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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SIGOLENE on March 1, 2000, at 15:13:52
all the SSRI's I tried untill now were worsening my depression.
But I wonder, if I take a tricyclic which acts on serotonine, (but in an other way than SSRI's), would it possible that the reaction will be different ?
Thanks.Sigolene
Posted by Cam W. on March 1, 2000, at 21:33:42
In reply to questions for the meds specialists around here, posted by SIGOLENE on March 1, 2000, at 15:13:52
Sigolene - Tricyclics block the serotonin (5-HT) reuptake pump just like SSRIs, but they also block norepinephrine (NE) reuptake pumps as well (also blocking cholinergic-muscarinic-M1, histamine-H1, and alpha-adrenergic receptors which is why we see so many side effects with the TCAs). They do work differently than SSRIs and one may work for you. Desipramine blocks NE reuptake more than 5-HT reuptake, but Clomipramine blocks 5-HT reuptake more than NE reuptake. Since you haven't responded to SSRIs, your doctor might be better off prescribing a TCA from the Desipramine end of the spectrum. With TCAs in general, you may notice more dry mouth and sedation than with SSRIs, but not as much sexual dysfunction (except, sometimes, with Clomipramine). Hope this helps - Cam W.
Posted by JohnL on March 2, 2000, at 3:51:03
In reply to questions for the meds specialists around here, posted by SIGOLENE on March 1, 2000, at 15:13:52
> all the SSRI's I tried untill now were worsening my depression.
> But I wonder, if I take a tricyclic which acts on serotonine, (but in an other way than SSRI's), would it possible that the reaction will be different ?
> Thanks.
>
> SigoleneSigolene,
I'm certainly no specialist, but I wanted to put in my two cents worth. I think trying a tricyclic at this point makes sense. If for no other reason, just to see if norepinephrine medications help or make you worse. That will give more clues as to what chemistry is causing your symptoms. Two good choices with the fewest side effects are Nortriptyline or Desipramine. Of the two, Desipramine is the most NE specific.If you get worse on one of these, then it proves there is some other chemistry involved. Then we would want to look at: Stimulants (NE/dopamine failure), mood stabilizers (chemical/electrical instability), antipsychotics (dopamine excess), or benzos (GABA deficient). Any or all of these may target the chemistry causing your symptoms when antidepressants don't. The fact that antidepressants worsen your condition proves there is some other chemistry involved, but testing a NE antidepressant is worth a try first in my opinion.
You might ask your doc to prescribe for you a dozen doses each of Stelazine (antipsychotic) and Xanax (benzo). Both of these are good anticdotes to take for relief if the antidepressant makes you feel worse. You shouldn't have to suffer through a bad reaction. Hold the broken pill in your mouth for a minute before swallowing to speed response (minutes). Both of these drugs are like seatbelts when the going gets rough. Not only that, but if you by chance find you feel better after taking either Stelazine or Xanax, that will further prove there is some other chemistry involved in your case.
For any of the classes of drugs I mentioned, long drawnout trials are not needed. If one is right for you, it will be obvious within a week, and possibly just a day or two. It all depends on how directly a particular drug targets the underlying chemistry. It will be very helpful if your doc will be prepared to allow you to make quick comparisons of various drugs. The purpose is to probe. Once superior matches have been found, then the purpose focuses on getting well. But first the right drugs need to be discovered. Probing allows us to do that. After multiple antidepressant failures, I believe it becomes a high priority to probe drugs of different classes. There are several chemical imblances/instabilities that can cause depression that antidepressants won't target, and indeed will only make worse.
Posted by JohnL2 on March 2, 2000, at 4:05:34
In reply to Re: questions , posted by JohnL on March 2, 2000, at 3:51:03
After reading my previous post, I wanted to clarify something. When I mentioned asking for a dozen doses of Stelazine and Xanax, I intended to specify taking one pill as needed. It kind of looks like I meant to take a dozen. Yikes! One at a time on an as-needed basis as a remedy to get through a bad reaction to an antidepressant is what I meant. Sorry it might have looked confusing. :)
Posted by Cam W. on March 2, 2000, at 6:53:35
In reply to Re: questions - clarification, posted by JohnL2 on March 2, 2000, at 4:05:34
John - You say your not a specialist, but I'll bet that not too many pharmacists could have given as good an answer as you have given above (as well as many of your other postings). Very impressive! You are not a specialist on paper only (eg no license). - Cam W.
Posted by SIGOLENE on March 2, 2000, at 11:01:43
In reply to Re: Specialist - JohnL, posted by Cam W. on March 2, 2000, at 6:53:35
Thank you John for your answer,
In fact I already in the past tried tricyclics AD which acts only on NE. There was an improvment for a while. But I had to stop these meds because I fall asleep during the whole day. And anticholinergic drugs are not good for me due to urinary tract chronic infections. (yes anticholinergics have also an effect on that ! It's contracting this muscle). I would like to find a tricyclic, no anticholinergic, and not too sedating, wich acts only on NE. But untill yet I couldn't find this product. The non- anticholinergics ones are all acting on NE and 5HT. That's why I was asking my first question of this thread. Do you have an idea? An did you know that anticholinergics drugs were also bad for memory ?
In your answer, please talk about the substance not the brand names of drugs, because in Europe the brand names are different for the same product.Thanks Sigolene
Posted by Sarah on March 2, 2000, at 11:25:21
In reply to Re: question to JohnL, posted by SIGOLENE on March 2, 2000, at 11:01:43
> Thank you John for your answer,
>
> In fact I already in the past tried tricyclics AD which acts only on NE. There was an improvment for a while. But I had to stop these meds because I fall asleep during the whole day. And anticholinergic drugs are not good for me due to urinary tract chronic infections. (yes anticholinergics have also an effect on that ! It's contracting this muscle). I would like to find a tricyclic, no anticholinergic, and not too sedating, wich acts only on NE. But untill yet I couldn't find this product. The non- anticholinergics ones are all acting on NE and 5HT. That's why I was asking my first question of this thread. Do you have an idea? An did you know that anticholinergics drugs were also bad for memory ?
> In your answer, please talk about the substance not the brand names of drugs, because in Europe the brand names are different for the same product.
>
> Thanks Sigolene
I was on Elavil (amitryptiline...sp?) a number of years ago and loved it!! The relief I recieved from it was better than any SSRI I have ever been on! Tho it didnt do much for my ADD, it certainly helped my depression! I quite taking it while we were planning for a family, and when we were finished with that and I got on it again, I couldnt handle the sedative effect of it. (my metabolic level was shot!) I have heard that it can be one of the less sedating tricylics there is, though...
Posted by AndrewB on March 2, 2000, at 14:14:30
In reply to Re: question to JohnL, posted by SIGOLENE on March 2, 2000, at 11:01:43
> Thank you John for your answer,
>
> In fact I already in the past tried tricyclics AD which acts only on NE. There was an improvment for a while. But I had to stop these meds because I fall asleep during the whole day. And anticholinergic drugs are not good for me due to urinary tract chronic infections. (yes anticholinergics have also an effect on that ! It's contracting this muscle). I would like to find a tricyclic, no anticholinergic, and not too sedating, wich acts only on NE. But untill yet I couldn't find this product. The non- anticholinergics ones are all acting on NE and 5HT. That's why I was asking my first question of this thread. Do you have an idea? An did you know that anticholinergics drugs were also bad for memory ?
> In your answer, please talk about the substance not the brand names of drugs, because in Europe the brand names are different for the same product.
>
> Thanks SigoleneSigolene,
Are you considering reboxetine. It think it is available to you in France. In studies it was shown to be more effective in general than desipramine. It is considered the cleanest of the NE active med.s. It tends to increase motivation and energy rather than be sedating. That has been my personal expereince. It does have some alpha-adrenergic affinty though meaning it tends to tighten the muscle around the urinary tract making it difficult to urinate. This side effect does not go away but can be countered by an alpha-andrenergic blocking agent such as tamsulosin HCL.
Didn't you say you have chronic fatigue? Have you been diagnosed with that? Have you gotten any blood tests to determine the underlying problem?
Posted by dove on March 2, 2000, at 15:05:08
In reply to Re: Sigolene, posted by AndrewB on March 2, 2000, at 14:14:30
Elavil's trade name is Amitriptyline, and it is one of the most sedating TCAs. I also believe it is one of the oldest ADs around. What others have you tried?
dove
Posted by JohnL on March 3, 2000, at 3:57:09
In reply to Re: Specialist - JohnL, posted by Cam W. on March 2, 2000, at 6:53:35
>
> John - You say your not a specialist, but I'll bet that not too many pharmacists could have given as good an answer as you have given above (as well as many of your other postings). Very impressive! You are not a specialist on paper only (eg no license). - Cam W.Thanks for the compliments Cam. Unfortunately I do have a license.....from the Perpetual School of Hard Knocks! :) I have had the good fortune, though, of knowing a couple outstanding psychiatrists who specialize in treating failed difficult cases of other psychiatrists. I have just started treatment with one of those outstanding psychiatrists, and hopefully in a few months I will earn my diploma from the School of Hard Knocks. :)
In the meantime, I look forward very much to reading all your posts. I'm glad you're here. JohnL
Posted by Sigolene on March 3, 2000, at 14:56:06
In reply to Re: Sigolene, posted by AndrewB on March 2, 2000, at 14:14:30
> Sigolene,
>
> Are you considering reboxetine. It think it is available to you in France. In studies it was shown to be more effective in general than desipramine. It is considered the cleanest of the NE active med.s. It tends to increase motivation and energy rather than be sedating. That has been my personal expereince. It does have some alpha-adrenergic affinty though meaning it tends to tighten the muscle around the urinary tract making it difficult to urinate. This side effect does not go away but can be countered by an alpha-andrenergic blocking agent such as tamsulosin HCL.
> Didn't you say you have chronic fatigue? Have you been diagnosed with that? Have you gotten any blood tests to determine the underlying problem?Andrew,
Good idea the reboxetine, but I just checked on the french web site for meds. I didn't find the reboxetine. Is it the brand name or substance ? Same question for tamsulosin HCL. thanks.
(appart from that, I was surprised that you remembered the chronic fatigue ! yes, I had blood tests, but like every time: nothing wrong in my tests.)
Sigolene
>
Posted by AndrewB on March 4, 2000, at 11:31:36
In reply to Re: andrewB, posted by Sigolene on March 3, 2000, at 14:56:06
I don't know if France has Reboxetine(That is the substance name). It might have a slightly different name in French. For example, it is ’Reboxetin’ in German. I know it is approved by the EU and available in the UK and other European countries. If it isn't available in France you can order it from the UK without a prescription. It costs $60 to $70 for about a month's supply.
Another medicine you might consider is amisulpride. This medicine is available in France. It was developed by a French company, Synthelabo. The French name for it might be slightly different though (amisulprida?). The brand name is Solian. It can be stimulating. I found it improved my energy for the first four months and it made the heavy fatigue I’d get from exercising go away. John L found it stimulating. Amisulpride doesn’t work on NE or serotonin, it activates dopamine receptors. It is a clean drug in the sense it has little in the way of side effects and it only activates the D2-D3 dopamine receptors, those involved in mood. A study showed it to be superior to Vivalan for dysthymia. Because it is fast acting, a one week trial should be all you need to determine if it is right for you.
Yes I remember that you have chronic fatigue (CFS). You have my sympathies, it sounds like quite a combination, chronic fatigue and depression. You know that most people with CFS don’t have depression, but a certain minority do.
Their depression is different than normal depression. Rather than having a hyperactive HPA axis and being somewhat hypercortisolic they have a hypoactive HPA axis and are somewhat hypocortisolic (See the article below).
I don’t know what this means as far as effective treatment strategies go. Atypical depressives are supposed to have hypoactive HPA axis too and they tend to respond to little else besides MAOIs. Maybe that means an MAOI (i.e. Parnate or Seligiline) might be effective for you.
If you haven’t already, I would go to the CFS boards, there are several, and ask those that have both depression and CFS what they have found effective for their depression.Best wishes for your health,
AndrewB
-------------------------------------------------------
J Affect Disord 1998 Jan;47(1-3):49-54
Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers.
Scott LV, Dinan TG
Department of Psychological Medicine, St. Bartholomew's Hospital and the Royal London School of Medicine, West Smithfield, UK.Urinary free cortisol excretion (UFC) was compared in 21 patients with chronic fatigue syndrome (CFS), in 10 melancholic depressives and in 15 healthy controls. Patients with depression had UFC values which were significantly higher than healthy comparison subjects, whereas UFC excretion of CFS patients was significantly lower than the comparison group. These findings are in keeping with currently held hypotheses of hyperactivity and hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis in depression and chronic fatigue syndrome respectively. Five of the 21 CFS patients had a co-morbid depressive illness. This sub-group retained the profile of UFC excretion of those with CFS alone, suggesting a different pathophysiological basis for depressive symptoms in CFS.
Posted by Sigolene on March 4, 2000, at 16:37:12
In reply to Re: andrewB, posted by Sigolene on March 3, 2000, at 14:56:06
Andrew,
Just one last question.
How is it possible that Solian can improve depression ? because it's decreasing domapamine. Normally, the AD are increasing domapamine, not decreasing. But we have it in switzerland.
We have also Vivalan, but it seems that we haven't this reboxetine. What do you know about Vivalan. No one is talking from that med here.
Sigolene.
Posted by AndrewB on March 5, 2000, at 11:27:31
In reply to Re: andrewB, posted by Sigolene on March 4, 2000, at 16:37:12
> Andrew,
>
> Just one last question.
> How is it possible that Solian can improve depression ? because it's decreasing domapamine. Normally, the AD are increasing domapamine, not decreasing. But we have it in switzerland.
> We have also Vivalan, but it seems that we haven't this reboxetine. What do you know about Vivalan. No one is talking from that med here.
> Sigolene.Sigolene,
Amisulpride does increase dopamine, at low doses. At high doses it decreases dopamine. At doses of 50 to 100mgs it is a presynaptic autoreceptor antagonist and used as an antidepressant. At doses of 400 to 800 mgs it is a postsynaptic receptor antagonist and used as an antipsychotic.
Sorry, I don't know anything about Vivalan (viloxazine). It works like a trycyclic doesn't it, even though it isn't one? I guess it is not available in the US.
Posted by AndrewB on March 6, 2000, at 17:33:07
In reply to Re: andrewB, posted by Sigolene on March 4, 2000, at 16:37:12
Sigolene,
You may find my post about CFS and amisulpride interesting. To find it look at the 'Atypical Depression' string.
This is the end of the thread.
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