![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by delna on November 1, 2009, at 10:02:53
Hi,
For those who know me, yes, I'm back to my Geodon obsession, but this time there's a twist.Well since I am posting about this for the first time on the Neurotransmitter board, I will briefly explain.
I have BP disorder but my main problem is the atypical depression that goes with it. Mainly extreme tiredness, suicidal depression and lack of interest in life. I also have co-morbid OCD and get anxiety too.
Like everyone here, I have tried many different combination without real success.
Why I am fixated on Geodon:
Recent history (2 years ago)I was on a combination of:
Lamictal 200mg
Effexor 37.5 (for OCD)
Provigil 100mg
Wellbutrin 150mgI stayed in bed all day and was actively suicidal but I didn't somehow see myself as depressed as such because I wasn't 'sad'. Anyway I have lived in a semi-comatose state in bed since forever, so I thought it was just 'me'. I really didn't know any better.
I was in NYC at the time and was pushed to see a Psychopharmacologist there as a last resort.
He added 40mg of Geodon to the combination and within a few doses I felt like I had awoken from a life-long coma. I also realized how depressed I had been for so many years (20 yrs +). I was shocked because I never dreamed an AP could totally change my life. I was 100% normal (job, life and all!).
To cut a really long story short, I had to give the Geodon up after about a year and a half because I developed severe nerve pain on it (untreatable with meds) which is possibly linked to TD (am still investigating that)
(BTW, I am back in India now.)
When I stopped the Geodon, the pain went but all my original symptoms are back. I am suicidal again and a zombie.And now I AM sad becasue I DO know better.
I relapsed into this severe suicidal depression even though I was taking Lexapro, wellbutrin, lamictal and provigil.I want to be back on Geodon but this is not an option. Because of the possible link with TD, and for the moment Abilify (the apparent next best bet) is not an option, either.
Just to give you an indication of my level of tiredness I experience; I take:
400mg Provigil,
300mg Wellbutrin
200mg caffeine pills
just to keep awake (and that too , to sit in bed). I don't have a thyroid problem or a sleep disorder. I have been checked for all organic causes for the tiredness.On the Geodon I only took 300mg Provigil (and no other stimulants.). I found it sedating when I took it at night, but madly activating once I was awake. It wasn't like a high at all, i have had those before and Geodon didn't induce that at all.
I just failed a trial of Parnate (so I now have very limited options). It was way to sedating and made me sleep all day in spite of the Provigil. In fact most drugs sedate me and I am so intolerant to that side effect because I am a sleepy person anyway.
I was reading a presentation by Stahl, in which he talks about why Geodon (low dose) is SO activating. He attributes it to 5HT2C-antagonism. He then goes on to say that Prozac is the only other drug with strong antagonism at 5HT2C.This has made me think that maybe I can recreate Geodon (somewhat) by sort of mimicking its receptor binding effects.
I know that I can never recreate Geodon fully because binding etc is so complex and you cannot really predict the outcome.But I can at least try to get close....
Also this is where I really need your inputs.
Just to add why Geodon was such an amazing drug for me: it improved energy, mood, cognition, anxiety.... the list is endless. All this without destabilizing me at all. The only thing it didn't help was my OCD (which responds to any SSRI/ SNRI, so that was no big deal).
So with my limited knowledge on all the complex neurotransmitter actions,I was thinking:
-Prozac for the 5HT2C-antagonism. Plus for the OCD and as an antidepressant(?)
-Reboxetine/ Wellbutrin for the NA bit
-Provigil (as needed)
And of course, Lamictal 200mgAnything else I would theoretically need?
The reason I put a ? next to Prozac as an antidepressant is because SSRI's are generally like sugar pills for me in that they do NOTHING for my depression, they only help my OCD.
But I DO remember Prozac activating me and making me more alive and driven (when I took it some years ago, at 20mg) and getting me out of bed but I became really aggressive on it. I think I switched into dysphoric mania, so I got off it. But I was not on a mood stabilizer at the time.The other option is Effexor (high dose with add-ons) because it is recommended for hard to treat depressions.
I have been on 300mg Effexor before (all alone) but cannot comment on how it helped because I switched into a manic (euphoric) high. So, yes it was very activating and I was not depressed BUT I was high (for the whole 8 months)so overall the experience sucked as I was so 'crazy' on it. However now I am on Lamictal so that should not happen again.But now I don't know if (or believe) that it will be activating even with the add-ons.(because I won't be 'switching' -I think) I know that fatigue is one of it's side effects and talking to people I have found that they DO get this fatigue (even with add-ons).
I really, really think it was this special 5HT2C-antagonism of Geodon that pulled me up. I am confused if it is just a silly notion to try and recreate a complex drug like Geodon or if it's worth a shot (instead of just going on Effexor which is just a random thing and has a ridiculously long, difficult withdrawal, a problem if I need to change drugs)
As I am really suicidal and am struggling through this 15 day wash out period of Parnate, I don't want to have yet another failed (random) trial.
Any suggestions? Would be greatly appreciated.
Thanks sincerely, for reading
Take care
D
Posted by bulldog2 on November 1, 2009, at 14:40:54
In reply to Need help trying to 're-create' Geodon's effects.., posted by delna on November 1, 2009, at 10:02:53
> Hi,
> For those who know me, yes, I'm back to my Geodon obsession, but this time there's a twist.
>
> Well since I am posting about this for the first time on the Neurotransmitter board, I will briefly explain.
>
> I have BP disorder but my main problem is the atypical depression that goes with it. Mainly extreme tiredness, suicidal depression and lack of interest in life. I also have co-morbid OCD and get anxiety too.
>
> Like everyone here, I have tried many different combination without real success.
>
> Why I am fixated on Geodon:
> Recent history (2 years ago)
>
> I was on a combination of:
> Lamictal 200mg
> Effexor 37.5 (for OCD)
> Provigil 100mg
> Wellbutrin 150mg
>
> I stayed in bed all day and was actively suicidal but I didn't somehow see myself as depressed as such because I wasn't 'sad'. Anyway I have lived in a semi-comatose state in bed since forever, so I thought it was just 'me'. I really didn't know any better.
>
> I was in NYC at the time and was pushed to see a Psychopharmacologist there as a last resort.
>
> He added 40mg of Geodon to the combination and within a few doses I felt like I had awoken from a life-long coma. I also realized how depressed I had been for so many years (20 yrs +). I was shocked because I never dreamed an AP could totally change my life. I was 100% normal (job, life and all!).
>
> To cut a really long story short, I had to give the Geodon up after about a year and a half because I developed severe nerve pain on it (untreatable with meds) which is possibly linked to TD (am still investigating that)
>
> (BTW, I am back in India now.)
>
> When I stopped the Geodon, the pain went but all my original symptoms are back. I am suicidal again and a zombie.And now I AM sad becasue I DO know better.
> I relapsed into this severe suicidal depression even though I was taking Lexapro, wellbutrin, lamictal and provigil.
>
> I want to be back on Geodon but this is not an option. Because of the possible link with TD, and for the moment Abilify (the apparent next best bet) is not an option, either.
>
> Just to give you an indication of my level of tiredness I experience; I take:
> 400mg Provigil,
> 300mg Wellbutrin
> 200mg caffeine pills
> just to keep awake (and that too , to sit in bed). I don't have a thyroid problem or a sleep disorder. I have been checked for all organic causes for the tiredness.
>
> On the Geodon I only took 300mg Provigil (and no other stimulants.). I found it sedating when I took it at night, but madly activating once I was awake. It wasn't like a high at all, i have had those before and Geodon didn't induce that at all.
>
>
> I just failed a trial of Parnate (so I now have very limited options). It was way to sedating and made me sleep all day in spite of the Provigil. In fact most drugs sedate me and I am so intolerant to that side effect because I am a sleepy person anyway.
>
>
> I was reading a presentation by Stahl, in which he talks about why Geodon (low dose) is SO activating. He attributes it to 5HT2C-antagonism. He then goes on to say that Prozac is the only other drug with strong antagonism at 5HT2C.
>
> This has made me think that maybe I can recreate Geodon (somewhat) by sort of mimicking its receptor binding effects.
>
> I know that I can never recreate Geodon fully because binding etc is so complex and you cannot really predict the outcome.But I can at least try to get close....
>
> Also this is where I really need your inputs.
>
> Just to add why Geodon was such an amazing drug for me: it improved energy, mood, cognition, anxiety.... the list is endless. All this without destabilizing me at all. The only thing it didn't help was my OCD (which responds to any SSRI/ SNRI, so that was no big deal).
>
> So with my limited knowledge on all the complex neurotransmitter actions,I was thinking:
>
> -Prozac for the 5HT2C-antagonism. Plus for the OCD and as an antidepressant(?)
> -Reboxetine/ Wellbutrin for the NA bit
> -Provigil (as needed)
> And of course, Lamictal 200mg
>
> Anything else I would theoretically need?
>
> The reason I put a ? next to Prozac as an antidepressant is because SSRI's are generally like sugar pills for me in that they do NOTHING for my depression, they only help my OCD.
> But I DO remember Prozac activating me and making me more alive and driven (when I took it some years ago, at 20mg) and getting me out of bed but I became really aggressive on it. I think I switched into dysphoric mania, so I got off it. But I was not on a mood stabilizer at the time.
>
> The other option is Effexor (high dose with add-ons) because it is recommended for hard to treat depressions.
> I have been on 300mg Effexor before (all alone) but cannot comment on how it helped because I switched into a manic (euphoric) high. So, yes it was very activating and I was not depressed BUT I was high (for the whole 8 months)so overall the experience sucked as I was so 'crazy' on it. However now I am on Lamictal so that should not happen again.
>
> But now I don't know if (or believe) that it will be activating even with the add-ons.(because I won't be 'switching' -I think) I know that fatigue is one of it's side effects and talking to people I have found that they DO get this fatigue (even with add-ons).
>
> I really, really think it was this special 5HT2C-antagonism of Geodon that pulled me up. I am confused if it is just a silly notion to try and recreate a complex drug like Geodon or if it's worth a shot (instead of just going on Effexor which is just a random thing and has a ridiculously long, difficult withdrawal, a problem if I need to change drugs)
>
> As I am really suicidal and am struggling through this 15 day wash out period of Parnate, I don't want to have yet another failed (random) trial.
>
> Any suggestions? Would be greatly appreciated.
>
> Thanks sincerely, for reading
>
> Take care
> D
>
>
>Antagonists
Dimebon (non-selective)[21]
Fluoxetine[5]
FR-260,010: high affinity, selective over 5-HT2A and many other receptors; orally active.[22]
RS-102,221: 100-fold selectivity compared to the 5-HT2A and -HT2B receptor subtypes[23]
SDZ SER-082: mixed 5-HT2B/2C antagonist
SB-200,646: mixed 5-HT2B/2C antagonist
SB-206,553: mixed 5-HT2B/2C antagonist
SB-221,284: mixed 5-HT2B/2C antagonist
SB-242,084[24]
compound 15k: IC50 = 0.5 nM; >2000x selective over 5-HT1A, 5-HT-2A, and 5-HT-6, and dopamine D2D4 receptors[25]
agomelatine
methysergide
mirtazapine
risperidone
O-Desmethyltramadol (an active metabolite of tramadol, with considerable mu-opiate agonism)Well here's a list of some 5HT2C-antagonists
How about substituting effexor (since it worked) for prozac
and risperidone (can you tolerate that) in your combo
Posted by delna on November 2, 2009, at 4:29:55
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by bulldog2 on November 1, 2009, at 14:40:54
> Antagonists
> Dimebon (non-selective)[21]
> Fluoxetine[5]
> FR-260,010: high affinity, selective over 5-HT2A and many other receptors; orally active.[22]
> RS-102,221: 100-fold selectivity compared to the 5-HT2A and -HT2B receptor subtypes[23]
> SDZ SER-082: mixed 5-HT2B/2C antagonist
> SB-200,646: mixed 5-HT2B/2C antagonist
> SB-206,553: mixed 5-HT2B/2C antagonist
> SB-221,284: mixed 5-HT2B/2C antagonist
> SB-242,084[24]
> compound 15k: IC50 = 0.5 nM; >2000x selective over 5-HT1A, 5-HT-2A, and 5-HT-6, and dopamine D2D4 receptors[25]
> agomelatine
> methysergide
> mirtazapine
> risperidone
> O-Desmethyltramadol (an active metabolite of tramadol, with considerable mu-opiate agonism)
>
> Well here's a list of some 5HT2C-antagonistsThanks for the all your research and for the list! I really appreciate it!
Of all those, the only ones I know/ can get hold of are: agomelatine,methysergide, mirtazapine, risperidone and fluoxetine.methysergide- I don't think this has any AD or anti-OCD properties at all. So I can't really use it as my main serotonin influencing drug
mirtazapine- yes, I have thought of this drug seriously, especially in combination with effexor, but it is very, very sedating.risperidone- I can't take AP's since I may have developed TD on Geodon.
agomelatine- This is not available in India yet plus it doesn't have very strong 5ht2c binding. I am not sure about its other properties.
> How about substituting effexor (since it worked) for prozac
Effexor worked in that it switched me into mania. I don't know if it will work to activate me, if it can't switch me (because of my mood-stabilizer). Someone who is very close to me is taking it and she is finding that it makes her sleepy. We have really similar chemistries and drug reactions (but then we do share a strong genetic link).
> and risperidone (can you tolerate that) in your combo
AP's are not currently an option.Thanks again for your input
TC
Love
D
Posted by Phillipa on November 2, 2009, at 11:47:44
In reply to Re: Need help trying to 're-create' Geodon's effects.. » bulldog2, posted by delna on November 2, 2009, at 4:29:55
Delna you mention manic was lithium on that list? Could help if not? Phillipa
Posted by delna on November 2, 2009, at 11:58:18
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phillipa on November 2, 2009, at 11:47:44
> Delna you mention manic was lithium on that list? Could help if not? Phillipa
No I was not on a mood stabilizer when I took all these anti-depressants that made me high.
But now I am on Lamictal which is a good mood-stabilizer (for me, anyway). I never get high (even with AD's) anymore. I used to, but not after adding the Lamictal.
Thanks for the suggestion
Love
D
Posted by bulldog2 on November 2, 2009, at 13:13:26
In reply to Re: Need help trying to 're-create' Geodon's effects.. » bulldog2, posted by delna on November 2, 2009, at 4:29:55
> > Antagonists
> > Dimebon (non-selective)[21]
> > Fluoxetine[5]
> > FR-260,010: high affinity, selective over 5-HT2A and many other receptors; orally active.[22]
> > RS-102,221: 100-fold selectivity compared to the 5-HT2A and -HT2B receptor subtypes[23]
> > SDZ SER-082: mixed 5-HT2B/2C antagonist
> > SB-200,646: mixed 5-HT2B/2C antagonist
> > SB-206,553: mixed 5-HT2B/2C antagonist
> > SB-221,284: mixed 5-HT2B/2C antagonist
> > SB-242,084[24]
> > compound 15k: IC50 = 0.5 nM; >2000x selective over 5-HT1A, 5-HT-2A, and 5-HT-6, and dopamine D2D4 receptors[25]
> > agomelatine
> > methysergide
> > mirtazapine
> > risperidone
> > O-Desmethyltramadol (an active metabolite of tramadol, with considerable mu-opiate agonism)
> >
> > Well here's a list of some 5HT2C-antagonists
>
>
>
> Thanks for the all your research and for the list! I really appreciate it!
> Of all those, the only ones I know/ can get hold of are: agomelatine,methysergide, mirtazapine, risperidone and fluoxetine.
>
> methysergide- I don't think this has any AD or anti-OCD properties at all. So I can't really use it as my main serotonin influencing drug
>
> mirtazapine- yes, I have thought of this drug seriously, especially in combination with effexor, but it is very, very sedating.
>
> risperidone- I can't take AP's since I may have developed TD on Geodon.
>
> agomelatine- This is not available in India yet plus it doesn't have very strong 5ht2c binding. I am not sure about its other properties.
>
> > How about substituting effexor (since it worked) for prozac
>
> Effexor worked in that it switched me into mania. I don't know if it will work to activate me, if it can't switch me (because of my mood-stabilizer). Someone who is very close to me is taking it and she is finding that it makes her sleepy. We have really similar chemistries and drug reactions (but then we do share a strong genetic link).
>
> > and risperidone (can you tolerate that) in your combo
> AP's are not currently an option.
>
> Thanks again for your input
> TC
> Love
> DHi Delna
Maybe you have become side tracked with your old results from Geodon. If you can't take them and other APs than move on. I thought you had a good game plan with the rocket fuel plus a stimulant for sedation. Maybe substitute prozac (5htc2 antagonism) in place of effexor. Now put ritalin or robexetine or strattera in place for norepinephrine activity.Strattera is a good ne reuptake drug was once going to be marketed as an ad.
How about doing some research into abilify. How likely is it to cause td? Because Geodon caused it doesn't mean abilify will have the same result.
I'm doing this for selfish reason as this does help with my depression.You could move back to NY and have your p-doc prescribe adderall or vyvanse which is prohibited in India. A little amphetamine can bounce one out of depression quite quickly.
well my thoughts for right now..
Love
Jerry
Posted by Phidippus on November 2, 2009, at 15:03:28
In reply to Need help trying to 're-create' Geodon's effects.., posted by delna on November 1, 2009, at 10:02:53
You know, Lamictal can cause depression. Have you ever been on Lithium? That's the closest I've gotten to Geodon.
P
Posted by delna on November 2, 2009, at 15:28:14
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phidippus on November 2, 2009, at 15:03:28
> You know, Lamictal can cause depression. Have you ever been on Lithium? That's the closest I've gotten to Geodon.
>
> P
>
>Gosh, I only ever have negative replies to helpful suggestion :( I feel so bad about that...........but what can I say, I've tried most drugs with very little success..
In fact Lithium was one of the first drugs I was put on and it did nothing for me. (I was on a good dose and was on it for a while.) The only thing it was good at was making me fat! I didn't respond to it at ALL.
Lamictal really helps me because I have really agitated/ aggressive/ pull-my-hair-out depressions and that (craziness) has totally gone with Lamictal so its not an option to get off it. I have tried the other common mood stabilizers too eg valproate, carbamazepine but they usually knock me out. Plus a couple of other less popular ones. Lamictal is the only thing that has worked so well.
But thanks so much for sharing and for your input.
Love
D
Posted by delna on November 2, 2009, at 16:02:10
In reply to Re: Need help trying to 're-create' Geodon's effects.., posted by bulldog2 on November 2, 2009, at 13:13:26
>
> Maybe you have become side tracked with your old results from Geodon. If you can't take them and other APs than move on.LOL, I do try, I promise. But I grieve over Geodon like it was the love of my life (which I lost). And actually it was- how pathetic right.Some love songs make me cry because I think of Geodon. No, I'm not totally mad ;-)
>I thought you had a good game plan with the rocket fuel plus a stimulant for sedation.
Rocket fuel sounded great but for the sedation of Remeron which so many people are complaining about. And I am extra sensitive to sedation.I'm afraid a stimulant is no match for the sedation I get on drugs. I need stimulants when I'm not even on sedating drugs just to stay awake.
>Maybe substitute prozac (5htc2 antagonism) in place of effexor.
That's what I am debating. This 5htc2 antagonism of Prozac is not so simple and apparently comes with negative effects (like maybe doing something to dopamine and making u worse)I don't know. There are loads of discussions on this board about that but really I can't understand them- they are so advanced. I was hoping one of the really well-versed people (on this) could shed some light. There is someone who talks a lot about this (and Geodon too) but he's not here at the moment, it seems.
>Now put ritalin or robexetine or strattera in place for norepinephrine activity.
>Strattera is a good ne reuptake drug was once going to be marketed as an ad.Ritalin makes me bonkers even at the smallest doses. And Strattera is not here yet. So I guess it will be Reboxetine, after all!
> How about doing some research into abilify. How likely is it to cause td?
Same. But I have read (and been told by my US pdoc) possibly worse.
>Because Geodon caused it doesn't mean abilify will have the same result.
True, but its still scary. I hope my pdoc in the US replies- I sent him a thesis :) . I asked him about abilify- could I still try it if geodon had actually caused TD? I'm praying he will shed some light on the situation.
> I'm doing this for selfish reason as this does help with my depression. You could move back to NY and have your p-doc prescribe adderall or vyvanse which is prohibited in India. A little amphetamine can bounce one out of depression quite quickly.
That is a possibility- if its true that a short stint with amphetamines can help depression. I can't stay longer than 3 months though- I never lived there. I was just visiting my sister.
> well my thoughts for right now..
>
> Love
> Jerry
>
>
Thanks again Jerry. Your thoughts are really appreciated!
Love
D
Posted by Phillipa on November 2, 2009, at 18:51:31
In reply to Re: Need help trying to 're-create' Geodon's effects.. » bulldog2, posted by delna on November 2, 2009, at 16:02:10
Delna just have to say this you are so sweet and polite dispite the problems you're having. Love Phillipa
Posted by Phidippus on November 2, 2009, at 20:33:40
In reply to Re: Need help trying to 're-create' Geodon's effects.. » bulldog2, posted by delna on November 2, 2009, at 16:02:10
> > How about doing some research into abilify.
Abilify is very similar to Geodon but I found it more stimulating and it caused me lots of akathisia.
>How likely is it to cause td?
I asked him about abilify- could I still try it if geodon had actually caused TD?TD would not have caused your genital irritation. Its more likely you incurred priapism. Was your clitoris engorged? (sorry to ask) Priapism can occur with Geodon and can be very painful.
Try Abilify and look into Solian, which has a great antidepressant profile and has been compared to Geodon.
What is your current med regime?
P
Posted by Phidippus on November 2, 2009, at 20:35:03
In reply to Re: Need help trying to 're-create' Geodon's effects.. » Phidippus, posted by delna on November 2, 2009, at 15:28:14
Have you ever tried Zonegran?
P
Posted by delna on November 3, 2009, at 2:57:31
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phidippus on November 2, 2009, at 20:33:40
>> Abilify is very similar to Geodon but I found it more stimulating and it caused me lots of akathisia.
I tried it for a brief period but it was titrated up very slowly so I didn't get akathisia. I didn't find it activating but I believe you need to go to a highish dose for that. What dose were you taking? Did you have to quit because of the akathisia or did it pass?
>> TD would not have caused your genital irritation.
You know, I never dreamed it was possible because TD does not present like that, at all. But then I stumbled upon this paper in 'Neurology' journal quite accidentally.
The paper describes 'genital tardive pain syndrome', in which genital pain can be the only symptom. But it is still a presentation of TD, nonetheless.
It's so rare and hardly documented so that explains why my pdoc in NY didn't even consider it.>>Its more likely you incurred priapism. Was your clitoris engorged? (sorry to ask) Priapism can occur with Geodon and can be very painful.
In fact, priapism was what was suspected at one point (by my pain speacilist) She changed her mind when she sent me for tests and found that there was no engorgement whatsoever.
Plus the pain was time dependent. It only occurred once the drug levels fell (ie just before my next dose was due). That sort of masking effect by an AP is so typical of TD. Plus increasing the dose got rid of the pain.(for a while at least)Well, I hope my pdoc in NY rules TD out because I can find a way to deal with the pain (if its not TD related). There are nerve blocks etc that you can try. I think it's worth it.
>> Try Abilify and look into Solian, which has a great antidepressant profile and has been compared to Geodon.
I am waiting for some sort of response from my US pdoc. He recommended Abilify as the next option but then he didn't know about 'genital tardive pain syndrome'
He may tell me to stay away from all APs because of the changes in the brain that occur when u have had TD. It makes you more likely to get TD (full fledged maybe) the next time you take an AP.
Solian sounds good too.>> What is your current med regime?
Pretty much nothing because I am waiting for that horrible parnate to wash out. So it's just Lamictal 200mg and Provigil 200mg. I have 7 days left before I can add anything. I was on nortryptline (my pdoc here was trying to 'cover' me during this period) but I couldn't tolerate it. It made me feel ill so I gave it up.
Thanks a lot for your input. I truly do appreciate it.
Take care
Love
D
Posted by delna on November 3, 2009, at 3:02:40
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phidippus on November 2, 2009, at 20:35:03
> Have you ever tried Zonegran?
>
> PNo.
But for what though? As a mood stabilizer?Tc
D
Posted by delna on November 3, 2009, at 3:15:35
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phillipa on November 2, 2009, at 18:51:31
> Delna just have to say this you are so sweet and polite dispite the problems you're having. Love Phillipa
Phillipa, I think you are really sweet!
The way I see it is that everyone here is suffering and having problems, yet still trying to help (me) out. I think that is just so amazing and I'm so grateful!Plus I'm not a rude person anyway. Unless I'm off the Lamictal (or on ritalin). Or then if I am really, really provoked (and that takes a lot) ;-)
Love
D
Posted by Phidippus on November 3, 2009, at 21:54:18
In reply to Re: Need help trying to 're-create' Geodon's effects.. » Phidippus, posted by delna on November 3, 2009, at 3:02:40
> But for what though? As a mood stabilizer?
Yeah.
P
Posted by Phidippus on November 3, 2009, at 21:57:07
In reply to Re: Need help trying to 're-create' Geodon's effects.. » Phidippus, posted by delna on November 3, 2009, at 2:57:31
>What dose were you taking? Did you have to quit because of the akathisia or did it pass?
The akathisia never passed and I was up to 5mg
P
Posted by delna on November 4, 2009, at 8:00:05
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phidippus on November 3, 2009, at 21:57:07
> >What dose were you taking? Did you have to quit because of the akathisia or did it pass?
>
> The akathisia never passed and I was up to 5mg
>
> POh wow! I was meant to go up to 10mg.
Posted by delna on November 4, 2009, at 8:02:20
In reply to Re: Need help trying to 're-create' Geodon's effects.. » delna, posted by Phidippus on November 3, 2009, at 21:54:18
> > But for what though? As a mood stabilizer?
>
> Yeah.
>
> P
>
>You know I DARE not touch the Lamictal. Because I know what lurks beneath and that monster cannot be let loose....ever
Posted by Brainbeard on November 7, 2009, at 14:37:00
In reply to Need help trying to 're-create' Geodon's effects.., posted by delna on November 1, 2009, at 10:02:53
Hi Delna,
It's a real shame that the pharmacotherapeutical love of your life caused unbearable side-effects. I was wondering wether you couldn't return to Geodon with Neurontin (gabapentin) on board this time to counter neuropathic pain, but this probably isn't a very realistic idea.
The drug I'm missing yet in this thread is cyproheptadine, which is a quite potent 5HT2C and -A antagonist. It has its own problems, though; it's short-acting, for one thing, it's antihistaminergic and anticholinergic, and it appears to worsen depression in some people who take it along with an (S)SRI. Since it's dirt cheap, it might be worthwhile trying.
Because of Geodon's complex pharmacological actions, it's hard to know what mechanism(s) exactly worked like a charm for you. It might not be the 5Ht2C-antagonism at all. It could be its 5HT7-antagonism, which appears to be a powerful antidepressant mechanism according to newer research. Another drug that does that trick is amisulpride/Solian. Amisulpride makes prolactin levels go through the roof, but that may be less of a direct problem for a girlie like yourself.
I mean, with daily use it made my titties grow, which I didn't find particularly sexy.I have pondered combining Prozac with cyproheptadine as a means of achieving a lot of 5HT2C-antagonism for my buck.
Mirtazapine (Remeron) is in fact a very strong 5HT2C/A-antagonist, and when taken in higher doses it might be more activating. Still, most people seem to become sleepy, horny and fat on it, which may not be an accurate description of your ideal profile.
I myself have had fairly good results with 50mg of amitriptyline, another antihistaminergic 5HT2A/C-antagonist, combined with 25mg of imipramine. Once I got used to the antihistaminergic effects, I wasn't sedated anymore, and the imipramine also peppered things up.
Agomelatine, despite its weak affinity for 5HT2C receptors, may be interesting for you after all since it is said to restore normal sleeping patterns.
Indeed, as mentioned above, Tramadol is another lesser known 5HT2C-antagonist, though its affinity in this area is unknown to me. It is also, like Geodon, a moderately strong (or weak) SNRI - I personally think its noradrenergic action is more pronounced, since it comes across to me as a mix between a mild opiate and speed. It's a rather effective antidepressant for many - it is chemically very similar to Effexor. It can be pretty stimulating, like Geodon in the lower dose range. But it also has its problems - it is strongly dependence forming, possibly addictive, there may be a problem with tolerance and then I have also heard rumours of it possibly causing neuropathic pain in the longer term, which is odd since it it supposed to help with that.
So yeah - uhuh. Not that much to go on, I'm afraid. Some dead ends, some options. Keep us posted if you like.
Good luck!
Posted by delna on November 14, 2009, at 8:50:02
In reply to Re: Need help trying to 're-create' Geodon's effects.., posted by Brainbeard on November 7, 2009, at 14:37:00
Thanks so much for all your help!
I'm so sorry it took me so long to express my sincere and heartfelt thanks.
I really appreciate your helpful and informed inputs.
So thanks again and sorry for my delayed reaction- I am on another planet at the moment.
Love
D
Posted by mtdewcmu on November 30, 2009, at 23:56:47
In reply to Re: Need help trying to 're-create' Geodon's effects.., posted by Brainbeard on November 7, 2009, at 14:37:00
> Mirtazapine (Remeron) is in fact a very strong 5HT2C/A-antagonist, and when taken in higher doses it might be more activating. Still, most people seem to become sleepy, horny and fat on it, which may not be an accurate description of your ideal profile.
>I would not write off Remeron until you've tried it, Delna. Many people find it sedating, but you have unusual responses to meds to begin with, so you may find it stimulating. Your sedation problem could be specific to serotonergic drugs, whereas Remeron is sedating mainly due to its histamine antagonism.
Posted by conundrum on December 1, 2009, at 5:59:34
In reply to Re: Need help trying to 're-create' Geodon's effects.., posted by mtdewcmu on November 30, 2009, at 23:56:47
I have a friend who had checked himself into a hospital a couple times who is responding very well to 45mgs of Remeron. He had weight gain while depressed, but now that he is in remission his weight has gone back to normal and acts like his old self again. He says the only time remeron makes him tired is when he takes it which is at bedtime anyway. However he started with 30 mgs I believe, starting with 15mg may be to low and just knock you out.
Posted by mtdewcmu on December 1, 2009, at 11:39:56
In reply to Re: Need help trying to 're-create' Geodon's effects.. » mtdewcmu, posted by conundrum on December 1, 2009, at 5:59:34
> I have a friend who had checked himself into a hospital a couple times who is responding very well to 45mgs of Remeron. He had weight gain while depressed, but now that he is in remission his weight has gone back to normal and acts like his old self again. He says the only time remeron makes him tired is when he takes it which is at bedtime anyway. However he started with 30 mgs I believe, starting with 15mg may be to low and just knock you out.
Studies have shown that Remeron is one of the most effective ADs out there. I think it is probably under-utilized. (I love it.)
Posted by SLS on December 1, 2009, at 12:37:51
In reply to Need help trying to 're-create' Geodon's effects.., posted by delna on November 1, 2009, at 10:02:53
Don't forget buspirone for the 5-HT1a partial agonism. Also, its metabolite (1PP) is an antagonist of NE alpha2 receptors, similar to mirtazapine.
Off the top of my head:
Prozac
nortriptyline
buspirone
- Scott
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