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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 11 to 35 of 35. Go back in thread:
Posted by conundrum on September 9, 2010, at 14:44:29
In reply to Re: Another semi failed trial, posted by morgan miller on September 9, 2010, at 13:47:02
Wellbutrin only made me agitated for one day, but I did get tremors. I felt like I was full of adrenaline even though I was not nervous or anxious at all. I thought maybe the brand or watson generic might release at a slower rate and prevent those side effects. Like drinking 3 beers through out the day rather than all at once, less side effects.
Posted by conundrum on September 9, 2010, at 14:56:05
In reply to Re: Another semi failed trial » linkadge, posted by morgan miller on September 9, 2010, at 14:31:04
Abilify is worth a shot if you can afford it and other things have failed. To me its like a bigger caffeine buzz that fades. I know Emmanuel said it worked really well for him though. It probably is less likely to cause TD since it is a partial agonist at the D2 receptors, although TD has still occured. Its really expensive though.
Posted by morgan miller on September 9, 2010, at 15:14:30
In reply to Re: Another semi failed trial » morgan miller, posted by conundrum on September 9, 2010, at 14:56:05
Thanks for the input conundrum.
Posted by linkadge on September 9, 2010, at 15:45:51
In reply to Re: Another semi failed trial » conundrum, posted by morgan miller on September 9, 2010, at 15:14:30
I'm not saying that Abilify is no good for anybody. I just hate to see when people start blaming themselves for failing medications which are promoted by the drug companies as god's gift to the mentally ill.
Linkadge
Posted by Conundrum on September 9, 2010, at 15:53:54
In reply to Re: Another semi failed trial, posted by linkadge on September 9, 2010, at 15:45:51
Good point Link. (I hope you don't mind that, the triforce be with you.)
I guess in a way I do blame myself. These new super selective drugs just don't seem to hold up over time to the older drugs. Speaking of revo-health and askapatient the highest rated drugs are the MAOis and stimulants. Even my pdoc admitted the MAOis were more effective. They just have more side effects they say. I just don't buy into that. She named one side effect of desipramine, constipation. Thats what prune juice and muscarinic agonists are for.
Abilify only works to increase dopamine in the prefrontal cortex. Not in the reward or mesolimbic emotional areas. If you wanna hit that hard your gonna need side effect ridden zyprexa or addictive stims. OR! Nardil or Parnate!
Hmm, I have some in the drawer from my grandmom... I'd have to ween off everything first...
I know all the diet restrictions...
hmm...
for now i'll stay the course, and try to be compliant, and I did mention TCAs but my pdoc is younger and doesn't seem to keen on them. Its my body though right?Oh I have some vics so I might try them tomorrow.
Posted by morgan miller on September 9, 2010, at 16:16:11
In reply to Re: Another semi failed trial, posted by linkadge on September 9, 2010, at 15:45:51
> I'm not saying that Abilify is no good for anybody. I just hate to see when people start blaming themselves for failing medications which are promoted by the drug companies as god's gift to the mentally ill.
>
> LinkadgeI hear ya
Posted by emme on September 9, 2010, at 16:16:20
In reply to Re: Another semi failed trial, posted by linkadge on September 9, 2010, at 11:51:23
> Its B.S. that these meds are good for TRD.Three plus years of success with Lamictal + Abilify for me for TRD! Of course I'm an "n" of one, and no combo will work for everyone. But I suspect "fads" start because at least some portion of the population has success.
Posted by morgan miller on September 9, 2010, at 16:25:58
In reply to Re: Another semi failed trial » linkadge, posted by Conundrum on September 9, 2010, at 15:53:54
>Hmm, I have some in the drawer from my grandmom... I'd have to ween off everything first...
I know all the diet restrictions...
hmm...You lost me, what do you have in your drawer?
>for now i'll stay the course, and try to be compliant, and I did mention TCAs but my pdoc is younger and doesn't seem to keen on them. Its my body though right?
Yes, it is your body. I would tell your pdoc that you are going to try Nortriptyline whether they approve or not. That is, if this is what you choose to do. Bring some literature on SSRI + Nortriptyline in to them and print out other's experiences on SSRI + Nortriptyline treatment, if you have access to some. We have to be our own advocates!
I have to say, the one drug that made me feel like I had enhanced response to rewards and pleasure was Zoloft. It may not do this for me anymore, but for a long long time, it did. That's why I really want to try combining Zoloft with Nortriptyline to see what happens.
I didn't know Zyprexa hit the reward and mesolimbic areas of the brain. Is this through 5ht2c antagonism? Or is it through another mechanism? I can't do Zyprexa anymore, it makes it too easy for me to sleep in and ruminate over negative conditions in my life.
Morgan
Posted by linkadge on September 9, 2010, at 18:44:00
In reply to Re: Another semi failed trial » linkadge, posted by Conundrum on September 9, 2010, at 15:53:54
I was on parnate and it was one of the cleanest medications I have ever taken.
Linkadge
Posted by linkadge on September 9, 2010, at 18:47:00
In reply to Re: Another semi failed trial, posted by morgan miller on September 9, 2010, at 16:25:58
The overall effect of zyprexa on dopamine function is not clear. It does antagonize 5-ht2c receptors, which enhances dopamine release in certain brain regions, but it also blocks dopamine receptors. So the net effect on dopamine receptor mediated events? Who knows..
Linkadge
Posted by emmanuel98 on September 9, 2010, at 19:12:59
In reply to Re: Another semi failed trial, posted by linkadge on September 9, 2010, at 18:47:00
Well I'm just and n of one but abilify worked like magic for me. It's a shame it's still under patent and ridiculously expensive. But if you can't afford it, you can't afford it. Parnate worked like magic for me as well and that's cheap, generic (I think). It requires a two-week washout of other meds, but if the other meds aren't working,, who cares? Might be worth a shot.
Posted by SLS on September 10, 2010, at 5:03:58
In reply to Re: Another semi failed trial » linkadge, posted by Conundrum on September 9, 2010, at 15:53:54
> Abilify only works to increase dopamine in the prefrontal cortex.What about its partial D2 and D3 agonist activity? Do you know where I can find information affirming your statement here?
Thanks.
- Scott
Posted by SLS on September 10, 2010, at 5:15:35
In reply to Re: Another semi failed trial, posted by linkadge on September 9, 2010, at 18:47:00
> The overall effect of zyprexa on dopamine function is not clear. It does antagonize 5-ht2c receptors, which enhances dopamine release in certain brain regions, but it also blocks dopamine receptors. So the net effect on dopamine receptor mediated events? Who knows..
>
> LinkadgeWhat would be the effect of the partial 5-HT1a autoreceptor (somatodendritic?) agonism Abilify exhibits?
- Scott
Posted by Conundrum on September 10, 2010, at 6:41:48
In reply to Re: Another semi failed trial » Conundrum, posted by SLS on September 10, 2010, at 5:03:58
"Moreover, aripiprazole, 0.3 mg/kg, slightly but significantly increased dopamine release in the medial PREFRONTAL CORTEX but not in the NUCLEUS ACCUMBENS.(Nac) These increases were significantly inhibited by WAY100635. By contrast, aripiprazole, 3.0 mg/kg and 10 mg/kg, significantly decreased dopamine release in the nucleus accumbens but not the medical prefrontal cortex. "
It actually can decrease dopamine in the Nac.
"However, aripiprazole 10 mg/kg significantly decreased dopamine release in the both regions. Aripiprazole had no effect on acetylcholine release in the medial prefrontal cortex, hippocampus, or nucleus accumbens at any dose, except for 3.0 mg/kg, which decreased acetylcholine release in the nucleus accumbens only. "
Abilify is actually a 5 HT2C antagonist/agonist so that be part of the reason why there is no increase in the NAC.
http://www.ncbi.nlm.nih.gov/pubmed/16336943This seems to be the effect of the atypical drugs with 5HT2a antagonism and weak 5HT2C antagonism.
(may have to delete spaces in link for it to work)
Abilify is actually a 5 HT2C antagonist/agonist so that be part of the reason why there is no dopamine increase in the NAC.
http://www.ncbi.nlm.nih.gov/pubmed/16336943Zyprexa which is a stronger 5 HT2C antagonist the Nac.
http://www.springerlink.com/content/lmcjhp01pqf34jxy/
Here is a link to the binding affinities of Atypical Antipsychotics
http://www.nature.com/npp/journal/v28/n3/fig_tab/1300027t1.html#figure-title
Thats it before this gets moved to Neurotransmitters. :D
Posted by SLS on September 10, 2010, at 7:11:42
In reply to Re: Another semi failed trial, posted by Conundrum on September 10, 2010, at 6:41:48
Posted by linkadge on September 10, 2010, at 7:52:20
In reply to Re: Another semi failed trial » linkadge, posted by SLS on September 10, 2010, at 5:15:35
>What would be the effect of the partial 5-HT1a >autoreceptor (somatodendritic?) agonism Abilify >exhibits?
I'm not sure. Does it have any post synaptic efficacy at 5-ht1a?
The acute effects of agonizing 5-ht1a autoreceptors would be to decrease overall serotoninergic firing. This might be expected to increase dopamine release in certain brain regions which are under inhibitory control by serotonin.
OHOT, chronic administration might desensitize the autoreceptors, thus increasing serotonergic functioning and producing the reverse action.
It really depends on the brain region and the serotonin receptor involved. For instance, in the frontal cortex, post synaptic 5-ht1a agonism increases dopamine release, wheras 5-ht2c agonism decreases it.
Linkadge
Posted by linkadge on September 10, 2010, at 7:55:41
In reply to Re: Another semi failed trial, posted by Conundrum on September 10, 2010, at 6:41:48
Well, if abilify only slightly increases dopamine in the prefrontal cortex, then I would suspect that its otherwise potent (non d2) dopamine receptor antagonism would counteract this.
Linkadge
Posted by Conundrum on September 10, 2010, at 7:59:33
In reply to Re: Another semi failed trial, posted by linkadge on September 10, 2010, at 7:55:41
So basically it is like you said a newer drug but not as good as older drugs. The dirtier the drug the better the response right?
Thirty tablets of 2 mg, 5 mg and 10mg cost a good $440.
nortripytline $3.50 from a canadian pharmacy. 7.50 from adam's discount pharmacy.
Posted by SLS on September 10, 2010, at 8:03:54
In reply to Re: Another semi failed trial » SLS, posted by linkadge on September 10, 2010, at 7:52:20
> > What would be the effect of the partial 5-HT1a autoreceptor (somatodendritic?) agonism Abilify exhibits?
> I'm not sure. Does it have any post synaptic efficacy at 5-ht1a?From what I've read, it does. However, I don't know what the net effect on PFC activity would be.
> The acute effects of agonizing 5-ht1a autoreceptors would be to decrease overall serotoninergic firing. This might be expected to increase dopamine release in certain brain regions which are under inhibitory control by serotonin.
Okay. I understand.
> OHOT, chronic administration might desensitize the autoreceptors, thus increasing serotonergic functioning and producing the reverse action.
>
> It really depends on the brain region and the serotonin receptor involved. For instance, in the frontal cortex, post synaptic 5-ht1a agonism increases dopamine release, wheras 5-ht2c agonism decreases it.Interesting.
Thanks for replying.
- Scott
Posted by linkadge on September 10, 2010, at 8:04:30
In reply to Re: Another semi failed trial, posted by Conundrum on September 10, 2010, at 6:41:48
And again, if abilify is a potent d3 antagonist, this would be expected to block some / all the pleasurable effects of dopamine release in the NAc.
Linkadge
Posted by Conundrum on September 10, 2010, at 8:08:35
In reply to Re: Another semi failed trial, posted by linkadge on September 10, 2010, at 8:04:30
> And again, if abilify is a potent d3 antagonist, this would be expected to block some / all the pleasurable effects of dopamine release in the NAc.
>
> LinkadgeEff that shiz, anhedonia is one of my core symptoms.
Posted by linkadge on September 10, 2010, at 10:42:41
In reply to Re: Another semi failed trial » linkadge, posted by Conundrum on September 10, 2010, at 7:59:33
>So basically it is like you said a newer drug >but not as good as older drugs. The dirtier the >drug the better the response right?
Well I don't know if dirty directly equates to efficacy. I just think that there are fads in psychiatry. Sure, some will respond to abilify augmentation just as some respond to lithium augmentation or thyroid augmentation or nortriptyline augmentation. The key idea is that there is money to be made off of abilify at the moment.
The big thing 10 years ago was risperdal / olanzapine augmentation. There were all sorts of fancy studies demonstrating superior efficacy of SSRI + atypical. Overall attitudes have changed towards atypicals however, since the demonstration (in CATIE) that the atypicals are really not more effective than the typicals (in positive or negative symptoms) and that they have more metabolic side effects.
Can't you remember 10 years back everybody being on paxil + zyprexa.
I would think that perphenazine augmentation would be as effective as abilify augmentation. But significantly more doctors use abilify because it is the drug du jour.
Linkadge
Posted by linkadge on September 10, 2010, at 10:45:13
In reply to Re: Another semi failed trial, posted by Conundrum on September 10, 2010, at 8:08:35
I'll be the first to admit...
sometimes I get more pleasure out of talking about the medications (and how they might help me) than I do taking the medications :)
If you're more excited with the script in your hand than you are a week after treatment with the drug, then...
Linkadge
Posted by Conundrum on September 10, 2010, at 15:30:44
In reply to Re: Another semi failed trial, posted by linkadge on September 10, 2010, at 10:45:13
One of the things I've recently discovered is that some of the drugs that didn't work may have been because they are bad generics. I had teva bupropion which isn't highly regarded, generic methylphenidate, and Dr. Reddy's Lamotrigine. Im' thinking about getting the lamotrigine refilled with Teva since in this case its supposed to be better. I would consider bupropion xl since I know a pharmacy where they get have Watson.
> I'll be the first to admit...
>
> sometimes I get more pleasure out of talking about the medications (and how they might help me) than I do taking the medications :)
>
> If you're more excited with the script in your hand than you are a week after treatment with the drug, then...
>
> Linkadge
Posted by Conundrum on September 13, 2010, at 7:05:10
In reply to Re: Another semi failed trial » linkadge, posted by Conundrum on September 10, 2010, at 15:30:44
I've just recently started to feel a little big better. I don't know what caused it though, since I recently decreased abilify from 5mg, which just did not feel good, to 2.5 again. It could also be that I recently bumped mirtazapine back to 45 mg again, or it could be that I recently bumped up lamotrigine to 400mg and switched from Taro lamotrigine to the Teva generic.
I have to stop abilify due to the cost. I'm gonna hold the other drugs at a constant and then see how I feel. I really hate the mirtazapine because it makes me hungry. I really have to watch the carbs since thats what I crave the most. I hope its the lamictal that is finally working.
I'm kind of hoping desipramine or nortriptyline can replace mirtazapine and cause less weight gain while improving attention and who knows maybe even memory and concentration.
This is the end of the thread.
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