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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 74 to 98 of 201. Go back in thread:
Posted by Conundrum on September 22, 2011, at 5:10:33
In reply to Re: 40% down to 25% » Conundrum, posted by SLS on September 21, 2011, at 15:00:08
> > > > Scott, I hope the wash is going alright today. Thinking of you.
> > >
> > > Thanks, FB.
> > >
> > > My depression is somewhat worse, but tolerable. I am still experiencing sensations in my head that remind me of the brain-zaps seen with SRI withdrawal. My appetite has decreased dramatically, and I have lost 7 pounds. Only 50 pounds more to go.
> > >
> > >
> > > - Scott
> >
> > This is weight that you gained after starting nardil that you are losing now?
>
>
> Actually, most of the weight was gained over a period of three years while taking Abilify. The addition of Nardil made my weight jump another 17 pounds over the course of a few weeks. I had been 157 lbs or so before Abilify. I looked pretty good. I was as heavy as 227 lbs with Abilify and Nardil. I looked pretty disgusting. Now, I look just short of being pretty disgusting. I'm about 210 lbs.
>
>
> - Scott
>
>
>
>
>
>I'm around 223 so I know how you feel. I was around 200 before I tried remeron and then nardil and gained a lot of weight. The thing that sucks about Nardil is it makes me sweat profusely when I exercise so I feel less inclined to be bothered with it.
I need to talk to my pdoc soon, I think the Nardil is making my anhedonia worse not better and I hate wasting my time trialing "fat" pills.
Posted by SLS on September 22, 2011, at 7:04:55
In reply to Re: 40% down to 25% -- Viibryd trial question » SLS, posted by zonked on September 21, 2011, at 22:03:53
> In another post, you mentioned a good question:
>
> Since both Viibryd and Abilify are partial 5HT1A agonists, how would this affect receptor occupancy?
>
> Have you found the answer to this question?No. I think IC50 means the concentration at which 50% of the receptors are occupied and inhibited. The answer to the question is deceptively complicated. I've got a model floating around in my head, but it is difficult to explain briefly. One important question is to what degree these two drugs flip conformations to produce 5-HT1a agonism at a given receptor.
Questions like these are sometimes more esoteric than applicable. I think I would rather try Viibryd in ignorance and without predicting its potential to improve my condition. I might have an easier time suggesting answers to the questions asked once I establish how Viibryd affects me. I might even try removing Abilify if I respond well to the addition of Viibryd. Is D2 partial agonism important to the ability of Abilify to provide improvements in depression? Is 5-HT1a partial agonism sufficient? Remember, the most ubuquitous serotonin receptor in the brain is 5-HT1a. They populate numerous different regions and have different functions. Do Abilify and Viibryd mirror one another in the agonism of 5-HT1a receptor populations? I think Abilify is limited to somato-dendrytic autoreceptors. In addition to these receptors, Viibryd effectively acts upon inhibitory presynaptic autoreceptors and excitatory postsynaptic receptors, with it acting selectively on presynaptic autoreceptors, particularly at low dosages.
> Wikipedia reports the following:
>
> Vilazodone, 5HT1a :
> IC50 = 0.5 nM; IA = ~60-70%
>
> Aripiprazole, 5HT1a:
> Ki = 1.65 nMApples to oranges. I don't know how one would use these numbers to compare the two drugs.
Good morning.
- Scott
Posted by Phillipa on September 22, 2011, at 19:47:14
In reply to Re: 40% down to 25% -- Viibryd trial question » zonked, posted by SLS on September 22, 2011, at 7:04:55
Scott if you are even a bit like me in my case a little knowledge is dangerous. Always done better when knew nothing and just did it!!!! Phillipa
Posted by floatingbridge on September 23, 2011, at 16:08:55
In reply to Re: 40% down to 25%, posted by SLS on September 17, 2011, at 10:08:52
Do you start next week? (I track time pretty poorly.....)
How is your day going so far?
fb
Posted by SLS on September 23, 2011, at 16:20:58
In reply to Viibryd » SLS, posted by floatingbridge on September 23, 2011, at 16:08:55
> Do you start next week? (I track time pretty poorly.....)
Monday.
> How is your day going so far?Not too bad. I haven't relapsed to my untreated baseline. Perhaps there is an inertia that will allow me to function for a few weeks.
Who knows?
- Scott
Posted by floatingbridge on September 23, 2011, at 16:36:32
In reply to Re: Viibryd » floatingbridge, posted by SLS on September 23, 2011, at 16:20:58
> > Do you start next week? (I track time pretty poorly.....)
>
> Monday.
>
> > How is your day going so far?
>
> Not too bad. I haven't relapsed to my untreated baseline. Perhaps there is an inertia that will allow me to function for a few weeks.
>> Who knows?
>
>
> - ScottThat would be wonderful. I hope so :-)
Posted by zonked on September 23, 2011, at 16:59:54
In reply to Re: Viibryd » floatingbridge, posted by SLS on September 23, 2011, at 16:20:58
> > Do you start next week? (I track time pretty poorly.....)
>
> Monday.Were you able to secure samples or did you decide to go Effexor XR?
> > How is your day going so far?
>
> Not too bad. I haven't relapsed to my untreated baseline. Perhaps there is an inertia that will allow me to function for a few weeks.
>
> Who knows?
>
>
> - ScottI saw my (brilliant) doctor today and we usually spend most of the session just talking pharma/neuroscience - especially since I fixed my insurance problem and will maintain on my current regimen. I forgot to ask him what he makes of Viibryd.
We did make a little joke about Oleptra (he said when the drug rep came in to promote it, "we were so mean to them they never came back.") He laughed when I said "the first thing I thought when I heard about Oleptra was, hangover XR."
Anyway, I hope you were able to work something out. This is truly the most novel antidepressant to come to market in a long time.
(Please, Forest. When you launch your DTC campaign, nothing as disturbing as the Pristiq ladies and their wind-up-doll Avatars. Thanks!)
Best,
-z
Posted by SLS on September 23, 2011, at 19:53:59
In reply to Re: Viibryd » SLS, posted by zonked on September 23, 2011, at 16:59:54
> I saw my (brilliant) doctor today and we usually spend most of the session just talking pharma/neuroscience - especially since I fixed my insurance problem and will maintain on my current regimen. I forgot to ask him what he makes of Viibryd.
I would be very interested to know what your doctor thinks of Viibryd.
No word back from my insurance company. I will have my doctor's office send another fax on Monday.
- Scott
Posted by SLS on September 27, 2011, at 15:10:15
In reply to Re: Viibryd » zonked, posted by SLS on September 23, 2011, at 19:53:59
> No word back from my insurance company. I will have my doctor's office send another fax on Monday.
Got it!
I should be up to 40mg by the end of week 2. I am only on day 2. However, I feel it in my brain already. I am slightly improved. I have more energy and can process information faster. These are infrequent occurrences for me. It's just a blip, I guess. I wouldn't expect anything substantial until week 4.
- Scott
Posted by floatingbridge on September 27, 2011, at 21:02:36
In reply to Re: Viibryd, posted by SLS on September 27, 2011, at 15:10:15
Excellent news on the insurance. That makes things easier.
Steady on in the face of blips or dips.
:-)
Very best wishes, Scott.
Posted by Phillipa on September 27, 2011, at 21:05:58
In reply to Re: Viibryd, posted by SLS on September 27, 2011, at 15:10:15
Scott sorry no more blips allowed. This time this med will permantly cause remission. Now that is an order from me. Phillipa!!!!
Posted by SLS on September 27, 2011, at 21:37:46
In reply to Re: Viibryd » SLS, posted by Phillipa on September 27, 2011, at 21:05:58
Thanks!
- Scott
Posted by zonked on September 27, 2011, at 23:26:11
In reply to :-) » Everyone, posted by SLS on September 27, 2011, at 21:37:46
There are advocacy group for most conditions, but none that I am aware of for treatment-resistant depression (unipolar or bipolar.)
Depression robs one of energy, so perhaps that's a reason.
I don't think we are so few in number so as to not warrant an advocacy group of our own. No, NAMI doesn't count.
It's something I've been thinking about off and on. Unfortunately, of the many things I do graphic design and website design aren't among them.
I wonder if having such a group would get any attention (press perhaps?) or pressure pharma to consider us a distinct group to study in trials.
As far as I know, the only drugs with FDA *indications* for TRD are Symbyax (Zyprexa with Prozac) and Marplan.
Just an idea. Maybe if I return to full functioning (including occupational) this is a cause I could devote some time to.
I think if big pharma pursued indications for TRD as well as MDD for novel compound they might sell more product. Having said that, the product would have to be effective for TRD. TRD-ers are often excluded from trials for various reasons (previous suicide attempts, I believe, being one of them.)
What do you guys think?
-z
Posted by SLS on September 28, 2011, at 5:55:06
In reply to TRD advocacy, posted by zonked on September 27, 2011, at 23:26:11
Hi Z.
You offer very cogent arguments for greater recognition of TRD.
> There are advocacy group for most conditions, but none that I am aware of for treatment-resistant depression (unipolar or bipolar.)
As you suggest, people with severe depression have trouble getting out of bed and taking a shower. How could such a condition allow for that kind of active advocacy?
> I don't think we are so few in number so as to not warrant an advocacy group of our own. No, NAMI doesn't count.
Why not?
What about DBSA?
http://www.dbsalliance.org/site/PageServer?pagename=home
I didn't know that Marplan was indicated for TRD.
It is wonderful that you now have the resources to consider and act upon such issues.
Stay well.
- Scott
Posted by zonked on September 28, 2011, at 8:31:11
In reply to Re: TRD advocacy » zonked, posted by SLS on September 28, 2011, at 5:55:06
> Hi Z.
>
> You offer very cogent arguments for greater recognition of TRD.
>
> > I don't think we are so few in number so as to not warrant an advocacy group of our own. No, NAMI doesn't count.
>
> Why not?
NAMI *seems* to be focused more on other mental disorders perceived as more chronic and disabling.
Also, I don't have time to look at it now; someone once told me they had accepted donations from pharmaceutical companies. I can't say that's blanket good or bad...> What about DBSA?
>
> http://www.dbsalliance.org/site/PageServer?pagename=homeGood for support groups, but I was thinking more along the lines of, like, how The American Cancer Society is for Cancer.
> I didn't know that Marplan was indicated for TRD.
If you look at the advertising on their website, it's for "treatment resistant depression." US rules only allow advertising for approved indications. I think this supplemental indication is why it was brought back from the dead after Roche didn't seem to care that it pre-dated DESI and never bothered to implement it; and why the third party (Validus?) was interested in it.
> It is wonderful that you now have the resources to consider and act upon such issues.
>
> Stay well.
>
>
> - ScottScott, be patient, and your brain will feel like you remember again. Me, telling you to be patient, that's rich. Some of my own patience has been influenced by watching you over the years. I should say, one day you will feel like yourself - consistently - again. And you have the writing skills to write a novel about your experiences should you ever wish to.
I hope it's Viibryd that does the trick for you. BTW, how easily is the Nardil weight coming off? I am not going to mess with my regime, just curious.
BEST of luck always,
-z
Posted by SLS on September 28, 2011, at 9:10:11
In reply to Re: TRD advocacy » SLS, posted by zonked on September 28, 2011, at 8:31:11
> Scott, be patient, and your brain will feel like you remember again.
From your mouth to God's ears...
Thank you for the words of encouragement and everything else you have to say.
It has been 17 days since I took my last dose of Nardil.
Before: 220 pounds
Now: 207 poundsI have also changed my eating habits, so it is difficult to ascribe discontinuing Nardil for all 13 pounds. However, prior to coming off Nardil, the same eating habits yielded no weight loss.
Thank God for leptin! Burn that white adipose!
- Scott
Posted by SLS on September 28, 2011, at 9:13:28
In reply to Re: TRD advocacy » zonked, posted by SLS on September 28, 2011, at 9:10:11
Hi All.
I am experiencing an unexpected improvement in depression. It would be difficult not to attribute this to Viibryd. The only other thing I can think of is that it might be the result of discontinuing the Nardil with a resultant withdrawal rebound improvement. I believe that it is more likely to be due to Viibryd. You know that I respond to certain drugs for three days, only to relapse afterwards. Today is the third day of improvement. Viibryd differs from the other drugs I have taken in that the improvement began on the very first day. However, this might be the result of having had my 5-HT1a autoreceptors be downregulated by Nardil.
Viibryd works. It doesn't have to be novel on paper (it actually is novel, though) in order to be effective for people who previously were TRD. Viibryd only has to be different to be worthy of consideration as a treatment. Different is different. As proof of this, there are people who respond to Pristiq whom do not respond to Effexor, regardless of dosage. I like what this drug does on paper and in real life. My doctor has had several TRD patients respond to Viibryd. It is his feeling that it will work as a prophylactic against relapse. You know, I am thinking that Viibryd might act to potentiate the therapeutic effects of standard antidepressants. You can probably add Viibryd to anything except MAOIs. I hope I continue to improve and achieve remission with the addition of Viibryd. Ill keep you informed as to how I do with this drug. Lithium might be an important component to my Viibryd treatment. Both drugs act to release serotonin, albeit via different mechanisms.
I am currently taking:
Viibryd 20mg (target dosage is 40mg)
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mgI have a good feeling about Viibryd. Wish me luck.
- Scott
Posted by morgan miller on September 28, 2011, at 9:45:41
In reply to Viibrid Treatment, posted by SLS on September 28, 2011, at 9:13:28
Well, it's good to hear you are responding positively so far. I really do hope this continues for you Scott.
Hmm, I wonder what combining a 10 or 20 mg dose of Viibryd with an SSRI like Zoloft would do.
Anyway, good luck and best wishes Scott!
Morgan
Posted by Phillipa on September 28, 2011, at 19:01:07
In reply to Re: Viibrid Treatment, posted by morgan miller on September 28, 2011, at 9:45:41
Scott saying it again this med is the one for you!!!! Phillipa
Posted by Solstice on September 28, 2011, at 19:56:53
In reply to Viibrid Treatment, posted by SLS on September 28, 2011, at 9:13:28
Scott -
You are one of the most courageous people I have ever encountered. I will wait with anticipation for your updates - because I wish for you resounding success with remission on your new treatment. You are so very, Very deserving of remission.
Solstice
Posted by SLS on September 30, 2011, at 7:41:22
In reply to Re: Viibrid Treatment » SLS, posted by Solstice on September 28, 2011, at 19:56:53
Posted by SLS on September 30, 2011, at 7:50:07
In reply to Viibrid Treatment, posted by SLS on September 28, 2011, at 9:13:28
> Hi All.
>
> I am experiencing an unexpected improvement in depression. It would be difficult not to attribute this to Viibryd. The only other thing I can think of is that it might be the result of discontinuing the Nardil with a resultant withdrawal rebound improvement. I believe that it is more likely to be due to Viibryd. You know that I respond to certain drugs for three days, only to relapse afterwards. Today is the third day of improvement. Viibryd differs from the other drugs I have taken in that the improvement began on the very first day. However, this might be the result of having had my 5-HT1a autoreceptors be downregulated by Nardil.
>
> Viibryd works. It doesn't have to be novel on paper (it actually is novel, though) in order to be effective for people who previously were TRD. Viibryd only has to be different to be worthy of consideration as a treatment. Different is different. As proof of this, there are people who respond to Pristiq whom do not respond to Effexor, regardless of dosage. I like what this drug does on paper and in real life. My doctor has had several TRD patients respond to Viibryd. It is his feeling that it will work as a prophylactic against relapse. You know, I am thinking that Viibryd might act to potentiate the therapeutic effects of standard antidepressants. You can probably add Viibryd to anything except MAOIs. I hope I continue to improve and achieve remission with the addition of Viibryd. Ill keep you informed as to how I do with this drug. Lithium might be an important component to my Viibryd treatment. Both drugs act to release serotonin, albeit via different mechanisms.
>
> I am currently taking:
>
> Viibryd 20mg (target dosage is 40mg)
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 300mg
>
> I have a good feeling about Viibryd. Wish me luck.
Today is my fourth day of improvement with this drug. The responsse seems to be growing steadily.Today is my first day at 40mg.
Very cool.
- Scott
Posted by floatingbridge on September 30, 2011, at 8:45:30
In reply to Re: Viibrid Treatment, posted by SLS on September 30, 2011, at 7:50:07
Very cool.
:-)
I like this.
Posted by Phillipa on September 30, 2011, at 12:10:46
In reply to Re: Viibrid Treatment, posted by SLS on September 30, 2011, at 7:50:07
Scott knew it would work it's uphill from here to the very top. Phillipa
Posted by jhj on September 30, 2011, at 23:54:50
In reply to Re: Viibrid Treatment, posted by SLS on September 30, 2011, at 7:50:07
hiSorry to sound pessimistic but it might be a placebo effect.
jhj
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