Posted by yxibow on March 8, 2008, at 3:13:27
In reply to Re: Which is the *Best*? » tensor, posted by Jamal Spelling on March 4, 2008, at 7:41:29
> I expressed an interest to my doctor to augment Cymbalta with a low dose of an AP. These were the options we discussed:
>
> (i) flupenthixol (Fluanxol): a typical AP, it carries the risk of TD. It has motivating properties.
>
> (ii) olanzapine (Zyprexa): very effective, but too expensive and weight gain is going to be a problem w.r.t. diabetes and hypertension.For some, and this can be monitored with excercise and diet if this is a needed choice
> (iii) amisulpride (Solian): an atypical AP, it is, like flupenthixol, motivating. However, she says there are cardiovascular concerns, so I would have to go for regular ECGs.
QTc and torsades de pointes have occurred with Mellaril also. Its a hit and miss and varies with the individual, but prudency would say that getting tested every so often for a drug with that profile is probably a good thing.
> (iv) quetiapine (Seroquel): for the treatment of depression, this is currently her favourite. It is atypical, and has a reasonable risk profile. The main problem is that many find it sedating, and reading some posts on Psycho-Babble, I see many also complain that it flattens their mood.
>
> As for an AP with a benign side-effect profile, it does - unfortunately - not exist. APs are amongst the big guns of psychiatry, and they all have their own problems. At the low doses that one would use for depression, side-effects are less likely and less severe, but they still exist. Nature did not intend for dopamine receptors to be blockaded.
We are not born 100% perfect. But I can't have a nature vs. nurture argument. I know that there is some dopaminergic component of my current disorder, most likely, and certainly serotonergic. -- from being born with a disposition towards biological ilnesses, which most all mental illnesses are.
The risks of TD are now assesed about 5% per year in total for all typicals up to about a maximum of 25% over an unknown amount of time. With atypicals, Seroquel (and Zyprexa) are the safest agents at 0.1%Amisulpride and Sulpiride are not technically atypicals. Amisulpride acts more as an atypical with its side effect profile. Sulpiride has a very high affinity for D2 but not the same affinities for 5HT as atypicals usually do.
I would say the safest augmenting agents for SSRIs would be Seroquel first and Zyprexa possibly, at a low but clinical dose (100-200mg). As for Cymbalta, I took Seroquel along with it when I was using it, but that was for an unusual disorder and not so much for augmentation. But still Cymbalta having as much as a 6:1 SE to NE affinity, I would imagine it would function somewhat like an SSRI augmentation.
-- tidings
poster:yxibow
thread:816086
URL: http://www.dr-bob.org/babble/20080303/msgs/816829.html