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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Paul Forsyth on May 4, 2010, at 5:28:04
I currently take 300mg Venlafaxine and 1OO MG amisulpride for OCD. I take a combination of the SRI and antipsychotic because standard SRI alone does not work for me without the antipsychotic added. The treatment works well for me mentally. My problem is that I cannot tolerate the amisulpride physically. It makes me extremely fatigued to where I could sleep upwards of 14 hours a day and when I am awake I feel exceptionally tired and it's a struggle to maintain normal functioning like working or even washing because of the excess fatigue. If I take the venlafaxine alone the tiredness goes away completely and I suffer no side effects but my mental wellbeing goes rapidly downhill off the amisulpride. The question I want to ask is if anyone could recommend an alternative antipsychotic to the amisulpride or some other treatment which would rid me of this side effect of extreme tiredness. Considering I only take a small dose of amisulpride, if I changed to another antipsychotic as an adjunct to the venlafaxine, what dose of it would be best to take? Or could I add something like Modafinil to my meds to counteract the tiredness. Any suggestions would be much appreciated. Thanks.
Posted by sigismund on May 4, 2010, at 18:21:33
In reply to Alternatives to amisulpride, posted by Paul Forsyth on May 4, 2010, at 5:28:04
What would happen if you reduced the amisulpride to say 75mg/d or 50mg/d?
Posted by desolationrower on May 7, 2010, at 19:23:44
In reply to Re: Alternatives to amisulpride » Paul Forsyth, posted by sigismund on May 4, 2010, at 18:21:33
i might try adding a little aripiprazole if dose reduction or modafinal doesn't work
oh, and yohimbe too actually:
Effects of yohimbine in obsessive compulsive disorder
Abstract The 2-adrenergic receptor antagonist yohimbine was administered to 12 drug-free patients with obsessive compulsive disorder (OCD) and to 12 healthy subjects. Changes in behavior, cardiovascular symptoms, and in plasma levels of cortisol and the norepinephrine metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), were assessed. Yohimbine had no significant effect on OCD symptoms. The OCD patients did not differ from healthy controls in their behavioral and MHPG response to yohimbine. In contrast to healthy subjects, OCD patients, like previous reports of depressed and panic disorders patients, had an increased cortisol response to yohimbine. These data suggest it is unlikely that abnormal noradrenergic function plays a primary role in the pathogenesis of OCD.
-d/r
Posted by Brainbeard on May 25, 2010, at 7:12:25
In reply to Alternatives to amisulpride, posted by Paul Forsyth on May 4, 2010, at 5:28:04
The question is what makes amisulpride work for you: is it its preferential stimulation of dopamine autoreceptors at low doses? In that case, an alternative could be low dose flupentixol (0.5mg a day), BUT flupentixol can also be sedating. But if so, you could also simply lower the dose, since amisulpride does that trick even in doses of less than 25mg.
If it's the D2 antagonism helping you out, low dose pipamperone might be another option: it can work well together with an SSRI, presumably because of 5HT2-antagonism, and may be enough of an antipsychotic to replace amisulpride. It MAY be less sedating than amisulpride..
Finally, modafinil may be a very good idea, since it works synergistically with amisulpride in my experience and can do a good job of keeping you awake when you should be.
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