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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by twinleaf on October 18, 2010, at 22:10:18
I think most people who have tried Stablon consider is a mild AD. I do too. But once I got over the severe stage of my depression, I think it may have been very useful in preventing relapse. It is supposed to be one of the more strongly neuroprotective medications, although I don't know in what way. The only thing I notice when I take it is a mild calming effect. Has anyone else taken it for "maintenance"?
Posted by twinleaf on October 18, 2010, at 23:06:55
In reply to Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 22:10:18
I thought I should know a bare minimum about the neuroprotection! According to an article in Nature by McEwen, tianeptine works by normalizing the functions of the glutamate system. I think excess glutamate occurs as a consequence of an overactive HPA axis and elevated levels of cortisol. I believe lithium is thought to work on glutamate also.
Posted by Tomatheus on October 18, 2010, at 23:37:03
In reply to Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 22:10:18
> Has anyone else taken it for "maintenance"?
Twinleaf,
I took Stablon about two years ago and did not find it to be effective as a maintenance medication for depression. I noticed a definite antidepressant response (though not remission) and an increase in psychotic symptoms from the medication the first day that I took it, and it did very little after that. I stayed on Stablon for several months, and I did not notice any withdrawal effects or increase in depressive symptoms after I discontinued it.
Tomatheus
Posted by twinleaf on October 19, 2010, at 0:19:48
In reply to Re: Stablon (tianeptine), posted by Tomatheus on October 18, 2010, at 23:37:03
Thanks for telling about your experience with it. I have gotten the idea from several posters here, as well as other sources, that it isn't a particularly strong AD, even though it's used a lot more in Europe as a first-line treatment for depression. I tried it once before for a few weeks when my depression was more severe, and it didn't seem to have any effect. But now, I am using it more as a relapse prevention and as a mild anxiolytic. I don't really know whether it is helping to prevent a relapse, but the fact that it is neuroprotective and easy to take make it appealing.
Posted by SLS on October 19, 2010, at 4:39:53
In reply to Re: Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 23:06:55
> I thought I should know a bare minimum about the neuroprotection! According to an article in Nature by McEwen, tianeptine works by normalizing the functions of the glutamate system. I think excess glutamate occurs as a consequence of an overactive HPA axis and elevated levels of cortisol. I believe lithium is thought to work on glutamate also.
Have you thought to try Lamictal (lamotrigine)? It is anti-glutamatergic via inhibition of glutamate release.
- Scott
Posted by twinleaf on October 19, 2010, at 7:43:14
In reply to Re: Stablon (tianeptine) » twinleaf, posted by SLS on October 19, 2010, at 4:39:53
Being pretty much in remission, I don't need a strong AD with a high likelihood of side effects. Stablon seemed the best choice as it seems to be side effect free. Because it works both on the HPA axis- cortisol system and the glutamate system, it seems ideal for preventing a relapse by lowering stress hormones in the brain.
Posted by SLS on October 19, 2010, at 8:21:11
In reply to Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 22:10:18
> But once I got over the severe stage of my depression,
How did you go about accomplishing this?
I'm glad that tianeptine is acting as a prophylactic against relapse for you.
- Scott
Posted by twinleaf on October 19, 2010, at 9:44:40
In reply to Re: Stablon (tianeptine) » twinleaf, posted by SLS on October 19, 2010, at 8:21:11
The depression was precipitated by the sudden loss of four important people thirteen years ago. Initial treatment efforts of SSRIs, SNRIs, APs, tricyclics (pretty much everything except MAOIs) plus supportive psychotherapy didn't help much at all. After nine years, I changed to a more intensive psychoanalytic form of psychotherapy, slowly weaned off all the psychotropic medication and began having TMS (first a six-week course, then as needed maintenance treatments when my Mongomery-Asberg-S scores got above 8-10. I am still doing this, although I haven't needed any TMS for the past 18 months (the longest I have gone without a "booster"). I added tianeptine a year ago, and also take 300 mg. lithium. T3 and T4 , fish oil and vitamins. I think every part of this has been important, with the strong relationship formed in intensive therapy probably being the most important.
Although cortisol measures are not considered very reliable, I have an endocrinologist who has been interested in following my pattern of salivary cortisol as well as whether or not I suppress on the dexamethasone suppression test. Initially, I was a non-suppressor with salivary cortisols which remained high into the evening. Now I am a partial suppressor with salivary cortisols which decrease during the day but not as much as they should. We check once a year to see how it's doing.
Posted by SLS on October 19, 2010, at 10:03:08
In reply to Re: Stablon (tianeptine) » SLS, posted by twinleaf on October 19, 2010, at 9:44:40
Thanks for such a thorough reply.
:-)
You have me thinking more seriously about going for rTMS. I would do it if I didn't have to pay cash for it. I am hoping that, with the new data demonstrating the efficacy of rTMS for TRD, Medicare might cover it.
You are the second person on this forum to have success using tianeptine together with rTMS.
- Scott
> The depression was precipitated by the sudden loss of four important people thirteen years ago. Initial treatment efforts of SSRIs, SNRIs, APs, tricyclics (pretty much everything except MAOIs) plus supportive psychotherapy didn't help much at all. After nine years, I changed to a more intensive psychoanalytic form of psychotherapy, slowly weaned off all the psychotropic medication and began having TMS (first a six-week course, then as needed maintenance treatments when my Mongomery-Asberg-S scores got above 8-10. I am still doing this, although I haven't needed any TMS for the past 18 months (the longest I have gone without a "booster"). I added tianeptine a year ago, and also take 300 mg. lithium. T3 and T4 , fish oil and vitamins. I think every part of this has been important, with the strong relationship formed in intensive therapy probably being the most important.
>
> Although cortisol measures are not considered very reliable, I have an endocrinologist who has been interested in following my pattern of salivary cortisol as well as whether or not I suppress on the dexamethasone suppression test. Initially, I was a non-suppressor with salivary cortisols which remained high into the evening. Now I am a partial suppressor with salivary cortisols which decrease during the day but not as much as they should. We check once a year to see how it's doing.
Posted by Phillipa on October 19, 2010, at 10:05:21
In reply to Re: Stablon (tianeptine) » twinleaf, posted by SLS on October 19, 2010, at 10:03:08
I've read this thread with great interest. TMS medicaire? Seriously you feel this is going to come about? Phillipa ps would be great if it does
Posted by SLS on October 19, 2010, at 10:05:22
In reply to Re: Stablon (tianeptine) » SLS, posted by twinleaf on October 19, 2010, at 9:44:40
> You are the second person on this forum to have success using tianeptine together with rTMS.
Or perhaps you are the same person?
Hmm.
- Scott
Posted by SLS on October 19, 2010, at 10:36:25
In reply to Re: Stablon (tianeptine), posted by Phillipa on October 19, 2010, at 10:05:21
> I've read this thread with great interest. TMS medicaire? Seriously you feel this is going to come about? Phillipa ps would be great if it does
When Medicare decides to cover something, the insurance companies usually follow.
The more they play with rTMS, the more it seems to demonstrate efficacy for TRD. When it first came out 15 or so years ago, Mark George, MD, a developer of the procedure, did not think rTMS had much of a place for TRD. At one point, he told a friend of mine that she was not a canditate for treatment because she was so refractory to drug treatment. Who knows? Maybe I won't need it.
:-)
- Scott
Posted by twinleaf on October 19, 2010, at 12:51:19
In reply to Re: Stablon (tianeptine) » twinleaf, posted by SLS on October 19, 2010, at 10:05:22
I had the original course of TMS in 2003 and posted about it here under the name "Pfinstegg". I began tianeptine about a year ago, and think I listed all the parts of my treatment plan a couple of months ago, so it could have been me.
I think I am proof that calming down the HPA axis is key in my type of depression (reactive, unipolar)
Posted by floatingbridge on October 19, 2010, at 13:12:02
In reply to Re: Stablon (tianeptine) » SLS, posted by twinleaf on October 19, 2010, at 12:51:19
Twinleaf, what is 'reactive' unipolar depression? Do you think it's similar to ptsd symptoms of hyperactive responsiveness?
Posted by twinleaf on October 19, 2010, at 13:29:32
In reply to Re: Stablon (tianeptine) » twinleaf, posted by floatingbridge on October 19, 2010, at 13:12:02
I think that what is the same for everyone is that SOMETHING HAPPENED which massively overstressed our brains. It is often childhood neglect, abuse or trauma, but, as for me, it can also be overwhelming stresses occurring in adulthood. PTSD is a good term which covers all traumatic events which are beyond our coping abilities. I feel that the symptoms of PTSD, whether anxiety, hyperarousal or depression, all have the same root cause- an environmental trauma. I meant to contrast people like you and me versus people whose illness may have more of a genetic basis, such as bipolar illness, where traumatic events may not play much of a role.
Posted by floatingbridge on October 19, 2010, at 13:34:41
In reply to Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 22:10:18
Googled both questions, twinleaf. Thanks. Though I like your posts, thought I'd save you the work.
For my own interests, stabling has shown efficacy in a Russian study of ptsd and as helpful in cases of fibromyalgia.
Maybe these are teensy tinsy studies.
I rarely hear about stablon. An odd name.
Posted by floatingbridge on October 19, 2010, at 13:38:05
In reply to Re: Stablon (tianeptine) » floatingbridge, posted by twinleaf on October 19, 2010, at 13:29:32
Thank you for your explanation. Adds more nuance to 'the Map' I'm drawing in my imagination :)
Posted by bearfan on October 19, 2010, at 16:22:21
In reply to Stablon (tianeptine), posted by twinleaf on October 18, 2010, at 22:10:18
I can be helpful for maintenance if your depression is not too bad. Although it doesn't provide much 'mind numbness' as other anti-depressants can for stronger episodes.
Posted by floatingbridge on October 19, 2010, at 16:53:29
In reply to Re: Stablon (tianeptine), posted by bearfan on October 19, 2010, at 16:22:21
What I'm looking for is something that reduces the intensity of my _____? responses--the sort of phenomena that troubles ptsd, a.k.a 'my nerves are shot'.
I have benzo's now. Reduced them for quite awhile, and with this latest big depressive slide, it's all I have in my tool kit. Last night I dug out my old bottle of klonopine, and this morning remembered why I had quit it :(
Good news is, I think, this might be as low as I go. Cross my heart, hope to fly.
I'm very pleased twinleaf began this thread.
Why haven't I heard much about this?
Posted by Phillipa on October 19, 2010, at 20:06:00
In reply to Re: Stablon (tianeptine) » Phillipa, posted by SLS on October 19, 2010, at 10:36:25
Scott do I detect that your meds are starting to work? Phillipa
Posted by bearfan on October 19, 2010, at 21:19:26
In reply to Re: Stablon (tianeptine) » SLS, posted by Phillipa on October 19, 2010, at 20:06:00
Yes Scott, I remember reading a post where you were having problems with Parnate. I am interested to hear what is working for you at the moment.
Posted by SLS on October 20, 2010, at 5:29:21
In reply to Re: Stablon (tianeptine), posted by bearfan on October 19, 2010, at 21:19:26
> Yes Scott, I remember reading a post where you were having problems with Parnate. I am interested to hear what is working for you at the moment.
I added agomelatine (Valdoxan) to my regime. The antidepressant effect is currently mild at best. However, it is early. I have been taking agomelatine for only 10 days. I wouldn't want to guarantee what it is about this drug that allows it to exert an antidepressant effect. For now, it seems that melatonin M1 and M2 receptor stimulation and serotonin 5-HT2c blockade are both important as per elegantly designed studies.
I would like to give things another 2-4 weeks to measure the degree and persistence of the treatment adjustment. I am currently taking 25mg. As per the manufacturer's instructions, I will raise the dosage to 50mg after 2 weeks should the improvement plateau or wane.
Current treatment regime:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
agomelatine 25mgIt turns out that the only other person I know of for whom agomelatine is producing a robust therapeutic response is also taking Nardil 90mg.
I have been losing sleep because of the sleep disruptions agomelatine is known to produce early in treatment. I have been moderately sleep deprived for a few days. It is possible that this is what is responsible for the mild improvement I am now experiencing. For some people, sleep deprivation can induce a transient antidepressant effect. It can even precipitate mania in certain individuals.
I am cautiously optimistic. If the current improvement persists for longer than 3 days, I will become less cautious in my optimism.
Crossed-fingers, well wishes, and prayers for me are welcome.
:-)
- Scott
Posted by sigismund on October 20, 2010, at 14:14:32
In reply to Re: Stablon (tianeptine), posted by SLS on October 20, 2010, at 5:29:21
>I have been losing sleep because of the sleep disruptions agomelatine is known to produce early in treatment.
My two bob's worth is that the melatonin agonism is helpful to sleep and the 5ht2c antagonism can be disruptive of it (through the well known dopaminergic effect).
The first time I took 25mg and slept for an hour or two and then was awake for the night.
When I took 12.5mg thereafter my sleep was brilliant (for a while).
Posted by SLS on October 20, 2010, at 14:54:02
In reply to Agomelatine » SLS, posted by sigismund on October 20, 2010, at 14:14:32
> >I have been losing sleep because of the sleep disruptions agomelatine is known to produce early in treatment.
>
> My two bob's worth is that the melatonin agonism is helpful to sleep and the 5ht2c antagonism can be disruptive of it (through the well known dopaminergic effect).
>
> The first time I took 25mg and slept for an hour or two and then was awake for the night.
>
> When I took 12.5mg thereafter my sleep was brilliant (for a while).How would you describe the quality of your therapeutic response to agomelatine? Are you still taking it? Is 12.5mg as effective for you as 25mg?
Thanks.
- Scott
Posted by Tomatheus on October 20, 2010, at 15:53:45
In reply to Re: Stablon (tianeptine), posted by SLS on October 20, 2010, at 5:29:21
Scott,
It's good to hear that you're experiencing some benefits from agomelatine, even though the antidepressant effect is only mild. I will keep my fingers crossed that the improvement that you've noticed continues.
Tomatheus
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