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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by SadSuzie on June 14, 2000, at 22:33:27
Andrew,
I read a post that hypothesized too much serotonin
may be the culprit in some forms of depression.
If this is true, what do you think about a trial of
Tianeptine?Have you tried it? Any information on others who have
had experience with this drug?Thanks,
ssq
Posted by AndrewB on June 15, 2000, at 9:17:17
In reply to Andrew B - A Question, posted by SadSuzie on June 14, 2000, at 22:33:27
Suzie,
Suzie,
I've never read that too much serotonin may cause depression. Too much may cause anxiety, cognitive impairment, and other side effects, but not depression. Why do you ask? Have some of the meds you have taken made your mood worse?
Note that tianeptine’s mode of action is a bit mysterious. Though it does lower serotonin, this, in all likelihood, does not explain its efficacy.
I took tianeptine for a few days but I had to stop before I gave it a reasonable trial. I was gettig quite hateful towards my fellow man. I became scared that if I continued to progress I would turn into a Ted Bundy type! (What is it they say abouot violent criminals having low levels of serotonin in their brains?)
I've looked at this site (and others occasionally) for over a year, and I remember only one positive personal experience with tianeptine, so I will refer you to that. It was written by Pandey M on May 9. 1999. The post is entitled, "5 Months on Tianeptine'.
Anna P, who posts here somewhat regularly, is taking tianeptine now with what I understand are unremarkeable results.
Tianeptine may be most helpful for depression that is combined with 1) anxiety 2) mental impairment caused by the depression or 3) mood instabilty.
AndrewB
Posted by SadSuzie on June 15, 2000, at 16:38:19
In reply to Re: Andrew B - A Question, posted by AndrewB on June 15, 2000, at 9:17:17
Andrew,
Thanks for the response. I have been a silent observer of this site for about a year and have come to value your advice and insight. It is very possible that the post I read referenced anxiety - not depression.
Like many who post here, I have atypical depression ,social phobia and inattentive ADD. I've tried many antidepressants and anti-anxiety drugs with only partial relief. SSRIs make me climb the wall, and destroy my appetite (I'm thin and can't afford the weight loss). I became suicidal on Prozac, and the suicidal thoughts stopped as soon as the drug left my system. I've been through most of the tricyclics, Effexor (not XR), Parnate, Nardil, Neurotin, Buspar, etc., etc., etc.
I had my "best" response (but not complete) to Nardil, but couldn't take the side effects. I just completed a selegiline patch study and had pretty good results with it. It took care of the depression, the ADD somewhat, but not the social anxiety.
Before entering the selegiline study, I was taking Adderall and Klonopin, and they worked pretty well, except I got very tired and edgy between doses of Adderall. I see my local psy in two week and may go back to that combo. She's pretty receptive to my suggestions.
I live in hope, but it is getting tougher all the time.
suz
>
> Suzie,
>
> I've never read that too much serotonin may cause depression. Too much may cause anxiety, cognitive impairment, and other side effects, but not depression. Why do you ask? Have some of the meds you have taken made your mood worse?
>
> Note that tianeptine’s mode of action is a bit mysterious. Though it does lower serotonin, this, in all likelihood, does not explain its efficacy.
>
> I took tianeptine for a few days but I had to stop before I gave it a reasonable trial. I was gettig quite hateful towards my fellow man. I became scared that if I continued to progress I would turn into a Ted Bundy type! (What is it they say abouot violent criminals having low levels of serotonin in their brains?)
>
> I've looked at this site (and others occasionally) for over a year, and I remember only one positive personal experience with tianeptine, so I will refer you to that. It was written by Pandey M on May 9. 1999. The post is entitled, "5 Months on Tianeptine'.
>
> Anna P, who posts here somewhat regularly, is taking tianeptine now with what I understand are unremarkeable results.
>
> Tianeptine may be most helpful for depression that is combined with 1) anxiety 2) mental impairment caused by the depression or 3) mood instabilty.
>
> AndrewB
Posted by Ant-Rock on June 15, 2000, at 19:23:11
In reply to Re: Andrew B - A Question, posted by SadSuzie on June 15, 2000, at 16:38:19
Hi Suzie,
I was just curious, in what ways was the parnate different from the nardil for your atypical symptoms. Also, did they happen to mention when or if the selegiline patch was going to be put on the market?
Have you ever tried cognitive/behavioral therapy for the social anxiety? I have read articles in the past that have indicated success with therapy.
I'm glad you have an open minded Dr., this is very important in my book. Good luck with the adrafanil Suzie, I know exactly what you mean by "it's getting tougher all the time", but you have come to the best resource on the internet for support and information.
Sincerely,Anthony
Posted by SadSuzie on June 15, 2000, at 21:35:10
In reply to Re: Andrew B - A Question » SadSuzie, posted by Ant-Rock on June 15, 2000, at 19:23:11
Hello Anthony,
I have been through all types of therapy for my social anxiety, but no improvement.
The drug company sponsoring the selegiline patch study expects the patch to be available by the end of next year. However, who knows how long it will take the FDA. We know how they tend to drag their feet.
Nardil worked really well for my social anxiety, but I couldn't handle the side effects. On Parnate, I just felt drugged all the time.
I'm glad I finally got the nerve to post to this site instead of just observing. It is nice to have support from people who understand.
suz
Posted by KarenB on June 16, 2000, at 3:25:27
In reply to Re: Andrew B - A Question » SadSuzie, posted by Ant-Rock on June 15, 2000, at 19:23:11
Suzie,
Your symptoms/diagnoses sound much like mine, as do your responses to the listed meds.
The best combo I found was Sulpiride (a neuroleptic) taken with a modified tricyclic psychostimulant, Amineptine (discontinued - if pharmacies say they have it, it is just leftover stock and the end is near).
Amisulpride is very similar to Sulpiride and JohnL is having great results with it as an addition to the Adrafinil. He is also taking St John's Wort so I'm not sure how big a portion of the picture that would be.
With my symptoms, the Amineptine alone was no good, as was the Sulpiride alone. But together, it was "the bomb." I have never felt better. I would suggest you get some Amisulpride to take with the Adrafinil. You may want to try the Adrafinil alone first but do give it a shot with the Amisulpride. I think they may complement each other as the Sulp./Amin. cocktail did for me. In doses of below 300mg per day (check this out - I'm pretty sure but not positive of this mg), Sulpiride is very effective for social anxiety. It also lifted that heavy, lethargic feeling from me when nothing else could.
I have been attempting for almost a year to find the right combo available here in the States, so I don't have to depend on overseas shipments. My insurance will only cover meds available here in the US, so that is a major consideration as well. I will trial Provigil very soon, to use as an ADD/fatigue stimulant. I will probably get some Amisulpride to try with it, after I have determined what it will do on it's own. I will bail the Buspar when I do this, so as to not muddy the waters.
BTW, Sulpiride and Amisulpride, to a lesser degree, can help you put on some weight. Not a huge amount but for me it was between 5 and 10 lbs. The great thing is, though, you will feel like exercising, unlike some other meds that sedate and cause "exercise apathy" while making you gain. Oh, and there's a small chance (I fall into this small percentage)that your menstrual periods will become irregular or cease altogether during treatment on this neuroleptic. I did not consider this a problem and a side note is that with my menstrual periods gone, so were my migraines.
Best of health to you. And hey, please keep us updated if something works, doesn't work or whatever. I'll be looking for your posts to see how you're doing.
Karen
Posted by AndrewB on June 16, 2000, at 5:17:07
In reply to Re: Andrew B - A Question, posted by SadSuzie on June 15, 2000, at 21:35:10
Suzie,
Thanks for sharing your story Suzie. It is also nice to know that you have gotten something out of my posts. I don't want to add much to Karen's excellent post. She does have a diagnosis similar to yours, ADHD/atypical but no social anxiety I think. Your condition (atypical, ADHD, social anxiety) is one of those where I really believe you miss some of the foreign drugs out there. This is certainly true if you cannot tolerate Nardil. It is just my guess, but I don't think Nardil is that special. A combination of drugs can do what it does and do it a lot cleaner.
I think the adrafinil is a good choice to try. It should provide you with the arousal you need without the anxiety of a stimulant. Like you need more anxiety?
Let us know Suzie and Karen if Provigil and adrafinil are able to deal with your ADHD as well. I have my doubts.
By the way, I think maybe the reason selegiline didn’t help with the social anxiety is because at the higher doses of the patch it converts significantly into amphetamine, thus countering any social anxiety lessening effect its dopaminergic component may have had.
Suzie, you will probably need to add a dopaminergic drug on also. Your diagnosis...all of it - atypical, social anxiety, ADHD..... screams dopamine system malfunction. (In Bob’s Tips an ADHD researcher posts that ADHD is seemingly dopaminergic, as the efficacy of dopaminergic therapies for it indicate.) As Karen said, amisulpride is a good dopamine drug to take. I won’t add to what she said there. I suggest you also add on a low dose selegiline (you too Karen). Selegiline (10mg/day) is a different animal at low doses (no anxiety!) It has been found to have equal efficacy as stimulants in ADHD. Extrapolating from a small study, selegiline at 10mg. also has been found to have about 33% efficacy in social phobia and with an average of 32% improvement in social phobia per person. Selegiline of course doesn’t in itself compare with Nardil’s efficacy in social phobia of over 70%. But I believe when you combine selegiline with the ability of amisulpride, klonopin, and an alpha 1 agonist to reduce social anxiety, (presuming you are a responder).....you will have something that very well may work even better than Nardil for social anxiety without nearly the side effects. And you will also have, hopefully, the ADHD and the atypical depression taken care of; attention, energy, focus, mood.
Best wishes,
AndrewB
Posted by SadSuzie on June 16, 2000, at 19:31:31
In reply to Re: Suzie (and Karen!), posted by AndrewB on June 16, 2000, at 5:17:07
I found the following article and thought it very interesting. Do you agree with this theory? Which medication effects this receptor in particular?
Am J Psychiatry 157:457-459, March 2000
(c) 2000 American Psychiatric AssociationBrief Report
Low Dopamine D2 Receptor Binding Potential in Social Phobia
Franklin R. Schneier, M.D., Michael R. Liebowitz, M.D., Anissa Abi-Dargham, M.D.,
Yolanda Zea-Ponce, Ph.D., Shu-Hsing Lin, Ph.D. and Marc Laruelle, M.D.OBJECTIVE: This study compared dopamine D2 receptor binding potential in patients with social phobia and healthy
comparison subjects. METHOD: Dopamine D2 receptor binding potential was assessed in 10 unmedicated subjects with
generalized social phobia and no significant lifetime psychiatric comorbidity and 10 healthy comparison subjects matched for age and sex. Binding potential was
measured in the striatum by using single photon emission computerized tomography and constant infusion of the D2 receptor radiotracer [123I]iodobenzamide
([123I]IBZM). RESULTS: Mean D2 receptor binding potential was significantly lower in the subjects with social phobia than in the comparison subjects. Within the
social phobia group, there was a nonsignificant correlation of binding potential with the Liebowitz Social Anxiety Scale score. CONCLUSIONS: Generalized social
phobia may be associated with low binding of [123I]IBZM to D2 receptors in the striatum.
>
> Suzie,
>
> Thanks for sharing your story Suzie. It is also nice to know that you have gotten something out of my posts. I don't want to add much to Karen's excellent post. She does have a diagnosis similar to yours, ADHD/atypical but no social anxiety I think. Your condition (atypical, ADHD, social anxiety) is one of those where I really believe you miss some of the foreign drugs out there. This is certainly true if you cannot tolerate Nardil. It is just my guess, but I don't think Nardil is that special. A combination of drugs can do what it does and do it a lot cleaner.
>
> I think the adrafinil is a good choice to try. It should provide you with the arousal you need without the anxiety of a stimulant. Like you need more anxiety?
>
> Let us know Suzie and Karen if Provigil and adrafinil are able to deal with your ADHD as well. I have my doubts.
>
> By the way, I think maybe the reason selegiline didn’t help with the social anxiety is because at the higher doses of the patch it converts significantly into amphetamine, thus countering any social anxiety lessening effect its dopaminergic component may have had.
>
> Suzie, you will probably need to add a dopaminergic drug on also. Your diagnosis...all of it - atypical, social anxiety, ADHD..... screams dopamine system malfunction. (In Bob’s Tips an ADHD researcher posts that ADHD is seemingly dopaminergic, as the efficacy of dopaminergic therapies for it indicate.) As Karen said, amisulpride is a good dopamine drug to take. I won’t add to what she said there. I suggest you also add on a low dose selegiline (you too Karen). Selegiline (10mg/day) is a different animal at low doses (no anxiety!) It has been found to have equal efficacy as stimulants in ADHD. Extrapolating from a small study, selegiline at 10mg. also has been found to have about 33% efficacy in social phobia and with an average of 32% improvement in social phobia per person. Selegiline of course doesn’t in itself compare with Nardil’s efficacy in social phobia of over 70%. But I believe when you combine selegiline with the ability of amisulpride, klonopin, and an alpha 1 agonist to reduce social anxiety, (presuming you are a responder).....you will have something that very well may work even better than Nardil for social anxiety without nearly the side effects. And you will also have, hopefully, the ADHD and the atypical depression taken care of; attention, energy, focus, mood.
>
> Best wishes,
>
> AndrewB
Posted by S.D. on June 16, 2000, at 21:12:51
In reply to Andrew B - A Question, posted by SadSuzie on June 14, 2000, at 22:33:27
It's great to have you de-Lurking! As KarenB said, I hope you'll keep us posted on how you are doing.
BTW I also have social phobia, plus depression (in remission except still tiredness, lethargy) and what may be ADD without hyperactivity.Now for my 2¢:
I can try to find it if you want, or a medline search may turn it up, but regarding tianeptine I read recently that, in spite of it being a Serotonin Reuptake Agonist, it resulted in elevated Serotonin levels after chronic use. For whatever that's worth.
Regarding Sulpiride, mentalhealth.com has a monograph for it ( http://www.mentalhealth.com/drug/p30-s06.html#Head_2 )
A monograph for the apparently similar med "Solian" (amisulpride) is found at http://solian.com.ph/solian_monograph.html
Each of these has something to say about low-dose v. high-dose use (low dose apparently being what we'd want) but the Solian monograph is more explicit regarding particular dosages and the different neurochemical actions at these doses.Lastly, Neurontin or Kava Kava may be effective in reducing social anxiety. Each has worked for me but Neurontin is causing memory problems of the "absent mindedness" sort so probably I will switch back (or to Klonopin).
peace and health,
S.D.
Posted by KarenB on June 17, 2000, at 0:48:12
In reply to Welcome SadSuzie, and my 2¢, posted by S.D. on June 16, 2000, at 21:12:51
Well alrighty then...
So the original question was actually about Tianeptine. Hmmmm. I often miss the obvious and get embroiled in the details - sorry. I have limited knowledge about this but I do have some personal experience which I will share with you.
I tried Tianeptine, very hopefully, when Amineptine was discontinued. My Filipna doctora suggested that it should have the same effectiveness as Amineptine. No such luck. With me, it acted like an SSRI, leaving me sleeeeeeepy, lethaaaaargic, irritable AND depressed. I lost almost three weeks of my life to that med, waiting for it to get better. It didn't.
This is, of course, just one woman's experience. I have no idea what it has done or hasn't done for anyone else. Your mileage may vary.
Actually, the failure of Tianeptine is what started my fervent search for the right drug combination. I finally figured out that no one, not even my doctors, were going to take my mental health as seriously as I alone needed to.
I'm still looking but feel I am closer than I've ever been.
Karen
Posted by AndrewB on June 17, 2000, at 1:16:49
In reply to Re: Suzie (and Karen!), posted by SadSuzie on June 16, 2000, at 19:31:31
>
> Low Dopamine D2 Receptor Binding Potential in Social Phobia
>Karen,
This and other recentstudies has shown that, yes, D2 (and D3?) recpetor hypofunction plays a role in social phobia/anxiety. Studies like these explain the effectiveness that drugs that target these receptors can have in treating social anxiety. Amisulpride and sulpiride both targert these receptors. Sulpiride has studies showing its efficacy in treating social phobia.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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