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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Sheilac on October 29, 2007, at 9:16:13
I don't think that I was getting enough serotnin from either Emsam or Despiramine. Is there another tricylic that I should try that I could get more of a serotonin reaction?
I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused.
I can go back to taking an SSRI - but my bladder will spasm and hurt.
Posted by Maxime on October 29, 2007, at 10:49:16
In reply to Not enough serotonin/Despiramine, posted by Sheilac on October 29, 2007, at 9:16:13
> I don't think that I was getting enough serotnin from either Emsam or Despiramine. Is there another tricylic that I should try that I could get more of a serotonin reaction?
>
> I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused.
>
> I can go back to taking an SSRI - but my bladder will spasm and hurt.
>
>You could try adding tryptophan which is a precuser to serotonin.
Maxime
Posted by Racer on October 29, 2007, at 10:54:39
In reply to Not enough serotonin/Despiramine, posted by Sheilac on October 29, 2007, at 9:16:13
> I don't think that I was getting enough serotnin from either Emsam or Despiramine. Is there another tricylic that I should try that I could get more of a serotonin reaction?
EMSAM inhibits the production of the enzyme which breaks down catecholamine neurotransmitters. It doesn't cause you to "get" more of any neurotransmitter, it only makes those you synthesis stick around longer. That means that you're getting increased serotonin as well as increased dopamine/norepinephrine.
Amitriptyline targets serotonin a bit more than desipramine does. It might be worth a try. It will likely have more side effects, though.
>
> I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused.Spelling: norepinephrine.
I think it's worth remembering that all the "this neurotransmitter does this/that neurotransmitter does the that" is pretty speculative. In this case, you may be mistaking histaminergic activity for serotonergic, etc. The more important question is whether one drug works for you or not -- regardless of what biochemical system it targets. Even drugs in the same class can produce very different results -- such as Paxil versus Prozac. Yes, which neurortransmitter is targetted can be a good starting place, but it's not all there is to it.
Are you going to ask your doctor about options for your bladder?
Posted by Phillipa on October 29, 2007, at 11:45:16
In reply to Re: Not enough serotonin/Despiramine, posted by Racer on October 29, 2007, at 10:54:39
If you may have interstitial bladder problems this may help also pelvic floor excercises are recomended. Good luck. Phillipa
About Oral Medications
Some of the following oral medications are sold over-the-counter and others must be prescribed by a physician. As always, please remember that IC patients should make an extra effort to research these treatment alternatives, methods of action and the length of time required to see any results. Consultation with your personal care provider is essential.Bladder Coatings
Antidepressants: Elavil, Imiprimine
Antihistamines: Hydroxyzine (Vistaril & Atarax)
Antispasmodics: Anaspaz, Cystopas, Ditropan, Levsin, Levsinex, Urispas, Urised
Urinary Anaesthetics: Urised, Pyridium
Combination Therapies--------------------------------------------------------------------------------
Bladder Coating: ELMIRON (Sodium Pentosanpolysulfate):
In September of 1996, the IVAX Corporation received final approval from the FDA to immediately begin marketing ELMIRON®. This is the first oral drug developed and approved specifically for the treatment of IC and is now being distributed in the USA by Alza Pharmaceuticals. (DMSO is the only other FDA-approved drug for IC, but it is instilled directly into the bladder).
Over the years, ELMIRON® has been extensively discussed, studied and tested but much is still unknown about it. Dr. Lowell Parsons, a leading IC researcher who was instrumental in the development of ELMIRON®, believes it works by providing a protective coating to the bladder wall. He believes that some IC patients have a damaged or "leaky" bladder lining (epithelium). For those that do, the ELMIRON® coating appears to prevent urine, bacteria and other irritating substances from penetrating an otherwise "leaky" lining and causing inflammation in the muscle tissue.ELMIRON® is a white crystalline powder and comes in the form of capsules. The effective dose for ELMIRON® is 300 mg per day, taken either two or three times a day. ELMIRON® may take 3-6 months to work, and 6-12 months to work well by slowly rebuilding the GAG layer of the bladder (8). It may take more time to rebuild years of damage. Many doctors advise patients to give ELMIRON® at least a six month trial. Since ELMIRON® is thought to keep the bladder coated, it must be taken for the rest of the patient's life, or until a cure for IC is found.
Baker Norton conducted a very large physician use study in multiple centers across the USA. This trial enrolled 2,810 patients over a ten year period. One of the most comprehensive industry studies on IC, this may also be the longest IC treatment study to date. The data reveals that ELMIRON® patients showed a significant improvement during their course of treatment. The trial demonstrated that 42% of patients who had been treated for up to six months, and 60-62% of those treated for 24 months, had reported total, great or moderate relief of bladder pain. Of patients treated for six months, 55% had experienced a reduction in nocturia and 44% had reductions in frequency. Among patients who had no response to DMSO, more than 50% experienced moderate or better improvement when treated with ELMIRON® (8).
One of the benefits which ELMIRON® therapy can deliver is the elimination of the risk of infection that often accompanies catheterization and anesthesia. Some people experience side effects such as gastrointestinal upset or some hair loss. In some cases, your doctor may want to monitor your liver function through periodic blood tests while you are taking ELMIRON.®
Web Reference: Elmiron - USA
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--------------------------------------------------------------------------------
Tricyclic Antidepressants: ELAVIL & TOFRANIL
Elavil® (amitryptyline) is a tricyclic antidepressant that, in low doses, is effective at relieving chronic pain by interfering with nerve activity. It is commonly prescribed for several chronic pain conditions, including irritable bowel syndrome (IBS) and fibromyalgia, two conditions that many IC patients also have. Its strength as a long-term pain management strategy, an essential part of an IC tool kit, makes it helpful in treating IC. It also may inhibit bladder spasms.
Several studies have reported a positive response with amitriptyline (9,10). Hanno (11) reports that amitriptyline was quite effective for patients who had not responded to hydrodistention and DMSO. Amitriptyline has side effects which merit consideration prior to taking it, including dry mouth, drowsiness and, for some patients, cardiac arrhythmias (irregular heart rate) and tachycardia (rapid heart rate).Other antidepressants, such as Tofranil® (imiprimine), Prozac® and a host of others, may be options for physicians to consider. Amitriptyline, however, remains the most extensively tested medication of this type for IC.
Posted by tecknohed on October 29, 2007, at 13:52:20
In reply to Not enough serotonin/Despiramine, posted by Sheilac on October 29, 2007, at 9:16:13
Some tricyclics which inhibit norepinephrine/noradrenalin & serotonin (roughly) equally are:
Amitriptyline.
Doxepin.
Imipramine (also good for bladder problems, as Phillipa posted). Desipramine is also one of it's metabolites (in fact its a metabolite of a few tricyclics).However, as you seem to like the effects of desipramine, I personally would be very hesitant to change it. Adding something serotonergic (if you think thats what you really need) is probably a better option. Tryptophan has already been mentioned, or you could try 5-HTP. Trazodone might be worth adding at bedtime. But be carefull with these if you're still on Emsam (are you?) especially if on a high non-selective dose.
Posted by Sheilac on October 29, 2007, at 14:44:26
In reply to Re: Not enough serotonin/Despiramine » Sheilac, posted by tecknohed on October 29, 2007, at 13:52:20
> Some tricyclics which inhibit norepinephrine/noradrenalin & serotonin (roughly) equally are:
>
> Amitriptyline.
> Doxepin.
> Imipramine (also good for bladder problems, as Phillipa posted). Desipramine is also one of it's metabolites (in fact its a metabolite of a few tricyclics).
>
> However, as you seem to like the effects of desipramine, I personally would be very hesitant to change it. Adding something serotonergic (if you think thats what you really need) is probably a better option. Tryptophan has already been mentioned, or you could try 5-HTP. Trazodone might be worth adding at bedtime. But be carefull with these if you're still on Emsam (are you?) especially if on a high non-selective dose.
>
>No - I have been off Emsam for about 3 weeks. I'm not actually sure if I like Despiramine because I am depressed and it is making me fevered & sweaty at night. So, I stopped taking it. I feel suicidal without serotonin.
Posted by Polarbear206 on October 29, 2007, at 19:29:10
In reply to Not enough serotonin/Despiramine, posted by Sheilac on October 29, 2007, at 9:16:13
> I don't think that I was getting enough serotnin from either Emsam or Despiramine. Is there another tricylic that I should try that I could get more of a serotonin reaction?
>
> I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused.
>
> I can go back to taking an SSRI - but my bladder will spasm and hurt.
>
>What about effexor? It targets both.
PB
Posted by tecknohed on October 30, 2007, at 5:29:24
In reply to Re: Not enough serotonin/Despiramine, posted by Sheilac on October 29, 2007, at 14:44:26
>I'm not actually sure if I like Despiramine because I am depressed and it is making me fevered & sweaty at night. So, I stopped taking it. I feel suicidal without serotonin.
But you said at the start of the thread "I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused." But I'm NOT picking an argument with you, just trying to help.
I think that you may well do better on imipramine (if you can handle the side effects). It WILL raise your serotonin levels. Its even proved usefull for panic disorder for many years.
Venlafaxine (already mentioned by Polarbear206) is another option but you'll probably need to take 150mg-300mg+ daily to get a norepinephrine effect. Duloxetine might be better than venlafaxine, possibly needing a smaller dose.
Personally, I'd take tricyclics over SSRIs/SNRIs ANY DAY (and I've used a few tricyclics, all but one SSRIs, and venlafaxine at 300mg/day).
Posted by Polarbear206 on October 30, 2007, at 17:00:11
In reply to Re: Not enough serotonin/Despiramine » Sheilac, posted by tecknohed on October 30, 2007, at 5:29:24
> >I'm not actually sure if I like Despiramine because I am depressed and it is making me fevered & sweaty at night. So, I stopped taking it. I feel suicidal without serotonin.
>
>
> But you said at the start of the thread "I like that neuroepinephrine (spelling?)- it helps me lose weight and stay focused." But I'm NOT picking an argument with you, just trying to help.
>
> I think that you may well do better on imipramine (if you can handle the side effects). It WILL raise your serotonin levels. Its even proved usefull for panic disorder for many years.
>
> Venlafaxine (already mentioned by Polarbear206) is another option but you'll probably need to take 150mg-300mg+ daily to get a norepinephrine effect. Duloxetine might be better than venlafaxine, possibly needing a smaller dose.
>
> Personally, I'd take tricyclics over SSRIs/SNRIs ANY DAY (and I've used a few tricyclics, all but one SSRIs, and venlafaxine at 300mg/day).
>
>
Good suggestions from Technohead. Also, I had good results with Imipramine added with an ssri. Was on this combo for a long time before effexor came out.
Posted by Polarbear206 on October 30, 2007, at 17:02:48
In reply to Re: Not enough serotonin/Despiramine, posted by Polarbear206 on October 30, 2007, at 17:00:11
Posted by tecknohed on October 30, 2007, at 17:34:29
In reply to Oops, meant Tecknohed, sorry (nm), posted by Polarbear206 on October 30, 2007, at 17:02:48
Dont worry, EVERYONE seems to do that!
Or they call me 'tech' instead of 'teck'. Not bothered, really.
:)
Posted by Phillipa on October 30, 2007, at 20:05:02
In reply to Re: Oops, meant Tecknohed, sorry » Polarbear206, posted by tecknohed on October 30, 2007, at 17:34:29
Teck so you have no head having fun with you. Phillipa
Posted by tecknohed on October 30, 2007, at 20:17:26
In reply to Re: Oops, meant Tecknohed, sorry » tecknohed, posted by Phillipa on October 30, 2007, at 20:05:02
This is the end of the thread.
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