Posted by bulldog2 on November 1, 2009, at 14:40:54
In reply to Need help trying to 're-create' Geodon's effects.., posted by delna on November 1, 2009, at 10:02:53
> Hi,
> For those who know me, yes, I'm back to my Geodon obsession, but this time there's a twist.
>
> Well since I am posting about this for the first time on the Neurotransmitter board, I will briefly explain.
>
> I have BP disorder but my main problem is the atypical depression that goes with it. Mainly extreme tiredness, suicidal depression and lack of interest in life. I also have co-morbid OCD and get anxiety too.
>
> Like everyone here, I have tried many different combination without real success.
>
> Why I am fixated on Geodon:
> Recent history (2 years ago)
>
> I was on a combination of:
> Lamictal 200mg
> Effexor 37.5 (for OCD)
> Provigil 100mg
> Wellbutrin 150mg
>
> I stayed in bed all day and was actively suicidal but I didn't somehow see myself as depressed as such because I wasn't 'sad'. Anyway I have lived in a semi-comatose state in bed since forever, so I thought it was just 'me'. I really didn't know any better.
>
> I was in NYC at the time and was pushed to see a Psychopharmacologist there as a last resort.
>
> He added 40mg of Geodon to the combination and within a few doses I felt like I had awoken from a life-long coma. I also realized how depressed I had been for so many years (20 yrs +). I was shocked because I never dreamed an AP could totally change my life. I was 100% normal (job, life and all!).
>
> To cut a really long story short, I had to give the Geodon up after about a year and a half because I developed severe nerve pain on it (untreatable with meds) which is possibly linked to TD (am still investigating that)
>
> (BTW, I am back in India now.)
>
> When I stopped the Geodon, the pain went but all my original symptoms are back. I am suicidal again and a zombie.And now I AM sad becasue I DO know better.
> I relapsed into this severe suicidal depression even though I was taking Lexapro, wellbutrin, lamictal and provigil.
>
> I want to be back on Geodon but this is not an option. Because of the possible link with TD, and for the moment Abilify (the apparent next best bet) is not an option, either.
>
> Just to give you an indication of my level of tiredness I experience; I take:
> 400mg Provigil,
> 300mg Wellbutrin
> 200mg caffeine pills
> just to keep awake (and that too , to sit in bed). I don't have a thyroid problem or a sleep disorder. I have been checked for all organic causes for the tiredness.
>
> On the Geodon I only took 300mg Provigil (and no other stimulants.). I found it sedating when I took it at night, but madly activating once I was awake. It wasn't like a high at all, i have had those before and Geodon didn't induce that at all.
>
>
> I just failed a trial of Parnate (so I now have very limited options). It was way to sedating and made me sleep all day in spite of the Provigil. In fact most drugs sedate me and I am so intolerant to that side effect because I am a sleepy person anyway.
>
>
> I was reading a presentation by Stahl, in which he talks about why Geodon (low dose) is SO activating. He attributes it to 5HT2C-antagonism. He then goes on to say that Prozac is the only other drug with strong antagonism at 5HT2C.
>
> This has made me think that maybe I can recreate Geodon (somewhat) by sort of mimicking its receptor binding effects.
>
> I know that I can never recreate Geodon fully because binding etc is so complex and you cannot really predict the outcome.But I can at least try to get close....
>
> Also this is where I really need your inputs.
>
> Just to add why Geodon was such an amazing drug for me: it improved energy, mood, cognition, anxiety.... the list is endless. All this without destabilizing me at all. The only thing it didn't help was my OCD (which responds to any SSRI/ SNRI, so that was no big deal).
>
> So with my limited knowledge on all the complex neurotransmitter actions,I was thinking:
>
> -Prozac for the 5HT2C-antagonism. Plus for the OCD and as an antidepressant(?)
> -Reboxetine/ Wellbutrin for the NA bit
> -Provigil (as needed)
> And of course, Lamictal 200mg
>
> Anything else I would theoretically need?
>
> The reason I put a ? next to Prozac as an antidepressant is because SSRI's are generally like sugar pills for me in that they do NOTHING for my depression, they only help my OCD.
> But I DO remember Prozac activating me and making me more alive and driven (when I took it some years ago, at 20mg) and getting me out of bed but I became really aggressive on it. I think I switched into dysphoric mania, so I got off it. But I was not on a mood stabilizer at the time.
>
> The other option is Effexor (high dose with add-ons) because it is recommended for hard to treat depressions.
> I have been on 300mg Effexor before (all alone) but cannot comment on how it helped because I switched into a manic (euphoric) high. So, yes it was very activating and I was not depressed BUT I was high (for the whole 8 months)so overall the experience sucked as I was so 'crazy' on it. However now I am on Lamictal so that should not happen again.
>
> But now I don't know if (or believe) that it will be activating even with the add-ons.(because I won't be 'switching' -I think) I know that fatigue is one of it's side effects and talking to people I have found that they DO get this fatigue (even with add-ons).
>
> I really, really think it was this special 5HT2C-antagonism of Geodon that pulled me up. I am confused if it is just a silly notion to try and recreate a complex drug like Geodon or if it's worth a shot (instead of just going on Effexor which is just a random thing and has a ridiculously long, difficult withdrawal, a problem if I need to change drugs)
>
> As I am really suicidal and am struggling through this 15 day wash out period of Parnate, I don't want to have yet another failed (random) trial.
>
> Any suggestions? Would be greatly appreciated.
>
> Thanks sincerely, for reading
>
> Take care
> D
>
>
>Antagonists
Dimebon (non-selective)[21]
Fluoxetine[5]
FR-260,010: high affinity, selective over 5-HT2A and many other receptors; orally active.[22]
RS-102,221: 100-fold selectivity compared to the 5-HT2A and -HT2B receptor subtypes[23]
SDZ SER-082: mixed 5-HT2B/2C antagonist
SB-200,646: mixed 5-HT2B/2C antagonist
SB-206,553: mixed 5-HT2B/2C antagonist
SB-221,284: mixed 5-HT2B/2C antagonist
SB-242,084[24]
compound 15k: IC50 = 0.5 nM; >2000x selective over 5-HT1A, 5-HT-2A, and 5-HT-6, and dopamine D2D4 receptors[25]
agomelatine
methysergide
mirtazapine
risperidone
O-Desmethyltramadol (an active metabolite of tramadol, with considerable mu-opiate agonism)Well here's a list of some 5HT2C-antagonists
How about substituting effexor (since it worked) for prozac
and risperidone (can you tolerate that) in your combo
poster:bulldog2
thread:923807
URL: http://www.dr-bob.org/babble/neuro/20090701/msgs/923881.html