![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 35 to 59 of 64. Go back in thread:
Posted by X_ander on February 12, 2009, at 21:08:25
In reply to Re: Your vote to treat ANHEDONIA, posted by Jim45 on February 3, 2009, at 15:48:13
Hey Jim, cheers for replying, I'm quite interested in this cos there aren't many options for anhedonia, it really is quite sad...we have to fight for it, I'm glad you have.A few questions on your regimen...(hope you don't mind..)
1) On the breaking and pouring of the capsule.. you use a quarter of a 250mg capsule? That would make your dose around 60mg of PEA...sorry to be pedantic, but I'd like to know: do you go for as close to 100mg as you can or just approximately a quarter of the capsule...?
2) How do you store the rest once the capsule is broken?
3) How do you take the powder once it is out? Just with water or something..?
4) Have you found it absolutely necessary to take selegiline in the quarter/thirds dose as you describe? What happens if you don't?
My reason being that selegiline is an irreversible inhibitor of MAO-B, which allows for the slowing of the PEA breakdown...being irreversible, the effects of selegiline last a lot longer than after the tablet has been metabolised (up to 2 weeks, as you'll know from the warnings on antidepressant labels etc...) so I would have thought it not all that necessary to pace the dose of the selegiline so rigidly throughout the day (kind of like the principle of a drug having a really long half-life....), the effects of the previous doses are still well and truly alive...
my best wishes to you too mate.
Posted by Jim45 on February 13, 2009, at 14:38:53
In reply to Re: Your vote to treat ANHEDONIA, posted by X_ander on February 12, 2009, at 21:08:25
Dear X_ander.
I posted the following yesterday. Guess it didn't get through. Man I'm sorry, but I'm SO detail-oriented (doses/times) and careful with what I've been trying re the PEA/Selegiline.
After over a month of dose/time experimentation, even my "safe" regimen had problems. Following is an attempted repost that I've been putting everywhere I recommended PEA/Selegiline:
I THOUGHT that by experimenting I would find a safe PEA/Selegiline dose/time regimen.
I'm methodical and know enough about pharmacology, physiology and neurology to be dangerous .
THIS STUFF IS NOT SAFE. I HOPE I HAVEN'T HURT or will hurt anyone by what I've written about PEA/Selegiline.
Maybe....just maybe, if I can find a vasodilator and diuretic that will cancel out the vasoconstrictive and fluid retention properties of the combo, I'll write back.
Otherwise, my final word after 3 months using the combo is......
STAY AWAY FROM IT.
I don't know what in the world I'll do. Never found anything else like it.
I also kinda like life though and not having strokes from weird BP spikes or organ damage from fluid pressure. Mouth sores from the drying effect of the combo and rebound histamine spikes (PEA interferes with the enzyme that breaks down(?) histamine - NOT good for asthmatics or those with allergies.
X_ander, I can SOOOO relate to your condition, but I don't think PEA/Selegiline is the way to go. Again, if I can find countermeds for the dangerous effects, I'll post my findings.
Sorry
Jim
Posted by meltingpot on March 13, 2009, at 8:51:11
In reply to Re: Your vote to treat ANHEDONIA, posted by Cheryl-Lynn on January 17, 2009, at 15:53:21
Hi,
I was just looking at the threads on anhedonia. Did you manage to find anything to treat anhedonia as I've been suffering from this for years?
Thanks...Denise
Posted by ggggg123 on October 23, 2010, at 3:55:29
In reply to To Cheryl-Lynne Anhedonia, posted by meltingpot on March 13, 2009, at 8:51:11
I don't know if anyone still looks at this post, but what about using da agonists, benztropine, amineptine (if you can get hold of it) or any other kind of dopamine enhancing drug. What have people tried? is Tianeptine helpful for apathy? even though it enhances serotonin? thanks
Posted by Conundrum on October 26, 2010, at 9:18:04
In reply to Re: To Cheryl-Lynne Anhedonia » meltingpot, posted by ggggg123 on October 23, 2010, at 3:55:29
The more dopaminergic drugs I've tried include, ritalin, bupropion, and abilify. None helped with anhedonia.
I've also tried the supplements NADH, and mucana puriens and they didn't help either.
I think the best things to kind of help were low dose prozac, and remeron and pristiq, before they pooped out.
Never tried a direct agonist. I doubt it would be helpful.
Posted by ggggg123 on October 27, 2010, at 0:47:31
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 26, 2010, at 9:18:04
I know what you mean about going back on the ssri, that does seem to help, but its not ideal i want to be free of this stuff forever!! lol,I think most people will recover from ssri induced apathy, I have been going through it for a few months now, since discontinuing citalopram, which I had taken for 9 months. I think it takes a long time and exercise can be helpful. da agonists could be helpful in providing us with motivation, which may help get the blood and dopamine flowing in our brains again, thats my theory. The reason da agonists could be useful is the fact they can be used longterm. I think we need a boost to get fully back into life then the body may take over. We need to keep a positive attitude any negativety only inhibits recovery, although I know it is hard though. Anyways I'm gonna give very low dose Bromocriptine a good go over a long period of time along with some good lifestyle choices and see if I get anywhere. Also hopefully a very low dose of a dopamine agonist should'nt be very stimulating like amphetamines, so it may help restore interest in life without causing anxiety and restlessness.
Posted by Conundrum on October 27, 2010, at 10:04:13
In reply to Re: To Cheryl-Lynne Anhedonia » Conundrum, posted by ggggg123 on October 27, 2010, at 0:47:31
Let us know how it goes. I've found drugs that work strongly increasing dopamine to be hard edged. They didn't seem to increase motivation the way a low dose of prozac dose, or sensation and color the way pristiq weakly did, before it stopped working.
Posted by ggggg123 on October 27, 2010, at 23:30:42
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 27, 2010, at 10:04:13
I will do, I've just started the bromo, feeling a bit strange, everything's abit dark lol, but I'm gonna stick with it long term to see if this clears. I've never tried prozac, but I have taken citalopram, I hear prozac has some affinity for norep and dop, where as citalopram has non, are you still taking the low dose prozac? do you think its a good long term strategy? one other option I was considering is using benztropine, although it is an anticholinergic and will have the dry mouth side effect, it is also a dopamine reuptake inhibitor, which maybe more beneficial than a direct agonist, but unfortunately I think it may have been withdrawn in the uk, but I think its still available online.
Posted by Conundrum on October 28, 2010, at 0:07:27
In reply to Re: To Cheryl-Lynne Anhedonia » Conundrum, posted by ggggg123 on October 27, 2010, at 23:30:42
I'm not on the low dose prozac now, but if I can't find anything that works better, I would consider taking it again. Its good for motivation and drive, but it didn't totally hit anhedonia at the core. I think Pristiq was starting to hit anhedonia, but it just stopped working and felt like an SSRI. I'd consider low dose prozac with an NRI in the future. I think it could be a good longterm strategy if it works, but once you're on it for a long time, don't stop it.
I'm skeptical about DA agonists helping with anhedonia, or drugs that are mainly dopaminergic in general. I'm sure they work for some, but there is more to the brain than low dopamine = anhedonia. Unfortunately there are too many sites that say dopamine is the pleasure chemical, but its not that simple. All the other neurotransmitters carry your emotions too. For example, mice unable to synthesize norepinephrine cannot distinguish between a pleasurable drug like cocaine from an unpleasant drug Lithium cloride. So without adequate norepinephrine, no drug reward, atleast for mice. The same is probably true with serotonin and endorphins.
Also people feel flat on drugs that increase dopamine strongly, like parnate and ritalin. Don't believe me? Look it up, tons of people saying they feel less creative on ritalin or people feeling flat on parnate.
Some people, with anhedonia, do better on drugs like nardil or even dexedrine that do increase dopamine but also have stronger effects on other neurotransmitters when compared to ritalin and parnate, respectively. Some don't.
There was one person on this board with anhedonia, who was taking selegine, adderall, DLPA and maybe one other dopaminergic and had no relief from anhedonia. I'm not trying to discourage you, but there is a reason DA agonists aren't marketed as antidepressants, so if it doesn't help, you may want to consider other options. As you might be able to tell, my anhedonia has not responded well to dopaminergic drugs. Some people do. I think a DA agonist would tell you whether you are on the right path or not. I mean what can tell you whether or not you need dopamine more, than a drug that acts directly on dopamine receptors and its effects are even more potent than the natural ligand.
I really look forward to hearing how you respond to it. I think it is interesting.
Posted by ggggg123 on October 28, 2010, at 5:52:30
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 28, 2010, at 0:07:27
I agree with you that theres much more to it than dopamine, at least the dopamine that drugs provide, I think the only way is for the brain to normalize. But its very hard to succeed as drugs which increase one neurotransmitter often attenuate another, I think this is why we end up with anhedonia after taking ssri's. I agree that low dose should be the best policy in theory, still allowing the brain some natural input. Theres a new drug out here in the uk, called agomelatine, which indirectly increases norep and dop but not serotonin, also high dose venlafaxine is meant to have high affinity for norep and it is also dopaminergic (although I don't think going on a high dose ad is a great option), agomelatine might be useful though. I think norepinephrine and dopamine are very sensitive and respond to subtle changes, this is why stimulants and noradrenergic ad's don't make good ad's, as although it is well known they play a role in the aetiology of depression, these drugs can often increase dopamine and norep beyond normal levels, inducing mania and causing anxiety, basically theres a only a very thin line, between depression, feeling normal and mania. SSRI's can be beneficial as serotonin can be increased fairly substantially and the worst symptom you will experience is anhedonia,unlike dopaminergic drugs which are not ideal to dole out to the public as they could make you a threat to society or nervous wreck . There is virtually no ad's that increase dopaminergic output, just a few that have a slight disinhibiting affect and very slight reuptake inhibition.
My theory is to increase the brains dopamine very very slightly, hopefully acting as a probe to help initiate the flow of da and to also help motivate one back into an active life which inturn could prove very beneficial to the mind. I think its alot of trial and error to find something that helps, but I am positive that something will. I will keep you updated on the bromo and my progress. Cheers.
Posted by ggggg123 on October 29, 2010, at 9:45:46
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 28, 2010, at 0:07:27
day 3 of my new regime, I am taking 10/100mg carbidopa/levodopa and 1.25mg bromocriptine everyday, I am feeling slightly improved, more energy, more excited about life, it definitely affects my anhedonia, I do think for most people that dopamine is the main culprit in their anhedonia, its just many dopaminergic drugs don't pinpoint the pleasure centres, thats where exercise and being active comes in to help get some natural dopamine which is by far the best. But to beat anhedonia i do think dopaminergic medicine is the only method to speed up the process and help get back to life. I know you might say taking levodopa is'nt sustainable, but its very low dose just to give me a kick start and some people have taken it continuously for over 10 years. So basically after 3 days I am feeling alot better, I keep getting urges of excitement to go and get my life back. I hope the pattern continues and I see more improvement over the coming weeks.
Posted by Conundrum on October 29, 2010, at 11:47:37
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 9:45:46
Wow that sounds great!
Like I had said, if one thing would tell you if dopamine would help, its a direct agonist. How did you manage to get a hold of those drugs?
Right now I'm trying tianeptine, which is a serotonin reuptake enhancer. One of the results of increasing serotonin reuptake is dopamine increases. But I doubt it is as strong as taking a direct agonist or supplementing with those forms of dopa.
Posted by ggggg123 on October 29, 2010, at 23:43:30
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 29, 2010, at 11:47:37
I got hold of the drugs over the internet theyre from india, one is made by sun pharmaceuticals a generic and the other is brand gsk, its not all plain sailing I'm feeling abit nauseous, not so good today, I found this on the internet:
When only 5-HTP is used in treatment, 5-HTP depletes dopamine, norepinephrine, and epinephrine levels. When dopamine levels drop low enough, 5-HTP becomes ineffective and the side effects of dopamine depletion occur. 5-HTP and dopa must be provided in proper balance to affect optimal serotonin dopamine balance. For years doctors have depleted serotonin levels in Parkinson's Disease patient by prescribing only levodopa
with no properly balance serotonin precursors. People taking 5-HTP never realize that when the 5-HTP does not work or quits working it is because the serotonin dopamine system is not in balance.I'm not sure whether to add a very low dose ssri. Sinemet (carbidopa/levodopa) is a very cheap drug you can get it off many websites, I think its making me feel abit sick though so not sure wether to continue taking it. But i think the bromo is quite good and can be taken longterm.
But overall I think its about getting the right serotonin norep and dopamine balance, maybe by taking something that regulates all of them long term, as ssri's only regulate one, it seems that for a subgroup of people this has a negative effect on dopamine and norepinephrine so aslong as we start raising the norep and dopamine we should be on to a winner, I am thinking of adding imipramine or reboxetine.
Which meds are you taking at the moment? are you taking remeron, I found remeron really good for the first few weeks then its stopped working and only worked 20% of the time.
Posted by Conundrum on October 29, 2010, at 23:52:24
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:43:30
I found the same quick poopout with remeron as well. I'm probably gonna be coming off it. I just came off lamictal. I just started tianeptine today, which decreases serotonin and increases dopamine.
Posted by ggggg123 on October 29, 2010, at 23:54:10
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:43:30
sorry I misread your post, I see you are taking tianeptine not mirtazapine, did mirtazapine stop working? I wanted to try tianeptine,its got some good reviews, I really wanted to try amineptine, but its completely banned and the one source available is ridiculously expensive. I think I made the mistake of taking high dose ssri for a while, which seemed to cause this problem, I have heard on the tips part of this website of psychiatrists using ssri's with da agonist and having excellent results.
Posted by Conundrum on October 30, 2010, at 0:11:56
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:54:10
> sorry I misread your post, I see you are taking tianeptine not mirtazapine, did mirtazapine stop working? I wanted to try tianeptine,its got some good reviews, I really wanted to try amineptine, but its completely banned and the one source available is ridiculously expensive. I think I made the mistake of taking high dose ssri for a while, which seemed to cause this problem, I have heard on the tips part of this website of psychiatrists using ssri's with da agonist and having excellent results.
I'm taking mirtazapine and tianeptine right now.
My anhedonia started after stopping prozac. Go figure. I felt great on it.
Posted by ggggg123 on October 30, 2010, at 13:01:16
In reply to Re: To Cheryl-Lynne Anhedonia, posted by Conundrum on October 30, 2010, at 0:11:56
heres an extract from dr bobs tips page:
From: [email protected]
Date: Wed, 7 Feb 1996 21:32:19 -0800
Subject: Bromocriptine for SSRI poop outI have had a very similar experience. This is now spoken about in many psychopharm conferences as "poop out." In my experience it sometimes happens as late as 3 years into an SSRI (typically Prozac, since it's been around the longest), in as many as 20% of patients.
What is to be done? There is talk among "poop out" veterans of adding bromocriptine since there is speculation that this might be a dopaminergic depletion phenomenon. People have said this helps, but I haven't used it yet myself
--------------------------------------------------did you not poop out on prozac? maybe low dose prozac with a dopaminergic could be a good strategy. I think it is worse when withdrawaing from the drug. How was the aripiprazole, that is supposed to increase dopamine, did you feel any benefit? cheers
Posted by Conundrum on October 30, 2010, at 15:19:53
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 30, 2010, at 13:01:16
> did you not poop out on prozac? maybe low dose prozac with a dopaminergic could be a good strategy. I think it is worse when withdrawaing from the drug. How was the aripiprazole, that is supposed to increase dopamine, did you feel any benefit? cheersHi again,
Well what happened with me and prozac was that I had been taking it successfully for years and while studying music in boston, I stopped taking it cuz I ran out. Being me, I didn't take the time to get it filled and, I remember my pdoc, saying because it has a long half life, you don't need to ween off of it. So after taking it for 4.5 years I stopped it abruptly. Akathesia, the feeling to constantly keep moving, anhedonia, and anxiety ensued. I saw a doctor in Boston and got a new script and when I went back on it I felt like I was in another world. I just felt awful, although I think the akathesia went away, the anhedonia stayed.
So if there is a moral to the story, its that if you find something that works, don't stop it, cuz it might not work again! AND don't stop psych drugs abruptly, even if its got a 2 week half life.
Now I can take a low dose, 5mg every other day, and get some motivation. I've tried adding ritalin to it, but it did not help. I would think ritalin would be one of the more powerful dopaminergics around. (Ritalin does help me if I'm really sad, not anhedonic. It has a very artificial rescue effect.)
Given that Pristiq added some "color" to my world, I tend to think I have a norepinephrine deficiency. Pristiq does not have the DRI effects that the parent drug, Effexor has.
Aripiprazole, hmm. At 2 mg I noticed a feeling that I had a lot of energy and wanted to get things done, similar to a cup of coffee, but this feeling lasted for a couple days. I noticed another boost at 2.5 mg, and then a fade. At 5mg I felt worse, it just made my head feel weird, I went back to 2.5 and felt that boost again, and then a fade.
I'm curious about taking that low dose of prozac with desipramine, or nortriptyline.
Right now I'm on tianeptine, so I won't be taking any SRI drug while I'm on it.
Since remeron felt like a stronger prozac, I wonder what combining remeron with an SNRI would be like. I think the 5 HT2A/C antagonism of remeron works better with SRI action, this is the mechanism by which low dose prozac increases norepinephrine and dopamine in the prefrontal cortex.
Oh also abilify, only increase dopamine in the prefrontal cortex, not in the striatum or nucleus accumbens, and at higher doses it decreases dopamine in the reward regions of the brain.
The motivation from remeron and low dose prozac felt more natural than abilify which seemed, kind of hyper and robotic.
Posted by ggggg123 on October 31, 2010, at 11:06:06
In reply to Re: To Cheryl-Lynne Anhedonia, posted by Conundrum on October 30, 2010, at 15:19:53
I think remeron is a good drug when combined with other ad's, but not as a sole agent. I think as many of its ad properties consist of antagonism that synergistic use is the best policy. I have tried very briefly combining with venlafaxine, but i did'nt like the side effects of taking venlafaxine as it was making me feel sick, so I did'nt stick with it, although I know it is suppose to be very effective and they call it Californian rocket fuel, once the side effects have passed it could be a good combo. My theory on anhedonia is that norepinephrine and dopamine downregulaton must play a big part, i think to see any benefit one would have to take drugs to raise these for many many months to try and reverse the years of downregulations by the ssri, the tcas could be a good bet, exercise could also be very helpful, I'm pretty sure that once proper norep and dop functioning is restored one would feel normal again, although it could be a long process, I am definately feeling better taking the bromocriptine, but its not very strong, as I'm only taking low dose, so the effects are'nt amazing, but the only drugs I believe that could fully relieve the symptoms of anhedonia would be illegal and unsustainable, this is why it is inevitably a long process and all we can do is find other drugs which can provide a helping hand. Personally it annoys me that doctors dish out ssri's for any kind of mental disturbance, when everybodys depression is so unique, maybe if they understood mental health better then we would'nt be put in this mess!
I think the nortryptiline could be a good idea, I am also thinking about trying a noradrenergic tca, but I am unsure about the anticholinergic side effects and whether they would subside. Personally I don't think serotonin deficiency is the cause of depresson, it certainly was'nt the cause of mine, straight away I suffered side effects from citalopram, which included sexual dysfunction and blunted emotions, when a diabetic takes insuline they normally experience no side effects!!! now that is replacing a deficiency, now ssri's seem to produce side effects at even low dose, which would indicate a rise beyond normal levels. If you ask me, if you experience any side effects on an ad, which makes you feel very abnormal and are representative of a change in neurotransmitter level, such as apathy, anxiety, sexual dysfunction, loss of energy/motivation and the side effects persist then I would say to anybody that the ad is not for you and to find another rather than putting up with it for years and letting our doctors fool us into thinking its doing us some good.
I think recovering from anhedonia is one of lifes big challenges as it trys to prevent you from doing the things that will aid recovery.
Posted by Conundrum on October 31, 2010, at 16:34:26
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 31, 2010, at 11:06:06
> I think remeron is a good drug when combined with other ad's, but not as a sole agent. I think as many of its ad properties consist of antagonism that synergistic use is the best policy.
I agree, I think this is the reason why low dose prozac works so well for me, but a higher dose does not. Prozac is a 5HT2A/C antagonist, most of the studies emphasize its actions as a 5HT2C antagonist more than its effect at the 2A receptor, so I think it may have a stronger effect on the 2C receptors. At a low dose there is an increase in motivation. At a higher dose there is the opposite effect. So i think that antagonism comes into play at the lower dose but the SRI effect isn't too strong. Its there believe, me, there is still sexual dysfunction, for me, even at that low dose. It seems like the antagonism needs an increase in serotonin to have an effect. Perhaps pure antagonism, creates an upregulation in receptors so the effect is lost, but with some agonism by serotonin the receptors are down regulated and some are blocked, leading to increase NE/DA release in the PFC.
My experience with low dose prozac and remeron, is that the subjective effect was EXACTLY THE SAME, except when remeron kicked in the effect was stronger, but short lived. I wonder what it would do in conjunction with pristiq or cymbalta.
My theory on anhedonia is that norepinephrine and dopamine downregulaton must play a big part, i think to see any benefit one would have to take drugs to raise these for many many months to try and reverse the years of downregulations by the ssri, the tcas could be a good bet, exercise could also be very helpful, I'm pretty sure that once proper norep and dop functioning is restored one would feel normal again, although it could be a long process.
Yes its important not to leave noradrenaline out of the process of treating anhedonia. Its not just the "energizing" neurotransmitter, it doesn't just increased blood pressure and heart rate, it actually has an effect on mood. The same is true with dopamine, its not just the feel good transmitter and if the other levels aren't right it won't work so good. Also dopamine and norepinephrine are administered in hospitals to stabalize low blood pressure, so dopamine does increase BP and energy as well.
> I think the nortryptiline could be a good idea, I am also thinking about trying a noradrenergic tca, but I am unsure about the anticholinergic side effects and whether they would subside. Personally I don't think serotonin deficiency is the cause of depresson, it certainly was'nt the cause of mine, straight away I suffered side effects from citalopram, which included sexual dysfunction and blunted emotions, when a diabetic takes insuline they normally experience no side effects!!! now that is replacing a deficiency, now ssri's seem to produce side effects at even low dose, which would indicate a rise beyond normal levels. If you ask me, if you experience any side effects on an ad, which makes you feel very abnormal and are representative of a change in neurotransmitter level, such as apathy, anxiety, sexual dysfunction, loss of energy/motivation and the side effects persist then I would say to anybody that the ad is not for you and to find another rather than putting up with it for years and letting our doctors fool us into thinking its doing us some good.
Well there is also desipramine, which is supposed to have less anticholinergic effects. I think many people reporting these effects going away with time, probably similar to Remeron poop out, since the anticholonergic effects are due to muscarinic antagonism.
>
> I think recovering from anhedonia is one of lifes big challenges as it trys to prevent you from doing the things that will aid recovery.Thats so true. Sometimes I'll go and exercise and feel good about it. The next day I could go to exercise and not like it and be fighting the whole time. Usually I just don't exercise. I try to walk, because anhedonia hasn't me me so lazy I can't do that.
I think I find stablon a bit relaxing but its too soon to say.
Posted by ggggg123 on October 31, 2010, at 17:22:55
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 31, 2010, at 16:34:26
>------I agree, I think this is the reason why low dose prozac works so well for me, but a higher dose does not. Prozac is a 5HT2A/C antagonist, most of the studies emphasize its actions as a 5HT2C antagonist more than its effect at the 2A receptor, so I think it may have a stronger effect on the 2C receptors. At a low dose there is an increase in motivation. At a higher dose there is the opposite effect. So i think that antagonism comes into play at the lower dose but the SRI effect isn't too strong. Its there believe, me, there is still sexual dysfunction, for me, even at that low dose. It seems like the antagonism needs an increase in serotonin to have an effect. Perhaps pure antagonism, creates an upregulation in receptors so the effect is lost, but with some agonism by serotonin the receptors are down regulated and some are blocked, leading to increase NE/DA release in the PFC
Maybe the upregulation is the reason why we experience worse symptoms when off the drug, as when we go back on the drugs they antagonize the receptors but when we come off they are upregulated, causing anhedonia, maybe a long term strategy using a 5ht2c and a agonist might help return receptor functioning to pre ssri levels. we need a drug that is the opposite to an ssri lol
lol just a thought, but there seems to be some reason why symptoms are even worse off the drug.
Posted by Conundrum on October 31, 2010, at 17:32:20
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 31, 2010, at 17:22:55
> >------I agree, I think this is the reason why low dose prozac works so well for me, but a higher dose does not. Prozac is a 5HT2A/C antagonist, most of the studies emphasize its actions as a 5HT2C antagonist more than its effect at the 2A receptor, so I think it may have a stronger effect on the 2C receptors. At a low dose there is an increase in motivation. At a higher dose there is the opposite effect. So i think that antagonism comes into play at the lower dose but the SRI effect isn't too strong. Its there believe, me, there is still sexual dysfunction, for me, even at that low dose. It seems like the antagonism needs an increase in serotonin to have an effect. Perhaps pure antagonism, creates an upregulation in receptors so the effect is lost, but with some agonism by serotonin the receptors are down regulated and some are blocked, leading to increase NE/DA release in the PFC
>
>
>
> Maybe the upregulation is the reason why we experience worse symptoms when off the drug, as when we go back on the drugs they antagonize the receptors but when we come off they are upregulated, causing anhedonia, maybe a long term strategy using a 5ht2c and a agonist might help return receptor functioning to pre ssri levels. we need a drug that is the opposite to an ssri lol
>
> lol just a thought, but there seems to be some reason why symptoms are even worse off the drug.Well I just started taking tianeptine, which is a serotonin reuptake enhancer, so it is an indirect serotonergic antagonist. In the end it may not make a different. Taking an SSRI decreases the number of transporters that bring serotonin back into the cell, tianeptine does the same thing, which would seem to limit its effectiveness overtime. I'm not convinced there is a way to get the brain to function the way it once had. I've been off prozac for 7 years. For of those years I took no drugs, save ginkgo biloba, which is supposed to help the brain. I also took choline precursors and fish oil. My brain never went back to the way it was. I'm not convinced that it is possible. Some people do get back to their previous state, but I'm just not that lucky.
Perhaps I would have ended up in this state without the drugs? Idk.
Posted by ggggg123 on October 31, 2010, at 17:49:11
In reply to Re: To Cheryl-Lynne Anhedonia, posted by Conundrum on October 31, 2010, at 17:32:20
Many GPCRs downregulate in response to agonists for the receptor, and upregulate in response to antagonists. The 5-HT2A and 5-HT2C receptors appear to downregulate in response to both antagonists and agonists. Chronic treatment with antipsychotic drugs, which possess 5-HT2 antagonist activity, results in downregulation of both 5-HT2A and 5-HT2C, as does chronic treatment with SSRIs and other 5-HT agonists.[12] However, chronic SSRI treatment may increase 5-HT2C expression, specifically in the choroid plexus.
This is an extract from wikipedia, its a little bit ambiguous and contradictory, but in the end it points out that ssri's may increase 5ht2c expression, which could play a major factor I think in post ssri apathy. If any receptor is responsible for anhedonia it would be this one, this is the one that stops our dopamine and norepinephrine from working. Basically the cure should be a drug which reduces 5ht2c expression or causes downregulation. Maybe a tca or 5htp supplement could be beneficial? or maybe an anti psychotic taken for a long period? how long did you take aripiprazole for?
Posted by Conundrum on October 31, 2010, at 18:01:40
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 31, 2010, at 17:49:11
> Many GPCRs downregulate in response to agonists for the receptor, and upregulate in response to antagonists. The 5-HT2A and 5-HT2C receptors appear to downregulate in response to both antagonists and agonists. Chronic treatment with antipsychotic drugs, which possess 5-HT2 antagonist activity, results in downregulation of both 5-HT2A and 5-HT2C, as does chronic treatment with SSRIs and other 5-HT agonists.[12] However, chronic SSRI treatment may increase 5-HT2C expression, specifically in the choroid plexus.
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> This is an extract from wikipedia, its a little bit ambiguous and contradictory, but in the end it points out that ssri's may increase 5ht2c expression, which could play a major factor I think in post ssri apathy. If any receptor is responsible for anhedonia it would be this one, this is the one that stops our dopamine and norepinephrine from working. Basically the cure should be a drug which reduces 5ht2c expression or causes downregulation. Maybe a tca or 5htp supplement could be beneficial? or maybe an anti psychotic taken for a long period? how long did you take aripiprazole for?Perhaps, I assume the reason that low dose prozac can increase motivation without pooping out(when i first took prozac, I took the normal 20mg dose) and remeron poops out has to do with an increase in serotonin due to reuptake inhibition. Hmm I have buspar, perhaps adding it to remeron would increase dopamine release. IDK. I don't think there is enough knowledge on the 17 varieties of serotonergic receptors to be sure what does what.
The TCAs amitriptyline and nortriptyline would be good for antagonizing these receptors, the drugs from Imipramine would be less so. I was only on Abilify for 3 weeks, I had samples just to see if it worked. Its very expensive. I wouldn't want to be on an antipsychotic longterm, they cause a whole host of problems due to D2 antagonism. Zyprexa would probably be the most potent drug AP for blocking the 5 HT2C receptor.
It might make more sense to do what you said and take a dopamine agonist with an adrenergic TCA.
One thing I've noticed about SSRIs, is that they prevent me from having bad dreams, so maybe I have some deficiency there, and it just needs to be properly balanced with excitatory neurotransmitters.
Posted by ggggg123 on November 2, 2010, at 6:34:46
In reply to Re: To Cheryl-Lynne Anhedonia, posted by Conundrum on October 31, 2010, at 18:01:40
I am definately starting to feel alot better, taking the 1.25mg of bromo and I've been taking a little bit of bupropion, defo seems to be a norep and dopa thing, today I have a doctors appointment and I'm going to ask to start reboxetine, as its an nri and bupropion is'nt available over here. I am thinking nri low dose combined with small amount of bromo and exercise/getting out and about, today I feel like going out for the first time in a while, which is how I used to feel before I went into hibernation.
I'm not going to try to antagonize the 5ht2c receptor as, when i took mirt all i wanted to do was eat and sleep, I believe you are right about the nor and dop drugs, my problem really seems to be a pure norep and dop deficiency, basically a depression, which could stem from the original symptoms prior to using an ssri and have later been attenuated by the serotonergic properties of the drug. Also most tca's are serotonergic aswell, which I really do want to avoid, its is said that norep increases serotonin indirectly, pesonally I think it increases both serotonin and dopamine, and can be very useful, where as serotonin seems to diminsh the other neurotransmitters. I know I have a norepinephrine deficiency, because I no longer get nervous or excited, I used to be fairly nervous and felt quite alot of emotion, since my anhedonia I have felt non. I think long term nri therapy at a reasonably low dose could be the best strategy for a subgroup of people wo do not improve after ssri therapy. Adding a small amount of a dopamine agonist may also be very useful. Theres a section on the good drug guide at biopsychiatry . c o m which talks about reboxetine, I don't know how it will compare to bupropion as its also twice a day dosing. But honestly I am feeling so much better now I can feel some norepinephrine and dopamine in my brain, it makes you feel content and almost half way to happy.
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