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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 harry b. on June 13, 2000, at 10:56:04
Hi Andrew-
I took the Amisulpride info (and some others too) to
my pdoc yesterday. She was not interested/didn't have
the time to read them. I told her she could have them
to read later but she said maybe next time.Not too encouraging. I've been tapering off Celexa &
refuse to go the SSRI route again, so I had decided
to give Wellbutrin another try, having used it several
years ago. My pdoc agreed. Med cocktail now:Celexa 10mg (planned taper to 0 by end of week)
Lithium 300mg x 2
Klonopin 3-4mg
Ritalin 10mg x 3-4
Wellbutrin SR 150mg x 2Any comments? I may do a trial of the Amisulpride, but
I'm not sure about trying it along with the Ritalin
and Wellbutrin.Thanks,
hb
Posted by AndrewB on June 13, 2000, at 12:50:57
In reply to Andrew B., posted by harry b. on June 13, 2000, at 10:56:04
Some people like their psych.s to have the ball all the time, but other patients want a more active role in their recovery. If you are of the latter group, maybe you should let her know that if she doesn't have time for your input, you don't have time for her. Fact is, certain depressives have hypofunction of the D2/D3 receptor systems, most notably dysthymics. Moreover, amisulpride is the best studied and, probably, in general, the most efficacious of the meds out there to deal with D2/D3 dysfunction.
A couple more thoughts:
+While dysthymia I think is a broad spectrum of different chronic low grade conditions, it is something physically separate from major depression. For example, while platelet serotonin is decreased in endogonous depression, it is increased in dysthymia.+In dysthymia, while dopaminergic drugs are not necessarily the first line therapy, they should be considered soon afterwords, due to the frequency of D2/D3 hypofunction in dysthymics.
+Dysthymia is poorly understood and, in my opiniion, a bit overlooked by the research community. Psychiatrists often have little idea what a proper treatment approach for dysthymia may be.
+A high % of dysthymics also have mood disorders that perhaps predated the onset of dysthymia. It is my guess that often these mood disorders have a part in the chronicity of the depression, being a driver for depressive modifications of the brain by continually delivering stress upon it. Regardless, it is important to determine if comorbid personality disorders exist and deal with them. In my case amisulpride took away my dysthymia. However some fatigue remained and some social anxiety remained. Rebox. took away the fatigue, 2 down one to go. I am currently trying to remedy the social anxiety. I am optimistic that I will find a solution but my point is that it sometimes helps to view yourself as having separate conditions that will require different medications.
+You can take the amisulpride with ritalin and I see no reason why you can't take it with Wellbutrin too. Remember though, one drug trial at a time. Amisulpride also goes well with reboxetine and adrafinil and probably provigil. You might want to try the naphazoline eye drops to see how you respond to alpha 1 stimulation and how that relates to your fatigue. It is a great diagnostic tool in this man's opinion.
AndrewB
Posted by michael on June 13, 2000, at 16:46:50
In reply to Re: Andrew B., posted by AndrewB on June 13, 2000, at 12:50:57
...my case amisulpride took away my dysthymia. However some fatigue remained and some social anxiety remained. Rebox. took away the fatigue, 2 down one to go. I am currently trying to remedy the social anxiety. ...
> AndrewBHey Andrew -
Just wondering what symptoms of dysthymia that the amisulpride helped with... mood?
Just asking because the fatigue is one of the major elements of "my dysthymia", along with focus/concentration...
When I was trying the amisulpride, it seemed to help a little bit in terms of being a bit less withdrawn (social anxiety/phobia??) & perhaps w/mood? It's kind of difficult to say, because it was rather subtle - not a striking difference...
Btw - have you tried adrafinil yet? Just curious about it relative to rebox, for fatigue/energy.
Posted by AndrewB on June 14, 2000, at 9:21:50
In reply to Re: Andrew B. » AndrewB, posted by michael on June 13, 2000, at 16:46:50
Michael,
I have never taken adrafinil. I presume though that its effect for fatigue and arousal are similar to reboxetine’s . Both, I believe, derive there significant effect through alpha 1 andrenergic receptor stimulation. When this receptor is robustly stimulated, the effect is very noticeable. For example, your heart rate increases, you may sweat more, you head feels clearer, without any sense of agitation (if you haven’t taken too much), you feel more aroused. You obviously aren’t getting that response. Maybe all you need to do is take a higher dose. If adrafinil acts like reboxetine, there is a certain threshold of dosage that it must pass over before the alpha 1 receptor is stimulated and you feel much of any effect. You can also quickly determine if your alpha 1 receptor has a normal responsiveness by taking naphazoline eye drops since it is a quick onset alpha 1 agonist.
You asked me what amisulpride does for my dysthymia. It does a lot. My mood is better, I don’t have those feelings of hopelessness, My concentration is better and it takes away my brain fog. I am less moody and irritable. I am less tired. I have the energy to care about life. Amisulpride takes away the vicious, self deprecating talk that would go on in my head. It takes away some anxiety. So, you see, with amisulpride I feel much better. But there are some things it doesn’t completely do. Reboxetine is able to deal with many of these residual complaints. Namely, even with amisulpride, I still get some tiredness, mental fatigue and irritability long after I exercise. This kind of response is common in those with Chronic Fatigue Syndrome (CFS). I believe my dysthymia overlaps into CFS somewhat. I also get spells of daytime sleepiness and tiredness. It is for these residual symptoms for which reboxetine (now along with naphazoline) has proven effective. It arouses me and takes away mental and physical tiredness, sleepiness and irritability. What, remains as residual symptoms that neither reboxetine or amisulpride has taken away is a subtle but pervasive social anxiety. Let’s see if a solution can be found for that.
Obviously you are not getting a robust response to amisulpride if any at all. In my mind this could mean two things. Either you have no D2/D3 hypofunction or your presynaptic D2/D3 receptors aren’t being antagonized by the amisulpride. In the future you may consider a trial with bromocriptine. It is fairly cheap and easy to get overseas without an Rx. It is a D2 agonist, thus it has a different mode of action than amisulpride. If your fatigue is a result of D2/D3 hypofunction, you should get some effect from it, especially with mental fatigue.
There are other strategies to deal with fatigue, but that is another story and another day.
AndrewB
Posted by michael on June 14, 2000, at 10:52:21
In reply to Re: Michael, posted by AndrewB on June 14, 2000, at 9:21:50
Hi Andrew -
Have you ever tried any stimulants to address the fatigue aspect? I think you mentioned recently that you were going to give ritalin a shot?
> Michael,
>
> I have never taken adrafinil. I presume though that its effect for fatigue and arousal are similar to reboxetine’s . Both, I believe, derive there significant effect through alpha 1 andrenergic receptor stimulation. When this receptor is robustly stimulated, the effect is very noticeable. For example, your heart rate increases, you may sweat more, you head feels clearer, without any sense of agitation (if you haven’t taken too much), you feel more aroused. You obviously aren’t getting that response. Maybe all you need to do is take a higher dose. If adrafinil acts like reboxetine, there is a certain threshold of dosage that it must pass over before the alpha 1 receptor is stimulated and you feel much of any effect. You can also quickly determine if your alpha 1 receptor has a normal responsiveness by taking naphazoline eye drops since it is a quick onset alpha 1 agonist.
>
> You asked me what amisulpride does for my dysthymia. It does a lot. My mood is better, I don’t have those feelings of hopelessness, My concentration is better and it takes away my brain fog. I am less moody and irritable. I am less tired. I have the energy to care about life. Amisulpride takes away the vicious, self deprecating talk that would go on in my head. It takes away some anxiety. So, you see, with amisulpride I feel much better. But there are some things it doesn’t completely do. Reboxetine is able to deal with many of these residual complaints. Namely, even with amisulpride, I still get some tiredness, mental fatigue and irritability long after I exercise. This kind of response is common in those with Chronic Fatigue Syndrome (CFS). I believe my dysthymia overlaps into CFS somewhat. I also get spells of daytime sleepiness and tiredness. It is for these residual symptoms for which reboxetine (now along with naphazoline) has proven effective. It arouses me and takes away mental and physical tiredness, sleepiness and irritability. What, remains as residual symptoms that neither reboxetine or amisulpride has taken away is a subtle but pervasive social anxiety. Let’s see if a solution can be found for that.
>
> Obviously you are not getting a robust response to amisulpride if any at all. In my mind this could mean two things. Either you have no D2/D3 hypofunction or your presynaptic D2/D3 receptors aren’t being antagonized by the amisulpride. In the future you may consider a trial with bromocriptine. It is fairly cheap and easy to get overseas without an Rx. It is a D2 agonist, thus it has a different mode of action than amisulpride. If your fatigue is a result of D2/D3 hypofunction, you should get some effect from it, especially with mental fatigue.
>
> There are other strategies to deal with fatigue, but that is another story and another day.
>
> AndrewB
This is the end of the thread.
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