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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by linkadge on July 7, 2015, at 18:32:00
This seems like a promising treatment for mania, psychosis, and possibly mixed states / insomnia.
It can induce depression (in higher doses).
Google this substance - but caution, it depletes monoamines (mainly dopamine and norepinephrine).
Linkadge
Posted by SLS on July 9, 2015, at 14:59:56
In reply to Reserpine, posted by linkadge on July 7, 2015, at 18:32:00
> This seems like a promising treatment for mania, psychosis, and possibly mixed states / insomnia.
>
> It can induce depression (in higher doses).
>
> Google this substance - but caution, it depletes monoamines (mainly dopamine and norepinephrine).There is some old literature about the use of reserpine for various psychotic states. It didn't seem to garner much support by the medical community as a clinical treatment. I don't remember why. One rather interesting proposal for the treatment of depression was to administer reserpine first, followed by a TCA. Perhaps it somehow changes the function of storage vesicles. That's just a wild guess.
Medline / PubMed isn't working for me right now. You should find some titles, but probably not necessarily the abstracts. I'll check out Google.
- Scott
Posted by SLS on July 9, 2015, at 15:11:07
In reply to Re: Reserpine » linkadge, posted by SLS on July 9, 2015, at 14:59:56
> > This seems like a promising treatment for mania, psychosis, and possibly mixed states / insomnia.
> >
> > It can induce depression (in higher doses).
> >
> > Google this substance - but caution, it depletes monoamines (mainly dopamine and norepinephrine).> There is some old literature about the use of reserpine for various psychotic states. It didn't seem to garner much support by the medical community as a clinical treatment. I don't remember why. One rather interesting proposal for the treatment of depression was to administer reserpine first, followed by a TCA. Perhaps it somehow changes the function of storage vesicles. That's just a wild guess.
>
> Medline / PubMed isn't working for me right now. You should find some titles, but probably not necessarily the abstracts. I'll check out Google.I found some stuff on Google that suggested using a tricyclic first as a pretreatment, followed by reserpine. This is the opposite order of what I had indicated, but my memory sucks.
https://www.google.com/?gws_rd=ssl#q=reserpine+depression+tricyclic
- Scott
Posted by Christ_empowered on July 10, 2015, at 11:02:02
In reply to Re: Reserpine, posted by SLS on July 9, 2015, at 15:11:07
hey...I just did a paper on mental health treatment, and I used the example of rauwolfia and reserpine.
I had this david healy article...apparently, the "depression" was more akathisia, and it responded to stimulants (which were handed out like candy back then). Part of the problem is that rauwolfia wasn't something they could get "me too" drugs out of, so...yeah...phenothiazines won the day.
I seem to recall reading about it being an option besides clozapine. I mean, if I needed AP and demonstrated treatment resistance, I'd take reserpine over clozapine, personally.
Posted by linkadge on July 10, 2015, at 18:07:18
In reply to Re: Reserpine, posted by Christ_empowered on July 10, 2015, at 11:02:02
Yeah, reserpine is a very interesting substance. I remember reading that it actually was the first substance to sucessfully go through a trial as an (get this) antidepressant! There is so much that we don't know.
It seems to be used by herbalists for anxiety, agitation and insomnia. Interestingly there are case studies of it being helpful in bipolar disorder (mania and mixed states), and as an ajunctive to antipsychotics. In studies, it counteracts many of the effects of methlyphendate and PCP, but not amphetamine.
Of course, it has a different mechanism to conventional antipsychotics which block dopamine receptors rather than depleat dopamine.
It also lowers blood pressure, through a central effect on norepinephrine.It seems to primarily deplete catecholamines dopamine and norepinephirine. In agitated depression, it might be beneficial to combine this with an SSRI, to shift the brain towards serotonin predominance. The fact that it purportedly relives insomnia is interesting.
Posted by SLS on July 10, 2015, at 21:39:04
In reply to Re: Reserpine, posted by linkadge on July 10, 2015, at 18:07:18
Thanks for all of the information. History is interesting.
> It seems to be used by herbalists for anxiety, agitation and insomnia. Interestingly there are case studies of it being helpful in bipolar disorder (mania and mixed states), and as an ajunctive to antipsychotics. In studies, it counteracts many of the effects of methlyphendate and PCP, but not amphetamine.
The first thing that strikes me is that methylphenidate and PCP are dopamine reuptake inhibitors (among other things), whereas amphetamine is primarily a releaser. I don't know what that means, though. I like puzzles.
I just researched a bit on how reserpine and amphetamine work. Reserpine renders storage vesicles nonfunctional by irreversibly binding to VMAT (vesicular monoamine transporter). Dopamine can no longer be sequestered from the cytosol and protected from breakdown by MAO. The result is that there is no dopamine released - reuptake inhibitors stop working because there is no synaptic dopamine to inhibit. Long story short, it looks to me like amphetamine releases dopamine into the synapse directly from the cytosol through reverse transport before MAO has a chance to catabolize it.
I really should get a hobby.
- Scott
Posted by Linkadge on July 16, 2015, at 21:23:52
In reply to Re: Reserpine, posted by SLS on July 10, 2015, at 21:39:04
And....amphetamine also inhibits mao.
Posted by SLS on July 17, 2015, at 8:03:05
In reply to Re: Reserpine, posted by Linkadge on July 16, 2015, at 21:23:52
> And....amphetamine also inhibits mao.
It seems that every drug ever studied is a MAOI of varying potencies.
If it is safe to combine amphetamine with a SRI, then I don't think any MAO inhibition it is given credit for is substantial enough to factor into its clinical effects. However, if all reversible inhibitors of MAO-A are safe to take with a SRI, then my conclusion is likely to be wrong.
- Scott
Posted by linkadge on July 17, 2015, at 20:36:50
In reply to Re: Reserpine, posted by SLS on July 17, 2015, at 8:03:05
There are case reports of amphetamine causing serotonin syndrome with SSRIs. I think it is safer to combine methylphenidate with SSRIs than amphetamine.
This is an interesting study, but I admit, I fail to fully comprehend it:
http://www.sciencedirect.com/science/article/pii/0006295280904293
Posted by linkadge on July 17, 2015, at 20:41:08
In reply to Re: Reserpine, posted by SLS on July 17, 2015, at 8:03:05
Question....if VMAT2 and MAO are inhibited, where does the neurotransmitter (which has been taken back up by the presynaptic cell) go? Does inhibition of VMAT2 and MAO effectively prevent neurotransmitter reuptake?
Linkadge
Posted by SLS on July 17, 2015, at 22:39:37
In reply to Re: Reserpine, posted by linkadge on July 17, 2015, at 20:36:50
> There are case reports of amphetamine causing serotonin syndrome with SSRIs.
I find that surprising. I guess the brain is full of surprises.
> I think it is safer to combine methylphenidate with SSRIs than amphetamine.
Okay. I'll remember that.
> This is an interesting study, but I admit, I fail to fully comprehend it:
>
> http://www.sciencedirect.com/science/article/pii/0006295280904293There was some pretty amazing research performed in the 1970s and 1980s. If you need to know things about the older drugs (pre-fluoxetine), you need to look for stuff done before 1990. I'll need to read this thing a few times if I am going to come close to understanding the logic behind the protocol described.
- Scott
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