Posted by Bastiat on October 12, 2013, at 22:43:12
In reply to Re: Agomelatine and Tranylcypromine for OCD, posted by yearism on September 23, 2013, at 16:57:51
> > > A 5-ht2c antagonist could theoretically increase OCD like behavior. Although fluoxetine is a 5-ht2c antagonist, it is also a SSRI. In other words, the net effect is 5-h5t2c agonism (I believe). Most SSRIs are 5-ht2c agonists, and there are case reports of drugs like cyproheptadine (combined 5-ht2a/c antagonists) causing relapse in OCD patients on SSRIs. Also, there are reports of 5-ht2a/c agonists like tryptamine, mescaline etc. rapidly improving OCD symptoms.
> > >
> > > Another (theoretical) possiblility is potentiation of 5-ht1a mediated neurotransmission and possible serotonin syndrome. If you haven't experienced this yet, the risk seems low. However, since certain sertonergic antagonists (like antipsychotics) can increase 5-ht1a mediated effects when combined with SSRIs, the risk with combination with agomelatine is a possbililty.
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> > > You might find that simply taking periodic breaks from the agomelatine (or reducing the dose) is sufficent to regain the anti-ocd effect.
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> > > Linkadge
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> > I am confused. Why use agomelatine (which I am trying with some problems like short sleep, nightmares, etc.) if fluoxetine is also a 5-ht2c antagonist?. Is it because of the side effects?
> >
> > Fluoxetine looks like escitalopram+agomelatine and much cheaper. Why are we taking newer and expensive drugs?.
> >
> > Thanks
>
> this is all wrong.mcpp which is a typical 5ht2c agonists is used in challenging studies for ocd.ssris dont show an agonist effect on serotonergic receptors.conversely,it has antagonistic effects on ser. receptors in long-term.serotonergic agonism doesnt always mean good clinical results.please read to learn the reliable sources in a careful way!I have a hard time with your statement that in the long-term SSRIs have antagonistic properties on 5-HT receptors. This is vast oversimplification; SSRIs probably do cause down-regulation of some serotonin receptors in the long-term but the truth is we don't actually know the precise mechanism.
However, I also have a hard time seeing how 5-HT2C receptor antagonism would worsen OCD. If anything it should help with OCD but definately not worsen it. Perhaps you are confusing 5-HT2C with 5-HT2A since 5-HT2A receptor agonist (such as psychedelics like psilocybin and LSD) actually have shown relief of OCD. One could argue however that psychedelics also agonize 5-HT2C but the truth is their affinity at 5-HT2C is much less pronounced. I strongly believe that 5-HT2A agonism likely can help reduce OCD but strongly disagree with the statement that 5-HT2C antagonism would worsen it.
Keep in mind that most of this is highly theoretical speculation and the brain is an insanely complex system that happens to have a vastly different structure between individuals.
poster:Bastiat
thread:980414
URL: http://www.dr-bob.org/babble/20130930/msgs/1052098.html