Posted by zeugma on November 7, 2004, at 13:07:13
In reply to Re: resuming the thread » zeugma, posted by KaraS on November 6, 2004, at 18:47:35
> > I've always been underweight. Provigil, strangely, made me gain weight. I think it has to do with the orexins that are deficient in my brain. I tried to write an explanation at the post you guided me to.
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> Yes, I read that. I understand. I have had some prolonged periods in my life where I couldn't eat because of extreme anxiety. That's just as bad as having to worry about weight gain.
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> > > > > > So you think that there's still movement disorder risk to using amisulpride at AD dosage level?
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> > > > Yes, there is a risk, which increases with duration and dosage.> >
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> I have a friend who just started on low-dose Seroquel for anxiety (as an addition to Wellbutrin). I have not said much to him about the possible side effects but I have wanted to. I wanted to check out how valid my concerns are first. I am also afraid that my mother's doctor is going to prescribe Seroquel for her. I wish he would prescribe a small amount of doxepin or maprotiline instead. How much should I worry about the cardio effects on a woman in her mid-70s though?
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I don't know, honestly. I don't think a low dose of doxepin would be dangerous. About seroquel: I think it is one of the safest AP's. But I think it is irrational to prescribe an AP for anxiety, unless there is a bipolar condition involved. Wellbutrin is a bad choice itself for someone with anxiety, although I take it that the anxiety is a s/e of the WB and not a preexisting condition. But again, I don't know that much about the dangers of Seroquel. Still, I think it's bad practice to prescribe an AP for an AD side effect. You should by all means tell your friend about your concerns.
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> > > > > > > Something you might want to consider is Abilify. It is a partial agonist of D2 receptors. In theory, if your D2 receptors are overly sensitive, then Abilify will desensitize them, much like buspirone is thought to desensitize the 5HT-1A receptor. I have also read claims that Abilify is the only AP besides clozapine that does not carry the risk of tardive dyskinesia. I would say Seroquel would be the least likely of the others to induce TD.
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> > > > > > My pdoc recommened Abilfy to add on to something else for my potential "soft bipolar'" condiiton - if in fact i have that. If so, might be able to kill two birds with one stone.
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> Abilify is a consideration for the future. It's not my first choice now though. I'm leaning towards starting on Parnate. I've been depressed and dysfunctional for far too long now. It's time to go for the gusto I think.
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I'll address this further down some more, but if depression is your biggest problem now, it makes more sense to try an AD than Abilify.
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> > > > That's a commendable aim. I thought I was killing two birds with one with the nortriptyline/methylphenidate combination. As my pdoc said, though, I seem to have killed one bird- the narcolepsy, not the ADD.
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> I thought it was the other way around.
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Well, so did I. Strattera helped my ADD, but at the cost of intolerable s/e. Provigil also helped my ADD, to a much greater extent than Strattera, but again at an intolerable cost. Ritalin does increase my responsiveness. I mean this in the sense that sleep specialists do: it is easier to get a reaction from me on Ritalin than when not medicatated, just as it's easier to rouse someone from stage 1 sleep than from stage 4.It is interesting that on the website Stanford University's center for sleep research, Strattera has been added to the list of narcolepsy meds. This is in keeping with my observations, that Strattera reduced cataplectic attacks to zero, until I added Klonopin. Of course it is not a stimulant, and worsens EDS, but it is a very powerful REM suppressor, in keeping with its affinity for the NE transporter.
I had an episode of hypnagogic hallucinations last night, during the 'trough' period for nortriptyline to take effect. I think the Ritalin helped, because I was awake enough to not look at the hallucinatory content (i.e., I 'closed my eyes' during the dream). So I think that Ritalin makes me more wakeful, although I'm still fatigued and the heightened 'responsiveness' may actually aggravate my ADD, by speeding my reaction time, in contrast to Provigil, which slowed it. It's a complicated situation I have here.
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> I can only imagine since I haven't experienced anything like it. It doesn't sound like you are able to be upfront about any of this with the people you work with or for. That must make it all the more difficult.
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> Well, people last year saw me crash on caffeine and Strattera, but those crashes made me virtually speechless, and so I said nothing. Crashing on ritalin causes the anger I mentioned before, and I have been so alarmed about the feelings of those around me, as well as for my job itself, that I have explained my condition to several colleagues. I am hoping that the 30 mg Ritalin LA am, plus 30 mg LA pm, will keep my methylphenidate levels high enough for a long enough time that this effect doesn't happen.> > > > Abilify MIGHT not be an agent that causes TD. It is still a new med so it is still uncertain, but I recall reading an article that compared its structure to clozapine, an agent known not to cause TD.
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> Yes, it's always to soon to say for sure until a med has been around for a long time and tested out in the real world.Well, I think Abilify can cause marked akathasia, but it is only a partial agonist of the D2 receptor, and while partial agonists by their nature have ambiguous effects (compare with buspirone), I do think that it is safer from a TD pov than anything other than clozapine. Clozapine, by the way, is an option, although (get this) it requires weekly blood monitoring. I would think that it would be an option for anyone with severe, treatment-resistant depression. But not a pleasant one. Maybe less pleasant than ECT. But its efficacy is striking.>
> > Is tianeptine another of those French drugs that causes spontaneous orgasms? That sounds like a reason to to think well of it :)
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> I'm sure there are worse side effects but, actually, I would need that particular side effect now like I'd need a hole in my head.
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Well, I doubt you need to worry about that one then. I think that statement is an index of your level of depression :( I hope you can find something soon that helps. I've probably asked this before, but are you experiencing complete anhedonia?[about Parnate]
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> Yes, very seriously. I just left my doctor a message to that effect. It's one of the most powerful ADs there is and it might have the potential to reduce the density of the DA autoreceptors. All indicators seem to be pointing in that direction now. I'm terrified to try it though for many reasons - the biggest of which is that it seems like it's one of the strongest, most comprehensive ADs. If this doesn't work, what hope would I have left?
>Well, I understand your reluctance. One thing that may (or may not) console you is that MAOI's are NOT considered the most broadly effective AD's by everyone, although this is highly disputed. Most meta-analyses suggest that amitriptyline and clomipramine are the most effective of all AD's. ECT is supposed to be the most effective of all treatments. One study I read suggested that nortriptyline, if kept in a plasma level range of 90-130 ng/mL, is as effective as ECT.
All of these drugs have idiosyncracies that makes response a highly individual matter, although some effects, such as Strattera's anticataleptic effect, would probably qualify as universal given the close association between NE reuptake inhibition and REM suppression. (Dreaming, by the way, can occur in the absence of REM, although cataplexy can't. There is a particular anatomical reason for this that would take this parenthesis beyond the bounds of relevance.) There is also the matter of the therapeutic relationship between pdoc and patient. If this is suboptimal, it may interfere with your response.
> What did you and your doctor decide your next move should be?
I am doing the dosing change. He also told me that my response to meds was more typical of a narcolepsy than a pure ADD patient. This helps me in that it clarifies aspects of my diagnosis. My next move is to meet with my ADD coach this week. These, I understand, are not drastic moves. But there are no obvious, drastic moves that i can see right now.
-z
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> Kara
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poster:zeugma
thread:406397
URL: http://www.dr-bob.org/babble/20041103/msgs/412925.html