version of a medication not being therapeutically equivalent to the brand version involved a generic version of Wellbutrin -- 300-mg "Budeprion XL" tablets. A bioequivalence study that The U.S. Food and Drug Administration conducted beginning in 2010 found that the 300-mg "Budeprion XL" tablets did not release bupropion (the active ingredient in Wellbutrin/Budeprion) into the bloodstream at the same rate and to the same extent that Wellbutrin XL did. After the FDA found the 300-mg "Budeprion XL" tablets to not be therapeutically equivalent to Wellbutrin XL, the companies manufacturing and marketing the Budeprion product removed it from the market.
So, there are definitely instances in which generic drugs aren't therapeutically equivalent to their brand-name counterparts, but the extent to which this occurs doesn't seem to be entirely clear. The FDA investigated the differences between Budeprion XL and Wellbutrin XL (in the case of the 300-mg tablets) because a lot of patients complained about the differences between the generic product and the brand product, but I can only wonder if the agency would do the same with medications that have less people taking them. There could very well be several generic medications that aren't as effective or as tolerable as their brand-name counterparts for most people that haven't received the attention that the 300-mg "Budeprion XL" tablets received because a smaller number of people could be taking the medications. All in all, I would say that there is always some risk involved when a patient switches from a brand version of a medication to a generic version, but I would say that the severity of such a risk is debatable. Some would probably say that the risk of having problems with a generic version of a medication is small, while others might be more concerned. I would probably fall somewhere in the middle.
Well, that sums up my thoughts on generic medications as they compare to the brand versions. Please feel free to let me know if you have any questions on what I've written.
T.
Posted by doxogenic boy on September 9, 2013, at 15:19:57
In reply to Re: My meds are working » doxogenic boy, posted by Tomatheus on September 9, 2013, at 12:54:07
Hello,
Thank you, this was interesting. Is "Budeprion XL" the only psychotropic generic that FDA has investigated? Does it exist generic tianeptine in the U.S. or in Great Britain, and if not - could a generic manufacturer in the U.S. start to make tianeptine if there are enough customers wanting it?My psychiatrist has told me that there have been complaints about more side effects or less effect from generic SSRI users amongst his patients. The quetiapine generic users were ok. He has also said that the manufacturers of generic drugs don't need to prove that their drugs are working, and that the absorption and bioavailability can be different compared with branded drugs.
All my current meds are (as far I know) branded drugs. I prefer to continue with the branded drugs,both because of possible chemical differences, and because of the psychological effect/placebo effect; if I fear that a generic won't work as good as my current branded drugs, it may happen. And therefore my psychologist (I have both a psychiatrist and a psychologist) said to me that I should be positive about Tianeurax, so I avoid to lose the psychological/placebo part of the effect. My local pharmacy has ordered Tianeurax from Germany today, and they expect it to arrive in a week.I saw that Dr. Bob has added my success with my high dose tianeptine combo to a success stories thread.
http://www.dr-bob.org/babble/20130828/msgs/1050358.html
http://www.dr-bob.org/babble/20130501/msgs/1044117.htmlI am very grateful for that.
- doxogenic
Posted by sigismund on September 9, 2013, at 15:29:59
In reply to Re: My meds are working, posted by doxogenic boy on September 8, 2013, at 15:54:40
I am currently taking trimipramine (12.5mg), SAMe (400mg) and tianeptine (3/d) with good enough effect.
Posted by Tomatheus on September 9, 2013, at 16:56:41
In reply to Re: My meds are working » Tomatheus, posted by doxogenic boy on September 9, 2013, at 15:19:57
Hi Doxogenic boy,
Thank you for your reply. My responses to your questions are below. I don't have the answers to everything that you've asked, but I've answered your questions as well as I think I could.
> Is "Budeprion XL" the only psychotropic generic that FDA has investigated?
Budeprion XL (in the strength of 300 mg) is the only generic psychotropic medication that I'm aware of that the FDA has investigated. It could be the case, though, that there are other generics that the FDA has investigated that I'm not aware of.
> Does it exist generic tianeptine in the U.S. or in Great Britain, and if not - could a generic manufacturer in the U.S. start to make tianeptine if there are enough customers wanting it?
I know that no version of tianeptine is marketed in the U.S., and it seems to be the case that the same is true of the U.K., at least if Wikipedia is to be believed. I don't know for sure whether or not a generic manufacturer in the U.S. would be able to make tianeptine if there were enough customer demand for it. My guess would be that a company wanting to market tianeptine in the U.S. would have to get it approved as a new drug since the FDA has yet to approve any version of tianeptine, but I'm not sure exactly how it works.
> My local pharmacy has ordered Tianeurax from Germany today, and they expect it to arrive in a week.
I wish you luck with the Tianeurax, if you end up going ahead with that version of tianeptine.
T.
Posted by doxogenic boy on September 9, 2013, at 18:39:46
In reply to Re: My meds are working » doxogenic boy, posted by Tomatheus on September 9, 2013, at 16:56:41
> I wish you luck with the Tianeurax, if you end up going ahead with that version of tianeptine.
Thank you very much for this and for your answers.I will try Tianeurax, but I have asked the pharmacy to check if they are allowed to import Stablon from France (instead of Austria), so if Tianeurax doesn't work properly or has more side effects, I can go back to Stablon. But that will take some time for the pharmacy to find out, and it is not sure that it is possible. Therefore, I should probably prepare to settle down with Tianeurax.
- doxogenic
Posted by doxogenic boy on September 10, 2013, at 15:20:31
In reply to Re: My meds are working, posted by sigismund on September 9, 2013, at 15:29:59
> I am currently taking trimipramine (12.5mg), SAMe (400mg) and tianeptine (3/d) with good enough effect.
Have you reached recovery? How long has this combo worked for you?
Posted by sigismund on September 10, 2013, at 15:38:52
In reply to Re: My meds are working, posted by doxogenic boy on September 10, 2013, at 15:20:31
>Have you reached recovery?
Guess not, dunno really, I'm not sure what that means, of what I have a right to expect, so to speak.
>How long has this combo worked for you?
Not long enough! I try all sorts of things in a somewhat systematic manner. My last trial of agmatine activated a latent herpes infection but was otherwise promising. This present combo is not absolutely useless.
Posted by Riloal on September 19, 2013, at 4:42:24
In reply to Re: My meds are working, posted by sigismund on September 10, 2013, at 15:38:52
Doxogenic, i did a trial with agomelatine this year. I was on tianeptine also. I tried agomelatine for 15 days, it improved my sleep, but i was very tired the next morning. Did you had this side effect at the beginning? What,s your experience with agomelatine? Thanks
Posted by doxogenic boy on September 19, 2013, at 5:41:13
In reply to Re: My meds are working, posted by Riloal on September 19, 2013, at 4:42:24
> Doxogenic, i did a trial with agomelatine this year. I was on tianeptine also. I tried agomelatine for 15 days, it improved my sleep, but i was very tired the next morning. Did you had this side effect at the beginning? What,s your experience with agomelatine? Thanks
I can't remember if I was tired in the morning in the beginning, but I think agomelatine led to additional improvement of my condition. I have used agomelatine continuously since March 12, 2010, and I am very satisfied. If I have had bad side effects, I probably would have remembered. I take agomelatine about an hour before I go to bed, and it improves my sleep, too.
- doxogenic
This is the end of the thread.
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