![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 50. Go back in thread:
Posted by topcatclr on February 5, 2010, at 23:11:38
In reply to Re: Oregon University's new antidepressant, posted by JayBTV2 on February 5, 2010, at 18:50:34
Cymbalta is the thing that separates me from panic and depression. Excellent drug!
Posted by floatingbridge on February 6, 2010, at 1:04:16
In reply to Re: Oregon University's new antidepressant, posted by floatingbridge on February 5, 2010, at 19:52:19
Wow. That's great! Finding what works is awesome. I'm glad.
Hmmmm. I'm wondering why it hasn't been suggested for me instead of pristiq....
Posted by conundrum on February 6, 2010, at 6:50:40
In reply to correct link, posted by West on February 5, 2010, at 16:24:41
I'm curious if it increases norepinephrine how it decreases constipation. Maybe it blocks some other adrenergic receptors as well. Unfortunately Savella isn't FDA approved for the treatement of depression in the U.S. It is only approved for fibro/cfs. I guess U of O want their creation approved for depression.
Posted by conundrum on February 6, 2010, at 6:53:12
In reply to Re: Oregon University's new antidepressant » West, posted by floatingbridge on February 5, 2010, at 17:04:10
A triple reuptake inhibitor would be nice I think. Wellbutrin isn't very powerful and just doesn't work for everyone. The nice thing about Norepinephrine reuptake is that the norepinephrine transporter recycles dopamine in the Prefrontal Cortex. IF you block norepinephrine transporters there you also increase dopamine!
Posted by conundrum on February 6, 2010, at 6:55:07
In reply to Re: correct link, posted by linkadge on February 5, 2010, at 17:36:34
I guess what they mean is less people will stop it due to less side effects? You are right though it ssays similar so its probably not more effective. I think its good cuz different people required different ratios of SE and NE.
Posted by conundrum on February 6, 2010, at 7:04:46
In reply to Re: Oregon University's new antidepressant » bulldog2, posted by floatingbridge on February 5, 2010, at 19:07:17
In my mind, I think dopamine is overrated. Many people enjoy amphetamines more than ritalin and they think its the dopamine, but amphetamines release more NE than dopamine followed by serotonin. Ritalin acts more on DA yet it doesn't make as many people euphoric. It makes some people more depressed and certainly doesn't make them out going or creative like Amphetamine.
My grandmom became psychotic on Nardil after being in a euphoric stage. The euphoria was probably from too much SE/NE and the psychosis was probably too much dopamine. It all went away after lowering the dose though.
On the other hand many people need DA augmentation. Unfortunately its hard to differentiate DA from NE because there is no pure reuptake inhibitor, the only way to tell is with a DA agonist.
FB what did you find helped you with low DA?
Posted by conundrum on February 6, 2010, at 7:06:01
In reply to cymbalta, topcatclr, posted by floatingbridge on February 6, 2010, at 1:04:16
Posted by bulldog2 on February 6, 2010, at 8:50:18
In reply to Re: Oregon University's new antidepressant » bulldog2, posted by floatingbridge on February 5, 2010, at 19:07:17
> Crazy, huh? Even the Stanford Guy said dopamine has not been addressed--and clearly there is a percentage of the population for which that is the determining key.
>
> Could it also be that the actions of dopamine are not as well understood despite active research, that seritonin and ne were easier to (begin to) utilize?
>
> Dopamine seems problematic because it is so powerful--too much, psychosis, impluse control problems (and I'm referring to self-destructive decision-making). Too little is implicated in more illnesses than parkensons that I can name.
>
> Just some thoughts from a dopamine responder....
>
> fbDopamine makes people feel good so therefore there are issues of addiction that our government wishes to protect us from.
Posted by linkadge on February 6, 2010, at 10:26:44
In reply to Re: Oregon University's new antidepressant, posted by bulldog2 on February 6, 2010, at 8:50:18
I don't know where this whole idea of dopamine being the magic cure comes from. So many people come on this board and say "I've got a dopamine problem because I have yadi-yada symptoms".
Fist off, there are virtually no AD's that target dopamine. Wellbutrin (contrary to popular belief) has only very weak effects on the dopamine transporter.
Mirapex is also not a miracle antidepressant.
Animals studies also show that if you increase dopamine in the pleasure centres of the brain it activates BDNF in that area. BDNF in the neucleus accumbens produces behavioral depression.
Long term admistration of many drugs of abuse often increases feelings of craving and of depression.
You can block the behavioral depressant effects of accumbal dopamine by administering antipsychotics. This is why antipsychotics probably have a better record of being adjuncts for depression than do stimulants.
D3 receptor activation likely produces the depressant effects as mice lacking the d3 receptor do not respond this way to dopaminergic drugs.
Infact mice that have been administered dopamine precursors or dopaminergic drugs behave like they have been defeated in social models of depression. Serotonin on the other hand facilitates social dominance.
There is a difference between pleasure and an antidepressant effect. For instance, smoking weed. Sure you get a hit, then you just feel like a looser.
Linkadge
Posted by linkadge on February 6, 2010, at 10:31:49
In reply to Re: Oregon University's new antidepressant, posted by conundrum on February 6, 2010, at 7:04:46
Sorry conundrum, you had addressed the same issue I did. I should have read all the posts.
I agree. Parnate made me depressed as f*ck. Ritalin is very inpredictable.
Ritalin does increase feelings of pleasure, but its not an antidepressant feeling for me. It makes me antisocial and sad. It often makes me feel like........a looser. Thats the best way to describe the feeling.
Linkadge
Posted by West on February 6, 2010, at 14:58:30
In reply to Re: Oregon University's new antidepressant » conundrum, posted by linkadge on February 6, 2010, at 10:31:49
To all intents and purposes I have found concerta to be a completely different drug to mph ir. The L-isomer, L-threo-methyphenidate, is covered by several patents citing its use as a short-acting mood lifter to be used during the 2-6 week waiting period for antidepressants.
My experience so far (3-4 months) has shown concerta to add another level to my treatment, however I am diagnosed with ADD. Nevertheless I think it might have this benefit in those not diagnosed. Particularly, cognitive problems relating to treatment might - to a degree - be restored. You may feel you're getting your brain back and start to have some positive affect.
There are also positive implications regarding dopaminergic dysregulation if one is also taking an SSRI/SNRI (though I don't pretend to know a lot about this). I could see how MPH on its own could be problematic.
Posted by bulldog2 on February 6, 2010, at 16:11:14
In reply to Re: Ritalin. Antidepressant effect., posted by West on February 6, 2010, at 14:58:30
> To all intents and purposes I have found concerta to be a completely different drug to mph ir. The L-isomer, L-threo-methyphenidate, is covered by several patents citing its use as a short-acting mood lifter to be used during the 2-6 week waiting period for antidepressants.
>
> My experience so far (3-4 months) has shown concerta to add another level to my treatment, however I am diagnosed with ADD. Nevertheless I think it might have this benefit in those not diagnosed. Particularly, cognitive problems relating to treatment might - to a degree - be restored. You may feel you're getting your brain back and start to have some positive affect.
>
> There are also positive implications regarding dopaminergic dysregulation if one is also taking an SSRI/SNRI (though I don't pretend to know a lot about this). I could see how MPH on its own could be problematic.I believe the effect of ssris may in fact be at least partially dopamine down regulation. Now when dopamine is overactive down regulation may be a good thing. The ssri is in fact acting a bit like an ap. But for those of
Posted by Cherry Carver on February 8, 2010, at 19:18:17
In reply to Oregon University's new antidepressant, posted by West on February 5, 2010, at 16:24:01
I mentioned this before, but Cymbalta made me throw up all day long after one dose and nearly stopped my heart. I hate this drug with all my might. I can't imagine what a stronger version would do! Wow!
>
> A stronger cymbalta? Less Hypotension (do they mean hypertension?) Don't they know milnacipran has been available for 15 years? Don't all shout at once...
>
>
> www.psychcentral.com/news/2010/02/05/improved-antidepressant-in-the-works/11212.html
Posted by floatingbridge on February 8, 2010, at 20:37:53
In reply to Re: Oregon University's new antidepressant » West, posted by Cherry Carver on February 8, 2010, at 19:18:17
CC, would it be stronger, or have less side effects--like effexor vs. pristiq? Could be you could not tolerate either. I tolerate both effexor and pristiq.... Pristiq does not work as well for me--but then, I compare that with the effexor response I had ten years ago....
fb
> I mentioned this before, but Cymbalta made me throw up all day long after one dose and nearly stopped my heart. I hate this drug with all my might. I can't imagine what a stronger version would do! Wow!
>
> >
> > A stronger cymbalta? Less Hypotension (do they mean hypertension?) Don't they know milnacipran has been available for 15 years? Don't all shout at once...
> >
> >
> > www.psychcentral.com/news/2010/02/05/improved-antidepressant-in-the-works/11212.html
>
>
Posted by Cherry Carver on February 9, 2010, at 0:05:42
In reply to Re: Oregon University's new antidepressant » Cherry Carver, posted by floatingbridge on February 8, 2010, at 20:37:53
Haven't tried any of those...here's what they prescribed for me in 1997 (Cymbalta came much later):
Wellbutrin
Buspar
Tegretol
Librium
Lithium
Depakote
Tofranil
Paxil
Mellaril
DesyrelAll these drugs were prescribed for me during the span of one month, several at the same time (even though they were contraindicated!). Needless to say, my mind has never been very clear since then.
I couldn't tolerate any of these, so they finally put me back on Klonopin. They did give me a brief course of Phenobarbital along with the other pills, but, to my great sorrow, I couldn't stay on it forever.
What was your response to Effexor? Also, you said you keep a mood chart--is that a doctor-specific chart or one you just keep to measure your own ebb and flow? How do you create a mood chart? I'd like to do that.
> CC, would it be stronger, or have less side effects--like effexor vs. pristiq? Could be you could not tolerate either. I tolerate both effexor and pristiq.... Pristiq does not work as well for me--but then, I compare that with the effexor response I had ten years ago....
>
> fb
>
> > I mentioned this before, but Cymbalta made me throw up all day long after one dose and nearly stopped my heart. I hate this drug with all my might. I can't imagine what a stronger version would do! Wow!
> >
> > >
> > > A stronger cymbalta? Less Hypotension (do they mean hypertension?) Don't they know milnacipran has been available for 15 years? Don't all shout at once...
> > >
> > >
> > > www.psychcentral.com/news/2010/02/05/improved-antidepressant-in-the-works/11212.html
> >
> >
>
>
Posted by floatingbridge on February 9, 2010, at 1:26:27
In reply to Re: Oregon University's new antidepressant » floatingbridge, posted by Cherry Carver on February 9, 2010, at 0:05:42
CC, that's one heck of a month! My head spins just reading the list. Don't know all of them.
My mood chart is on graph paper--pretty homey. Mood (depression & anxiety) registered 3x per day (sometimes all at the end of the day); meds and dosage taken; certain activities (walking, therapy); plus any events of note, illnesses, pain level jotted in the header.
I also keep pages of notes on triggers, dreams, preoccupations, whatever. Over a year and a half now--enormously helpful to me. I am sooooo scattered!
SLS here has posted his own template of a mood chart. Google mood chart and all sorts of templates & examples come
up.
Posted by Sigismund on February 9, 2010, at 1:50:29
In reply to Re: Oregon University's new antidepressant » floatingbridge, posted by Cherry Carver on February 9, 2010, at 0:05:42
I had an old friend who had cancer, heart disease and other things besides.
The doctors had him on an shoe box full of worthless crap on what was then known as schedule 4, meaning it cost the doctor no attention from the Health Department to Rx it.
Eventually he came across a doctor with some brains, courage and ethics who, knowing he was was dying, prescribed narcotics and had all the rest thrown out.
That doctor said 'You can't feel any good on all of this'.
>Haven't tried any of those...here's what they prescribed for me in 1997 (Cymbalta came much later):Wellbutrin
Buspar
Tegretol
Librium
Lithium
Depakote
Tofranil
Paxil
Mellaril
Desyrel
Posted by bleauberry on February 9, 2010, at 19:14:40
In reply to Re: Oregon University's new antidepressant » floatingbridge, posted by Cherry Carver on February 9, 2010, at 0:05:42
I can understand not being able to tolerate any of those meds. Some people are very sensitive. I am. Any of those drugs can feel like serious nuclear bombs to certain people.
As for cymbalta, its power does not come from its NE reuptake. That is minimal, at just 1 part NE per 10 parts serotonin. There is something else about cymbalta, I'm not sure what, that makes it as harsh as it is. Its withdrawals are hell also.
A med much stronger than cymbalta, yet feels much cleaner and much easier to tolerate and much faster to work, is Savella. It is almost an equal balance between NE and serotonin. What makes it so much friendlier I have no idea. As sensitive as I am, and an ECT failure, Savella really surprised me.
You were asking about effexor. If you couldn't tolerate any of those other meds, I would stay far away from effexor or pristiq if I were you.
Safest bets for someone like you:
Lexapro liquid. With the measuring dropper you get at the pharmacy, you can make custom doses as accurate as 1/10th of a milligram. One of my doctors has people in remission on as little as 1mg lexapro. The usual doses are supposed to be 10mg to 20mg. Takes more time for small doses to work, but they can still work.I'm not suggesting lexapro in particular, just using it as an example. Prozac, zoloft, risperdal...many meds...available as liquids for custom small dosing. Me, I make my own custom doses.
I think doctors commonly and blindly overdose patients on what are supposedly normal doses. As I see it, there is no one-size-fits-all. For people with a history like yours or mine, I feel it becomes an integral and crucial part of the strategy to approach any new med with very tiny doses. Custom-made doses at home if need be. I've gotten real good at that.
Who knows, one of those meds you couldn't handle might have been magic for you, if they had you start at a much lower dose (1/10th) and go from there. Me and cymbalta...I found 3mg was decent...how do you get 3mg?...inside the capsule are coated beads...about 10 of them is 1mg...just count out a custom dose and swallow with applesauce. The usual dose of cymbalta...30mg...holy cow.
Anyway, yeah, cymbalta sucks bigtime. A few people love it. Savella is in my opinion the unsung hero that probably won't be fully discovered for another 5 or 10 years.
> Haven't tried any of those...here's what they prescribed for me in 1997 (Cymbalta came much later):
>
> Wellbutrin
> Buspar
> Tegretol
> Librium
> Lithium
> Depakote
> Tofranil
> Paxil
> Mellaril
> Desyrel
>
> All these drugs were prescribed for me during the span of one month, several at the same time (even though they were contraindicated!). Needless to say, my mind has never been very clear since then.
>
> I couldn't tolerate any of these, so they finally put me back on Klonopin. They did give me a brief course of Phenobarbital along with the other pills, but, to my great sorrow, I couldn't stay on it forever.
>
> What was your response to Effexor? Also, you said you keep a mood chart--is that a doctor-specific chart or one you just keep to measure your own ebb and flow? How do you create a mood chart? I'd like to do that.
>
> > CC, would it be stronger, or have less side effects--like effexor vs. pristiq? Could be you could not tolerate either. I tolerate both effexor and pristiq.... Pristiq does not work as well for me--but then, I compare that with the effexor response I had ten years ago....
> >
> > fb
> >
> > > I mentioned this before, but Cymbalta made me throw up all day long after one dose and nearly stopped my heart. I hate this drug with all my might. I can't imagine what a stronger version would do! Wow!
> > >
> > > >
> > > > A stronger cymbalta? Less Hypotension (do they mean hypertension?) Don't they know milnacipran has been available for 15 years? Don't all shout at once...
> > > >
> > > >
> > > > www.psychcentral.com/news/2010/02/05/improved-antidepressant-in-the-works/11212.html
> > >
> > >
> >
> >
>
>
Posted by Phillipa on February 9, 2010, at 20:09:50
In reply to Re: Oregon University's new antidepressant » Cherry Carver, posted by bleauberry on February 9, 2010, at 19:14:40
BB seriously when on 60mg of cymbalta went from 60mg to 30mg then off no side effects. Thinking at the time just crossed over to the luvox where I remain but cut the dose in half last two nights a bit of anxiety but fine now will keep in half. Also got the official website about 25 letters long from the health dept here for a direct line to CDC lymes. If interested I can give it to you. Health dept talked to for a very long time. Phillipa
Posted by Cherry Carver on February 10, 2010, at 17:56:37
In reply to Re: Oregon University's new antidepressant » Cherry Carver, posted by floatingbridge on February 9, 2010, at 1:26:27
Thank you for the mood chart recipe! I'll get right on it--I think I need to be keeping track, since I'm off to see a shrink on 2/18. I used to keep a journal, but it turned into an entry-of-the-month kind of thing about various obsessions, and it is stunningly repetitive.
Indeed, that was a hellish month. I think it wrecked my metabolism forever. One night I had so many pills handed to me that I thought the number would kill me. (I always palmed my pills anyway--either I was really good at it, or the pharmacist never looked to see if I was swallowing more than just water.) I took only half the dosage they gave me that night. Next day I awoke barely able to move. They had to take me to ICU. Ack!!!
> CC, that's one heck of a month! My head spins just reading the list. Don't know all of them.
>
> My mood chart is on graph paper--pretty homey. Mood (depression & anxiety) registered 3x per day (sometimes all at the end of the day); meds and dosage taken; certain activities (walking, therapy); plus any events of note, illnesses, pain level jotted in the header.
>
> I also keep pages of notes on triggers, dreams, preoccupations, whatever. Over a year and a half now--enormously helpful to me. I am sooooo scattered!
>
> SLS here has posted his own template of a mood chart. Google mood chart and all sorts of templates & examples come
> up.
Posted by Cherry Carver on February 10, 2010, at 18:33:25
In reply to Re: Oregon University's new antidepressant » Cherry Carver, posted by bleauberry on February 9, 2010, at 19:14:40
I totally agree with you. Nuclear bomb says it all. Cymbalta = death.
So many different reuptake inhibitors...Savella is described as a dual-reuptake inhibitor that eases the pain of fibromyalgia. So far, I don't have that, but I do have mild arthritis.
Klonopin works well enough without any noticeable side-effects, but it's always good to keep apprised of new things in case somebody wants to offer me something better than K. Mr. Carver takes Lorazepam and he was taking Lexapro, but his insurance wouldn't cover it. I thought about trying it, but the expense is prohibitive (I am uninsured). K already costs over $260/100mgs, and generic isn't an option (tried it with poor results).
Thank you so much for all your suggestions! I especially like your home laboratory experiments. Your way is the most sensible way to go with a new med: try less than the doctor prescribes and work up to the right dose. Everybody ought to do that. It never occurred to me to take a few grains of Cymbalta instead of the whole dose. It would have saved me a day of agony.
> I can understand not being able to tolerate any of those meds. Some people are very sensitive. I am. Any of those drugs can feel like serious nuclear bombs to certain people.
>
> As for cymbalta, its power does not come from its NE reuptake. That is minimal, at just 1 part NE per 10 parts serotonin. There is something else about cymbalta, I'm not sure what, that makes it as harsh as it is. Its withdrawals are hell also.
>
> A med much stronger than cymbalta, yet feels much cleaner and much easier to tolerate and much faster to work, is Savella. It is almost an equal balance between NE and serotonin. What makes it so much friendlier I have no idea. As sensitive as I am, and an ECT failure, Savella really surprised me.
>
> You were asking about effexor. If you couldn't tolerate any of those other meds, I would stay far away from effexor or pristiq if I were you.
>
> Safest bets for someone like you:
> Lexapro liquid. With the measuring dropper you get at the pharmacy, you can make custom doses as accurate as 1/10th of a milligram. One of my doctors has people in remission on as little as 1mg lexapro. The usual doses are supposed to be 10mg to 20mg. Takes more time for small doses to work, but they can still work.
>
> I'm not suggesting lexapro in particular, just using it as an example. Prozac, zoloft, risperdal...many meds...available as liquids for custom small dosing. Me, I make my own custom doses.
>
> I think doctors commonly and blindly overdose patients on what are supposedly normal doses. As I see it, there is no one-size-fits-all. For people with a history like yours or mine, I feel it becomes an integral and crucial part of the strategy to approach any new med with very tiny doses. Custom-made doses at home if need be. I've gotten real good at that.
>
> Who knows, one of those meds you couldn't handle might have been magic for you, if they had you start at a much lower dose (1/10th) and go from there. Me and cymbalta...I found 3mg was decent...how do you get 3mg?...inside the capsule are coated beads...about 10 of them is 1mg...just count out a custom dose and swallow with applesauce. The usual dose of cymbalta...30mg...holy cow.
>
> Anyway, yeah, cymbalta sucks bigtime. A few people love it. Savella is in my opinion the unsung hero that probably won't be fully discovered for another 5 or 10 years.
>
Posted by morganator on February 11, 2010, at 18:12:29
In reply to Re: Oregon University's new antidepressant » Cherry Carver, posted by bleauberry on February 9, 2010, at 19:14:40
Do you think Savella can be combined with an SSRI? I wish there was an extended release version of Savella. I wonder what it is that makes certain drugs have a shorter half life. I wish there was an easy way for drug companies to give the drugs they make much longer half lives so they could only be taken one time a day. I just hate being so dependent on a medication and having to make sure that I take it again half way through the day just to feel better.
Posted by floatingbridge on February 11, 2010, at 19:38:26
In reply to Bleauberry-Combining Savella with an SSRI, posted by morganator on February 11, 2010, at 18:12:29
Morganator,
Would you mind commenting on how Savella is going for you? Do you have a sense of how it compares to effexor? Or pristiq?
You may have commented elsewhere; I'm not up on all the threads.
fb
> Do you think Savella can be combined with an SSRI? I wish there was an extended release version of Savella. I wonder what it is that makes certain drugs have a shorter half life. I wish there was an easy way for drug companies to give the drugs they make much longer half lives so they could only be taken one time a day. I just hate being so dependent on a medication and having to make sure that I take it again half way through the day just to feel better.
Posted by morganator on February 12, 2010, at 1:20:25
In reply to Re: Bleauberry-Combining Savella with an SSRI, posted by floatingbridge on February 11, 2010, at 19:38:26
Actually it's the other way around. Sorry if my post was misleading. I am taking an SSRI and have interest in adding Savella. It's either Savella or Nortriptyline or nothing. Still in the early phase of Prozac so I may feel considerably better in 3 or 4 weeks.
If I do try it in a month or so I will definitely tell you how it goes. It sounds like an exciting drug.
Posted by bleauberry on February 13, 2010, at 18:00:58
In reply to Bleauberry-Combining Savella with an SSRI, posted by morganator on February 11, 2010, at 18:12:29
In Japan where Savella is one of their top performing antidepressants, it is commonly in combination with Luvox or Paxil...when Savella on its own fails, or the SSRI on its own fails, they then combine them.
At another forum...can't remember if it was revolutionhealth or askapatient...some took high doses of Savella with maximum doses of Cymbalta.
So yes, it can and has been combined with other SSRIs and SNRIs.
As for longer lasting versions, yeah, I hear ya, I wish they were all like that.
> Do you think Savella can be combined with an SSRI? I wish there was an extended release version of Savella. I wonder what it is that makes certain drugs have a shorter half life. I wish there was an easy way for drug companies to give the drugs they make much longer half lives so they could only be taken one time a day. I just hate being so dependent on a medication and having to make sure that I take it again half way through the day just to feel better.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.