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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by elanor roosevelt on November 22, 2006, at 21:28:14
Posted this last night and it's gone.
I have been thinking about how to find two meds to switch between that will re-set the chemistry of my brain for one another.
My idea is to get back on lexapro and when it melts down try tianeptine
one blocks serotonin one enhances production of serotoningoing from med to med to med is wearing me down
switching between 2 would,nt be so badwhat do you think?
Posted by Declan on November 23, 2006, at 1:09:15
In reply to finding a solution to TRD, posted by elanor roosevelt on November 22, 2006, at 21:28:14
My ignorant opinion? It's a bad idea. Too much change. All meds are toxic. The less the better. Even tianeptine bothers me.
But why don't you try it first, as it is the lesser of the evils?My feeling with tianeptine is that *eventually* I will land in the sh*t. This will end with agitated depression.
No CBT for me though.
Posted by Phillipa on November 23, 2006, at 11:44:09
In reply to Re: finding a solution to TRD » elanor roosevelt, posted by Declan on November 23, 2006, at 1:09:15
Why up serotonin and down it? Seems like you'd be in neutral? I don't know I'm not a drug expert. Love Phillipa
Posted by blueberry on November 23, 2006, at 12:53:38
In reply to finding a solution to TRD, posted by elanor roosevelt on November 22, 2006, at 21:28:14
You might find on tianepine that you don't have to switch it out. It basicially creates a constant accelerated flow of serotonin versus the stagnant pool that SSRIs create.
Posted by ed_uk on November 23, 2006, at 14:17:56
In reply to Re: finding a solution to TRD » elanor roosevelt, posted by Declan on November 23, 2006, at 1:09:15
Why so negative Dec?
Ed
Posted by Declan on November 23, 2006, at 14:20:44
In reply to Re: finding a solution to TRD, posted by blueberry on November 23, 2006, at 12:53:38
Metaphors.
The fast running crystal stream as against the stagnant pool.
Or is it the useful dam (hydroelectric power, family fun), as against the dry parched gully?
Don't ask me, I have no idea.I don't want to end up like that bloke who took 110 tianeptine tabs a day.
Breakthrough depression? Hmmmm.
There are some feelings that you want to run away from as fast as you can.
Posted by tensor on November 23, 2006, at 15:02:00
In reply to finding a solution to TRD, posted by elanor roosevelt on November 22, 2006, at 21:28:14
I'm also looking for the holy grail, I don't know your medical history. I've tried a lot of meds, the problem is not that I don't respond to them, it's that they stop working after a year or so, why? I don't know. Trying to find a mood stabilizer that works.
A few combos worth consideration:
Remeron+Nortriptyline
Remeron+Zoloft
Remeren+Wellbutrin
Remeron+Efexor
Zoloft+Wellbutrin
Zoloft+Nortriptyline
+ an augmentor
/Mattias
Posted by Declan on November 23, 2006, at 17:39:30
In reply to Re: finding a solution to TRD » Declan, posted by ed_uk on November 23, 2006, at 14:17:56
Hi Ed
Bad day yesterday. Why? No idea. Then I drank too much, a ridiculously small amount of whisky, then I didn't sleep.
Dec
Posted by tensor on November 23, 2006, at 17:43:35
In reply to Re: finding a solution to TRD » ed_uk, posted by Declan on November 23, 2006, at 17:39:30
>No CBT for me though.
OT, but why? Negative results?
Posted by Declan on November 23, 2006, at 18:24:04
In reply to Re: finding a solution to TRD » Declan, posted by tensor on November 23, 2006, at 17:43:35
No, I've not tried it Mattias. Just felt bad yesterday.....that's it.
Posted by elanor roosevelt on November 25, 2006, at 20:34:07
In reply to Re: finding a solution to TRD, posted by Phillipa on November 23, 2006, at 11:44:09
> Why up serotonin and down it? Seems like you'd be in neutral? I don't know I'm not a drug expert. Phillipa, I mean to switch after one melts down. If you melt down on an ssri why should another work, Why not use a drug that worksdifferently?
I just started lexapro again and i love it. If history repeats i have between 3 an 10 months on lexapro before it no longer works. I need a plan of action.
Posted by SLS on November 25, 2006, at 21:22:36
In reply to Re: finding a solution to TRD, posted by elanor roosevelt on November 25, 2006, at 20:34:07
> I just started lexapro again and i love it. If history repeats i have between 3 an 10 months on lexapro before it no longer works. I need a plan of action.
Do you think Buspar might help? It is sometimes chosen to augment SSRIs. I have never heard of anyone using it preemptively to prevent poop-out, but it might be worth thinking about. It might possibly help modulate serotonergic tone through partial 5-HT1a receptor agonism. It is too bad that gepirone was not approved by the FDA (although the application was to be resubmitted). It provides the same 5-HT action, but without the D2 antagonism that comes with Buspar.
- Scott
Posted by elanor roosevelt on November 26, 2006, at 13:28:32
In reply to Re: finding a solution to TRD, posted by SLS on November 25, 2006, at 21:22:36
Scott,
Tryptophan?
Is that 5-HT?
Posted by SLS on November 26, 2006, at 14:55:35
In reply to tryptophan, posted by elanor roosevelt on November 26, 2006, at 13:28:32
> Scott,
> Tryptophan?
> Is that 5-HT?5-HT is the chemical designation for serotonin. When serotonin receptors are described, they are usually designated as 5-HT receptors.
5-HT = 5-hydroxytryptamine = serotonin
The pathway through which serotonin is manufactured in the body starts with the amino-acid, tryptophan.
tryptophan > 5-HTP > 5-HT
The conversion of tryptophan to 5-HTP by the enzyme tryptophan hydroxylase is the rate-limiting step in this manufacturing process. The second step occurs more quickly. Since 5-HTP crosses into the brain more readily than tryptophan, it is actually a more effective precursor strategy to use 5-HTP rather than tryptophan to augment antidepressants.
- Scott
Posted by Phillipa on November 26, 2006, at 19:15:25
In reply to Re: tryptophan, posted by SLS on November 26, 2006, at 14:55:35
Scott thanks you described that so well. Love Jan
Posted by elanor roosevelt on November 26, 2006, at 20:52:53
In reply to Re: tryptophan, posted by SLS on November 26, 2006, at 14:55:35
> > Scott,
> > Tryptophan?
> > Is that 5-HT?
>
> 5-HT is the chemical designation for serotonin. When serotonin receptors are described, they are usually designated as 5-HT receptors.
>
> 5-HT = 5-hydroxytryptamine = serotonin
>
> The pathway through which serotonin is manufactured in the body starts with the amino-acid, tryptophan.
>
> tryptophan > 5-HTP > 5-HT
>
> The conversion of tryptophan to 5-HTP by the enzyme tryptophan hydroxylase is the rate-limiting step in this manufacturing process. The second step occurs more quickly. Since 5-HTP crosses into the brain more readily than tryptophan, it is actually a more effective precursor strategy to use 5-HTP rather than tryptophan to augment antidepressants.
>
So,gepirone is 5-HTP and is not available in this country?
Posted by SLS on November 26, 2006, at 21:49:33
In reply to Re: tryptophan, posted by elanor roosevelt on November 26, 2006, at 20:52:53
> So,gepirone is 5-HTP and is not available in this country?
Gepirone is a drug that attaches to one of the serotonin receptors of the subtype designated as 5-HT1a. It acts to stimulate this receptor, but only partially so. It might thus help to stabilize the activity of the serotonergic neuron.
5-HTP is available in the US as a food supplement and can be purchased in vitamin stores.
- Scott
Posted by saturn on November 28, 2006, at 20:16:07
In reply to Re: tryptophan, posted by SLS on November 26, 2006, at 14:55:35
> > Scott,
> > Tryptophan?
> > Is that 5-HT?
>
> 5-HT is the chemical designation for serotonin. When serotonin receptors are described, they are usually designated as 5-HT receptors.
>
> 5-HT = 5-hydroxytryptamine = serotonin
>
> The pathway through which serotonin is manufactured in the body starts with the amino-acid, tryptophan.
>
> tryptophan > 5-HTP > 5-HT
>
> The conversion of tryptophan to 5-HTP by the enzyme tryptophan hydroxylase is the rate-limiting step in this manufacturing process. The second step occurs more quickly. Since 5-HTP crosses into the brain more readily than tryptophan, it is actually a more effective precursor strategy to use 5-HTP rather than tryptophan to augment antidepressants.
>
>
> - ScottHey Scott,
You are *way* more knowledgeable than myself on this stuff and I often learn so much from your posts. That said, I'd once read that the problem with 5-HTP is that even if has easier CNS penetrance than tryptophan, that in actuality the bulk of 5-HTP is converted rather quickly into serotonin *in the blood stream*--before it can cross the blood brain barrier (I'm assuming pure serotonin doesn't cross the blood brain barrier).
So the net effect is increased blood serotonin with neglibeable serotonin changes in the brain. I apologize that I can't provide this reference. Please let me know if this is incorrect. Thanks.
Peace...Saturn.
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