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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 5 to 29 of 183. Go back in thread:
Posted by sukarno on March 27, 2005, at 6:54:05
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
The side-effects went away about 24 hours ago, but I'm not feeling much antidepressant effect yet. I guess I just have to be more patient as it has only been 3 or 4 days and can take up to two weeks to feel the full effects.
I'm taking the recommended dose of 12.5mg three times a day.
I think I notice less anxiety in between Xanax doses, but not sure if that is the Stablon working or just placebo effect.
Posted by sukarno on March 29, 2005, at 15:16:56
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
It is day 6 or 7 of being on Stablon (12.5mg t.i.d.) and no more side effects, but also no significant antidepressant effect yet. The manufacturer says it can take two weeks to lift the depression, so I should be more patient.
I have heard of folks taking SSRIs and having to wait several weeks to get any noticeable effect.
I haven't read many stories of people on Stablon, so I am not sure what to expect from it. I have Seasonal Affective Disorder so it is possible this is a different type of depression, but then again, maybe it will respond to Stablon.
I guess what I can say is that I am not as severely depressed as I was the day I started taking this new drug. I'd say that maybe my mood has improved by 10%.
The only definite effect I can feel is a reduction in anxiety.. moreso a reduction in anxiety rather than depression.
I hope others on this drug can post their stories here.
Posted by ed_uk on March 29, 2005, at 15:57:00
In reply to No more side effects to Stablon (tianeptine), posted by sukarno on March 29, 2005, at 15:16:56
Hello,
It's always interesting to hear from people taking unusual meds (ie one's we don't have here).
It's good that you've had a reduction in anxiety. Most antidepressants take longer than 2 weeks to have a good effect and I expect that tianeptine is no exception. Don't give up too early!
Keep posting :-)
Ed.
Posted by sukarno on April 2, 2005, at 12:53:03
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Last night I started to feel the antidepressant effect starting and feel a bit better today. No side effects, which is great. :) I'll keep you posted. :)
Posted by ed_uk on April 2, 2005, at 13:16:31
In reply to Feeling the antidepressant effect, posted by sukarno on April 2, 2005, at 12:53:03
Hi!
>Last night I started to feel the antidepressant effect starting and feel a bit better today.
Hey, that's great :-)
How long have you been taking the tianeptine for now???
>I'll keep you posted...
Please do!
Kind regards,
Ed.
Posted by sukarno on April 2, 2005, at 16:40:29
In reply to Re: Tianeptine » sukarno, posted by ed_uk on April 2, 2005, at 13:16:31
Hi there! :) This is day 11 of being on it. Which country do you live in? I was told that it is available in parts of Europe and also in the UK, but not 100% sure about the UK.
Paul
Posted by ed_uk on April 2, 2005, at 17:58:04
In reply to Re: Tianeptine, posted by sukarno on April 2, 2005, at 16:40:29
Hi Paul!
>Which country do you live in?
England. It's available in certain parts of Europe, I know it's available in France. It's never been available in England though.
Keep posting! It's nice to hear how you're doing,
Ed.
Posted by BradD on April 5, 2005, at 11:40:07
In reply to Feeling the antidepressant effect, posted by sukarno on April 2, 2005, at 12:53:03
Unfortunately Tianeptine did nothing for my depression/social-phobia. And I've used different doses to see if it kicks in.
Posted by sukarno on April 5, 2005, at 20:48:40
In reply to Re: Feeling the antidepressant effect, posted by BradD on April 5, 2005, at 11:40:07
On Day 12 or 13 I experienced a sudden effect from the tianeptine 30 minutes after taking my third dose of the day. It was somewhat indistinguishable from a hypoglycemic attack in the beginning (I have reactive hypoglycemia), in that there was a lot of adrenaline activity. Other that that it was best described as a "speedy" effect with unusual ease in breathing as if my lungs had opened right up, which would be consistent with adrenaline release.
I have no idea if adrenaline played any part in it though. It was definitely a pronounced psychostimulant effect and at one point I thought I was going to have a panic attack, perhaps because I misinterpretted the symptoms as being dangerous when they were only benign.
It was like drinking a few strong cups of coffee..definite bronchodilator effect along with an ability to concentrate much more than usual.
I decided to cut back on it to only 2 tablets today because even this 2nd dose today that I took just an hour ago is giving me a rush..not really euphoric...well, mildly.
Somewhat overstimulating. Maybe I don't need this much tianeptine. That "12.5mg t.i.d from the start!" that the drug company Servier promotes seems like it isn't appropriate for everyone.
No one size fits all I think. I hope I can obtain some anti-panic effect from it in the lower doses.
Posted by sukarno on April 6, 2005, at 12:12:22
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Hi again. Is this a stimulant? The manufacturer, Servier, claims there are no sedative or stimulant effects, but this is just overstimulating. I took 2 tablets yesterday and today I took only 1/2 tablet and then I felt really jittery and my heart jumped around a few times.
Of course, the good thing is I don't feel depressed like I did prior to treatment two weeks ago..maybe just slightly depressed. I'd say about a 50% improvement in depression and the anxiety that goes with it.
This stimulant effect though is too much for me. It is like I drank 2 or 3 cups of tea. Uncomfortable and anorectic also.
Whoever here has taken tianeptine before, did you experience these negative side effects?
I really can't see how this can be good for panic disorder if it is making me so nervous and full of adrenaline.
If it is so short-acting (half-life of 3 hours), how can it "accumulate" like this?I'll try to lower the dose. I have heard of good results from just 1/2 tablet twice a day (from this website).
The best way to describe what I'm feeling is that feeling you get when you are almost hit by a car, but instead that "fight or flight" feeling just persists.
If I could compare this to any drug I've ever taken before, I would say it is similar to Effexor.
Posted by sukarno on April 6, 2005, at 12:20:56
In reply to Re: Feeling the antidepressant effect, posted by BradD on April 5, 2005, at 11:40:07
> Unfortunately Tianeptine did nothing for my depression/social-phobia. And I've used different doses to see if it kicks in.
Hi Brad, how long did you take this drug and which dose? Did it make you nervous? I feel quite nervous...I had to take an extra 0.5mg Xanax to counter this effect somewhat.
Posted by ed_uk on April 6, 2005, at 13:36:28
In reply to Is tianeptine a stimulant?, posted by sukarno on April 6, 2005, at 12:12:22
Hi!
Tianeptine does seem to act as a stimulant in some people- it has been used 'recreationally' for this reason!
'The authors report a case of tianeptine abuse in a 30 year-old woman. After a medical prescription of the recommended dosage of 12.5 mg 3 times daily of oral tianeptine for a depressive illness, the patient spontaneously increased the dosage which after two months reached 150 tablets per day. No severe toxic effects were observed. As adverse effects, the patient, in the beginning of this high treatment period suffered from nausea, vomiting, abdominal pain, anorexia with weight loss, constipation. These side effects progressively disappeared. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seek a *psychostimulant* effect. After seven months of such a therapy, she was hospitalized to undergo a withdrawal. The discontinuation of the tianeptine treatment occurs in four days.'
Posted by sukarno on April 11, 2005, at 20:50:28
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I'm still on tianeptine, but I lowered the dose for a while. Today is day 20 of being on it and I feel ok. At least I don't feel as depressed as before. I'd say it's a 75% improvement in my mood. When I am happy, I really feel happy, whereas when I was on Prozac I remember it blunting my emotions so I felt "artificially happy". Hard to describe and I guess that is a bit subjective.
I'm taking about 12.5mg a day in divided doses (instead of the 12.5mg t.i.d.)
Paul
Posted by ed_uk on April 12, 2005, at 10:46:37
In reply to Doing ok now, posted by sukarno on April 11, 2005, at 20:50:28
Hi Paul!
>I'd say it's a 75% improvement in my mood. When I am happy, I really feel happy.........
Excellent :-)
RE the Xanax, have you tried reducing the dose?
Regards,
Ed.
Posted by sukarno on April 12, 2005, at 19:23:21
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 12, 2005, at 10:46:37
Hi Ed! :) Unfortunately, I don't think I'm able to reduce the Xanax at this time. I did attempt a taper in 2003 and only reduced the dose by 0.125mg, but woke up sweating and breathless with tachycardia and anxiety. Definitely Xanax is very hard to taper, whereas I had little trouble tapering Valium or Tranxene.
I'd like to get off Xanax someday as long as there is something else there to stop the panic attacks.
I've noticed a problem with lack of cross-tolerance between Xanax and Valium. One does not substitute well for the other in my experience. I've quit Valium (5mg 4x/day) and substituted it with Xanax (0.5mg 4x/day) and 4 days later experienced significant withdrawal symptoms from Valium (insomnia, nervous wreck, sweating, rebound anxiety, seeing spots, problems with visual accomodation and double vision..even saw an eye doctor for it not knowing it was Valium withdrawal). Xanax didn't seem to "cover" for the Valium.
Conversely, switching from Xanax to Valium is worse. I noticed muscle cramps all over my body and a sense of paralysis along with severe anxiety (and that was from being on Xanax for only one week). I raised the Valium temporarily and then all the withdrawal was gone, except for some muscle cramps that were mild.
I've been on Xanax daily since October 2002 at 1mg 4x/day by prescription from a psychiatrist, and now just see a GP.
I've read Dr. Heather Ashton's website on Valium substitution and am giving that some thought.
Have you heard of her? I think she is popular in the UK.
Apparently most people can taper using Xanax alone, but it doesn't seem to be the case with me. Luckily I don't feel any psychological dependence on it, but the physical dependence is severe.
At least it works as it did from the beginning. Zero panic attacks (or very rarely), whereas prior to medication years ago I had 3 to 5 panic attacks per day. :(
I don't like the cognitive effects and they persist. Feeling like everything you've done is a "dream". I don't forget things, but that sense that nothing is real enough is very bothersome and I'd like to be off all drugs someday if possible.
I hope tianeptine can control the panic disorder. If not, I thought about going back on imipramine even though it really raised havoc with my heart.
I am desperate for something that won't interfere with or dull my mind and at the same time won't cause dependence, so should I want to quit, it will be easy.
Thanks for listening.. I think I've rambled on and on. hehheh.
Posted by ed_uk on April 13, 2005, at 8:50:35
In reply to Re: Doing ok now, posted by sukarno on April 12, 2005, at 19:23:21
Hi!
>I'd like to get off Xanax someday as long as there is something else there to stop the panic attacks.
Apart from Valium, Tranxene and Xanax, which medications have you tried so far? (for the panic) I imagine you've tried many of the common drugs such as the SSRIs.
>Xanax didn't seem to "cover" for the Valium.
That's very interesting, I've heard of people having problems switching from Xanax to Valium but never vice versa.
I once tried Xanax but it didn't seem to help- I think I'll stick to Valium!
>I've been on Xanax daily since October 2002 at 1mg 4x/day by prescription from a psychiatrist, and now just see a GP.
When you were on Valium, what dose did you take?
What dose of Tranxene did you take?
Which benzodiazepine did you find the most effective?
Which drug caused the most side effects? (including cognitive effects)(sorry for all the questions LOL)
>I've read Dr. Heather Ashton's website on Valium substitution and am giving that some thought.
Yes, you could cross-taper onto Valium and then taper the Valium. 1mg Xanax = (approx) 10-20mg Valium.
>Conversely, switching from Xanax to Valium is worse. I noticed muscle cramps all over my body and a sense of paralysis along with severe anxiety (and that was from being on Xanax for only one week). I raised the Valium temporarily and then all the withdrawal was gone, except for some muscle cramps that were mild.
Perhaps you'd need to substitute 20mg of Valium per 1mg of Xanax to prevent withdrawal symptoms.
>Have you heard of her? I think she is popular in the UK.
Yes, I like her withdrawal guide. I do think she tends to be overly negative about benzos though. They can certainly cause very severe withdrawal symptoms but they do have their uses!
>I don't like the cognitive effects and they persist. Feeling like everything you've done is a "dream".
I know what you mean! I can't 'function' if I've taken a benzo. I tend to need quite high doses and I can't concentrate or remember anything. Valium makes me feel quite introverted and I don't pay attention to my surroundings- I'm not quite there! I only take diazepam occasionally though, I don't know what I'd be like if I took it regularly.
>I thought about going back on imipramine even though it really raised havoc with my heart.
What did it do to your heart? Did you have an ECG? Imipramine commonly causes a rapid pulse (sinus tachycardia) but serious arrhythmias are uncommon. It often causes orthostatic hypotension as well, and resulting dizziness on standing up.
I take a tricyclic myself: lofepramine, my heart rate is 100 beats per minute at rest- it has been 100 bpm for the last two years! It's reassuring to remember that the chronically elevated heart rate that tricyclics so commonly cause isn't related to any of their serious cardiac side effects. Have you tried any of the other tricyclic antidepressants?
>I hope tianeptine can control the panic disorder.
Me too :-)
>Thanks for listening.. I think I've rambled on and on. hehheh.
It was a nice post :-)
Kind regards,
Ed.PS. Are you from Indonesia or did I just imagine that?
Posted by sukarno on April 13, 2005, at 21:02:52
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 13, 2005, at 8:50:35
Thanks for the post. :) I've tried about 15 medications: Imipramine, nortriptyline, desipramine, trazodone, fluoxetine (Prozac), paroxetine (Paxil/Seroxat), sertraline (Zoloft/Lustral), buspirone (BuSpar), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax), clonazepam (Klonopin/Rivotril), oxazepam (Serax..was given it in ER once), venlafaxine (Effexor) and hydroxyzine (Atarax/Vistaril).
I was diagnosed in 1988 when I was 16 and prescribed imipramine 25mg in November '88. It was quite sedating and made me feel weak the first few days..along with some increased blood pressure and tachycardia (90bpm).
My psychiatrist recommended taking up some exercise, so I did that and my resting heart rate dropped to an average of 60bpm, sometimes lower.
I was in good shape then and my grades went back up to 4.0 in high school and I worked part-time too. The problem with my heart started about 1 month later and felt like "skipped beats" and then I woke up one night with a rapid pulse of 120bpm and palpitations/irregular heart action and my face felt flushed. My father called up the psychiatrist and she told me she wouldn't prescribe imipramine again.
She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it. When I quit nortriptyline my panic did not return for at least 10 days, but when it did resume it was back to the classic 3 to 5 a day as it was prior to diagosis and medication.
I did notice in the 18 months preceding my first panic attack, that I felt a lack of motivation and ambition, lowered sense of self-esteem but nothing major. My grades did suffer and dropped to below 3.0. I began to drink more caffeinated beverages to help increase my attention and focus on school and resorted to caffeine pills at one point.I certainly hope that caffeine wasn't responsible for my current problems. Perhaps it set it off earlier than it would have, had I not been taking caffeine.
I could tolerate large doses of caffeine without any palpitations or anxiety prior to panic disorder. However, after panic disorder struck me, I no longer had a tolerance to caffeine and even 1/2 cup of coffee would trigger heart palpitations.
I saw another psychiatrist in 1989 who tried Prozac since it was quite new and he thought it might work. I took it for 3 days at 20mg/day and on day 3 I was walking to school and suddenly felt as if my body was on fire along with the worst anxiety I had ever experienced in my life. I immediately went to the school nurse and called my psychiatrist who then asked me if I'd heard of Valium or Xanax, because that was what he was going to try next. I did try Xanax and felt it didn't last long enough to keep the anxiety away at 0.5mg 3x/day and also gave me some vertigo a few times which was unpleasant. Valium worked excellently, but it also made me quite sleepy in class, so I complained to him about it and he took me off it.He then tried BuSpar (buspirone) and it had no effect whatsoever on my anxiety, even after taking it for a while. I tried trazodone (Desyrel) 50mg and it made me very sleepy and the dry mouth I experienced with it along with feeling quite drugged was not something I liked, so I quit taking that.
Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time. I couldn't tolerate the side effects. It was different than the other tricyclics in that it wasn't sedating and caused more orthostatic hypotension. My psychiatrist wasn't too understanding of the suffering I was experiencing from desipramine and I just decided to stop taking it.
In the fall of 1990 I had seen a GP at my college who gave me BuSpar again and it gave me side effects such as dizziness/mild vertigo, palpitations and diarrhea after about 1 week. I told the GP about this and he handed me some free samples of Tranxene (clorazepate) saying, "I don't like to prescribe this to college students.". He really had no choice though as I didn't respond well to other medications.
Tranxene took effect quickly and I felt so relieved: no more palpitations or anxiety or apprehension. I could sleep well and felt like a huge burden was lifted from me, however, it did cause me to sleep quite deeply and caused a few paradoxical reactions a few times. It certainly wasn't good for my studies.
I remained on Tranxene for the next 10 years and only briefly tried other SSRIs.I had tried 1/2 tablet of Paxil/Seroxat and I ended up going to the ER with severe panic attacks.
I also tried a low dose of Zoloft/Lustral and felt a tingling sensation all over, so I quit that too.
I asked for Effexor and my psychiatrist prescribed 25mg (the lowest dose). I took only 1/4 tablet and a few hours later my pulse was up to 90bpm and I had difficulty sleeping. I also developed a severe headache and pressure in the head, so I went to have my blood pressure checked and it was marginally high (150/95).
I told him I'd never take it again, yet he didn't seem to think it was a big deal...either that, or he didn't want to believe it. So he tried to get me on Klonopin/Rivotril along with another SSRI, but I refused that. I had tried Klonopin once years ago and it was far too sedating for me. For some odd reason he didn't like prescribing Valium, but didn't tell me why.
When it comes to benzos, I have found that Valium and Tranxene were quite similar. Actually Tranxene is one of Valium's active metabolites. :)
However, the advantage of Valium is that, according to the British National Formulary or BNF, it is the fastest acting BZD due to his high lipid solubility. It would take effect within 7 minutes, so it was useful in the event I felt a panic attack coming on.Xanax is slower to take effect..about 20-30 minutes. I found Xanax to produce dysarthria (trouble speaking at times) and more cognitive deficits, but less sedation.
Valium produced more muscle relaxation, no dysarthria and was heavily sedating, but not as bad as Klonopin/Rivotril.
Ativan (lorazepam) produced dysarthria and hypersalivation along with some nasty cognitive effects such as a sense of amnesia. I couldn't tell when I was on Ativan or withdrawing from it. hehheh. It just made my mind so fuzzy that I thought I was going to lose my mind totally... well, it wasn't _that_ bad, but I see it as more of a sleeping pill than a daytime anxiolytic.
Overall, Valium was an excellent medication. The only problem I had with it was elevation of my liver enzymes. Other than that I liked it. Tranxene was similar but took about 15 minutes to take effect, but when it did take effect it felt identical to Valium.
Xanax just seems like a different drug. It lacks the muscle relaxant effects of Valium and muscle relaxation is very useful for me in controlling my GAD (Generalised Anxiety Disorder) which then prevents my panic attacks from occuring. Valium is also, like Tranxene, *very* easy to taper. I could taper 20mg/day (5mg 4x/day) down to 12.5mg/day in 3 weeks without any problems, except an increase in my asthma attacks.
I've also found hydroxyzine (Atarax/Vistaril), a sedating antihistamine, to be useful as needed for anxiety and it is also doesn't produce dependence, although it can produce tolerance when taken regularly.
If I had to label a benzo as being "addictive"..and that is a highly charged word often taking out of context these days, I would say Ativan is the worst offender because it had a lot of cognitive effects (to me that was unpleasant, but perhaps others like that and abuse it for that feeling).
Otherwise I've never escalated the dose of any BZD I've ever taken. I've found myself wanting to lower the dose over time.
I would prefer Valium above all other benzos (or Tranxene..it is similar), but I'm afraid of developing high liver enzymes again.
Have you had your liver enzymes checked? My GGT (Gamma GT) was 205 and ALT was 78 on Valium. Three liver function tests taken over a 2 month period confirmed the same results. That's the only thing keeping me off Valium and why I asked for Xanax. Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
But on Valium I could still think. You'll develop a tolerance for it when you take it 3 or 4 times a day, but it was still effective at preventing the panic attacks. The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Everyone is different though and might react differently. :)
I think more doctors should use Valium whenever possible since it is tried and true and also easy to discontinue relative to other BZDs. In my opinion, the high-potency BZDs should only be used as a last resort when conventional BZDs fail.
I'm originally from the USA, but lived in Malaysia from 2001-2003 and Indonesia since then. Psychiatrists were very professional in Malaysia.
Here in Indonesia they are ok too, but Malaysia was much more organised about everything and all prescriptions were accounted for by the government. Indonesia is a bit lax on controlled substances. :)
Have you tried Ativan? What benzos have you tried so far?
Thanks for taking the time to read this post! :)
Paul
Posted by sukarno on April 13, 2005, at 21:42:40
In reply to Re: Doing ok now » sukarno, posted by ed_uk on April 13, 2005, at 8:50:35
"When you were on Valium, what dose did you take?"
5mg 4x/day
"What dose of Tranxene did you take?"
7.5mg 4x/day, although sometimes I tapered it down to 3.75mg 4x/day if I was feeling better.
"Which benzodiazepine did you find the most effective?"
Xanax, for panic attacks.
Valium for Generalised Anxiety Disorder. (Maybe I wasn't on enough Valium though, since 5mg 4x/day is the equivalent of 0.25-0.5mg Xanax 4x/day and I'm currently on 1mg 4x/day.)"Which drug caused the most side effects? (including cognitive effects)"
Ativan (lorazepam) :-)
I would rank them like this for mental side effects, with the first one causing the most:
Ativan
Xanax
Valium
Tranxene
For physical side effects, I would rank it like this:
Valium
Tranxene
Ativan
Xanax
Posted by sukarno on April 14, 2005, at 7:09:39
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I'm going to lower the dose again. I was increasing it to 1/2 tablet twice a day and today I started feeling the "adrenaline" again.
I am not depressed at all though. LOL. I was in a great mood today and laughing at jokes I was reading online. :)
This stuff just gives me the jitters. I guess it won't be too hard to titrate the dose since it has a 3 hour half-life. :)
Hey, Ed, you should move to Indonesia.
Posted by sukarno on April 14, 2005, at 7:16:44
In reply to Nervous again on tianeptine, posted by sukarno on April 14, 2005, at 7:09:39
I know I can't list sources, but I asked my doctor about Survector (amineptine) and there is some here in Jakarta, Indonesia. It is expensive for me though..about $4 for 6 tablets.
Should I try Survector, or will that make me more nervous than tianeptine?
I think both of them are related, but Survector is more of a dopamine reuptake inhibitor and doesn't claim to be of use in anxiety disorders.
Survector is also toxic to the liver in some people so I'd need to have frequent liver function tests (LFTs) done to be safe.
The reason I am interested in Survector is because of low libido and lack of motivation/ambition/drive. Despite not feeling depressed one bit, I just don't have any motivation or libido. Is Xanax doing this to me perhaps? I had read that Xanax can also cause hyperprolactinaemia.
Soon I'll be getting a liver function test done and also test for prolactin and thyroid hormone levels. If that all turns out to be normal then I can try to move on in a new direction.
I guess I'm in a dilemma because:
1. Stablon is good for asthma and that's been proven in a few studies. I know I can breathe a *lot* better now.
2. Survector doesn't do anything for asthma, but it can increase libido *and* also increase motivation and ambition.
3. Stablon might have use in treating panic attacks, but Survector doesn't.
What should I do? Take both? My doctor is willing to give me Survector but I forgot to ask her if I can take Stablon and Survector at the same time.
What do you think Ed?
Thanks,
Paul
Posted by ed_uk on April 14, 2005, at 10:00:54
In reply to Survector (amineptine), tianeptine's cousin, posted by sukarno on April 14, 2005, at 7:16:44
Hi Paul!
>imipramine 25mg
Imipramine was very effective at only 25mg/day??? I wonder whether you are a slow metaboliser of tricyclic antidepressants ie. low activity of the enzyme CYP2D6. Most ADs are metabolised by CYP2D6, not just TCAs. Slow metabolisers may need very low doses of most ADs, 'standard' doses may cause severe side effects.
>She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it.
In terms of effectiveness and side effects, did you prefer nortriptryline or imipramine?
>When I quit nortriptyline my panic did not return for at least 10 days.........
It seems that you only need very low doses of TCAs. Perhaps you would do well on an extremely low dose of nortriptyline eg. 10mg/day. Even after you discontinued nortriptyline, it was still effective for several days, perhaps you had a high serum level on 25mg and it took several days to drop below the therapeutic range. If you decided to try nort, your doctor could monitor your nortriptyline serum concentration and also your ECG.
>Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time.
What dose did you try?
If you are a slow metaboliser of TCAs, you are also likely to be a slow metaboliser of certain SSRIs such as paroxetine. Many people are slow metabolisers of TCAs, people who are slow metabolisers will have high drug serum levels at low doses. Slow metabolisers can often be effectively treated with unusally low doses, 'standard' doses may cause severe side effects. You might actually do well on a micro-dose of Paxil, you could use the oral solution.
>Ativan..........
Yes, I've tried Ativan. I found it less sedating than Valium but it did seem to cause a lot of amnesia.
>The only problem I had with it was elevation of my liver enzymes.
Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again.
I'm not sure whether your elevation of liver enzymes on diazepam was important. With many drugs, mild elevation of LFTs occurs in the absense of any evidence of liver disease. Did you see a liver specialist?
>Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
AFAIK, it's not really a case of oxazepam being easier on the liver, it's more a case of oxazepam being safer than diazepam in patients with established liver disease because it is more rapidly eliminated. Serious liver damage is very rare with benzodiazepines, including diazepam.
>The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Did the sedation wear off? You said you found it very sedating at first.
>What benzos have you tried so far?
I've mainly used diazepam 10-15mg when required. I've also tried lorazepam and alprazolam. Alprazolam isn't available on the National Health Service in the UK, a friend gave me a few Xanax tablets that he bought on the internet! I didn't like Xanax at all- it made me feel extremely dumb and it didn't seem to treat my anxiety very well! I prefer Valium to be honest. Lorazepam was effective but only at high doses, 3mg 'when required' seemed to work ok. I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension.
>For physical side effects, I would rank it like this:
Valium
Tranxene
Ativan
XanaxWhat physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation.
>I was in a great mood today and laughing at jokes I was reading online.......
:-)
>Should I try Survector, or will that make me more nervous than tianeptine?
It's hard to predict. Have you ever taken a stimulant such as Ritalin or an amphetamine? Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore.
>The reason I am interested in Survector is because of low libido and lack of motivation/ambition/drive. Despite not feeling depressed one bit, I just don't have any motivation or libido. Is Xanax doing this to me perhaps?
Possibly :-(
>I had read that Xanax can also cause hyperprolactinaemia.
Various benozos have rarely been implicated in causing hyperprolactinemia. Diazepam can cause mild hyperprolactinemia at very high doses, I don't think it's generally significant.
>My doctor is willing to give me Survector but I forgot to ask her if I can take Stablon and Survector at the same time.
I don't know whether they interact, I've never heard of anyone taking them together.
Kind regards,
Ed.
Posted by sukarno on April 15, 2005, at 2:04:40
In reply to Panic » sukarno, posted by ed_uk on April 14, 2005, at 10:00:54
Hi Ed! :-)
My imipramine level was monitored once by my psychiatrist and she had said it was low. Maybe I am a slow metaboliser nevertheless. I found nortriptyline to have less side effects.. that's the reason she put me on that after the cardiac events triggered by imipramine. Both were very sedating in the beginning and although she had warned me that those medications could worsen my panic disorder before it became better, I only got better after beginning treatment. With despramine, I had tried the lowest possible dose. I forgot what the dosage was..maybe 10mg? Definitely it was less than 25mg.
With SSRIs she told me that panic disorder patients just cannot tolerate standard doses and must be started out on low doses and maybe gradually increase it over time. She gave me Prozac elixir and told me to take 5mg/day, but I only took 1mg/day because of my previous experience with Prozac in 1990 where I felt like my body was on fire at the standard dose of 20mg.
Within 36 hours after taking 1mg Prozac in 1995 for seasonal depression, the depression began to lift and a few days later I was normal. It was very nice. I had to lower the dose to 0.5mg/day because I would get heart palpitations at only 1mg/day. It still maintained a strong antidepressant effect and made me nauseated in the beginning and briefly exacerbated my anxiety and panic attacks.The unfortunate thing about Prozac, even in such a low dose, was that it killed my libido. Other than that, I was ok, but gradually began to feel a burning sensation in my stomach which persisted for several weeks.
One night I felt nauseated and weak and was passing black, tarry stools, so I went to the hospital and the nurse did some tests and said my blood levels were dropping. The GI doc came in the next day and I underwent endoscopy where he diagnosed gastritis. He couldn't find H. Pylori bacteria and then couldn't understand why I had gastritis, since I didn't take aspirin or other NSAIDs, didn't eat black pepper, etc...didn't drink or smoke or fit any of the risk factors.Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
I also had developed a rash and fevers during that time. I quit Prozac and it disappeared. Three months later I tried Prozac once more and had a worse reaction: purplish-red rash on both arms and legs along with itchy throat. I would also feel chills in the morning. That was the last time I ever took that. It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy, but I am not sure or willing to try it again to find out. hehheh.The bad experience with Prozac could have been the symptoms of Serum Sickness Syndrome, which has been reported rarely with fluoxetine. It too begins with a rash and is followed by multiple organ failure. After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions. The only one I tried after Prozac was Effexor in 2002 but it gave me hypertension even at an extremely low dose of 6.25mg (1/4 of 25mg tablet).
(I had also tried Paxil in 1993 but forgot to mention that I experienced "zaps" for several days after that single 1/2 tablet dose. Zaps weren't documented at that time and neither was SSRI dependence...I was worried that I was having seizures but my pdoc had no idea what was going on. I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions? I'm afraid to start Paxil even on a low dose due to the possibility of having those zaps...and of course the sexual side effects.)
That is a good idea though about trying the TCAs at a lower dose. Maybe I should try nortriptyline at 10mg/day and see what happens.
Is there a way to find out if I am a slow metaboliser?
I've never tried amphetamines or Ritalin. Is it fair to compare caffeine to amphetamine? I know that for panic disorder patients, caffeine is one of the most offending substances. I wonder if poor response to caffeine (e.g. palpitations, severe anxiety) predicts future response to amphetamines. Have you ever tried Survector or other CNS stimulants?
Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?"Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again."
Yes, unfortunately they were elevated each time I had a LFT over the years. In 1996 they were elevated, but not by much. In 2000 they were elevated (I took a glance at my chart) and couldn't figure out why the doctor didn't make mention of it, so I asked her if it was ok to take paracetamol and she told me to avoid that due to the elevated liver enzymes.
My GGT was quite high in 2002... approximately 205 and ALT was roughly double the normal limit. The Malaysian doctors weren't interested in those values. The only thing they said to me was that I must be a heavy drinker, but I told them I don't drink at all. This really puzzled one of my doctors when I was there as an inpatient. He couldn't understand why my GGT was so high. Maximum limit of normal is 50. I did eat a high fat, fast-food diet on a daily basis and have learned that high fat diets are hard on the liver and can cause fatty liver.
My last LFT was in 2003 and I had been on Xanax for several months at that time. The results were near normal then.
Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them? I haven't seen a liver specialist, but I remember asking many doctors about my LFT and they didn't think it was much to worry about. They kept thinking that I must be a drinker. hehheh.I requested a test for Hepatitis B and C and both came back negative, so that was ruled out as the cause.
If high GGT is not dangerous, then I would rather be back on Valium. I liked the muscle relaxant effect and rapid onset of action. I could see Valium being useful as PRN for panic attacks. Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
"Did the sedation wear off? You said you found it very sedating at first."
At first it made me feel quite "out of it" or sometimes "high". lol... but after a few days it wasn't sedating in that way anymore. I could still enjoy the muscle relaxation and anxiolytic effects in the long term."What physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation."
Mostly ataxia..feeling a bit uncoordinated, but nothing major. The kind of feeling you get in your muscles when you've had a few beers, but not yet drunk. :-) I preferred to take 10mg in the morning since my level of anxiety in the morning has always been higher, even prior to medication. I would take the remaining two 5mg tablets in the late afternoon and before falling asleep.
"I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension."
I was prescribed that here from an Indonesian psychiatrist, but I had never heard of it, although I suspected it was a benzo. I never filled the prescription and instead sought a second opinion. How much Frisium did you try? Have you ever tried Rivotril (Klonopin)? I wonder if they are similar since they are both anticonvulsants.
"Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore."
I've been told that Survector is now out-of-patent and is available in Brazil, perhaps being manufactured by a generic drug company. Here in Indonesia I am not sure who makes it...it might be the brand name or it could be a generic. I guess I could try it once and find out what it's like.
I am just afraid of the liver toxicity associated with it. Maybe the FDA and media blew it out of proportion. I'm not sure how high the incidence of liver dysfunction/damage is with amineptine use.
I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
With my lack of motivation, I was thinking that dopamine agonists and/or norepinephrine reuptake inhibitors might be useful for me. Tianeptine is making me feel good, but still isn't helping with motivation.
With all these antidepressants there are so many positives and negatives. It's difficult to figure out which one is the appropriate one for treatment. I would go to a psychiatrist here, but I have a feeling they are on the SSRI bandwagon and I just don't want to risk dependence or loss of libido again. I've heard of them losing efficacy in long-term use too. They are great for some folks though, I admit.
So, I have Stablon, Survector and nortriptyline on my list. I guess I'll just have to give Stablon another month or so to find out if it will really work for more than just depression. If not, then it will be on to Survector....and then nortriptyline as a last resort. :)
Here you can buy prescription drugs without a prescription at some pharmacies..that's what I do, but with the exception of Xanax, which definitely requires a prescription as that is controlled.
I'm interested to hear more about Survector from people who have tried it. It seems that information on it (and even Stablon) is very limited. It might be that if I got on Valium or Klonopin/Rivotril that I could handle any stimulant effects from Survector and yet still feel motivated. It surely has been a miracle for some people where other antidepressants have failed.
:-)
My email is [email protected]
Paul
Posted by ed_uk on April 15, 2005, at 9:43:29
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 2:04:40
Hi Paul!
>My imipramine level was monitored once by my psychiatrist and she had said it was low.
Some people only need low levels :-)
>Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
It's thought that it might be related to the effects that SSRIs can have on platelet aggregation. Since SSRIs inhibit the uptake of serotonin into platelets, platelet function is disturbed and the risk of bleeding may be increased.
'A case-control study has suggested that treatment with SSRIs produces a moderately increased risk of upper gastrointestinal bleeding (adjusted relative risk 3.0).'
>I also had developed a rash and fevers during that time.
It certainly sounds like some kind of hypersensitivity reaction. Prozac has been associated with vasculitis. What starts out as a rash can turn into a very serious condition if Prozac is continued.
>After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions.
Since the various SSRIs are chemically/structurally unrelated, it seems unlikely that you would be hypersensitive to another SSRI. Rarely, cross-sensitivity has been reported...........
Ann Pharmacother. 2002 Apr;36(4):631-3.
Cross-sensitivity between paroxetine and sertraline.Warnock CA, Azadian AG.
Department of Pharmaceutical Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. [email protected]
OBJECTIVE: To report a case of possible cross-sensitivity between selective serotonin-reuptake inhibitors (SSRIs). CASE SUMMARY: A 20-year-old Southeast Asian man developed a maculopapular rash soon after starting paroxetine. Following resolution of this rash, another skin reaction with the same distribution and appearance occurred after sertraline therapy was started. DISCUSSION: Cross-reactivity between drugs with similar structures has been reported; however, cross-reactivity among SSRI antidepressants is unexpected given their differences in chemical structure. CONCLUSIONS: The possibility of cross-reactivity between SSRI antidepressants should be considered by clinicians who wish to switch from one SSRI to another due to a dermatologic reaction.
>It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy........
AFAIK, quite a lot of hypersensitivity reactions to fluoxetine (capsules) have been reported. I think you probably reacted to the fluoxetine itself.
>I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions?
I once had withdrawal symptoms (mild vertigo) after taking paroxetine 20mg for only five days! I didn't taper, I wasn't expecting withdrawal symptoms after I'd only been on it for five days!
Previously, after taking 40-60mg/day paroxetine for several years, I didn't have any withdrawal symptoms when I withdrew. I tapered to 20mg and then subsituted fluoxetine 20mg without a washout period. I didn't have any withdrawal symptoms when I abruptly d/ced the fluoxetine several months later. It would have been nice to have some fluoxetine caps lying around when I was having withdrawal symptoms from venlafaxine!
>Maybe I should try nortriptyline at 10mg/day and see what happens.
Perhaps you could start at 5mg/day, especially if you want to combine it with tianeptine. I don't expect that they'll interact but I don't think their interaction (or absense of interaction) has been studied.
>Is there a way to find out if I am a slow metaboliser?
I wondered whether you had low CYP2D6 activity.
There are many different variants of the CYP2D6 gene- genetic tests can be performed to identify which gene is present. These genetic tests can identify poor metabolisers.
Another way to find out whether a person is a poor metaboliser (in relation to CYP2D6) is to administer a 'probe' drug such as debrisoquine, dextromethorphan, metoprolol or sparteine. After the drug has been given, a urine sample is collected. The urine is assayed for the parent drug and metabolites. The ratio of parent drug to metabolite can be calculated in order to determine whether the person is a........
Poor metabolizer,
Intermediate metabolizer,
Extensive (normal) metabolizer,
Ultrarapid metabolizer.Even if a person is taking medication which affects CYP2D6, the genetic test is still accurate. The 'probe drug' test only works if a person is not taking any medication which affects CYP2D6.
>Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them?
If you were able to take diazepam and clorazepate for many years without developing any signs of liver disease, I would imagine that it would be safe for you to take them in future. I'm not sure though. If you were to take either of these drugs in future, it might be best to have your liver function assessed by a specialist.
>Is it fair to compare caffeine to amphetamine?
Not really, their effects can differ considerably.
>Have you ever tried Survector or other CNS stimulants?
No, stimulants are rarely prescribed in the UK, I would like to try one though. Most adult psychiatrists in the UK never prescribe stimulants at all. The number of people taking prescribed stimulants is VASTLY greater in American than it is in the UK.
>Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?
People respond very variably. Some people certainly find stimulants very anxiogenic. Certain people on this board have apparantly found amphetamines helpful in the treatment of social anxiety disorder. Several people have told me that they find methylphenidate more anxiety-inducing than amphetamines such as Dexedrine.
>Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
LOL, many doctors are very susceptible to marketing!
>How much Frisium did you try?
I tried 10mg, 20mg and 30mg doses.
>Have you ever tried Rivotril (Klonopin)?
I once took 2mg, I think it made me a bit drowsy but that's about it!
>I wonder if they are similar since they are both anticonvulsants.
Many of the major benzodiazepines are anticonvulsants. Diazepam and lorazepam are very powerful anticonvulsants, at least in the short term. Tolerance to the anticonvulsant properties of benzos often develops quite fast.
When clonazepam was introduced, Roche, the manufacturer, already marketed several benzos for anxiety and insomnia- why not invent another benzo to sell as an anticonvulsant lol!
Diazepam, clonazepam, lorazepam and clorazepate are 1,4-benzodiazepines. Clobazam (Frisium) is a 1,5-benzodiazepine, it is structurally different from the other benzos. Clobazam is claimed to cause less drowsiness than the other benzos. I didn't like it- you might like it though!
>Here in Indonesia I am not sure who makes it...
I think it would be a good idea to find out whether amineptine is still being manufactured in Indonesia. It has been discontinued in most countries but stocks may still remain.
If you are interested in the effects of amineptine, you could email Dave at HedWeb. He lives in the UK but has been importing amineptine for some time. He combines it with selegiline. I don't know what he's going to do when he can't get hold of amineptine anymore :-S
>I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
You could consider trying an alternative dopamine agonist such as ropinirole or pramipexole. Are they available in Indonesia?
>Here you can buy prescription drugs without a prescription at some pharmacies....
I wish it was like that here, I've given up on NHS psychiatrists. All they are willing to do is prescribe another SSRI or venlafaxine. I don't have any intention of going back on an SSRI or venlafaxine!
>My email is [email protected]
Mine is [email protected]
Kind regards,
Ed.
Posted by sukarno on April 15, 2005, at 20:54:11
In reply to Re: Panic » sukarno, posted by ed_uk on April 15, 2005, at 9:43:29
Hi Ed! :-)
Wow, thanks for the information. I really appreciate that.
I wonder though, is it safe for Dave to take amineptine, a TCA, with selegiline, an MAO-b inhibitor? In doses over 10mg/day, selegiline has been shown to also inhibit MAO-a and patients have experienced hypertensive crisis.
I've read that TCAs are contraindicated with MAO inhibitors. I know that my Stablon package insert says it is.
Have you heard of Parlodel? We have that here. What's your opinion of that drug?Do you have panic disorder? I've been wondering why several people, including myself, with this disorder often experience ADD-like symptoms even prior to being started on medication. 18 months before my first panic attacks, my grades began to suffer and I remember taking caffeine pills to help restore my concentration.
One of the good things about benzos I can say is that they are good for filtering out lots of background "noise" so you can concentrate more on the task at hand. If I'm walking through a shopping mall unmedicated, I will feel quite anxious and be distracted by my anxiety. Under the influence of Xanax or Valium I'll feel almost "normal" and be able to concentrate more, but usually only on one task at a time.
I suppose the stimulants such as amineptine and amphetamine could enable you to do multiple tasks?I had read a study recently that suggested that benzos might be of use in the elderly, since they can filter out the "noise" because as we age our brains are less and less able to filter out various auditory stimuli, etc.
Overall though if I had to take any drug, I would prefer stimulants or "smart drugs". I don't feel that any CNS depressant would be good for intellect.
About the nortriptyline, since it is can inhibit the reuptake of serotonin, would that conflict with tianpetine, since it does the opposite? (accelerates/enhances the reuptake of serotonin)
I'll ask a doctor about the supply of amineptine here and see if it is still being produced locally or not. :)
What do you think of the risks of amineptine with regards to hepatotoxicity? It has been said that there is a genetic susceptibility to hepatotoxicity with that drug. Some study mentioned rapid vs. slow metabolisers, and talked about giving dextromethorphan as you suggested to try to predict if it would be dangerous or not to take amineptine.
If I am indeed a slow metaboliser, does that put me at increased or decreased risk for hepatotoxicity from amineptine?What frightens me, is the study which revealed that tianeptine is reduced to the same reactive metabolites as amineptine and there are cases of hepatitis and liver damage associated with this drug too.
I guess is my eyes and/or skin start turning yellow or I start becoming nauseated or develop a rash, I'll surely stop taking it just to be safe and in the meantime have a LFT.
I'll be emailing you with what I find out about the amineptine. I think it would be disallowed on Dr. Bob's website to post any source information here. hehheh.
Have a good day! :-)
Paul
Posted by sukarno on April 15, 2005, at 21:05:36
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 20:54:11
Tuesday, 10 July, 2001, 10:04 GMT 11:04 UK
Sex drive claim in £8m action
A businessman is suing for £8m after he was given drugs which, he says, resulted in a dramatic increase in his sex drive and changed his personality.
Richard Davis, 53, was diagnosed with a non-malignant pituitary gland tumour in 1989.
The High Court in London heard that Mr Davis, who founded magazine publishers, Parkway Publications Ltd, became bankrupt with criminal convictions and no business.
Novartis Pharmaceuticals (UK) Ltd; Camden and Islington Health Authority (sued as managers of Middlesex Hospital where Mr Davis was treated) and consultant Professor Howard Saul Jacobs, now retired, all deny liability.
Until 1993, Mr Davis, from Mill Hill in London, was prescribed a class of drugs known as dopamine agonists.
Psychiatric effects
His counsel, Roger Henderson QC, said these were known to have psychiatric effects on some patients.
Initially prescribed a drug called bromocriptine, which goes under the proprietary label Parlodel, he also took part in clinical trials of an experimental drug - known as CV205-502 - which had at that time not been licensed for sale in the UK.
Bromocriptine also brought on a "marked and sometimes dramatic increase in libido" that made his sexual behaviour "incontinent and inappropriate", said Mr Henderson.
Mr Davis was convicted of dishonesty on two occasions, in December 1992 and March 1995 and was made bankrupt in 1993.
The hearing is expected to last up to eight weeks.
====================
Now, that bromocriptine (Parlodel) sounds good to me! lol. Is it good as an antidepressant too?
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