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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 former poster on September 27, 2015, at 23:45:20
Why don't Doctors prescribe Savella (Milnacipran) for social anxiety?
"Conditioned fear stress (CFS)-induced freezing behavior has been proposed as an animal model of anxiety especially social anxiety. CFS-induced freezing is attenuated by the acute administration of milnacipran as well as the SSRIs, citalopram and fluvoxamine, whereas the selective NE reuptake inhibitor, maprotiline, was inactive (Hashimoto et al 1996). These results suggest an important role for the facilitation of 5-HT neurotransmission in the reduction of CFS-induced freezing behavior. A study in an analogous model in mice showed similar results with milnacipran and fluvoxamine inhibiting conditioned fear stress induced freezing behavior to a similar extent (Miyamoto et al 2004)."
Posted by SLS on September 28, 2015, at 7:23:12
In reply to Savella good for social anxiety study says:, posted by former poster on September 27, 2015, at 23:45:20
> Why don't Doctors prescribe Savella (Milnacipran) for social anxiety?
>
> "Conditioned fear stress (CFS)-induced freezing behavior has been proposed as an animal model of anxiety especially social anxiety. CFS-induced freezing is attenuated by the acute administration of milnacipran as well as the SSRIs, citalopram and fluvoxamine, whereas the selective NE reuptake inhibitor, maprotiline, was inactive (Hashimoto et al 1996). These results suggest an important role for the facilitation of 5-HT neurotransmission in the reduction of CFS-induced freezing behavior. A study in an analogous model in mice showed similar results with milnacipran and fluvoxamine inhibiting conditioned fear stress induced freezing behavior to a similar extent (Miyamoto et al 2004)."
>
> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654524/I don't mean to be trite, but mouse studies don't always generalize to humans. That's why clinical studies in humans and anecdotes reveal the true worth of a substance. Effexor has demonstrated efficacy in GAD and SAD in humans. If Effexor doesn't work and you are committed to trying Savella (milnacipran), you might want to take a look at Fetzima (levomilnacipran), a Savella isomer. I would go with Fetzima if you find evidence that it is better for depression. I couldn't find any studies offering direct comparisons. It is supposed to be more effective for depression according to some sources, though. I don't know if that can be generalized to SAD, but I think it's a good bet. If that doesn't work, there is always Nardil and Paxil.
- Scott
Posted by former poster on September 28, 2015, at 21:19:39
In reply to Re: Savella good for social anxiety study says: » former poster, posted by SLS on September 28, 2015, at 7:23:12
Scott.. You seem to be having quite a robust response to Brintellix. Great news! Any problems with insomnia? Weird dreams?
Fetzima has replaced the off label use of Savella for depression (in USA). Now I can't get a prescription for Savella unless it is for fibromyalgia. Savella actually improves sleep where Fetzima causes insomnia. Fetzima's sexual side effects are around 10%, about as bad as it gets. Sad news because I believe it is very good AD.
I usually respond well to norepinephrine agonists so Effexor is on my list of meds to
try.
Posted by Lamdage22 on September 29, 2015, at 11:44:22
In reply to Re: Savella good for social anxiety study says: » SLS, posted by former poster on September 28, 2015, at 21:19:39
I thought you dont take Brintellix, Scott???
You are wondering wether to withdraw from Parnate. Is SSRI + Nortriptyline a good idea?
Posted by SLS on September 29, 2015, at 15:29:22
In reply to Re: Savella good for social anxiety study says:, posted by Lamdage22 on September 29, 2015, at 11:44:22
> I thought you dont take Brintellix, Scott???
I wasn't too crazy about how Brintellix looked on paper. Previously, I had failed to respond robustly to Viibryd, and switched back to high-dose Parnate. Since then, Brintellix was approved, but I need to see enough clinical success with it to entertain the idea of coming off of Parnate again.
Some TRD people have reported a miraculous improvement while taking Brintellix. Brintellix binds to a lot of serotonin (5-HT) receptors as well as inhibiting the reuptake of serotonin. 5-HT7 antagonism and 5-HT1a full agonism have captured my interested, only because I have never taken a drug with these properties. I would, of course, need to discontinue Parnate to avoid serotonin syndrome, but I would keep taking everything else.
> You are wondering wether to withdraw from Parnate. Is SSRI + Nortriptyline a good idea?
Nortriptyline goes well with SSRI and SNRI.
Wellbutrin goes well with SSRI and SNRI
Remeron goes well with SSRI and SNRI.I have seen nortriptyline, Wellbutrin, and Remeron act more potently when added to SNRIs than to SSRIs. These are just my impressions from personal observation of others and myself.
I am not so sure about taking combinations of nortriptyline, Wellbutrin and Remeron in the absence of SSRI, SNRI, and MAOI.
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Excerpted from Brintellix (vortioxetine) prescribing information:
"12 CLINICAL PHARMACOLOGY12.1 Mechanism of Action The mechanism of the antidepressant effect of vortioxetine is not fully understood, but is thought to be related to its enhancement of serotonergic activity in the CNS through inhibition of the reuptake of serotonin (5-HT). It also has several other activities including 5-HT3 receptor antagonism and 5-HT1A receptor agonism. The contribution of these activities to vortioxetines antidepressant effect has not been established.
12.2 Pharmacodynamics Vortioxetine binds with high affinity to the human serotonin transporter (Ki=1.6 nM), but not to the norepinephrine (Ki=113 nM) or dopamine (Ki>1000 nM) transporters. Vortioxetine potently and selectively inhibits reuptake of serotonin (IC50=5.4 nM). Vortioxetine binds to 5-HT3 (Ki=3.7 nM), 5-HT1A (Ki=15 nM), 5-HT7 (Ki=19 nM), 5-HT1D (Ki=54 nM), and 5-HT1B (Ki=33 nM), receptors and is a 5-HT3, 5-HT1D, and 5-HT7 receptor antagonist, 5-HT1B receptor partial agonist, and 5-HT1A receptor agonist. In humans, the mean 5-HT transporter occupancy, based on the results from 2 clinical PET studies using 5-HTT ligands ([ 11 C]-MADAM or [ 11 C]-DASB), was approximately 50% at 5 mg/day, 65% at 10 mg/day and approximately 80% at 20 mg/day in the regions of interest."
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- Scott
Posted by former poster on September 30, 2015, at 14:24:49
In reply to Re: Savella good for social anxiety study says: » Lamdage22, posted by SLS on September 29, 2015, at 15:29:22
I'm still having abnormal dreams/sleep that started with my Brintellix trial. It's been about 3 weeks since I quit it.
Sad that we don't all don't respond the same.
Posted by bleauberry on October 2, 2015, at 13:59:31
In reply to Savella good for social anxiety study says:, posted by former poster on September 27, 2015, at 23:45:20
I strongly disagree with animal testing models which then try to superimpose the subjective results onto human beings. But that's another topic enough for a whole book.
That said, yes, I can speak from experience, Savella was excellent for social skills.
Common mistakes made with the med, in my opinion, are dosing too high. I think even the smallest dose is too much for some people. My best dose was 1/4 of the smallest dose available. I was improved in significant ways at that dose, but worsened severely at higher doses.
Savella can cause increased anxiety, rage, or aggression in the early days or weeks. It is after all increasing the adrenaline side of things. A dose too high can do that too.
But as it kicks in and things begin to down regulate and the feedback loops start to wake up and do their job, calm and peace set it. It doesn't make sense that an adrenaline-like drug would calm things down, but I believe it is because the feedback loops sense all the extra norepinephrine and turn the production and firing down.
People in the Savella clinical studies, some of them were given very high doses, up to 200mg. Some of them said the over stimulation thing was there for months, but eventually went away. That's why I favor small doses....same effect, far easier, way faster.
I recall folks here who tried Savella and didn't stay with it. In 100% of those cases, it is because they went to high doses fairly quickly and then bailed out too soon. Everyone responds differently, and everyone manages their doses differently.
I am overall not a fan of psych drugs. But a short list of ones I favor and recommend include:
Savella
Prozac
Zoloft
Zyprexa
Abilify
Parnate
Nortrityline
LDN (low dose Naltrexone)
Ritalin
Any combo of above
Posted by former poster on October 5, 2015, at 12:30:15
In reply to Re: Savella good for social anxiety study says:, posted by bleauberry on October 2, 2015, at 13:59:31
Thank you for that valuable input bleauberry. I'm glad I'm not the only one that responds to savella favourably. Amazing how some highly effective meds are ignored and thrown into the abyss of ignorance.
This is the end of the thread.
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