Posted by SLS on October 9, 2000, at 12:20:10
In reply to Re: Help -- Looking for ritanserin -- to Scott, posted by anita on October 8, 2000, at 19:04:12
Hiya Anita!
> I'm interested in 5HT2A antagonism because it may help with the negative symptoms of schizophrenia, which are similiar to certain aspects of my depression, particularly apathy and lack of motivation. Theoretically, SSRIs (I'm on Zoloft) that increase 5HT2A can cause a resultant decrease in dopamine particularly in the mesocortical areas, thereby (via the medial prefrontal cortex) resulting in negative-like symptoms.
Gosh.
:-)
> Zyprexa and remeron are out because of the weight gain problem. Uncertain if I can add serzone to zoloft (do you know?).
Yes, you can. There are quite a few people here on Psycho-Babble currently taking SSRI-Serzone or Effexor-Serzone combinations. In addition, these combinations are suggested in the medical literature, especially when OCD is comorbid with depression. Serotonin-syndrome does not seem to be an issue. However, like any other combination of serotonergic drugs, it must be screened for. Even lithium, a drug with pro-serotonergic properties, has been known to induce a serotonin-syndrome when added to an SSRI.
Does weight-gain with Remeron tend to reverse at higher dosages?
> Looking into the potency of 5HT2A antagonism in cyproheptadine.
Will try risperidone if I can't get ziprasidone, ritanserin, or ketanserin.> Do you know if ketanserin is available?
No, I don't. It might only be supplied for use in scientific investigations. I will look more into this.
> Any comments?
Yes. You are brilliant.
I think your evaluation of the possible therapeutic benefits of pursuing 5-HT2 antagonism, and how to go about it, is accurate and well thought-out. I have been thinking about this myself. I am a bit pissed that my old doctor felt that Serzone was a waste of time when I asked him about it. Since I'm currently taking an MAO-inhibitor, I don't know how great a risk adding Serzone would represent regarding serotonin-syndrome. Do you think it would be any greater than trazodone? I hadn't even thought of cyproheptadine. Good one!
Risperidone is the most potent 5-HT2 antagonist of the atypical neuroleptics, and would make an excellent choice. I may conduct a two-week trial to add it to Parnate+desipramine+Lamictal. The first time I tried it, I bailed-out after only a week. I developed an abnormal gait while walking, and could barely dorsi-flex my foot to avoid tripping over my toes. I was scared that this was some sort of EPS. When I saw my doctor the other day, he was disappointed, but understanding. He didn't think that it was EPS, but rather, an "unrecognized" sedation. This actually makes some sense to me. Risperidone may have been helping.
It is ashame about ritanserin. It is such a clean and specific drug. As monotherapy, it is a drug without an illness. However, it represents a tremendous tool for composing refined and elegant treatment strategies for many illnesses. I know that ritanserin has been investigated for schizophrenia. It seems to have a definite benefit in some cases. It would be a great add-on to one of the older and more powerful neuroleptics (Haldol) when using such an antipsychotic is necessary.
Anita, I would love to correspond with you via email. If you are so inclined, please feel free to.
- Scott>
> :-),
> anita
poster:SLS
thread:45919
URL: http://www.dr-bob.org/babble/20000926/msgs/46007.html