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Dr. Bob is Robert Hsiung, MD,
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Posted by Trotter on October 18, 2008, at 4:26:32
In reply to Tianeptine and Agomelatine, posted by Trotter on October 5, 2008, at 17:20:05
Day 18
I think I have reached a neutral stage. I don't have any significant negative side effects, although I am perhaps just a little more vague and tense than usual. The more severe depression I experienced for 10 days or so seems to have eased. I am pretty much back to how I was before starting Tianeptine.
I am satisfied that things are on track. No antidepressant or anxiolytic benefit yet, but I was not expecting any real benefit inside a month or so. I'm just content not to be suffering from significant side effects. Sleep and sex are certainly no worse, maybe even slightly improved.
Trotter
Posted by missmolly on October 19, 2008, at 17:57:20
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 18, 2008, at 4:26:32
Hello - I just wanted to say that I have been following your posts, and I appreciate the updates on your experience with Tianeptine. I am going to begin taking Tianeptine next week for the first time - although I have no current or history of depression. I am taking it because I have Huntingtons Disease - a heredity neurodegenerative disorder. HD's first effects on the brain are atrophy of the hippocampus - much the same as is seen in the brains of those who have major depression. In fact, the first symptoms of HD are usually depression - although I am not yet symptomatic. My neurologist has suggested I begin a Tianeptine regimine- as more of a 'hail mary pass' that this will delay the onset of the disease (other SSRI's are currently in clinical trials for the treatment of HD-but tianeptine has shown less side effects and similar neuroprotective benefits). There is currently no cure, and no treatments for HD. It is always terminal - so I am willing to try just about anything. I would greatly appreciate any information on expected side effects - or any predictions on what this will do to my mood, etc - as I am not depressed. I am in the US - and although my doctor is quite progressive, he doesn't seem to have much experience with this medicine either - so I'm trying my best to educate myself.
Many Thanks to you all for sharing!
~M
Posted by Trotter on October 19, 2008, at 19:06:43
In reply to Re: Tianeptine and Agomelatine, posted by missmolly on October 19, 2008, at 17:57:20
Hi missmolly, sorry to hear you have HD. I think you are doing the right thing in finding out what you can about a medication before taking it.
Of course I don't know much about HD, but if it involves atrophy of the hippocampus, and likely future depression, then I can certainly understand why Tianeptine was prescribed. According to Servier, Tianeptine does more neural regeneration than other ADs. Have you checked out Servier's website for the science behind Tianeptine?
As far as side effects go, a lot of people experience vivid dreaming. I do too, but I don't find this a major problem. This is probably the only side effect you can pretty much count on getting. Other side effects are individual. Some people don't notice any. Since you've already read my posts, you are already familiar with my own experiences.
Take care, Trotter.
Posted by Phillipa on October 19, 2008, at 19:38:57
In reply to Re: Tianeptine and Agomelatine, posted by missmolly on October 19, 2008, at 17:57:20
Missmolly I so deeply sorry and agree would try just about anything. How did you discover you has this disease if I might ask. Phillipa
Posted by missmolly on October 19, 2008, at 23:31:38
In reply to Re: Tianeptine and Agomelatine » missmolly, posted by Phillipa on October 19, 2008, at 19:38:57
> Missmolly I so deeply sorry and agree would try just about anything. How did you discover you has this disease if I might ask. Phillipa
Hi Phillipa - Thanks for responding :) HD is passed down from a carrier of the gene, any children will have a 50% chance of having it. My mother, grandfather and aunt have all died of HD. I was tested for the HD gene 6 months ago because I was deciding if I would have a family - I tested positive, and I have decided not to have children (atleast until they find a cure ;) I have a brother who has decided not to be tested. I'm 29, and with my CAG repeat# on chromosone 4 (a predictor of when you will first show symptoms in HD) I shouldn't start to show symptoms until I am 35 or 36....so I am looking at Tianeptine for long term use. Has anyone heard of any problems with long term use? Of course its possible they will find something that shows better neuroprotection/neurogenesis, but until then I'll be trying out the Tianeptine. Is this a common drug? I've heard its used more in Europe than in the US? I also have a Swedish citizenship - does anyone know if it is available there? I've just checked out their website-and I'm still a bit confused about how it works (for depression or neuroprotection). It seems maybe nobody understands fully since it seems to have an opposite effect on serotonin, correct? Is it the BDNF that is ultimately affected then? I could have misunderstood...
...geez, all these acronyms. Maybe I'll go work for a pharmaceutical co for the next 7 or 8 years since it looks like I'm going to be learning alot about this stuff anyway :)
Best ~M
Posted by Trotter on October 20, 2008, at 0:46:26
In reply to Re: Tianeptine and Agomelatine, posted by missmolly on October 19, 2008, at 23:31:38
>It seems maybe nobody understands fully since it seems to have an opposite effect on serotonin, correct?
I think you are probably quite right - nobody knows for sure what's going on.
Posted by Phillipa on October 20, 2008, at 19:29:43
In reply to Re: Tianeptine and Agomelatine, posted by missmolly on October 19, 2008, at 23:31:38
Well that is also six years for other meds to pop up and maybe even a cure I do hope so for your sake. Love Phillipa
Posted by Trotter on October 21, 2008, at 22:03:27
In reply to Tianeptine and Agomelatine, posted by Trotter on October 5, 2008, at 17:20:05
Day 22
Just finished answering a pile of mail that had built up since starting Tianeptine. I take that as a good sign.
I feel okay. Best I have felt for a few weeks. Is this my first taste of things to come? I hope so.
Still a bit vague and forgetful, otherwise no side effects that bother me.
Trotter
Posted by clipper40 on October 22, 2008, at 2:13:14
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 21, 2008, at 22:03:27
VERY ENCOURAGING! Thanks. That's one of the things that I need to get from an AD. My piles of papers are way too high.
Posted by Marty on October 22, 2008, at 20:30:23
In reply to Tianeptine and Agomelatine, posted by Trotter on October 5, 2008, at 17:20:05
Trotter,
I'm not reading your thread, but I'd like to know if you're having Wellbutrin into your cocktail. I have discovered that some (like me) react badly to Wellbutrin + Tianeptine.
If you do, then reply .. if not then don't mind replying me. :)
Good luck,
/\/\arty
Posted by Trotter on October 25, 2008, at 13:08:52
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 21, 2008, at 22:03:27
Day 26 (on Tianeptine)
Had an awful day a couple of days back. In fact worst mood day in many months and there was no stressful event to trigger it. Anxiety, depression and brain fog. I was not suffering from anxiety prior to starting Tianeptine so this is certainly a side effect. Recovered somewhat the next day, but some anxiety still there.
Nearing the end of my fourth week. I keep daily mood ratings to chart my progress, and I can report that my average mood has been significantly lower in each of the four weeks (compared to average mood prior to starting). I think the factor which has caused this is the anxiety that didn't exist before. Most of the time this anxiety is subtle, but some days it is more dominant. This anxiety and emotional sensitivity, even slight paranoia, has also triggered depression. The most worrying thing about the anxiety is that it is not showing any signs of going away. In fact, if anything, it is probably worse in week 4 compared to week 1.
I have got to the point where I want to stop, but I am forcing myself to continue. If I stop now I will always wonder whether things might have improved if I had given it a bit longer.
Tianeptine reduces plasma serotonin, the opposite of SSRIs. Putting aside the awful side effects, I respond well to SSRIs. I am wondering whether people who respond to SSRIs have much chance on Tianeptine. One can argue that it could make things worse.
Trotter
Posted by Sigismund on October 25, 2008, at 19:13:11
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 25, 2008, at 13:08:52
There was a time when tianeptine made me a bit chatty and content while also feeling stimulated.
That was at its best and lasted for the best part of a year.But at some point the stimulating feeling turned a little nasty on me and in some circumstances I found myself feeling frightened and anxious.
That was when I lowered the dose and eventually came off.
You could try to lower the dose and see if that is an improvement.
I never found tianeptine helpful for brain fog.
Posted by Phillipa on October 25, 2008, at 19:14:56
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 25, 2008, at 13:08:52
Trotter since you respond to SSRI's why not go back on one? Phillipa
Posted by Trotter on October 27, 2008, at 14:31:02
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 25, 2008, at 13:08:52
Day 28
I'm quitting Tianeptine. If I didn't have this persistent anxiety, which wasn't there before I started, I would give it another week. My dysthymic depression was tolerable, but the added anxiety has made it very hard. My mood in week 4 was actually worse than week 1. I also think the very fact that I now believe this medication to be hopeless (for me) is itself an indication of a lack of antidepressant response.
When you have hope, you can put up with a lot of suffering. I have just lost all hope with this one.
Trotter
Posted by Trotter on October 27, 2008, at 15:57:09
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 14:31:02
I have spent a lot of time studying the nature of happiness. This has been motivated by a desire to be more happy (as in not depressed), but also because it is in my personality to want to understand things.
In my research I have indentified a paradox between desire and acceptance. Desire leads to purpose, meaning, goals, passion and energy, all of which can contribute to a sense of happiness. On the other hand, acceptance, as in feeling satisfied with oneself and one's world also gives one a sense of happiness. Yet there is much conflict between the two. A highly motivated, passionate person will have great difficulty feeling contentment, and vice versa.
Okay, you are no doubt thinking, where is he going with this? Well, I believe the desire system is largely controlled by dopamine, and acceptance/contentment is more a function of serotonin. If you suffer anxiety, low self-esteem and depression, then you will likely benefit from raising serotonin. If you suffer anhedonia, lack of energy, passion etc, then you will likely respond to increasing dopamine.
A problem with this is that I believe there is a conflict between dopamine and serotonin. Raise serotonin and you lower dopamine (SSRI emotional blunting). My understanding is that Tianeptine raises dopamine by lowering serotonin. This can address anhedonia, but risks causing anxiety and dissatisfaction (lower serotonin).
I tend to think whether one benefits more from a SSRI or Tianeptine is an individual thing based on one's relative lack of serotonin or dopamine. For me, I respond well to SSRIs, which probably predicts a poor response to Tianeptine. Does this make sense, or am I just rationalzing my decision to stop Tianeptine?
Of course many depressed people suffer low serotonin AND dopamine, not to mention noradrenaline. Perhaps this explains why most ADs do not result in remission.
Sorry if this reads like a psycho's babble. :)
Trotter
Posted by dapper on October 27, 2008, at 16:55:25
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 15:57:09
I had the same response to tianeptine, it didn't even touch my depression. Some people say it works for them, but must be people with a different neural problem than I have! Currently trying nefazadone myself, entering the sixth day.
Posted by Trotter on October 27, 2008, at 17:12:28
In reply to Re: Tianeptine and Agomelatine, posted by dapper on October 27, 2008, at 16:55:25
> I had the same response to tianeptine, it didn't even touch my depression. Some people say it works for them, but must be people with a different neural problem than I have! Currently trying nefazadone myself, entering the sixth day.
I would have tried nefazadone myself, but it's banned in Australia. I think it is a good option for those who benefit from a serotonin boost. Good luck. Keep an eye on your liver though. :)
Posted by Phillipa on October 27, 2008, at 19:42:05
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 17:12:28
Trotter any idea what is next for you to try? Love Phillipa
Posted by peggyaus on October 27, 2008, at 19:57:42
In reply to Tianeptine and Agomelatine, posted by Trotter on October 5, 2008, at 17:20:05
Hi Trotter,
I'm an Australian living in the US. Is Stablon available in Australia. Would you let me know from where/how you are obtaining it. I am interested in trying this drug.
Thanks for your help,
peggyaus
Posted by clipper40 on October 28, 2008, at 4:41:04
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 15:57:09
And some people may need both serotonin and dopamine (as well as norepinephrine and/or other neurotransmitters). Maybe you would have found some success combining the tianeptine with an SSRI or another tricyclic. If/when I try tianeptine, I will definitely take something along with it to control my anxiety, probably some doxepin.
Posted by dapper on October 28, 2008, at 19:51:29
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 17:12:28
Trotter, sent you a babble mail.
Posted by Trotter on October 28, 2008, at 21:54:33
In reply to Re: Tianeptine and Agomelatine, posted by peggyaus on October 27, 2008, at 19:57:42
I'm not sure if Babblemail is currently delivering my messages. So if anyone thinks I haven't answered, it's not that I haven't tried.
Trotter
Posted by Questionmark on October 29, 2008, at 16:08:23
In reply to Re: Tianeptine and Agomelatine, posted by Trotter on October 27, 2008, at 15:57:09
This was incredibly insightful and brilliantly articulated.
Oh wow this has so much significance in terms of philosophy, psychology, AND behavioral pharmacology.
I have been thinking about almost the same exact things you discussed quite a lot lately, particularly in the past year. But you put words to some of the ideas that I could not-- or qualified them in a way that I have not been able. Brilliant.
I agree and think there is a significant amount of conflict between desire and acceptance or contentment. Buddhism seems to be particularly aware of this conflict and has been speaking about it for over two millenia since the Buddha himself is said to have given us the Four Noble Truths-- one of which states that all suffering is a result of desire (or attachment to desire/s) and another that the only way to free oneself from suffering is to free oneself from desire. The simple yet profound brilliance of that is always amazing to me.More practically speaking, I think it's possible to have an overall life of relative happiness and contentment, even of course if some amount of suffering remains (as is the case for every person who regards themselves as "happy" and "content"). But even this, however, requires an adequate balance between unfulfilled desire, and acceptance-- as you have said. If the amount of desire far enough exceeds the amount of acceptance, then unhappiness, discontentment, and painful depression can ensue. But, i think it is even possible for an extreme enough *opposite* imbalance (e.g. too little desire compared to acceptance, so to speak) to have negative consequences: namely boredom, numbness, apathy, and anhedonia-- up to even an emotionless, empty depression. Also, as you touched on, people can fail to improve their lives to the point that, if/when they do have a sufficient fall in acceptance or rise in desire, they are left with disappointment, pain, and depression.
And getting into the psychiatric context, THIS is why I think it can be very detrimental (at least or especially in the long run) for people to be on too high a dose of serotonergic [or other desire-reducing, acceptance-enhancing] antidepressants, and for some-- many-- people to even be on them at all. Depression is an evolutionary adaptation. It must be. Otherwise we would probably not experience it-- esPECially so many of us. And it makes sense. The more our lives and our selves become unsatisfactory, the more unhappy and eventually depressed we will become, and the more we will *desire* to try to change things. So if we drug everyone so that they are content no matter what, what effect will this have on the individuals and society??? Now certainly there are those who are excessively susceptible to depression, and there are those-- such as myself-- whose depressions are so severe as to warrant pharmacological assistance (thank mercy for Nardil!). But even THOSE people should be adequately informed and cautioned about the ramifications of the drug effects and *carefully* tried to be given the most ideal dose (meaning the minimum effective-yet-sufficiently life-assisting dose, in my opinion). Most doctors when prescribing a psychiatric medication are less cautious than a car mechanic in trying to fix a problem while still trying not to create or exacerbate other problems in the process. And, as important as a motor vehicle is, I would say that a person's brain and life are more important (and at times even more expensive to try to fix-- incidentally).
I'm rambling now sorry. But I've tried to explain some of these concepts and my correspondent concerns to some psychiatrists at different times (though not nearly as thoroughly), including the evolutionary role of depression and all that, but they just relate to me the same dogma about how depression is much more damaging than medications could be, and how untreated depression frequently grows worse and worse over time. It's not that I don't believe or agree with these views to a large extent, although I do unequivocally believe there are times when antidepressant drugs can be more damaging-- neurologically AND/or behaviorally-- than depression itself. I just want these doctors to also understand where *I* am coming from, and what I am saying, and to give it some consideration.
So where the hell was I? I suppose that's mostly it. One last thing.A lot of the time when people make a statement about one of the roles of a certain neurotransmitter(s)-- as most of us who discuss these matters including myself have done at one time or another-- it is a gross generalization and vastly oversimplified. But I really think there is a great deal of truth in what you have just stated about dopamine and serotonin and their roles in the experience of desire and acceptance & contentment. It's too bad we are not researchers and could test this in some way. Of course, it's also possible there are already studies out there which support this. (Or we could try to convince Dr. Bob to try start one :?) .)
Regardless, I think the ramifications of all this are pretty significant-- in a *number* of ways. Great insight and great job on pointing this out. There is a lot to be considered in relation to all this.
> I have spent a lot of time studying the nature of happiness. This has been motivated by a desire to be more happy (as in not depressed), but also because it is in my personality to want to understand things.
>
> In my research I have indentified a paradox between desire and acceptance. Desire leads to purpose, meaning, goals, passion and energy, all of which can contribute to a sense of happiness. On the other hand, acceptance, as in feeling satisfied with oneself and one's world also gives one a sense of happiness. Yet there is much conflict between the two. A highly motivated, passionate person will have great difficulty feeling contentment, and vice versa.
>
> Okay, you are no doubt thinking, where is he going with this? Well, I believe the desire system is largely controlled by dopamine, and acceptance/contentment is more a function of serotonin. If you suffer anxiety, low self-esteem and depression, then you will likely benefit from raising serotonin. If you suffer anhedonia, lack of energy, passion etc, then you will likely respond to increasing dopamine.
>
> A problem with this is that I believe there is a conflict between dopamine and serotonin. Raise serotonin and you lower dopamine (SSRI emotional blunting). My understanding is that Tianeptine raises dopamine by lowering serotonin. This can address anhedonia, but risks causing anxiety and dissatisfaction (lower serotonin).
>
> I tend to think whether one benefits more from a SSRI or Tianeptine is an individual thing based on one's relative lack of serotonin or dopamine. For me, I respond well to SSRIs, which probably predicts a poor response to Tianeptine. Does this make sense, or am I just rationalzing my decision to stop Tianeptine?
>
> Of course many depressed people suffer low serotonin AND dopamine, not to mention noradrenaline. Perhaps this explains why most ADs do not result in remission.
>
> Sorry if this reads like a psycho's babble. :)
>
> Trotter
Posted by Trotter on October 29, 2008, at 18:12:35
In reply to (Nature of Happiness: desire/acceptance, DA/5HT) » Trotter, posted by Questionmark on October 29, 2008, at 16:08:23
Hi Questionmark,
I agree very much with your post. I've sent you a Babblemail message. Not sure if you'll get it though.
Trotter
Posted by JadeKelly on November 2, 2008, at 2:38:02
In reply to Re: Tianeptine and Agomelatine, posted by missmolly on October 19, 2008, at 17:57:20
> Hello - I just wanted to say that I have been following your posts, and I appreciate the updates on your experience with Tianeptine. I am going to begin taking Tianeptine next week for the first time - although I have no current or history of depression. I am taking it because I have Huntingtons Disease - a heredity neurodegenerative disorder. HD's first effects on the brain are atrophy of the hippocampus - much the same as is seen in the brains of those who have major depression. In fact, the first symptoms of HD are usually depression - although I am not yet symptomatic. My neurologist has suggested I begin a Tianeptine regimine- as more of a 'hail mary pass' that this will delay the onset of the disease (other SSRI's are currently in clinical trials for the treatment of HD-but tianeptine has shown less side effects and similar neuroprotective benefits). There is currently no cure, and no treatments for HD. It is always terminal - so I am willing to try just about anything. I would greatly appreciate any information on expected side effects - or any predictions on what this will do to my mood, etc - as I am not depressed. I am in the US - and although my doctor is quite progressive, he doesn't seem to have much experience with this medicine either - so I'm trying my best to educate myself.
>
> Many Thanks to you all for sharing!
>
> ~MHi Miss Molly, I am terribly sorry to hear of your (recent?) diagnosis. You are most resillent to have dodged any depression so far. From what I've read, sounds like you caught it early and could have a long time to figure this out, especially with all the new drugs and discoveries coming our way. It was your doc who advised Tianeptine? If its an obvious choice for your condition, I wondered why it sounded like he didnt know much about it? Also, I know there aren't a lot of treatments available for this disease right now, but what about selegiline, if the tianeptine doesn't work, or, if they can augment each other? Seems Parkinson's is similar in its symptoms? Well I'm not a Doc, but I do hope you get the BEST DOC because I've seen it make the difference. I only mention selegiline because I know it to be neuro-protective, works well for depression for many (me), and may reduce symptoms. Not sure doses would be compatible for each symptom, but worth asking, right?
Hope to see you post again with your progress!!
Best wishes-Jade
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