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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by PeterMartin on February 16, 2015, at 11:45:54
I'd like to have a discussion about Lorcaserin a 5ht2c agonist (only one on the market?) and mania. Lorcaserin was approved in 2013 for obesity and I'm current on a trial. I have had manic episodes before but not since 2009 when I was still smoking pot/drinking (sober 5yrs). My doctor OKed Lorcaserin (Belviq) for weight loss about a month ago. Down about 15lbs so far.
I've been a little weary that Lorcaserin could potentially send me into mania but based on everything I've googled it seems 5h2c agonists might be more likely to +help+ prevent mania than the opposite. For example: http://otm.uic.edu/technologies/potent-safe-and-selective-5ht2c-agonists-treatment
Any thoughts on Lorcaserin/5ht2c agonists and their potential to cause (or prevent) mania? I've been a little spacey the past few days and I'm hoping it's due to coming off Marplan after 5yrs vs a side effect from Lorcaserin (On half dose since Jan 6th)
Thanks for the discussion.
Posted by PeterMartin on February 16, 2015, at 12:09:41
In reply to 5ht2c Agonists for BP Mania? (Lorcaserin), posted by PeterMartin on February 16, 2015, at 11:45:54
I guess the DEA found evidence Lorcaserin can cause euphoria/hallucinations at higher dosages (40-60mg when max is 10mg bid). Hence its schedule IV class:
http://www.deadiversion.usdoj.gov/fed_regs/rules/2012/fr1219.htm
I'm only taking 10mg in the AM. Guess it could be the cause of my spaciness. Eh. I see my doc soon so I'll have to talk to him about the risk again. Would be unfortunate to come off as I think it's also helping fight back the depression I was anticipating after ceasing Marplan to start 2015 (Insurance issue).
I still think this is a good discussion. Does anyone thing Lorcaserin could have a as a place
Posted by ed_uk2010 on February 16, 2015, at 13:20:24
In reply to 5ht2c Agonists for BP Mania? (Lorcaserin), posted by PeterMartin on February 16, 2015, at 11:45:54
Interesting thread.
Do you have reason to be concerned that you might become manic? I imagine you'd be a lot more likely to become manic on isocarboxazid.....
Posted by linkadge on February 16, 2015, at 16:50:25
In reply to Re: 5ht2c Agonists for BP Mania? (Lorcaserin), posted by ed_uk2010 on February 16, 2015, at 13:20:24
Stimulation of the 5-ht2c receptors can have the same effect as bright light, in altering sleep cycles. Thus, you could theoretically get insomnia.
5-ht2c stimulation might cause dysphoria (acutely) as these receptors supress the release of dopamine in rewards centers of the brain. But, there would likely be a rebound to this as the drug wears off.
5-ht2c agonists might also have anticonvulsant effects and antiagressive effects.
Most literature suggests that 5-ht2c antagonist are antidepressant. Therefore, it might be reasonable to suggest that 5-ht2c agonists might be depressant or at least anxiogenic. As mentioned, I think agonists might be acutely dysphoric / anxiogenic, with some rebound effect as the drug wears off.
Linkadge
Posted by PeterMartin on February 17, 2015, at 8:50:31
In reply to Re: 5ht2c Agonists for BP Mania? (Lorcaserin), posted by linkadge on February 16, 2015, at 16:50:25
Odd about insomnia as everything I've read from anecdotes on drugs.com says it seems to help sleep (or one side effect is fatigue). I think I'm sleeping a little bit heavier but I'm also just off an MAOI so could be rebound REM.
Thanks for the insight.
Random Sexual Side "effect" note:
One other thing I wanted to mention is that it really seems to have decreased my time to orgasm. Like to the point of making me feel like I'm having a premature ejaculation. In the past (pre-medication) I had a difficult time orgasming during sex. I'll see if this continues but I did find this study which suggests 5ht2c could be at play w/ time to ejaculation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721550/
It's odd to me how drugs approved for "weight loss" are stigmatized somewhat. I mean if Topamax was first tried for weight loss (and approved as Qsaymia as it's now also marketed) would people have been against trying it for psychologic conditions?
Posted by ed_uk2010 on February 17, 2015, at 15:18:09
In reply to Re: 5ht2c Agonists for BP Mania? (Lorcaserin), posted by PeterMartin on February 17, 2015, at 8:50:31
>it really seems to have decreased my time to orgasm. Like to the point of making me feel like I'm having a premature ejaculation.
I think that's very likely to be a rebound effect from stopping the MAOI.
Posted by hello123 on February 18, 2015, at 21:05:05
In reply to Re: 5ht2c Agonists for BP Mania? (Lorcaserin) » PeterMartin, posted by ed_uk2010 on February 17, 2015, at 15:18:09
just wanted to mention my experience with medication
that targets the 5ht2c receptor. but opposite from Lorcaserin, im referring to Cyproheptadine, that works as a 5ht2c antagonist among a few other effects on other receptors. yeah, it had the opposite effects on my appetite and caused me to gain over 20 pounds. i took it for a couple of months and never got tolerant to the increased hunger side effect. but it was worth it, because of the amazing benefit it had on my mood, energy, focus etc.. and it also increased my libido and made me last longer, which is also opposite from what you said you experience with Lorcaserin.when Lorcaserin first came out i figured it would work great for weight loss after my experience with a med that works opposite from it. good to hear its working for you.
Posted by phidippus on March 2, 2015, at 13:52:37
In reply to 5ht2c Agonists for BP Mania? (Lorcaserin), posted by PeterMartin on February 16, 2015, at 11:45:54
Antagonising the 5t2c receptor produces anxiolytic effects.
You really want to target the 5ht2a receptor when you're treating bipolar disorder. Agonizing this receptor causes manic like symptoms.
Eric
Posted by jrbecker76 on March 4, 2015, at 14:37:03
In reply to 5ht2c Agonists for BP Mania? (Lorcaserin), posted by PeterMartin on February 16, 2015, at 11:45:54
> I'd like to have a discussion about Lorcaserin a 5ht2c agonist (only one on the market?) and mania. Lorcaserin was approved in 2013 for obesity and I'm current on a trial. I have had manic episodes before but not since 2009 when I was still smoking pot/drinking (sober 5yrs). My doctor OKed Lorcaserin (Belviq) for weight loss about a month ago. Down about 15lbs so far.
>
> I've been a little weary that Lorcaserin could potentially send me into mania but based on everything I've googled it seems 5h2c agonists might be more likely to +help+ prevent mania than the opposite. For example: http://otm.uic.edu/technologies/potent-safe-and-selective-5ht2c-agonists-treatment
>
> Any thoughts on Lorcaserin/5ht2c agonists and their potential to cause (or prevent) mania? I've been a little spacey the past few days and I'm hoping it's due to coming off Marplan after 5yrs vs a side effect from Lorcaserin (On half dose since Jan 6th)
>
> Thanks for the discussion.I've been looking into a lot of the peer reviews on Belviq(Lorcaserin) and it's been extremely interesting.
Much of the research on the 5-HT2c receptor is due to observing the drug m-CPP. m-CPP is an agonist at 5-HT2c, but also 5-HT1b, 2a, and to a lesser extent, an antagonist at 5-HT3. Most of the acute effects of m-CPP in both animals and humans showed increased anxiety/neuroses, dysphoria, blood pressure, etc. From this research, it has been proposed that antagonism at the 2c receptor can be both anxiolytic and antidepressant. This has been furthered by the observation that 2c antagonism increases dopaminergic activity in certain reward areas in the brain (i.e., nucleus accumbens) as well as the prefrontal cortex. To date, despite early development, there are no targeted 5-HT2c antagonist compounds that have reached ph II development (the phase in which it would be tested in the indicated population) to test this theory.
I took an interest in Belviq with the belief that a 5-HT2c agonist would indeed cause mood/anxiety problems based on these earlier presumptions. In fact, that has not been the case with online peer reports, quite actually, the opposite. While some users have reported an increase in anxiety within the the first few days of starting Belviq, there is definitely a frequent pattern of reporting for "feeling calmer," "in a better mood," and "sleeping better" even in users who have mentioned they suffer from depression and are taking it with antidepressants concurrently. Whether this is due to the mechanism of 2c agonism or eventual receptor downregulation is unknown, however, there is evidence in the literature to the latter occurring.
As for whether Belviq is prone to causing mania, I have not seen any evidence of this, but I don't think I've also come across a lot of users who have mentioned suffering bipolar symptoms.
Most common side effects in the online peer reports are headache, fatigue/somnolence, feeling cold, cognitive dysfunction/memory impairment, and constipation. Most users report that the side effects get better with time, but the fatigue and mild cognitive issues are also some events I've noticed can certainly linger to some degree.
One more thing I'll say is that Belviq definitely seems to work for its intended indication for most users. Appetite suppression and satiety definitely are impacted and users seem to continue to lose weight consistently.
There's a facebook private group that might interest you if you're looking for peer support and want to ask some questions.
Hope this helps.
Posted by ed_uk2010 on March 5, 2015, at 15:16:25
In reply to Re: 5ht2c Agonists for BP Mania? (Lorcaserin), posted by jrbecker76 on March 4, 2015, at 14:37:03
Great post, thanks. Good to see you posting. We need more of your new med updates.
This is the end of the thread.
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