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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Questionmark on April 26, 2013, at 0:16:15
If you're short on time or feeling impatient, skip the detailed crap between the asterisks. In summary it basically just says memantine has been good for my depression and SA/SP but possibly bad for my OCD-type stuff.
I have been on memantine for about 4 weeks. Started at 5mg for a week, then 10, and now 15mg for about 2 wks.*******
All these emotional and psychological processes are complex -- far more than is justified by saying "depression" or "anxiety." But to be concise, I'll say that so far it has helped quite significantly with depression and certain depressive ways of thinking. It has also been subtly but tremendously helpful for anxiety, particularly SA and discomfort.
However, for the main "condition" or set of issues I take it for -- those falling under the umbrella of pathologically perfectionistic OCD/OCPD (e.g. extreme indecisiveness, uncontrollable and grossly excessive thoroughness in all tasks, time management problems, hyper-focus and extreme interest/curiosity in certain subjects to the point of devouring obscene quantities of time, etc.) -- it has been slightly helpful in some ways, but dreadfully detrimental in many other ways and possibly overall. The constant thinking about certain things, hyper-focus, and overpowering extreme excessive interest & curiosity in certain subjects (e.g., things relating to politics; psychology; philosophy; psychopharmacology) seems to have gotten much worse. (It's hard to say as it was already so bad when not depressed.) Also the perfectionistic and overly thorough behavior seems to have gotten even worse. But certain other things seem to have somewhat improved: negative ruminating over things I can't change, overly critical self-judgement. ... Dammit. Anyway...
*******
I am quite concerned about memantine's D2 agonist activity and the sort of side effects that may occur as a result of this, particularly in terms of cognitive and behavioral side effects, and even more especially in terms of its potential effects on obsessive-compulsive types of thinking and behavior. It would help too if I could determine its affinity for this receptor in comparison to the NMDA receptor, but I have not been able to find this.
... I have scoured the internet -- in both study abstracts and various discussion boards -- trying to find any input (opINions even) on the significance of memantine's D2 agonism, or even its affinity for it, yet have found almost nothing. I don't understand it.
So, if anyone could help me with any of these questions, I would GREATLY appreciate it.I mean, there's all this talk about memantine being potentially good for OCD or obsessive-compulsive type issues due to its effect on certain NMDA receptors, yet there is NO talk about its effect on the D2 receptor and its potential consequences! What is going on here?? Isn't D2 agonism often associated with a significant increase in obsessive thinking and compulsive behavior??
I'm also concerned about my D2 receptors being significantly downregulated while taking a medication that I'm not even USing for its D2 activity! .. Memantine is a fairly dirty drug in terms of pharmacological activity (tho pretty clean in its effects). Yet no one seems to talk about this.
Please help me sort all this out if possible.Oh, and finally, I am very concerned about potential effects on appetite and weight (as I'm sure many others would be, tho usu for opposite reasons). I cannot afford to lose any more weight or have a weaker appetite than I already do. Has anyone who has tried this noticed any differences in appetite or weight gain/loss? This is another concern I have w the D2 agonism, as I would guess this could cause a reduction in appetite.
Otherwise, however, the drug seems to be very benign in terms of side effects, at least up to 15mg/day. The only other things I would mention are that my insomnia seems to have been exacerbated pretty badly (even more so), and there might be a minor decrease in bowel motility.
Sorry for the long post, and thank you so much for any guidance.
Posted by Questionmark on April 26, 2013, at 0:31:07
In reply to Memantine: Remarks and Questions, posted by Questionmark on April 26, 2013, at 0:16:15
In case anyone's curious, I am also on Nardil, 37.5mg/day (a sub-par dose, but I have been forcing myself to stay below 45mg, for better or worse, stupidly or wisely, due to various concerns about side effects and long-term CNS and neuro-endocrine effects). I was at 45mg for awhile years ago, but dropped down and tried to stay below there. Quite possibly a very detrimental decision in retrospect, but since I stuck with it I didn't want to go back. Plus the effectiveness/side effect ratio grew worse (possibly from my frequent tweaking of dose).
ANYway, that's for another thread. Just wanted to mention in case it's relevant or helpful -- and elaborated in order to head off any confusion or questions (about the Nardil).
I also frequently take zolpidem or zaleplon at night for sleep (and caffeine upon waking), but that is all.Questions welcomed; advice appreciated.
Posted by g_g_g_unit on April 28, 2013, at 22:47:04
In reply to Memantine: Remarks and Questions, posted by Questionmark on April 26, 2013, at 0:16:15
I don't have any sources to back me up, but I recall being informed that Memantine was a weak D2 agonist in comparison to its other receptor affinities.
Regardless, when you reach an empirical conclusion (i.e. that it seems to be worsening your condition), does it matter which receptor might/might not be responsible?
For what it's worth, Memantine yielded me a net increase in mental energy and stamina, but also drastically increased OC activity.
Posted by Questionmark on May 1, 2013, at 3:14:32
In reply to Re: Memantine: Remarks and Questions » Questionmark, posted by g_g_g_unit on April 28, 2013, at 22:47:04
Thanks for response. .. The one study/abstract on the matter concludes or stated that the affinity for D2 is about equal to that of its affinity for the NMDA receptors.
> I don't have any sources to back me up, but I recall being informed that Memantine was a weak D2 agonist in comparison to its other receptor affinities.
>
> Regardless, when you reach an empirical conclusion (i.e. that it seems to be worsening your condition), does it matter which receptor might/might not be responsible?
>
> For what it's worth, Memantine yielded me a net increase in mental energy and stamina, but also drastically increased OC activity.
Posted by g_g_g_unit on May 1, 2013, at 4:46:21
In reply to Re: Memantine: Remarks and Questions, posted by Questionmark on May 1, 2013, at 3:14:32
No problem. It's kind of a pity, since Memantine seems to be testing so well for OCD and OC-spectrum type disorders (at least if the scattering of studies on Pubmed are anything to go by). I was really hoping it might be my silver bullet. Being an outlier sucks.
Just out of curiosity - I also suffer from a rather severe perfectionistic streak (in addition to out-and-out OCD) and have been contemplating a Nardil trial. I was on Parnate for 6 months last year and it helped depression and cognition, but worsened my anxiety. Has Nardil had any beneficial impact on your condition?
Posted by Questionmark on May 4, 2013, at 0:41:40
In reply to Re: Memantine: Remarks and Questions » Questionmark, posted by g_g_g_unit on May 1, 2013, at 4:46:21
It's an exTREMe pity, and disappointment. Maybe for some it can be beneficial for OC-type problems though, I don't know.
Reg. your question, it's difficult to answer. These things are so complicated. ... I mean, in some ways there is sort of an inverse correlation for me between depression and my perfectionistic, OCD/OCPD-type problems (at least behaviorally, if not psychologically). When my depression is worse, I care less about things, have less desire -- things like that -- and therefore my perfectionistic compulsive behavior is reduced in many ways. I have major problems with "all-or-nothing" thinking and behavior, and so the more depressed I am the more my behavior shifts to the "nothing" end of the spectrum.
Anyway the point is, Nardil was profoundly helpful for my depression overall, and as a consequence I started caring a lot more about things, and so my compulsive behavior in many ways increased (say, getting ready for the day and trying to make my appearance "good enough" for example, rather than being too depressed to spend as much time & energy on that).
But Nardil is very serotonergic feeling and just very beneficial mood-wise, so it does also help me care much less about many things that would otherwise deeply bother me. Or i.e., my disappointment/bother when things are "imperfect" is also greater when depressed, and vice versa.So it is really difficult for me to say one way or the other how Nardil is for OCD and O-C perfectionistic problems. And I have analyzed this question quite a bit over the years. (My issues are so complex and multi-dimensional and overlapping though, so maybe another person with more straightforward OCD (so-to-speak) could answer better.)
Nardil is *much* better than Parnate for anxiety though, in my opinion (or for me and I would guess most people), so I would definitely consider giving it a try. Parnate and Nardil are very, very different drugs, despite unfortunately being lumped together so often since they're both MAOIs. Nardil is much more serotonergic, and also has the moderate GABA increasing properties (from its metabolite) that Parnate lacks.
But you know, hypothesizing based on pharmacology only goes so far. With something novel, one has to try it to really know how they will be affected. I really saw this again with my memantine trial.But I will say this. Sadly, nothing has really helped my hyper-perfectionistic OCD-type problems significantly (without just making me nonfunctional otherwise of course-- like say being sedated or something). Nothing.
Nevertheless, Nardil was a wonderful gift. .. Far from perfect obviously. It doesn't take away the problems of life -- which are many. And the side effects can be quite bothersome, libido side effects especially. But it can be *profoundly* helpful.
With responsible caution and measured expectations, I would strongly recommend it to anyone who has serious mood and anxiety problems.
> No problem. It's kind of a pity, since Memantine seems to be testing so well for OCD and OC-spectrum type disorders (at least if the scattering of studies on Pubmed are anything to go by). I was really hoping it might be my silver bullet. Being an outlier sucks.
>
> Just out of curiosity - I also suffer from a rather severe perfectionistic streak (in addition to out-and-out OCD) and have been contemplating a Nardil trial. I was on Parnate for 6 months last year and it helped depression and cognition, but worsened my anxiety. Has Nardil had any beneficial impact on your condition?
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