![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 47. This is the beginning of the thread.
Posted by tiopenster on May 30, 2015, at 21:58:09
I seem to really react poorly to SSRIs, SNRIs, Serzone, Buspar because they mess with the 5ht1 receptor. I get a lot of anti-anxiety benefit from Remeron (probably because it doesn't touch that one, but it turns me into a zombie. I am having decent success so far with the German medication Insidon, but don't know where I can find it online anymore. (help with that would be greatly appreciated) (It doesn't touch 5HT1) I'm looking for other alternatives if I can't refill what I have.
What I experience on these meds with 5ht1 is immediate positive feelings within a day and then day 3 or 4 I crash terribly and go ballistic with intense anxiety. Then I'll go manic or depressed or normal - I rapid cycle even though I'm not bi-polar.
Neurontin doesn't help me with my anxiety although Lyrica is excellent for about 1-2 weeks and then poops out.
To get my last bought of anxiety under control I was on Geodon, Lyrica, Lamictal, Remeron & Klonopin. I was a zombie though! I was fine for 2 years and then relapsed as I was slowly tapering off klonopin.
I don't know how I would respond to Brintallix because it does affect 5ht1, but it has a novel approach. It's not a reuptake inhibitor, but a a serotonin modulator and stimulator. I really don't now if I have a problem with the reuptake process or 5ht1 regardless of all mechanisms.
Thanks in advance
Posted by SLS on June 2, 2015, at 6:26:15
In reply to Medications that don't touch the 5HT1 receptor?, posted by tiopenster on May 30, 2015, at 21:58:09
Hi.
A few quick thoughts...
You pose a challenging question.
How did you come to the conclusion that 5-HT1a stimulation is bad for you?
Perhaps a partial agonist would be helpful. Brintellix is a potent serotonin reuptake inhibitor along with its antagonist effects at 5-HT7 and nearly full agonism at 5-HT1a. Abilify is more of a partial agonist at 5-HT1a receptors.
A few antidepressive agents that I think are devoid of direct serotonin effects:
bupropion
desipramine
nortriptyline
reboxetine
agomelatine
modafinil
atomoxetine
maprotiline
memantine
lamotrigineMirtazapine and mianserin should not affect serotonin 5-HT1a receptors.
- Scott
Posted by tom2228 on June 4, 2015, at 0:43:49
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by SLS on June 2, 2015, at 6:26:15
This kind of thinking is unproductive. Believing that the effects, or lack thereof, at the 5-HT1 receptor are responsible for your response to these medications is as logical as guessing that they don't work because they don't affect bloodflow to your toes. Guessing the 5-HT1 receptor is about as random any of the other receptors that these medications may or may not affect.
And Remeron likely does affect serotonin release at 5-HT1a neurons via downstream effects from alpha-2 antagonism, Geodon surely affects the 5-HT1a receptor, as are desipramine and nortriptyline SRIs. A med is either going to work for you or it's not. For example, I react badly to bupropion (Wellbutrin) -- this could lead me to determine that norepinephrine reuptake inhibition was responsible for this. The reality is that I respond favorably to other medications that inhibit norepineprhine reuptake, such as desipramine, nortriptyline, and select stimulants. So I could take another stab at it and say hey, well maybe it's that Wellbutrin is a dopamine reuptake inhibitor.... while truthfully I do respond to other meds that block dopamine uptake. All my 3 failed trails with Wellbutrin indicate is that I do not respond to Wellbutrin.
Especially for meds that have multiple receptor targets, picking one or two and generalizing from there is not helpful. Two or more drugs may affect very similar receptor targets yet produce significantly different effects and responses for any given person. A more realistic way of thinking about this is that each medication has a unique neurochemcial signature, affecting different combinations of neurochemical targets to varying degrees (affinities). For example, take Cymbalta and desipramine, two drugs that affect both reuptake of serotonin and norepineprhine, but to different extents -- Cymbalta affecting the reuptake of serotonin to a greater extent than that of norepinephrine, and the opposite for desipramine. Bearing in mind other explanations such as the fact that particularly desipramine has other neurochemical targets, this difference in balance among the affects of the different actions of these drugs *may* offer an explanation of why a particular person may respond to one drug and not the other.
If you go a med trial thinking that it's not going to work out because of a particular chemical property, well, you're f*ck*d.
In the end it's trial and error, which is difficult to sit with. Just don't give up. You'll find something that works for you. It's taken me 10 years and 52 medications but I'm at last responding to treatment, very very well! Good luck
Posted by tiopenster on June 4, 2015, at 1:00:52
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tom2228 on June 4, 2015, at 0:43:49
It's not so crazy when you think that I react the same way to Lexapro, Zoloft, Cymbalta, Serzone, Buspar, Effexor, Paxil, Nortryptiline. I would feel great within 24 hours and then it would spiral out of control into increased anxiety, depression, manic or normal. Rapid cycling multiple times a day. The common thread in there is the 5ht1 receptor.
I've confirmed this theory with Insidon (Opipramol) which doesn't affect 5ht1. I didn't feel great immediately, rather a slow and gradual response with it kicking in after about a week. We'll see if it holds, but that's how these meds are "supposed" to work. I would just like a medicine similar to this that I can buy in America.
Zyprexa works for me, but makes me a zombie.
Lyrica worked excellent for me for 2 weeks. 100% great, but then stopped working.
Methylfolate worked 100% on any depression I've had, but the anxiety is tougher to treat (for me). I would really recommend anyone with depression trying Deplin of methylfolate. Could be a real game changer.
Posted by SLS on June 4, 2015, at 6:53:31
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tom2228 on June 4, 2015, at 0:43:49
> In the end it's trial and error, which is difficult to sit with. Just don't give up. You'll find something that works for you. It's taken me 10 years and 52 medications but I'm at last responding to treatment, very very well! Good luck
That is quite a few medications that you have tried.
If I may ask, what is your current treatment regime? I am desperate for ideas.
Thanks!
- Scott
Posted by tom2228 on June 4, 2015, at 11:37:50
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 4, 2015, at 1:00:52
> It's not so crazy when you think that I react the same way to Lexapro, Zoloft, Cymbalta, Serzone, Buspar, Effexor, Paxil, Nortryptiline. I would feel great within 24 hours and then it would spiral out of control into increased anxiety, depression, manic or normal. Rapid cycling multiple times a day. The common thread in there is the 5ht1 receptor.
>
> I've confirmed this theory with Insidon (Opipramol) which doesn't affect 5ht1. I didn't feel great immediately, rather a slow and gradual response with it kicking in after about a week. We'll see if it holds, but that's how these meds are "supposed" to work. I would just like a medicine similar to this that I can buy in America.
>
> Zyprexa works for me, but makes me a zombie.
>
> Lyrica worked excellent for me for 2 weeks. 100% great, but then stopped working.
>
> Methylfolate worked 100% on any depression I've had, but the anxiety is tougher to treat (for me). I would really recommend anyone with depression trying Deplin of methylfolate. Could be a real game changer.Concluding that the common thread along those medications is the 5-HT1 receptor is about as logical as concluding that the resounding similarity among the numbers 1-27 is the number 13. SRIs affect every type of serotonin receptor -- why are you fixated on 5-HT1? Just because you did not respond to the 5-HT1a receptor partial agonist Buspar doesn't mean it's that receptor. It means you do not respond to Buspar. Buspar also has other mechanisms of action as well as the idea that there is considerable individual variability among responses to different medications with similar modes of action. You are also neglecting that Remeron, Geodon, and Deplin, which you state you respond to, all affect the 5-HT1a receptor, either directly or indirectly. Opipramol has several pharmacological actions aside from it's lack of direct effects on the 5-HT1 receptor.
This kind of selective reasoning is common among people who attempt to defend their situations with intellectualism, whereby one fixates on perceptibly logical ideas to the extent that one loses sight of the big picture. This is highly understandable as you are attempting to make sense of our struggles with your symptoms and medications, but ideas like having it out for the 5-HT1 receptor are not helping you.
A better way to navigate the efficacy of medications is to observe and compare the degree of improvement of your symptoms as you gradually expose yourself to the situations and feelings that surround your difficulties in functioning. This requires work on your part and is going to be uncomfortable. Psyhiatric diagnoses do not exist in a vacuum and medications to do work on humans as they do in a Petri dish.
That being said, if Deplin works so well what is the issue then? Why not stay on it and find another way to manage the anxiety? I am on Deplin myself and find that it is quite helpful. I was without it for 3 days this week and had a relapse in my depression and anxiety that have since recovered.
What dose of Zyprexa were you taking? I experienced trouble with bluntedness at higher doses, but am now taking 2.5mg and find I feel less of a zombie than the depressed state of not being on it.
Have you tried MAOIs?
Posted by tiopenster on June 4, 2015, at 20:58:53
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by tom2228 on June 4, 2015, at 11:37:50
I stay on the methylfolate because I feel much better on it. Helps the depression. I have the MTHFR genetic defect.
I know that methylfolate and methyl b12 create all three neurotransmitters and I do great on that. That's why I wondered if I have a problem with the reuptake mechanism of the SSRIs
I'm still doing well on the Insidon (Opipramol)
I had to take north of 10mg of Zyprexa for anxiety relief, but I gained 45 pounds on it.
Posted by tiopenster on June 4, 2015, at 21:00:27
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 4, 2015, at 20:58:53
No, I have not gone down the MAOI route because my pdoc thought it would aggravate the 5HT1 big and cause all sorts of problems
Posted by SLS on June 4, 2015, at 21:22:13
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 4, 2015, at 20:58:53
> I stay on the methylfolate because I feel much better on it. Helps the depression. I have the MTHFR genetic defect.
>
> I know that methylfolate and methyl b12 create all three neurotransmitters and I do great on that. That's why I wondered if I have a problem with the reuptake mechanism of the SSRIs
>
> I'm still doing well on the Insidon (Opipramol)
>
> I had to take north of 10mg of Zyprexa for anxiety relief, but I gained 45 pounds on it.I know someone who had to take Zyprexa for chronic anxiety. It worked well, but he gained an unhealthy amount of weight. It was discontinued and substituted with promethazine (Phenergan). Promethazine was as effective as Zyprexa for this person.
5-HT1a receptor partial agonism might not create a problem if you are so sure that full agonism is problematic. Viibryd and Brintellix are potent serotonin reuptake inhibitors, but act as partial agonists at 5-HT1a. With DA D2/D3 receptors, partial agonism results in a balance between blockade and stimulation depending on synaptic DA concentrations. Perhaps 5-HT1a partial agonism acts as a modulator in the same way. In the presence of too much serotonin, a partial agonist would then work as an antagonist. You might consider combining Viibryd or Brintellix with Remeron, which, at higher dosages, blocks other serotonin receptors as well as boosts norepineprhine via NE alpha-2a antagonism.
- Scott
Posted by Horse on June 4, 2015, at 22:30:27
In reply to Medications that don't touch the 5HT1 receptor?, posted by tiopenster on May 30, 2015, at 21:58:09
An idea with lyrica is to vary the daily dose. I'm prescribed a high dose (600 mg) and I usually take 200 mg most days and supplement if I need to break an anxiety cycle. I think I take extra about 3x weekly. My sleep has improved greatly! Good luck with the anxiety.
Posted by SLS on June 5, 2015, at 7:44:02
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by Horse on June 4, 2015, at 22:30:27
> An idea with lyrica is to vary the daily dose. I'm prescribed a high dose (600 mg) and I usually take 200 mg most days and supplement if I need to break an anxiety cycle. I think I take extra about 3x weekly. My sleep has improved greatly! Good luck with the anxiety.
Nice method.
:-)
- Scott
Posted by tom2228 on June 5, 2015, at 9:45:56
In reply to Re: Medications that don't touch the 5HT1 receptor? » tom2228, posted by SLS on June 4, 2015, at 6:53:31
> > In the end it's trial and error, which is difficult to sit with. Just don't give up. You'll find something that works for you. It's taken me 10 years and 52 medications but I'm at last responding to treatment, very very well! Good luck
>
> That is quite a few medications that you have tried.
>
> If I may ask, what is your current treatment regime? I am desperate for ideas.
>
> Thanks!
>
>
> - ScottHey Scott,
my latest and here-to-stay medication regimen looks like:
lithium carbonate 900mg
Lamictal ER 100mg
Abilify 4mg
Zyprexa 2.5mg
Marplan 40mg
desipramine 125mg
Mirapex ER 0.375mg
Deplin 30mg
Desoxyn (methamphetamine HCl) 20mg
betahistine 48mg -- finding dose
Synthroid (levothyroxine -- T4) 50mcg
Cytomel (liyothyronine -- T3) 12.5mcg
metformin 2000mg
Truvada 200/300mg
The recent changes of switching back to Desoxyn and adding the betahistine have solidified the upward trajectory I have been in for the past 5 months. I am taking the betahistine to counteract the sedation and weight gain from Zyprexa and the other antihistaminergics I am taking. I feel lighter, less depressed, more able to think and talk clearly, and do my job.The Desoxyn has really made a positive difference in my ADHD, depression, and anxiety. It is qualitatively different from the other stimulants, and I have zero side-effects except a little dry mouth. I feel calm, confident, steadily and evenly focused, and more in control of myself. I feel like myself, just functional. You say you are desperate for ideas... try the Desoxyn Scott!!! I find it hard to understand that you are considering DBS but won't try Desoxyn.
And now back to your question, which asked what is my original *treatment* regimen, which brings me to the point that I was trying to convey in my last post on this thread. Yes depression and anxiety are biological illnesses, but they do not exist in a vacuum. Everything biological going on between our ears has a psychogenic correlate. To defend one's depression with the idea that solely direct chemical or physical intervention can make a difference is to distance oneself from the message that our depression and anxiety are trying to tell us -- that we need to change -- and to relieve oneself from the responsibility to make these difficult changes to address the causes and core beliefs that keep us in depression. As they say in Alcoholics Anonymous, we are not responsible for our disease, but we *are* responsible for our *recovery*. The medications can help get us going -- they put gas in our car -- but they will not continue to work if we do not work with them.
The other components of my treatment include efforts to better understand myself, my illnesses, and learn what situations trigger feelings that combine with my biological diathesis to convert setbacks and uncomfortability into episodes of depression/ mania and incalculable anxiety. I strongly believe that one can only discover his vulnerabilities -- and strengths and capabilities -- by exposing himself to the uncomfortable situations that depression and anxiety keep us guarded from. The more I attempt to connect to life, talk to life, and experience new things, the more learn more about myself and what my liabilities are.
To accomplish this I attended two months of inpatient dual-diagnosis rehab earlier this year, attending a chemical dependency outpatient program, and I am current in a psychiatric outpatient program that is proving very helpful to me. I have been living in sober living for the past 3 months and attending Alcoholics Anonymous meetings every single day to meet new people who understand me, listen to my fears, and show me the evidence that recovery is highly, highly possible. I see a psychiatrist whom I trust and who trusts me, as well as a therapist with whom I am working on dealing with the traumas that have historically kept my psyche in the paralytic stagnation of fear.
After 5 years of not working, and not much experience working with other people at all, I have faced my fear and found work. After 2 months in I was promoted yesterday to a career-level-paying position. To be a commission-only salesmen after 23 years of social anxiety disorder and avoidant personality disorder, this is an insanely rewarding challenge for me. I am continually amazed at what is possible now that I have stepped my foot out the door. The results have been at or near full remission. I can honestly say that I am happy and highly satisfied with my life... Step back to 2014, I was acutely suicidality every day for a year or more with no end in sight. Don't short-change yourself. Your case and medication histoey is complex but not unique. There are other out there with TRD like yours who have gotten better. You can too, Scott.
I cannot stress more the importance of taking action -- getting out of your head and into the world. I really would recommend considering the Desoxyn. I find it to be very helpful and easy to tolerate. It takes 1-2 weeks to properly adjust.
Posted by tom2228 on June 5, 2015, at 10:01:52
In reply to Re: Medications that don't touch the 5HT1 receptor? » tom2228, posted by SLS on June 4, 2015, at 6:53:31
> > In the end it's trial and error, which is difficult to sit with. Just don't give up. You'll find something that works for you. It's taken me 10 years and 52 medications but I'm at last responding to treatment, very very well! Good luck
>
> That is quite a few medications that you have tried.
>
> If I may ask, what is your current treatment regime? I am desperate for ideas.
>
> Thanks!
>
>
> - ScottHey Scott,
my latest and here-to-stay medication regimen looks like:
lithium carbonate 900mg
Lamictal ER 100mg
Abilify 4mg
Zyprexa 2.5mg
Marplan 40mg
desipramine 125mg
Mirapex ER 0.375mg
Deplin 30mg
Desoxyn (methamphetamine HCl) 20mg
betahistine 48mg -- finding dose
Synthroid (levothyroxine -- T4) 50mcg
Cytomel (liyothyronine -- T3) 12.5mcg
metformin 2000mg
Truvada 200/300mg
The recent changes of switching back to Desoxyn and adding the betahistine have solidified the upward trajectory I have been in for the past 5 months. I am taking the betahistine to counteract the sedation and weight gain from Zyprexa and the other antihistaminergics I am taking. I feel lighter, less depressed, more able to think and talk clearly, and do my job.The Desoxyn has really made a positive difference in my ADHD, depression, and anxiety. It is qualitatively different from the other stimulants, and I have zero side-effects except a little dry mouth. I feel calm, confident, steadily and evenly focused, and more in control of myself. I feel like myself, just functional. You say you are desperate for ideas... try the Desoxyn Scott!!! I find it hard to understand that you are considering DBS but won't try Desoxyn.
And now back to your question, which asked what is my original *treatment* regimen, which brings me to the point that I was trying to convey in my last post on this thread. Yes depression and anxiety are biological illnesses, but they do not exist in a vacuum. Everything biological going on between our ears has a psychogenic correlate. To defend one's depression with the idea that solely direct chemical or physical intervention can make a difference is to distance oneself from the message that our depression and anxiety are trying to tell us -- that we need to change -- and to relieve oneself from the responsibility to make these difficult changes to address the causes and core beliefs that keep us in depression. As they say in Alcoholics Anonymous, we are not responsible for our disease, but we *are* responsible for our *recovery*. The medications can help get us going -- they put gas in our car -- but they will not continue to work if we do not work with them.
The other components of my treatment include efforts to better understand myself, my illnesses, and learn what situations trigger feelings that combine with my biological diathesis to convert setbacks and uncomfortability into episodes of depression/ mania and incalculable anxiety. I strongly believe that one can only discover his vulnerabilities -- and strengths and capabilities -- by exposing himself to the uncomfortable situations that depression and anxiety keep us guarded from. The more I attempt to connect to life, talk to life, and experience new things, the more learn more about myself and what my liabilities are.
To accomplish this I attended two months of inpatient dual-diagnosis rehab earlier this year, attending a chemical dependency outpatient program, and I am current in a psychiatric outpatient program that is proving very helpful to me. I have been living in sober living for the past 3 months and attending Alcoholics Anonymous meetings every single day to meet new people who understand me, listen to my fears, and show me the evidence that recovery is highly, highly possible. I see a psychiatrist whom I trust and who trusts me, as well as a therapist with whom I am working on dealing with the traumas that have historically kept my psyche in the paralytic stagnation of fear.
After 5 years of not working, and not much experience working with other people at all, I have faced my fear and found work. After 2 months in I was promoted yesterday to a career-level-paying position. To be a commission-only salesmen after 23 years of social anxiety disorder and avoidant personality disorder, this is an insanely rewarding challenge for me. I am continually amazed at what is possible now that I have stepped my foot out the door. The results have been at or near full remission. I can honestly say that I am happy and highly satisfied with my life... Step back to 2014, I was acutely suicidality every day for a year or more with no end in sight. Don't short-change yourself. Your case and medication histoey is complex but not unique. There are other out there with TRD like yours who have gotten better. You can too, Scott.
I cannot stress more the importance of taking action -- getting out of your head and into the world. I really would recommend considering the Desoxyn. I find it to be very helpful and easy to tolerate. It takes 1-2 weeks to properly adjust.
Posted by Lamdage22 on June 8, 2015, at 12:53:48
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 4, 2015, at 20:58:53
> I have the MTHFR genetic defect.
Have you tested it?
Posted by tiopenster on June 8, 2015, at 15:47:03
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by Lamdage22 on June 8, 2015, at 12:53:48
Yes. Out of the genes that seem to affect mental issues, here are my results
COMT V158 +/-
COMT H62H +/-
MAO A R297R +/+
MTHFR C677 +/-
MTRR A66G +/+
BHMT-02 +/+
BHMT-08 +/+
CBS A360 +/-I got tested through 23andme - I would encourage everyone to do it. If you have a problem with your MTHRF - there is a huge chance it is affecting depression, bi-polar and maybe anxiety. I know the COMT and MAO A affect anxiety, but I'm not sure if there is a supplement to treat those like there is to treat MTHFR
Posted by phidippus on June 11, 2015, at 1:15:05
In reply to Medications that don't touch the 5HT1 receptor?, posted by tiopenster on May 30, 2015, at 21:58:09
>Then I'll go manic or depressed or normal - I rapid cycle even though I'm not bi-polar.
if you become manic and depressed you are bi-polar.
How are you with no medications?
Eric
Posted by tiopenster on June 11, 2015, at 10:19:05
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by phidippus on June 11, 2015, at 1:15:05
I've never manifested bi-polar in my entire lift except when I'm on SSRIs
Posted by SLS on June 11, 2015, at 12:10:50
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by phidippus on June 11, 2015, at 1:15:05
> >Then I'll go manic or depressed or normal - I rapid cycle even though I'm not bi-polar.
>
> if you become manic and depressed you are bi-polar.
>
> How are you with no medications?
>
> Eric
Eric might be right.Chronic depression with episodes of drug-induced mania is diagnosed in the DSM 5 as being a form of bipolar disorder. That you describe rapid cycling just reinforces this diagnosis in my opinion. I think that it is a difference in the set of physiological processes that are most important in the separation of the phenemenologies of bipolar versus unipolar mood illnesses. If your depression is a manifestation of bipolar biology, despite the lack of spontaneous mania, treating it as a bipolar apectrum disorder might increase your chances of getting well. A new set of approaches might yield better results, especially if you haven't tried lithium, anticonvulants, or second-generation (atypical) neuroleptic antipsychotics.
Very few people relish having a diagnosis of bipolar depression. It is notoriously difficult to treat.
- Scott
Posted by tiopenster on June 11, 2015, at 12:21:01
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by SLS on June 11, 2015, at 12:10:50
Thanks for your input. I should state that my problem was anxiety, not depression. I only experience depression as a withdrawal side effect. When I would rapid cycle, it would be worse anxiety, normal, mania (rarely), and some times depression. Anxiety was always the core.
Posted by SLS on June 11, 2015, at 13:57:11
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 12:21:01
> Thanks for your input. I should state that my problem was anxiety, not depression. I only experience depression as a withdrawal side effect. When I would rapid cycle, it would be worse anxiety, normal, mania (rarely), and some times depression. Anxiety was always the core.
Thanks for the clarification.
I guess we'll need to rethink this a bit.
Anxiety can be a prominent symptom of a mixed-state bipolar disorder (or even unipolar disorder), especially earlier in life. Anxiety was a bigger problem for me than depression prior to my first severe depressive episode at age 17. Also, bipolar disorder and anxiety disorders can occur comorbidly. This might be a better explanation in your case.
How old are you now? How old were you when symptoms first appeared? Bipolar disorder usually appears earlier in life than unipolar depression.
Is your anxiety constant (like GAD), or is it more of a social anxiety?
I'm not trying to force a bipolar diagnosis down your throat. I am hoping to offer information that might make things easier for you to receive effective treatment. For instance, it might be interesting to discuss with your doctor combining Lamictal, Trileptal, and Paxil. Lamictal will help with bipolar depression. Trileptal will help stabilize you and prevent mania. Paxil will help with generalized anxiety disorder (GAD) and add enhanced antidpressant effects. Effexor can be substituted for Paxil, as it is also good for GAD, but Paxil is the best. If you get stuck, you can try discontinuing Paxil and Effexor and add an MAO inhibitor. Nardil is usually chosen when anxiety is prominent. Someone I know suffered from GAD, bipolar disorder, and a touch of panic disorder. Nardil monotherapy worked to bring her into remission of all symptoms. She would have been better off if she took a mood stabilizer at the same time, though, as the Nardil produced hypomania.
- Scott
Posted by phidippus on June 11, 2015, at 14:22:44
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 12:21:01
Anxiety can be a major component of mania-it is sometimes the only presentation mania.
Have you ever tried a mood stabilizer?
How exactly do you react to 5ht1a agonists?
Eric
Posted by tiopenster on June 11, 2015, at 15:11:08
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by phidippus on June 11, 2015, at 14:22:44
I've been on
neurontin (not effective),
depakote (not effective),
lamictal (somewhat effective),
lithium (not effective),
topamax (made me feel depressed)
lyrica (very effective, but poops out after a week)abilify (not effective),
seroquel (akastisia),
geodon (effective, then dropped in effectiveness)
risperdal (not effective)
zyprexa (very effective at over 10mg, but made me gain 45 lbs and very very tired)SSRIs & SNRIs
(all would make me feel perfect the first 2 to 3 days, but then would make me cycle - usually anxiety, normal, manic (only on lexapro), and sometimes depressedLexapro - made me crazy anxious and gave me panic attacks
Serozone - increased anxiety 10 fold
Cymbalta (cycling every few days
Paxil (same pattern)
Zoloft (same pattern)
Nortryptiline (same pattern)
Effexor (felt good immediately, but got a rash)
Buspar (same pattern)Remeron (very effective, - similar to zyprexa. made me gain a lot of weight and turned me into a zombie
The cocktail that resolved my problems 2 years ago was the following, but I was a zombie that slept a lot and didn't talk much
Geodon
Lamictal
Lyrica
Remeron
KlonopinI had gotten off Lamictal, Lyrica & Remeron. I got my geodon to 20mg but kept that dose for insomnia that would come from tapering off Klonopin. My anxiety came back after I had gotten down to .5mg of Klonopin after being on 2mg.
I am doing better on 225mg of lyrica and 50mg of Insidon (german medication). I'm back on 2mg of klonopin and still on 20mg of Geodon. I still need something more - i will most likely go up on the insidon.
The ones I do best on are the ones that don't touch my 5ht1 receptor - remeron and insidon. Zyprexa seems to be weak at the 5ht1a. Lyrics works 100% when i start it but then drops in effectiveness a week later (dose is irrelevant).
Any other suggestions would be great. I have looked at Trimipramine which doesn't touch that receptor either, but makes me incredibly zombie like the next day for anything over 50mg.
Posted by phidippus on June 11, 2015, at 16:24:53
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 15:11:08
>lamictal (somewhat effective)
What was your dose?
>lyrica (very effective, but poops out after a week)
How did it effect you? Less anxiety?
what made you think it pooped out?
>geodon (effective, then dropped in effectiveness)
Your symptoms worsened. I doubt the Geodon lost effectiveness.
>The cocktail that resolved my problems 2 years ago was the following, but I was a zombie that slept a lot and didn't talk much
Geodon
Lamictal
Lyrica
Remeron
KlonopinThat's a bipolar person's regimen. If I were to venture a guess, I would say you're bipolar 2 because of all the anxiety.
>Insidon
Opipramol acts as a high affinity sigma receptor agonist - a mechanism shared by Luvox.
Based on your response to past medications, I would strongly recommend you seek treatment for bipolar disorder.
When treating bipolar disorder it is essential that you start with a mood stabilizer. You responded to Lamictal in the past-I would encourage you to start treatment with it.
Once your mood is stabilized and you still have an excess of anxiety, I would recommend starting an SSRI as this is the best way to treat anxiety. If you have adequate mood stabilization, you shouldn't react to them as you did in the past.
OR, you can take the Remeron, as you have had success with this in the past.
I wouldn't mess with the Geodon. Antipsychoticss are not designed to treat anxiety.
I would instead recommend Keppra, Riluzole or Zonegran-all are glutumate inhibitors and have anxiolytic properties.
Your reaction to 5ht1a agonists is simply bipolar.
Eric
Posted by tiopenster on June 11, 2015, at 17:01:16
In reply to Re: Medications that don't touch the 5HT1 receptor? » tiopenster, posted by phidippus on June 11, 2015, at 16:24:53
I was at 150mg of Lamictal
Lyrics totally erased the anxiety, but then it dropped in how well it worked about 2 weeks in.
I responded to the Geodon similar to SSRIs. Felt great for 2-3 days and then the effectiveness dropped.
Posted by phidippus on June 11, 2015, at 17:05:14
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 17:01:16
150 is on the low side. I would try lamictal again and push it to 300/400 mg.
Eric
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