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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by yesac on June 5, 2005, at 13:37:04
Has anyone taken Ascendin (amoxapine)?
I'm looking for something to add to lithium, especially if I go off Seroquel.
Ascendin seems kind of unique and different. You never hear much about it though, which makes me wonder.
Posted by SLS on June 5, 2005, at 14:12:45
In reply to Ascendin, posted by yesac on June 5, 2005, at 13:37:04
> Has anyone taken Ascendin (amoxapine)?
>
> I'm looking for something to add to lithium, especially if I go off Seroquel.
>
> Ascendin seems kind of unique and different. You never hear much about it though, which makes me wonder.What attracts you to amoxapine?
Med_Empowered recently commented that he thought loxapine was a unique antipsychotic worth consideration in certain situations. Perhaps he can expand on that a bit here. Amoxapine is a derivative of loxapine and retains much of the antpsychotic properties of the parent compound in addition to its antidepressant properties as a tricyclic. Unfortunately, amoxapine shares with loxapine a risk of developing EPS. This was evident as early as the pilot studies.
I tried amoxapine when it was first approved in 1982. I didn't like it. It dulled me in ways that my illness doesn't tolerate well. I was particularly annoyed by the decrease in libido that amoxapine produced. Like most of the other TCAs, anticholinergic effects were significant.
- Scott
Posted by med_empowered on June 5, 2005, at 16:12:35
In reply to Re: Ascendin, posted by SLS on June 5, 2005, at 14:12:45
hi! Amoxapine has been of interest to me for a while, and I considered asking my doctor for it but changed my mind. I have Bipolar I/NOS, so I have some pretty severe depressive episodes to deal with now and then. What attracted me to amoxapine was the ability, based mostly on anecdotal evidence, to treat: teatment-resistant depression (both people who fail to respond and those who fail to achieve remission w/ standard antidepressant treatment), psychotic depression (my variant of BPD involves this form of depression), and depression with significant agitation and extreme anxiety (in this respect its kind of like Triavil, the Elavil+perphenazine combo). The good news is that while it doesn't seem anymore effective than other TCAs, it does seem better at the hard-to-treat cases mentioned above. The other piece of good news is that the anti-psychotic component *may* act as a built-in mood-stabilizer, so "switching" in bipolar and/or activation of psychosis in schizophrenia isn't as big a problem as it would be with a standard TCA. The problems, though, are pretty significant: basically you have all your standard TCA problems (minus the mania/psychosis one), plus some anti-psychotic problems (EPS, prolactin elevation), though these problems are milder than "typical" antipsychotics. I can't really offer advice without knowing you and your situation. A lot of the attention lately has been on using it as a full-fledged antipsychotic, since it could elevate the mood of those with schizoaffective disorder and also those with "moody schizophrenia." Since its so old, it is pretty cheap, and although there are definite EPS problems (including, of course, neuroleptic malignancy syndrome and some cases of tardive dyskinesia), it doesn't seem to have the weird metabolic effects (diabetes, massive sudden weight gain) that you see with the atypical antipsychotics. If it works, it works fast; 80% of responders report an improvement within 4-14 days. On the other hand, there are tolerance problems, which sucks b/c with all TCAs you want to stay at a the lowest-possible dose; factor in EPS+NMS and this is even more important. So, I guess I'd say that if you **need** something unique that you haven't tried before, this may be it for you. I wouldn't recommend it if you respond well to other antidepressants, nor would I recommend it if you do well on atypical AP/anti-depressant combos. I also wouldn't recommend it for long-term use, unless you're inclined to treatment-resistant and/or psychotic depressive epsidoes that are both severe and recurrent.
Posted by yesac on June 6, 2005, at 0:40:58
In reply to Re: Ascendin, posted by med_empowered on June 5, 2005, at 16:12:35
Hi-- thanks for your responses. I guess to say a little more about why I'm interested.... well, basically I think I am attracted to the antidepressant/antipsychotic features of the drug, and because it's supposed to be useful for resistant depression and agitated depression. Those two phrases pretty much sum me up! I have not been diagnosed as bipolar, but my belief is that I may have some kind of bipolar spectrum thing going on, or at least depression with certain hypomanic features (whatever you want to call that). I have tried MANY drugs. None of the *newer* antidepressants have been helpful at all. A few have been worse than not being on them-- more agitated or activated or more depressed. I've been on Parnate, which was awful for me. The only TCA I've tried is desipramine/norpramin. I was only on that for a few weeks and stopped taking it when I found that I was unable to pee for many hours. Atypical antipsychotics are okay, but for the most part make me too damn tired. I hated Abilify (too activating) and I haven't tried Geodon. I'm on Seroquel now but considering going off because I just feel too tired and it's so hard to get up at any reasonable hour, which I can't stand. But I definitely need something for sleep--- I could go back to trazodone which I took for several years before starting Seroquel last November.
Soooo... I'm not really sure what to do. I have a pretty severe, suicidal, agitated, aggressive depression. It's maybe gotten slightly better recently due, I think, to lithium. But I'm still pretty troubled and I just don't believe that lithium by itself is going to do the trick. So, I am looking, as always, for other options.
Posted by SLS on June 6, 2005, at 5:10:56
In reply to Re: Ascendin SLS, MedEmpowered, posted by yesac on June 6, 2005, at 0:40:58
I never much cared for the idea of using a single medicinal preparation containing an antidepressant with a antipsychotic. I think it can make a mess of things. It would be better to titrate each independantly to optimize treatment. However, Asendin is a single drug with multiple sites of action. It just might have the right proportion of effects to do the job.
It is difficult to say whether or not Asendin will be more or less problematic with micturition (initiating urination) than desipramine was. Although both are anticholinergic, the more potent NE properties of desipramine probably amplify some of these side effects. In any event, knowing that you have a sensitivity for side effects would argue in favor of a very slow titration.
How did you go about initiating and titrating desipramine?
- Scott
Posted by SLS on June 6, 2005, at 5:13:31
In reply to Re: Ascendin SLS, MedEmpowered » yesac, posted by SLS on June 6, 2005, at 5:10:56
Hi Yesac.
Speaking of older neuroleptics, have you ever tried perphenazine? I'm not sure I would recommend it at this point, but I am curious.
- Scott
Posted by seamus2 on June 6, 2005, at 8:54:41
In reply to Ascendin, posted by yesac on June 5, 2005, at 13:37:04
Ascendin was the 1st AD I ever tried. Within a just a couple days I was actually moving again.
The only side effect I recall was LNS.
(limp noodle syndrome) :)
Posted by yesac on June 6, 2005, at 14:26:20
In reply to Re: Ascendin SLS, MedEmpowered, posted by SLS on June 6, 2005, at 5:13:31
No I haven't tried perpenazine. What's the brand name on that?
I haven't really tried too many older drugs except parnate, lithium of course, desipramine. I haven't tried any older antipsychotics, although there was talk for a while between my psychiatrist and me about trying Haldol. I think that might be just a bit too much for me though, considering that the new APs pretty well knock me out. Maybe a low dose, I don't know.
But I really want something with antidepressant properties. Something that will not make agitation worse, something calming but also antidepressing.
It's just so damn frustrating. I've been doing this for years, and I know some people have been at it a lot longer, but.... well I really have had enough.
Sometimes I think things have really just gotten worse and worse and worse, despite trying all these drugs. I wonder if the drugs themselves have made things worse--- worsened my bipolar symptoms, made me much more exhausted and drained. But it's hard to know if that is because of drugs or if it was just the natural progression of the illness and would have happened anyways.
Posted by yesac on June 6, 2005, at 14:34:26
In reply to Re: Ascendin SLS, MedEmpowered » yesac, posted by SLS on June 6, 2005, at 5:10:56
> I never much cared for the idea of using a single medicinal preparation containing an antidepressant with a antipsychotic. I think it can make a mess of things. It would be better to titrate each independantly to optimize treatment.
You're probably right. I don't know how much I like the idea either. I certainly am not a fan of Symbyax, but that's more because they took two already existing drugs and made them into one, which seems stupid to me.> It is difficult to say whether or not Asendin will be more or less problematic with micturition (initiating urination) than desipramine was. Although both are anticholinergic, the more potent NE properties of desipramine probably amplify some of these side effects. In any event, knowing that you have a sensitivity for side effects would argue in favor of a very slow titration.
That whole problem scared me away from TCAs. But I have been on other drugs with norepinephrine reuptake and didn't have problems, so maybe I should give another TCA a chance.Honestly though, I am kind of afraid of all ADs at this point because not one of them has helped me and several have really been much worse. So I wonder if maybe I should just steer clear of them from now on. I guess you can never know how any one drug will affect you though.
> How did you go about initiating and titrating desipramine?
I can't exactly remember, it's been a while.... I think I started with 10mgs maybe and stayed on that for a week, then went up to 15, then 20.... or maybe it was up to 20mgs then 30. I was on it for a total of 3 weeks.
This is the end of the thread.
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