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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by bigcat on September 23, 2005, at 13:46:11
Hey There:
I've tried every AD multiple times, and apart from a brief remission on Nardil and then Marplan, I've responded very little to other meds. Surprisingly, Serzone recently put me in full remission just a few days after starting it, though today the depression returned full force, so I'm back to square one. I have an aggressive pdoc and am very med-tolerant, so how high have you heard of the Serzone going (apart from the mild doses the PDR recommends)?
And what would be some good cocktailing or augmenting agents? I'm not having any noticeable side effects, so I'm prepared to go up on it with doc's approval. I've had a chronic, severe, treatment-resistant depression for 15 years (in treatment for 6 years; I am now 24) I'm also currently taking lamictal, as I have had some manic reactions to meds, though I've never had a spontaneous manic episode and wouldn't consideer myself a manic depressive. I greatly appreciate your help.
-matt-
Posted by blueberry on September 23, 2005, at 16:57:56
In reply to Highest Serzone Dose You've Heard Of, posted by bigcat on September 23, 2005, at 13:46:11
Serzone is tricky because it acts differently at different doses. I have a chart that shows its affinity at various blood levels. I remember myself when I tried it how I felt great at a certain dose, it kind of faded, the dose was increased, and then I got worse. It changes behavior at different doses. More isn't always better. It's a matter of finding that small window.
Depending on blood levels, these are the things it hits, from first to last, from lowest dose to highest...
5HT2A
NE a-1
Serotonin reuptake inhibition
Norepinephrine reuptake inhibition
NE a-2
Dopamine reuptake inhibition
Acetylcholine
Histamine...according to a psychiatrist chart of antidepressant affinities I found on the web.
Since you responded so well when first starting, maybe that was down in the 5ht2 and norepinephrine alpha-1 area.
I wonder how you would do with adrafinil...a mail order smart drug that enhances ne a-1 receptors as an agonist. It's a pretty tame med, and can take a few weeks to work, though the first day can feel stimulating. I tried it years ago and liked it a lot. Became interested in things, depression lifted, became more talkative. I took it I think for about 2 years along with prozac and remeron (in a way similar to serzone). One day I just decided I was fine and stopped it cold with no withdrawals whatsoever.
Anyway, I'm just thinking out loud. The clues from your good serzone experience say that somewhere in that chain of things it does is what you need. But again, different doses do different things.
I know it sounds weird, but maybe a lower dose might work better than a higher one. But since you asked, I do recall years ago of hearing people taking 800mg or more of it.
It's all so confusing. Wish I could help.
Posted by EERRIICC on September 23, 2005, at 20:21:31
In reply to Highest Serzone Dose You've Heard Of, posted by bigcat on September 23, 2005, at 13:46:11
Let me know if this works, as I am in a position similar to yours.
The 'dalhousie serotonin cocktail' for
treatment-resistant major depressive disorder
by
Dursun SM, Devarajan S, Kutcher S.
Department of Psychiatry,
Dalhousie University, Halifax, Nova Scotia, Canada.
sdursun@is.dal.ca
J Psychopharmacol 2001 Jun;15(2):136-8ABSTRACT
We describe the successful treatment of five patients with treatment-resistant major depressive disorder (TR-MDD) with a combination pharmacotherapy of pindolol, tryptophan and nefazodone. Five TR-MDD outpatients who had previously not responded to at least four different antidepressant medication trials were initiated on 300 mg/day of nefazodone, 7.5 mg/day of pindolol and 1 g/day of tryptophan. Pindolol doses remained the same throughout the 20 weeks, while tryptophan and nefazodone dosages were gradually increased to 8 g/day and 450 mg/day, respectively. The Hamilton Depression Rating Scale (HAM-D) was used to evaluate outcome. By week 4, all cases demonstrated at least 50% decrease in HAM-D scores. At the end of the trial, the group mean HAM-D score had significantly decreased from 26.8 (+/- 1.9) to 1.8 (+/- 0.8) (p < 0.001). No significant adverse effects were reported. These results suggest that if serotonin availability and release is further enhanced by tryptophan in the presence of nefazodone and pindolol, an antidepressant effect may be produced in patients who are otherwise treatment-resistant. Due to limited sample size, an open design and an 'unusually' high successful efficacy rate of this preliminary study, controlled studies are required to confirm the efficacy of this treatment strategy.Good Luck,
Eric
Posted by bigcat on September 26, 2005, at 10:48:03
In reply to The Dalhousie Seratonin Cocktail » bigcat, posted by EERRIICC on September 23, 2005, at 20:21:31
Thank you Eerriccc and Blueberry, I feel very informed after your replies. After years of a unbreakable, severe depression, responding to nothing except Nardil and Dexedrine, the last week on Serzone has been a roller coaster ride from hell. I was in full remission one afternoon, and in an agitated, excruciating depression by the next morning. That afternoon, I upped the dose 200mg and within hours, was having one of the best nights of my life, but now, even on a high dose +800mg, I'm doing horribly, worse than if I was on nothing at all.
Similar responses have occured before, when I have a great initial response to a med, but after a day or two it fizzles out completely and leaves me in such an acute depressive hell, the few hours of feeling good highlighting just how profoundly I suffer. I was wondering if this phenomenon would indicate what may be wrong with me chemically or treatment-wise and a strategy for finding a med and dose that works and keeps working. The remission I felt a few days ago was glorious, maybe I was slightly hypomanic, but the last four days have been such inescapapble hell, which no dosing changes seem to fix.
I went up to 1000mg after the push from 600-800 seemed to do wonders and then fade, and am back down at 600mg now. Am I too high, too low, or do I need to give the Serzone significantly more time to do it's thing properly? Soon after starting the Serzone, I had a great initial remission. When that faded, I moved the dose from 600 to 800, which brought a brilliant response within hours. Now I feel nothing at 1000, 800, or 600.
My only sucessful trials in the past have been MAOI's and stimulants, Nardil and dexedrine working beautifully for a couple weeks before fading out completely. I'd appreciate any advice or elaboration on your previous postings, which were already very helpful. Thanks.
-matt-
Posted by EERRIICC on September 27, 2005, at 0:58:40
In reply to Re: More Serzone questions...please help!, posted by bigcat on September 26, 2005, at 10:48:03
Go back on nardil and then cycle between stimulants to avoid poop-out.
Good luck,
Eric
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