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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by EERRIICC on June 26, 2005, at 22:35:04
How similar are these drugs? Will failure of a trial with lamactil for unipolar depression indicate that a trial with riluzole will probably fail as well?
Posted by SLS on June 27, 2005, at 7:44:12
In reply to Riluzole_and_Lamactil, posted by EERRIICC on June 26, 2005, at 22:35:04
> How similar are these drugs? Will failure of a trial with lamactil for unipolar depression indicate that a trial with riluzole will probably fail as well?
Incredibly expensive stuff. The drug company would not even supply for free the NIMH with riluzole to accomadate their studies of riluzole to treat bipolar depression.
Among its pharmacological properties, Lamictal inhibits the release of glutamate. In contrast, riluzole acts as a reuptake inhibitor of glutamate much the same way Prozac works with serotonin.
I glean only a mild antidepressant effect from Lamictal, and I need standard antidepressants for it to work at all.
I tried riluzole (Rilutek) to treat my bipolar depression. It did nothing for me except perhaps making me feel a little worse.
You know the deal. You won't know unless you try it. There is very little one can do to predict the outcome of a drug trial. I think the NIMH trial is ongoing and have yet to publish their results. I haven't a clue as to what they came up with. I've been waiting.
Wait...
It's about time. Zarate et. al just published their results. It appears on Medline.
It is a pretty poor abstract. One would need to read the full text to gather enough information to draw any conclusions. They don't even state how many of the 14 subjects who were enrolled in the study went on to respond to riluzole. Nor do they state the percentage of patients who responded and the magnitude of the improvements seen. What a disappointingly low number of subjects tested. They only managed to recruit 14 people in two years. What a crappy study.
http://www.clinicaltrials.gov/show/NCT00054704
- Scott
Posted by Phillipa on June 27, 2005, at 17:39:07
In reply to Re: Riluzole_and_Lamactil » EERRIICC, posted by SLS on June 27, 2005, at 7:44:12
Eric, I love the way you post your name. It sounds like you're screaming and it really gets attention. Just wanted to comment. Fondly, Phillipa
Posted by EERRIICC on June 28, 2005, at 0:20:23
In reply to Re: Riluzole_and_Lamactil » EERRIICC, posted by SLS on June 27, 2005, at 7:44:12
Thanks for your response Scott, as with all your posts it was educated and informative.
What was your dose and the duration of time you took riluzole? I'm on nothing (except some Valium) at the moment, but I'm flying down from Toronto to see a doctor at MGH on Thursday, so riluzole is an option. Like you, Parnate is one of the only drugs I've responded to, but it "poops out" on me. Once I'm off it for a few months and I go back on it and I get another couple months of response and then it's back to black.
This is my current theory on how to stop Parnate from quitting, and also to augment its efficacy, tell me what you think (all 4 are done simultaneously):
1.Add Strattera 18mg which (from past experience) should completely normalise my sleep patterns, which Parnate disturbs.
2.Add Adamantine/Memantine to create synergy.
3.Add Protriptyline, its stimulant actions seem right up my Parnate responding alley, so why not?
4.Take one or two days off of Parnate every week. (Why exactly I have no idea except some vague ideas along the lines of re-invigorating stimulants and coffee)
Posted by SLS on June 28, 2005, at 8:36:19
In reply to Re: Riluzole_and_Lamactil » SLS, posted by EERRIICC on June 28, 2005, at 0:20:23
Hi Eric.
Wow! That is quite an adventurous plan you have there.
> 1.Add Strattera 18mg which (from past experience) should completely normalise my sleep patterns, which Parnate disturbs.I see no problem with this. I'm just surprised that it works. Something for me to remember. I wish Parnate still caused insomnia for me. It always signalled the onset of an antidepressant effect.
> 2.Add Adamantine/Memantine to create synergy.
You took the words right out of my mouth. Because I received more of an antidepressant effect from memantine than from amantadine, I am partial to the memantine. I hope it acts to prevent tolerance to the antidepressant effects of Parnate.
> 3.Add Protriptyline, its stimulant actions seem right up my Parnate responding alley, so why not?
I am leery of protriptyline. I just don't like the drug. It seems to be overly sympathomimetic. I would instead recommend desipramine. Again, though, I am basing this bias on my personal experience with these drugs. I don't really know if you could find much in the literature differentiating the safety of the two drugs when combined with Parnate.
> 4.Take one or two days off of Parnate every week. (Why exactly I have no idea except some vague ideas along the lines of re-invigorating stimulants and coffee)My first reaction is to recommend not "pulsing" the Parnate this way. Although the half-life of Parnate is as short as 2 hours, its MAO-inhibition persists for days. I think the net effect would be to simply leave you undermedicated. HOWEVER, I can't really know for sure that you wouldn't be hitting the bullseye with your idea. If you feel strongly enough about it, I don't think it would hurt to try. If you don't get the results you are looking for, you have the option of returning to your therapeutic dosage or discontinuing it.
I have heard of at least one case where the patient rotated between Parnate and Nardil. The switch was made whenever the current drug lost its effectiveness. It worked, and less time was spent without having an antidepressant on-board.
You might be surprised how well simply adding desipramine might work. I think I would start there.
Regarding riluzole, the only thing I can say is that it did not show any signs of exerting an antidepressant effect for me. However, my degree of treatment resistance makes me a pretty poor global forecaster of the utility of any one drug. If you can afford the riluzole, you might as well give it a try and hope that the enthusiasm of the NIMH is justified.
I would be interested to know what decisions you come to. They aren't easy ones to make, but I think you will hit on one of them.
Good luck.
- Scott
Posted by EERRIICC on June 28, 2005, at 16:01:26
In reply to Re: Riluzole_and_Lamactil » EERRIICC, posted by SLS on June 28, 2005, at 8:36:19
I'll let you know what happens after I go to MGH on Thursday.
Posted by Phillipa on June 28, 2005, at 18:24:16
In reply to Re: Riluzole_and_Lamactil » SLS, posted by EERRIICC on June 28, 2005, at 16:01:26
Are you really only on valium right now? Or are you still taking the others for depression? Fondly, Phillipa
Posted by EERRIICC on June 28, 2005, at 19:41:19
In reply to Re: Riluzole_and_Lamactil » EERRIICC, posted by Phillipa on June 28, 2005, at 18:24:16
Just taking 2mg of valium twice a day at the moment.
Good luck Phillipa!
This is the end of the thread.
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