![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 54. Go back in thread:
Posted by MB on July 13, 2001, at 13:37:14
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 12, 2001, at 19:02:14
> > Doesn't Meridia work on Serotonin?
>
> It's a serotonin-norepinephrine reuptake inhibitor, just like Effexor. It even resembles venlafaxine structurally There's no reason it wouldn't be just as good an AD as EffexorThe excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that). But, if they can solve that problem with Wellbutrin by making SR, they could have solved it with sibutramine also (couldn't they have?)
> it wasn't marketed for this indication because the market for ADs was already saturated.
That sounds more plausible.
> But in early literature on sibutramine, it's referred to as an "antidepressant," not as a weight loss aid. (I would bet that it's a crappy diet pill, BTW. < g >) =Well, there must be something more to it; it's scheduled as a class IV, isn't it?
> > It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain.
>
> Well, they're strong antihistamines too (hence the sedation). Do "typical" antipsychotics block the 5HT-2c receptor? Or is weight gain from these drugs attributed solely to the H1 blocking?The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine). I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
> I'll take a look at that site.
>
> > in fact, I think the guy stated that this was the puted mechanism of Meridia.
>
> (You mean "putative," right?" I'm skeptical of that, since no other mechanisms have been IDed for Meridia besides monoamine reuptake inhibition, AFAIK.)Uh...yeah...putative. Sometimes I accidently make up new words (LOL!) When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition. I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
> BTW, SSRIs and Effexor don't "make people fat" across the board, and it's not clear that it's even a majority side effect. The people who gain weight are the ones who complain. As I mentioned, I took Prozac for between two and three years, and I didn't gain weight beyond my baseline weight *or* regain the weight that I'd lost while depressed.
Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative). Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
> > I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed.
>
> Perhaps you have two different problems going on at the same time. I think this might be what's happening with me (although I have fewer and subtler "atypical" symptoms).
>
> > That would go against an atypical dx, wouldn't it?
>
> Yes, but the subtypes haven't been defined perfectly yet. Constructing subtypes based on medication response is simply the most pragmatic way to go about doing clinical research until we have a better understanding of how the brain works (and how it malfunctions).I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g > Like you said, it seems that the best that doctors can do is to classify based on medication response. So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls (I assume that the axial nexus would be "normalcy," whatever *that* is).
> > Yeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
>
> People do tend to get heavier as they age. I easily lost all the weight I gained on Nardil -- I call it "the depression diet" -- but because I switched directly to Parnate, the weight from Marplan hasn't gone away completely. Losing weight is *hard*.
>
> -elizabeth(losing weight is hard)
Amen to that!Peace,
MB
Posted by DebbieLynn on July 13, 2001, at 22:49:08
In reply to Re: Weight gain and SSRIs - Metabolife? » TomV, posted by Elizabeth on July 12, 2001, at 19:06:36
> > Is it safe to combine Metabolife, or another similar "supplement" to Celexa?
>
> I *think* that the main active ingredient in Metabolife is ephedrine (similar to Sudafed, but less reliable). Ephedrine is a weak stimulant related to amphetamine, and it won't work long-term. Personally, if I were going to use stimulants as appetite suppressants, I'd go with phentermine, phendimetrazine, or some such.
>
> But yeah, it's safe with SSRIs, so far as I'm aware (don't use it with MAOIs and use caution with TCAs). Ask your doctor to be sure. I think that Celexa has fewer drug-drug interactions than other SSRIs (Prozac and Paxil in particular) due to more metabolic pathways.
>
> -elizabeth
I hate to butt in here, I was specifically told by my doctor to stay away from metabolife. I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
I am currently in nursing school, going into psychiatric nursing. I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs! Thanks for the info. I am going to restrict them to see what happens!Good Luck!
Debbie
Posted by Elizabeth on July 15, 2001, at 17:50:09
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 13, 2001, at 13:37:14
> The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.
> Well, there must be something more to it; it's scheduled as a class IV, isn't it?
Yeah. Totally ridiculous.
> The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.
> I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
They also help with negative symptoms, which are largely untouched by the older drugs.
> Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
Me too.
> When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
Ahh, ok. That's a looser use of the term "agonist."
> I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.
> Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
I'm sure that accounts for some of it. But I don't think that's all.
> Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
(Man, that sucks!)
Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.
> I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.
> Like you said, it seems that the best that doctors can do is to classify based on medication response.
Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
I think it's a little of both.
> (I assume that the axial nexus would be "normalcy," whatever *that* is).
< g >
-elizabeth
Posted by Elizabeth on July 15, 2001, at 17:56:08
In reply to Re: Weight gain and SSRIs - Metabolife?, posted by DebbieLynn on July 13, 2001, at 22:49:08
> I hate to butt in here,
IMO, there's no such thing as butting in. It's a public forum, and exchanging ideas is what it's here for, right?
> I was specifically told by my doctor to stay away from metabolife.
Well, OTC "herbal food supplements" (i.e., drugs that are sold without being FDA-approved) are notoriously unreliable. So I can see where your doctor is coming from.
> I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
You know, any effective drug has side effects. If a drug doesn't have side effects, it often seems to turn out that it doesn't do anything at all. (I'm thinking of the non-drowsy antihistamines here. They aren't *completely* ineffective, but they're pretty lousy compared to Benadryl or Atarax or ChlorTrimeton.)
> I am currently in nursing school, going into psychiatric nursing.
Cool! Good luck with it. I think it's great when people who have personal experience with depression, anxiety, mania, psychosis, etc. go into mental health professions.
> I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs!
Nothing to be ashamed of. < g > That happened to me on the hydrazine-type MAOIs (Nardil and Marplan) -- I was constantly obsessing about food, especially sweets. Weird stuff.
-elizabeth
Posted by MB on July 16, 2001, at 1:22:19
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 15, 2001, at 17:50:09
> > The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
>
> Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.Hmmm...I wonder what he was talking about, then. Have you had a chance to watch that video about the metabolic effects of atypical antidepressants? I may not of completely grasped what he was saying about sibutramine. I would be interested to hear your feedback on the lecture.
> > Well, there must be something more to it; it's scheduled as a class IV, isn't it?
>
> Yeah. Totally ridiculous.The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
> > The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
>
> FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.I think some people can actually *lose* weight on Moban!
> > I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
>
> They also help with negative symptoms, which are largely untouched by the older drugs.Negative symptoms...like flat affect, etc?
> > Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
>
> Me too.heh heh heh...
> > When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
>
> Ahh, ok. That's a looser use of the term "agonist."> > I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
>
> I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
> > Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
>
> I'm sure that accounts for some of it. But I don't think that's all.
>
> > Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
>
> (Man, that sucks!)
>
> Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
> > I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
>
> No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.yeah, I was just being a smart allec (sp?) :-)
but kinda serious at the same time...I think treatment plans need to be highly individualized> > Like you said, it seems that the best that doctors can do is to classify based on medication response.
>
> Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!That's kinda funny...but if it works and helps people get well...why not use that definition?
> > So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
>
> I think it's a little of both.It's a partical, it's a wave, it's...
> > (I assume that the axial nexus would be "normalcy," whatever *that* is).
>
> < g >
>
> -elizabeth
Posted by Elizabeth on July 16, 2001, at 18:31:45
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 16, 2001, at 1:22:19
> > Sibutramine is very long-acting -- you'd only have to take it once a day.
>
> Hmmm...I wonder what he was talking about, then.Hmmm back atcha. < g > I'm looking at the PI, and it seems that I was wrong about the elimination half-life (it's only an hour or so). It might be that (like other diet pills) it mainly works in the first few weeks (at most) so steady-state levels aren't an issue. The recommended dosing schedule is once daily.
> Have you had a chance to watch that video about the metabolic effects of atypical antidepressants?
Which video? Did I miss something?
> The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
My guess: because it's marketed as a diet pill and because some of the preclinical trials showed signs of abuse potential in animal models. There are always some false positives in those models, though.
> I think some people can actually *lose* weight on Moban!
If only in virtue of having gotten off of other antipsychotic drugs.
Moban did something totally weird to me when I tried it. I wasn't asleep (I was taking it for insomnia), but I was totally immobilised. Not comfortable!
> Negative symptoms...like flat affect, etc?
Yes.
> It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
I think that "d'oh!" is the appropriate expression here.
> No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)
> I think treatment plans need to be highly individualized
That's true. Everybody's different. (I don't think this is unique to psychiatry.)
> > Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
>
> That's kinda funny...but if it works and helps people get well...why not use that definition?That's mostly my general feeling, too.
-elizabeth
Posted by DebbieLynn on July 16, 2001, at 22:36:29
In reply to Re: Weight gain and SSRIs - Metabolife? » DebbieLynn, posted by Elizabeth on July 15, 2001, at 17:56:08
> > I hate to butt in here,
>
> IMO, there's no such thing as butting in. It's a public forum, and exchanging ideas is what it's here for, right?
>
> > I was specifically told by my doctor to stay away from metabolife.
>
> Well, OTC "herbal food supplements" (i.e., drugs that are sold without being FDA-approved) are notoriously unreliable. So I can see where your doctor is coming from.
>
> > I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
>
> You know, any effective drug has side effects. If a drug doesn't have side effects, it often seems to turn out that it doesn't do anything at all. (I'm thinking of the non-drowsy antihistamines here. They aren't *completely* ineffective, but they're pretty lousy compared to Benadryl or Atarax or ChlorTrimeton.)
>
> > I am currently in nursing school, going into psychiatric nursing.
>
> Cool! Good luck with it. I think it's great when people who have personal experience with depression, anxiety, mania, psychosis, etc. go into mental health professions.
>
> > I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs!
>
> Nothing to be ashamed of. < g > That happened to me on the hydrazine-type MAOIs (Nardil and Marplan) -- I was constantly obsessing about food, especially sweets. Weird stuff.
>
> -elizabethHi again!
The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
What do you think? I have had success with phentermine in the past!
Thanks for replying!
Debbie
Posted by MB on July 17, 2001, at 2:12:39
In reply to Meridia stuff » MB, posted by Elizabeth on July 16, 2001, at 18:31:45
> > > Sibutramine is very long-acting -- you'd only have to take it once a day.
> >
> > Hmmm...I wonder what he was talking about, then.
>
> Hmmm back atcha. < g >Shall we just hummm a tune... ;-)
> I'm looking at the PI, and it seems that I was wrong about the elimination half-life (it's only an hour or so). It might be that (like other diet pills) it mainly works in the first few weeks (at most) so steady-state levels aren't an issue. The recommended dosing schedule is once daily.
>
> > Have you had a chance to watch that video about the metabolic effects of atypical antidepressants?
>
> Which video? Did I miss something?Try this link:
http://www.mentalhealth.ucla.edu/cgi-bin/av-npi?gr010123jmB
or go here and scroll down to "Metabolic Effects of Atypical Antipsychotics"
http://www.mentalhealth.ucla.edu/opce/gr.html
I thought it was really interesting
> > The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
>
> My guess: because it's marketed as a diet pill and because some of the preclinical trials showed signs of abuse potential in animal models. There are always some false positives in those models, though.If I were a rat, I'd hit the damned lever too!! Oh, wait, I *am* a rat...but not that kind...
> > I think some people can actually *lose* weight on Moban!
>
> If only in virtue of having gotten off of other antipsychotic drugs.
>
> Moban did something totally weird to me when I tried it. I wasn't asleep (I was taking it for insomnia), but I was totally immobilised. Not comfortable!Thorazine did that to me. I was young and dumb and thought it could be taken recreationally...one of my dumber moments. I could move my eyes around, but couldn't move my body. Very un-fun.
> > Negative symptoms...like flat affect, etc?
>
> Yes.
>
> > It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
>
> I think that "d'oh!" is the appropriate expression here.
>
> > No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
>
> That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)How close do you think we are now? It seems like so many advances have been made in the past decade alone.
> > I think treatment plans need to be highly individualized
>
> That's true. Everybody's different. (I don't think this is unique to psychiatry.)
>
> > > Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> >
> > That's kinda funny...but if it works and helps people get well...why not use that definition?
>
> That's mostly my general feeling, too.
>
> -elizabeth
Posted by Zo on July 17, 2001, at 19:41:08
In reply to Re: Weight gain and SSRIs - Metabolife? Elizabeth, posted by DebbieLynn on July 16, 2001, at 22:36:29
> The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
>
> What do you think? I have had success with phentermine in the past!
>
> Thanks for replying!
> DebbieNo problems with that combo here. Bias against phentermine?
Zo
Posted by Elizabeth on July 18, 2001, at 0:22:39
In reply to Re: Weight gain and SSRIs - Metabolife? Elizabeth, posted by DebbieLynn on July 16, 2001, at 22:36:29
> Hi again!
'Ay.
> The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
-elizabeth
Posted by Elizabeth on July 18, 2001, at 0:25:43
In reply to Re: Meridia stuff » Elizabeth, posted by MB on July 17, 2001, at 2:12:39
> If I were a rat, I'd hit the damned lever too!! Oh, wait, I *am* a rat...but not that kind...
But do you press levers?
> Thorazine did that to me. I was young and dumb and thought it could be taken recreationally...one of my dumber moments.
D'oh!
> > That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)
>
> How close do you think we are now?Not very.
> It seems like so many advances have been made in the past decade alone.
More like the past 50 years, I'd say.
-e
Posted by DebbieLynn on July 18, 2001, at 6:42:24
In reply to Re: phentermine and Effexor » DebbieLynn, posted by Elizabeth on July 18, 2001, at 0:22:39
> > Hi again!
>
> 'Ay.
>
> > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
>
> They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
>
> -elizabethMy blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
Debbie
Posted by MB on July 18, 2001, at 10:47:01
In reply to Re: phentermine and Effexor, posted by DebbieLynn on July 18, 2001, at 6:42:24
> > > Hi again!
> >
> > 'Ay.
> >
> > > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
> >
> > They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
> >
> > -elizabeth
>
> My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
>
> DebbieHow much exercise are you getting? I get really bad fatigue, and people used to tell me to exercise more, and I was like, "yeah, screw you!" but a few months ago in a panic over how much weight I'd gained in the past three years (something like 30 lbs) I decided to *force* myself to exercise. My motivation had an unhealthy tinge of self-loathing to it: with the fatigue, I felt like if I exercised I'd die, and I didn't care (I'm not endorsing this attitude, by the way). Anyway, I started getting my heart rate up 5 times a week for 45 minutes and lifting weights three or four times a week. The fatigue actually got better and I've been losing about 2 lbs/week...and they say that with a slower rate of weight loss, you're more likely to keep it off. So I thought I'd throw some pro-exercise preaching at ya. You can tell me to screw off if you want, I won't mind, I've been there ;-)
Posted by Elizabeth on July 18, 2001, at 17:44:44
In reply to Re: phentermine and Effexor, posted by DebbieLynn on July 18, 2001, at 6:42:24
> My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80.
That's still well within the safe range. 120/80 is considered "normal," in fact. I would think that it would be okay to try a low dose of phentermine and see what happens to your blood pressure (if anything).
-elizabeth
Posted by jojo on July 18, 2001, at 23:33:21
In reply to Meridia stuff » MB, posted by Elizabeth on July 16, 2001, at 18:31:45
I've been taking SSRIs since Prozac came out, around 1987. Around 1982 I added stimulants
(Ritalin, Adderall, Desoxyn, and now Dexedrine tablets. The stimulants maintain their activating and anorectic properties when taken with an SSRI. I happened to hear this on NPR at the same time that I
was telling someone else of my experience, but not a word about it since then. If the FDA would like to observe my "withdrawal reaction, drug seeking behavior, and physical discomfort", they are welcome to observe me for one week (provided the results are publicized, so that others can benefit from my "addiction" experience) before I resume Dexedrine and get on with my life. As I have experienced
this already, my only reaction will be getting very little accomplished, increased depression, and eating more.
I am told that some people become "addicted" to stimulants, but I have no experience with that
phenomena.
Posted by Elizabeth on July 19, 2001, at 11:32:39
In reply to Re: Meridia stuff, posted by jojo on July 18, 2001, at 23:33:21
> The stimulants maintain their activating and anorectic properties when taken with an SSRI.
If that's true, you should try and get some sort of patent on the combination. :-)
> I am told that some people become "addicted" to stimulants, but I have no experience with that
> phenomena.Rule of thumb: if you don't take enough to get high, you won't become addicted.
(Stimulants, especially cocaine, are by some measures the most addictive drugs of all, much more so than alcohol or heroin.)
-elizabeth
Posted by Fenka on July 20, 2001, at 0:53:54
In reply to Re: phentermine and Effexor » DebbieLynn, posted by MB on July 18, 2001, at 10:47:01
May I jump in.I took phentermine with Effexor and did not notice any side effects. The effexor zoned me out so bad, I thought I was becoming narcoleptic. My doctor has heard of other combonations like Prozac and Ritilan or Prozac and phentermine that seems to work well.
If you do a little digging on the wire I know you will come up with something to either help you be comfortable with your decision, or look for a new route to take.
Best of luck.....
Fenka
> > > 'Ay.
> > >
> > > > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
> > >
> > > They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
> > >
> > > -elizabeth
> >
> > My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
> >
> > Debbie
>
> How much exercise are you getting? I get really bad fatigue, and people used to tell me to exercise more, and I was like, "yeah, screw you!" but a few months ago in a panic over how much weight I'd gained in the past three years (something like 30 lbs) I decided to *force* myself to exercise. My motivation had an unhealthy tinge of self-loathing to it: with the fatigue, I felt like if I exercised I'd die, and I didn't care (I'm not endorsing this attitude, by the way). Anyway, I started getting my heart rate up 5 times a week for 45 minutes and lifting weights three or four times a week. The fatigue actually got better and I've been losing about 2 lbs/week...and they say that with a slower rate of weight loss, you're more likely to keep it off. So I thought I'd throw some pro-exercise preaching at ya. You can tell me to screw off if you want, I won't mind, I've been there ;-)
Posted by erica a on October 29, 2001, at 11:00:54
In reply to Re: Weight gain and SSRIs-metabolism?, posted by Kathy99 on April 15, 2001, at 16:44:08
> > Well, I am guessing that cravings for carbohydrates like junk food, pasta or bread increase. Another theory would be, that metabolism slows down?
>
> That may be, that carbohydrate "craving" may be greater, but you'd still need to overeat to gain extra weight. Carbohydrates have only half the calories of fat, so cravings for bread are preferable to cravings for cheese!
>
> I looked up articles on Medline about this and saw one study that suggested that it wasn't the medication that may be the "cause" of weight gain, but the cure for depression itself.
>
> I also wonder why a person accustomed to being slim wouldn't be on their guard when gaining weight. Some people on this forum mention weight gains of 30-40 lbs.! That's quite a lot of extra calories! (an extra 3500 kcals = 1 lb. fat)
> > > Well I've never been a big eater, I did work out avidly, and ate right and I did not lose any weight. Yes I got my heart rate up and I felt good, but my weight did not come off. There have been several dietitians who have posted on this board who also complained about not being able to lose the weight while of effexor. I've stopped taking effexor and hopefully the 30lbs I put on WILL come off.
Posted by andys on March 27, 2002, at 10:47:53
In reply to Re: phentermine and Effexor, posted by Fenka on July 20, 2001, at 0:53:54
I am EXTREMELY treatment resistant Ultradian Bipolar II, and had a PROFOUND response to phentermine!! Within 2 days, I was completely stable (it acted like a mood stabilizer, in that it controlled depression and hypomania anxiety). And paradoxically, it worked only at very high dose (which, paradoxically, didn't make me anxious at all). That was three years ago, and have been searching ever since as to the action (5HT2, dopamine, etc.), that made this work. (I couldn't stay on the phentermine, due to increased blood pressure, and insomnia after several days). (But it worked as well, in several trials). I also had a decent response to Mirapex (primarily dopaminergic), but couldn't tolerate its side effects. I have not tried Effexor, because I typically can't tolerate ANY andidepressants, the ALL trigger hypomanic anxiety (even those known to cause low switch rates, like Wellbutrin, and the MAOI's). Anybody have any thoughts, ideas, comments??
Posted by djmmm on March 28, 2002, at 8:36:24
In reply to Re: phentermine and Effexor, posted by andys on March 27, 2002, at 10:47:53
well, phentermine stimulates the release of dopamine and norepinephrine, and acts as a re-uptake inhibitor, too; it has the same action as amphetamine...and is also dopamine neurotoxin
It also acts as a MAOI. Typically this action isn't significant at regular doses...what dose were you taking?
Posted by SLS on March 28, 2002, at 9:50:38
In reply to Re: phentermine and Effexor, posted by andys on March 27, 2002, at 10:47:53
> I am EXTREMELY treatment resistant Ultradian Bipolar II, and had a PROFOUND response to phentermine!! Within 2 days, I was completely stable (it acted like a mood stabilizer, in that it controlled depression and hypomania anxiety). And paradoxically, it worked only at very high dose (which, paradoxically, didn't make me anxious at all). That was three years ago, and have been searching ever since as to the action (5HT2, dopamine, etc.), that made this work. (I couldn't stay on the phentermine, due to increased blood pressure, and insomnia after several days). (But it worked as well, in several trials). I also had a decent response to Mirapex (primarily dopaminergic), but couldn't tolerate its side effects. I have not tried Effexor, because I typically can't tolerate ANY andidepressants, the ALL trigger hypomanic anxiety (even those known to cause low switch rates, like Wellbutrin, and the MAOI's). Anybody have any thoughts, ideas, comments??
Hi.
Have you ever tried high-dosage thyroid hormone? I have seen it mentioned as being helpful in treating rapid-cyclicity. Hoever, I forget which hormone was referred to: T3 or T4.
- Scott
Posted by SLS on March 28, 2002, at 10:22:46
In reply to Re: phentermine and Effexor » andys, posted by SLS on March 28, 2002, at 9:50:38
> > I am EXTREMELY treatment resistant Ultradian Bipolar II, and had a PROFOUND response to phentermine!! Within 2 days, I was completely stable (it acted like a mood stabilizer, in that it controlled depression and hypomania anxiety). And paradoxically, it worked only at very high dose (which, paradoxically, didn't make me anxious at all).
> Have you ever tried high-dosage thyroid hormone? I have seen it mentioned as being helpful in treating rapid-cyclicity. Hoever, I forget which hormone was referred to: T3 or T4.
>
>
> - ScottIt was T4 (thyroxine).
T3 = triidothyronine
T4 = thyroxineT4 gets transformed into T3 within individual cells. T3 is often given the credit for enhancing the therapeutic effects of antidepressants. T3 (Cytomel) made my bipolar depression much worse. I found T4 to be somewhat helpful.
- Scott
Posted by Bekka H. on March 28, 2002, at 10:44:34
In reply to Re: phentermine and Effexor, posted by djmmm on March 28, 2002, at 8:36:24
> well, phentermine stimulates the release of dopamine and norepinephrine, and acts as a re-uptake inhibitor, too; it has the same action as amphetamine...and is also dopamine neurotoxin
>
> It also acts as a MAOI. Typically this action isn't significant at regular doses...what dose were you taking
*************************************************Hi djmmm,
That's very interesting about the MAOI activity of Phentermine. I wonder whether this might be one reason that that "Phen-Fen" diet pill that was popular a few years ago was so terribly dangerous? It was taken off the market due to its causing pulmonary hypertension and heart valve abnormalities. The "Fen" half of the pill was Fenfluramine, a serotonin releaser. It seems to me that a serotonin release combined with a med that has MAOI activity could be lethal, even if the MAOI activity was low to moderate.
By the way, how is phentermine a neurotoxin? I ask because another PB member told me that of all the stimulants, she had gotten most help from Dexedrine and Phentermine. I have also been helped greatly by Dexedrine and have thought of trying Phentermine, but I probably won't, now that I've read your post!
Bekka
Posted by djmmm on March 28, 2002, at 13:02:40
In reply to Re: phentermine and Effexor - djmmm, posted by Bekka H. on March 28, 2002, at 10:44:34
There are so many things wrong with the phen/fen combo..
The main problem was that phentermine increased levels of catecholamines (dopamine, norepinephrine)and inhibiting monoamine oxidase (not very potently)... fenfluramine was increasing serotonin levels by *stimulating* the release, and blocking the re-uptake; fenfluramine also increased blood levels of serotonin.
also, both drugs are known neurotoxins...phentermine is neurotoxic to dopamine neurons, and fenfluramine is neurotoxic to serotonin neurons (via the exact mechanism as MDMA--the drug ecstacy)
...to compound this, some studies show phentermine increased the neurotoxicity of fenfluramine..
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9776127&dopt=Abstract
Posted by andys on March 28, 2002, at 15:26:14
In reply to Re: phentermine and Effexor - djmmm, posted by djmmm on March 28, 2002, at 13:02:40
thanks for your responses, some comments…..
the dose of phentermine I responded to was the maximum suggested dose of 90 mg. !! (the amazing part was it didn’t make me anxious or hypomanic, it completely leveled me out, and was very mellow. very strange!)
Re: phentermine as an MAOI:
I have a printout of the statement of the FDA, saying they will not classify phentermine as an MAOI, because it has MAOI action only in vitro, at very high dose, but in vivio, at clinical dosages, it is not. (I don’t have the web address, if someone is super-interested, I’ll hunt for it).Re: the suggestion of doing combined T3/T4 thyroid therapy:
Thanks, you’re right on. I’m on Cytomel (T3) now, and will be adding thyroxine (T4), as soon as I get back to “baseline”, after a bad trial on the “expensive” omega-3 supplement. (P.S.- I’ve done extensive thyroid research, anyone wanting a copy, email me).
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