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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Survector on March 27, 2004, at 20:50:57
Three nights ago, I began a regimen of 2 mg of Klonopin before bedtime for insomnia, anxiety and social phobia. Now I'm feeling agitated and depressed during the day. I'm also taking the French antidepressant Stablon (tianeptine) which is an SSRE (Selective Serotonin Reuptake *Enhancer*). I'm taking it because it doesn't have the normal sexual side effects that the standard SSRIs and Effexor has. I can't tell if I'm feeling agitated because my Klonopin dosage is too high or because I'm taking it with a potentially 'suboptimal' atypical antidepressant (as opposed to the standard SSRIs and Effexor).
The last time I was on Klonopin I felt great - I was on .5 mg before bed and took it with Celexa. My current Klonopin pills are 2 mg and scored, so I can only halve them into 1 mg tablets if I wish to reduce the dosage. Even with my pill cutter, I can't split them into fours (.5 mg each) without crumbling the entire pill. Will this agitation/depression continue unless I lower the dosage? Is .5 mg the only dosage that can provide a calming effect without making one foggy and agitated?
On another note, I'd like to ask any self-proclaimed psychopharmacology type gurus out there if you have yet to find for yourselves an antidepressant as effective as the standard SSRIs and Effexor without the sexual side effects (I realize this is the $1,000,000 question). Stablon is 'ok' but nothing like the SSRIs and Effexor - same goes for Serzone, Trazodone, Remeron and Wellbutrin. I'm open to any suggestions, particularly pertaining to novel antidepressant approaches (U.S. or international).
The standard SSRIs and Effexor are wonderful for depression but they have destroyed any possibility for a sex life, and hence, have caused great distress (especially when potential partners reject me once they see that I can't 'get it up' in bed - this has been demoralizing as it can make one appear less 'endowed' than he really is). Ginko Biloba, etc doesn't help enough and Viagra/Cialis/Levitra appear to be too expensive.
The medications I am now on are Stablon (standard dosage of 12.5 mg 3 times daily) and Klonopin (2 mg once at bedtime).
The medications I have been on as of the past many years: Zoloft, Paxil, Luvox, Celexa, Prozac, Lexapro, Remeron, Wellbutrin, Serzone, Neurontin and Risperdal (Wellbutrin made my anxiety worse and Remeron and Serzone were slightly calming/sedating but had no antidepressant effects). Of these meds, Effexor has been the best, followed closely by Luvox and Celexa - the rest did nothing for me. In addition, I have tried the mild, non-amphetamine based French psychostimulant Olmifon (adrafinil) which is the chemical analogue to Provigil (modafinil). The adrafinil made me alert, hypervigilant, anxious and somewhat paranoid but did not provide any type of 'mood boost' worthy of being considered useful for treating depression.
I did do some research on a supposed Effexor-like dual-reuptake European antidepressant called Ixel (milnacipran) which is touted as having less sexual side effects than Effexor (while working on both serotonin and norepinepherine), but user reports from this board don't appear encouraging. While the French-based dopamine reuptake inhibitor Survector (amineptine) appears to be an ideal antidepressant due to pro-sexual effects, it also has high abuse potential based on reports of friends who ordered a standard supply, abused it and consequently had no choice but to flush the remainder of their supply down the toilet (hence why it was taken off the market in every country in the late 90s). In addition, amineptine is extremely pricey due to only being available on the 'grey' market. I've also read about a relatively new MAO-based antidepressant called Manerix (moclamine) but I'm quite wary of even seemingly safe/new MAO drugs - but if one can convince me of its safety and effectiveness then I'm all ears. Edronax (raboxetine) appears interesting, but unfortunately it doesn't work on serotonin (only norepinepherine) which makes me skeptical since all of the seemingly effective antidepressants thus far appear to work mainly on serotonin (I tried Strattera, which is similar in action to Raboxetine, and it did nothing for my depression). As far as stimulants/amphetamines go, they are too short acting and addictive to be a viable option as standalone therapy or as adjunctive therapy to antidepressant medication.
Any constructive comments or advice from anyone who is familiar with novel or unique treatment approaches (for powerful antidepressant therapy options without the associated libido loss) are most welcome and appreciated.
Posted by snapper on March 27, 2004, at 23:26:39
In reply to Klonopin Problems and Novel Depression Treatments, posted by Survector on March 27, 2004, at 20:50:57
hey survector, welcome to the "CLUB MED" were all looking for that perfect drug!!! unfotunately
at this time I don't think it exists!
Snapper
Posted by spoc on March 28, 2004, at 23:07:22
In reply to Klonopin Problems and Novel Depression Treatments, posted by Survector on March 27, 2004, at 20:50:57
Hi Survector,
As far as novel AD treatments, have you read all the posts about tramadol/Ultram (U.S. names) available on this board? That's a controversy I myself haven't landed on one side of yet either (nor really tried yet). But a poster well-versed in it seems to have concluded that the withdrawal from it may be similar for some as that from Effexor, but that otherwise, dependency is dependency is dependency, so why disqualify it on that count alone... As an AD, I believe it is supposed to have some strong similarities with Effexor actually....
Posted by jlbl2l on March 30, 2004, at 19:46:58
In reply to Klonopin Problems and Novel Depression Treatments, posted by Survector on March 27, 2004, at 20:50:57
I added you, I tried many more than you and consider myself a guru, near expert in the field, but i cant spell pronounce or type, so excuse me for that.
My approach well I'm really looking forward to 1 drug this year, and that drug is actually, you may not know the name but its "Lyrica" LOL. AKA Pregabalin. Lots of the trial patients say it helped with what it was supposed to do -> but it actually gave an incredible antidepressant effect on life to them, more so then they had ever seen, and according to all data, its non abuseable, non-addiciting, minimal if any sexual or weight gain side effects. It should be due out in Europe in June 2004, well, we have to wait for marketing etc, so either way sometime this year, and in USA, approved OCT 2004 for neuropathic pain, anxiety, and seizures, and out by the end of the year. I for one, will be the first to try it.
Posted by BobS, on March 30, 2004, at 20:35:50
In reply to response, posted by jlbl2l on March 30, 2004, at 19:46:58
I too am waiting for pregabalin, but have been unable to pin down dates. Please cite the sources for your dates. Thanks.
BobS.
Posted by jlbl2l on March 31, 2004, at 9:33:44
In reply to response, posted by jlbl2l on March 30, 2004, at 19:46:58
This excerpt is for the June 2004 approval in Europe. For USA, expect October, this is because the FDA on a tee literally takes a year to approve a new drug. It was submitted in Oct 2003, by Oct 2004, we should def know weather or not it is approved or needs more studies or whatever from the USA that is....., either way, it will be out by the end of this year. The marketing may hold it up till late this year for the USA but we will have it and it will be our cure for many things. I am sure of it. mark my words. ill bump this post when you all come back saying how great it is.
::::::: ->
Pfizer's LYRICA Receives Positive Opinion in Europe from Committee for Proprietary Medicinal ProductsNEW YORK, March 25, 2004 -- Pfizer Inc said today that the Committee for Proprietary Medicinal Products (CPMP) adopted a positive opinion recommending marketing authorization of LYRICA® (pregabalin) in the European Union for the treatment of neuropathic pain and add-on therapy for partial seizures.
Following the CPMP's positive opinion, their recommendation will be reviewed by the European Commission (EC), which has authority to grant marketing authorizations for the European Union. Pfizer anticipates a final decision from the EC in June 2004.
Developed by Pfizer, pregabalin has a novel mechanism of action which allows treatment of certain neurologic and psychiatric disorders.
“We are pleased with the CPMP’s positive opinion of LYRICA and expect that marketing authorization will be granted by the European Commission,” said Dr. Joseph Feczko, president of Worldwide Development at Pfizer. “LYRICA will be a new treatment option for neuropathic pain, which is a debilitating form of chronic pain that affects millions of Europeans. In addition, LYRICA will benefit patients suffering from epilepsy by providing better control of their seizures.”
Neuropathic pain, often characterized by a burning, tingling and/or shock-like sensation, is a type of chronic pain that is often misdiagnosed, under-treated, and a significant burden to sufferers, their families, and society. Epilepsy, a chronic neurological condition that is marked by seizures, affects an estimated 50 million people worldwide. Treatment that effectively controls or reduces the frequency of seizures has important consequences not only on the physical well-being and productivity of patients but also their quality of life.
Pregabalin is currently under review by the U.S. Food and Drug Administration for the management of neuropathic pain associated with diabetic peripheral neuropathy and herpes zoster (postherpetic neuralgia), as adjunctive therapy in the treatment of partial seizures, and for the treatment of generalized anxiety disorder in adults.
Though there are no comprehensive figures estimating the costs associated with neuropathic pain, the condition contributes significantly to direct healthcare costs and indirect costs such as worker productivity and absenteeism.
Pfizer Inc discovers, develops, manufactures and markets leading prescription medicines, for humans and animals, and many of the world's best-known consumer products.
Posted by rod on March 31, 2004, at 11:41:00
In reply to response, posted by jlbl2l on March 30, 2004, at 19:46:58
>...but it actually gave an incredible antidepressant effect on life to them, more so then they had ever seen..
Sounds interesting. Could you post a link to this information? thanks
Roland
Posted by Survector on April 2, 2004, at 11:19:04
In reply to Re: response, posted by jlbl2l on March 31, 2004, at 9:33:44
Jason, why did you suddenly vanish off AOL Instant Messenger last night after reading my posting on Bluelight?
This is the end of the thread.
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