Posted by Mitch on July 12, 2001, at 23:58:55
In reply to Re: Going Crazy: Could it be Buspar????? Mitch, posted by AMenz on July 12, 2001, at 13:19:00
AMenz,
> I must say that the study left me perplexed as to how Buspar and SSRI's in combination could cause hypomania.
I don't think that Buspar per se is a *culprit* necessarily. I just think that the combo of Buspar+SSRI is a STRATEGY to treat people who are not showing a response to SSRi alone for UNIPOLAR depression. I just think the study shows that Buspar has a way of boosting other neurotransmitters that can help someone who is treatment-resistant for severe depression. SOMEONE WHO IS BIPOLAR SHOULD ALWAYS BE CAREFUL about what AD's they take and what agents are used to augment them. In my case I was just taking some Buspar to help reduce *anxiety* NOT to boost antidepressant response of the SSRi I was also taking.
>
> If when Buspar and SSRI's are administered conjointly the end result is that there is less serotonin potentiation (is this the right word?) than when SSRI is administered alone, I see no explanation for the concomitant hypomania, unless at least one of the following is true:
>
> (a) an increase in serotonin levels alone is not the cause of hypomania, {here serotonin was decreased but hypomania ensued].
>
> (b) the mimicking action creates an "as if" condition, so that the brain responds as if serotonin had increased, rather than decreased as is the case.
>
> c) Hypomania as you say is caused by the relative levels of the neurotransmitters as opposed to the absolute level to seratonin. One would then have to conclude that higher levels of NE and/or Dopamine relative to serotonin causes hypomania.This is a complex interaction between the SSRI and buspirone. It depends on the RELATIVE dose of EACH med and the person. Basically, I think it is the big boost in NE and DA that caused the irritability with me. You see I was taking a TINY dose of SSRi and added a NOT AS TINY dose of buspirone-so given my combination-I probably ended up with a NET decrease of serotonin (making me grouchy) and a BIG boost in NE and DA which made me all wired up. Which could be a magical response to someone resistant to treatment for pure depression.
>
> Well, I guess my frustration is that I simply do not see that my several practitioners understand any of these interactions any better than I do. At this point I don't think I am willing to try any further combinations of anything.I think you may be too pessimistic-although I understand your frustration!! This was just a *remarkable* combination in a bipolar person who is sensitive to AD's. There is an element of experimentation that has to take place to *find out* what is going to work for you and unfortunately at times what ISN"T going to work.
>
> I agree with you that the plethora of medication make it mathematically less probable that a particular combination that is favorable will be found. I've been thinking about this for quite a while.This possibly (hopefully!) could be a relatively short-term phenomenon until more selectively designed meds can come into the market (with the help of genomics).
>
> I also think that the continuous switching of medications and adjusting dosages willy nilly accounts for the worsening of symptoms with some patients (moi for instance) insofar as stasis is whats lacking in the brain of the bipolar. I cannot think of anything more destabilizing than ripping of Lithium, then conducting trials with Lamictal, Neurontin, Topomax in the space of less than six months.Some doctors want to get away from older more dangerous or toxic drugs such as Lithium, tricyclics, MAOI's for example. They might work for you, but what shape will your liver, kidneys, pancreas, etc. be in another 10 years?? Also, if you got very suicidal during a depressive episode (which say only lasted a few weeks) and chucked a bottle of Lithium or tricyclics and croaked-you wouldn't be around for a better future treatment would you??
>
> These people have done me a great disservice and they are not liable for malpractice in my state unless the damage they cause is permanent.
>
> I am really angry.This is a transitional period where doctors/patients/pharmaceutical co's are needing increased education and access to information to improve treatment. You have to remember that some of the meds that are just coming out have been under investigation for many years. I may sound a little apologetic for bad docs or greedy drug companies, but I am optimistic about the future of treatment. It is just a real thicket right now-and you are more likely to get bad medcombos for the time being until the pdocs catch up with and stay with all the new stuff.
Mitch
poster:Mitch
thread:69089
URL: http://www.dr-bob.org/babble/20010708/msgs/69935.html