![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 62 to 86 of 128. Go back in thread:
Posted by Sad Panda on July 12, 2004, at 13:33:49
In reply to Re: Seroquel users: a couple of questions (HELP) » BarbaraCat, posted by Sad Panda on July 12, 2004, at 11:23:40
> > Got a burning question for you Panda. After my recent bad experience with Seroquel, I have to agree with you. AP's are a bit overkill if all one wants is to get some sleep, and who knows what else is brewing in the chemical soup. I'm very curious as to my extreme and immediate reaction. Very difficult waking up, much like when I was taking trazodone. I felt quite depressed and out of it the 4 days I was on 6.25 or 12.5 pm. Very lethargic but jittery at the same time.
> >
> > My first thought was 'oh, I'm having a bad reaction to a reduction of dopamine - I need that dopamine'. Now, I realize that AP's reduce dopamine as part of their antipsychotic action, but I was under the impression Seroquel was not a heavy dopamine hitter. Also, none of these meds change neurotransmitter/receptor functionality that quickly, so dopamine doesn't seem a likely candidate. So perhaps the path is a similar 5Ht2-a blockade as w/trazodone and remeron, but we're still talking serotonin receptors and there's a lag time. It doesn't happen that quickly. My question is, is there also a histamine release which could account for the groggyness? Might this tie in with a possible dysfunction in my histamine levels? I haven't been tested for any of this but have been following the histadine/methylation theories. I'm also taking lithium and St. John's Wort (which is working surprisingly well). What could be at the root of the severe depression and restlessness I experienced immediately from Seroquel? After not taking it last night, I woke this morning fresh as a daisy and feeling sooooo much better. - Barbara
> >
> >
>
> Seroquel block Alpha-1 NE receptors the most, so I would possibly blame that. Coming in a close second is it's H1 blockade. At low doses I would say that's all it does as the next receptor is blocks is actually M1, so you'd probably notice a little dry mouth & constipation before 5-HT2A & D2 blockade ever comes to the party.
>
> On this page is a pretty good table showing the differences: http://www.vh.org/adult/provider/psychiatry/CPS/04.html#table2
>
> Cheers,
> Panda.
>Ooops, Ignore what I said about Seroquel probably causing antimuscarinic dry mouth & constipation. Most other websites say it doesn't block M1.
Cheers,
Panda.
Posted by Sad Panda on July 12, 2004, at 13:51:08
In reply to Re: Seroquel users: a couple of questions (HELP) » Sad Panda, posted by cpallen79 on July 12, 2004, at 12:11:59
> Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
>
>Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
Cheers,
Panda.
Posted by cpallen79 on July 12, 2004, at 14:22:05
In reply to Sounds like a question for CHEMIST!, posted by Sad Panda on July 12, 2004, at 13:51:08
Hi Chemist, what do you think?
I currently take 12.5 MGs of Lexapro, 15mgs of Buspar, and was also starting to take 7.5 mgs of immediate release adderall (was adderall taking XR before). The reason I went on meds was for anxious depression, OCD, and ADD. things had gotten a bit better (but still had problems with hypervigilance, etc... from anxiety), but then i added in Seroquel. After starting that Seroquel,I did well for about a week, but then I slowly began to notice nighttime agitation and restlessnes... it got worse and worse until I felt like I was back in a high anxiety state. I feel like the cast put on me for my "broken brain" was stripped off and rebroken! I still do not feel well, I stopped taking the Seroquel on Saturday. I'm so upset as I feel like any progress I made went right down the tubes. Maybe it's just me, I think I put alot of hope in the Seroquel for a good night's sleep, and my hopes were dashed, thus sending me into panic mode. Another time this occurred was when I tried to increase my Buspar, I felt so agitated, restless, and panicky that had to drop back down to the lower dose. I've been at this for months and I feel so discouraged, I jsut want a day to come where I peacefully wake up, look around, and say "what a great day!"
> > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> >
> >
>
> Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
>
> Cheers,
> Panda.
>
Posted by BarbaraCat on July 12, 2004, at 14:47:30
In reply to Re: Sounds like a question for CHEMIST!, posted by cpallen79 on July 12, 2004, at 14:22:05
HI Chris,
Let's pursue this one. I'm right there with ya and will post a separate question to Chemist. In the meantime, have you tried Ambien for sleep? It's what I'm currently on and find it very helpful. I have fibromyalgia along with bipolar depression and I NEED my sleep and can't take anything that interferes with Stage IV delta sleep. Ambien is great for this and there is absolutely no hangover. It does occasionally poop and I have to take more, but it hasn't been a problem.As with your experience, my recent foray into Seroquel was a nightmare, but a real good clue into what my personal chemistry is doing. It might have something to do with histamines. Keep you posted on anything interesting I dig up. - Barbara
Posted by chemist on July 12, 2004, at 14:48:13
In reply to Re: read this one, y'all... » chemist, posted by Sad Panda on July 12, 2004, at 11:02:43
> > > I've believe that the antipsychotics have no place as sleep meds. Seroquel at low doses is a bit like Remeron at low doses in that it only binds to H1 receptors. If all you want is some H1 blockade, then dirt cheap Doxepin or OTC Benadryl are all you really need to pay for.
> > >
> > > If Trazodone does the job, then I would recommend you try Nortriptyline. Traz gives sleep via 5-HT2A & Alpha-1 blockade, Nort does this and is a good norepinephrine reuptake inhibitor. It would replace Buspar with ease, possibly reduce your Aderall consumption, fit in very nicely with Lexapro & add some extra antidepressant effect of it's own.
> > >
> > > Cheers,
> > > Panda.
> > >
> > >
> > hello there, from chemist.....this is far more panda's territory than mine, i politely defer and suggest that you load up panda's in-box in re: this topic [sorry, panda, but that's what you get for being an expert:) ]....all the best, chemist
> >
> >
>
> Thanks Chemist, but I'm not an expert, I'm just a nosey parker with an opinion. :) If Seroquel blows your hair back, then that's fine with me & it does have less chance of causing weight gain than Zyprexa, Remeron & probably the sedating TCA's.
>
> Cheers,
> Panda.
>
>
>
well, your nose is deeper in the flora than mine, and i have a lousy track record with providing useful and/or factual info on certain meds....thus, you and SLS and King Vultan and Larry are getting the buck passed your way :).....cheers to you too, chemist
Posted by chemist on July 12, 2004, at 15:00:55
In reply to Ooops, Seroquel doesn't block M1, posted by Sad Panda on July 12, 2004, at 13:33:49
> > > Got a burning question for you Panda. After my recent bad experience with Seroquel, I have to agree with you. AP's are a bit overkill if all one wants is to get some sleep, and who knows what else is brewing in the chemical soup. I'm very curious as to my extreme and immediate reaction. Very difficult waking up, much like when I was taking trazodone. I felt quite depressed and out of it the 4 days I was on 6.25 or 12.5 pm. Very lethargic but jittery at the same time.
> > >
> > > My first thought was 'oh, I'm having a bad reaction to a reduction of dopamine - I need that dopamine'. Now, I realize that AP's reduce dopamine as part of their antipsychotic action, but I was under the impression Seroquel was not a heavy dopamine hitter. Also, none of these meds change neurotransmitter/receptor functionality that quickly, so dopamine doesn't seem a likely candidate. So perhaps the path is a similar 5Ht2-a blockade as w/trazodone and remeron, but we're still talking serotonin receptors and there's a lag time. It doesn't happen that quickly. My question is, is there also a histamine release which could account for the groggyness? Might this tie in with a possible dysfunction in my histamine levels? I haven't been tested for any of this but have been following the histadine/methylation theories. I'm also taking lithium and St. John's Wort (which is working surprisingly well). What could be at the root of the severe depression and restlessness I experienced immediately from Seroquel? After not taking it last night, I woke this morning fresh as a daisy and feeling sooooo much better. - Barbara
> > >
> > >
> >
> > Seroquel block Alpha-1 NE receptors the most, so I would possibly blame that. Coming in a close second is it's H1 blockade. At low doses I would say that's all it does as the next receptor is blocks is actually M1, so you'd probably notice a little dry mouth & constipation before 5-HT2A & D2 blockade ever comes to the party.
> >
> > On this page is a pretty good table showing the differences: http://www.vh.org/adult/provider/psychiatry/CPS/04.html#table2
> >
> > Cheers,
> > Panda.
> >
>
> Ooops, Ignore what I said about Seroquel probably causing antimuscarinic dry mouth & constipation. Most other websites say it doesn't block M1.
>
> Cheers,
> Panda.
>
>
>
panda, i'm not letting you off the hook so easily, having recently pronounced you the expert. my PDR white-sheet from astrazeneca says ``no appreciable affinity at cholinergic muscarinic and benzodiazepine receptors (IC_{50s} > 5000 nM).'' given an IC_{50} for D_{1} at 1268 nM and IC_{50} of 329 nM for D_{2}, what's an order of magnitude or two among friends? you're still in charge...... :) all the best, chemist
Posted by chemist on July 12, 2004, at 15:22:35
In reply to Sounds like a question for CHEMIST!, posted by Sad Panda on July 12, 2004, at 13:51:08
ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
> > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> >
> >
>
> Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
>
> Cheers,
> Panda.
>
Posted by chemist on July 12, 2004, at 15:36:55
In reply to Re: Sounds like a question for CHEMIST!, posted by cpallen79 on July 12, 2004, at 14:22:05
> Hi Chemist, what do you think?
i think panda secretly works for an HMO and is dividing his case load :)
seriously, i am not a fan of buspar: i have taken it, and would choose a lollipop over buspar if given the choice for an effective anxiolytic. my immediate guess is that your body got used to the little dabs of seroquel over the week or so and the buspar was not addressing the *transient* anxiety that can be experienced when titrating up on lexapro (note i wrote *transient*), that the adderall immediate release was a bigger surge of stimulation than you had had before with the extended release, and that you simply were/are overstimulated. in my opinion, the lexapro should slowly be taken to 20 mg - as your comfort level allows - and you should back off on your adderall for a while, or at least take in divided doses until things smooth out, and ditch the buspar. now, we will have you in some quasi-stable state, and sleep will likely need be addressed, as will breakthrough panic and/or daily anxiety. my usual line is, go with klonopin, perhaps 0.5 mg bid. if benzos are not an option, next up is trazadone, a drug i am not particularly fond of, but you can certainly tweak the dose for sleep and for daytime. my stance on trazadone has changed largely to favorable reports from other posters, and i think my experience is the outlier. finally, if you find that trazadone is making you too groggy, go with ambien for sleep and perhaps lower the lexapro for the anxiety. still, i am a fan of the benzos, but this may not be the case for you. please do let us know if this is of any use.....all the best, chemist
> I currently take 12.5 MGs of Lexapro, 15mgs of Buspar, and was also starting to take 7.5 mgs of immediate release adderall (was adderall taking XR before). The reason I went on meds was for anxious depression, OCD, and ADD. things had gotten a bit better (but still had problems with hypervigilance, etc... from anxiety), but then i added in Seroquel. After starting that Seroquel,I did well for about a week, but then I slowly began to notice nighttime agitation and restlessnes... it got worse and worse until I felt like I was back in a high anxiety state. I feel like the cast put on me for my "broken brain" was stripped off and rebroken! I still do not feel well, I stopped taking the Seroquel on Saturday. I'm so upset as I feel like any progress I made went right down the tubes. Maybe it's just me, I think I put alot of hope in the Seroquel for a good night's sleep, and my hopes were dashed, thus sending me into panic mode. Another time this occurred was when I tried to increase my Buspar, I felt so agitated, restless, and panicky that had to drop back down to the lower dose. I've been at this for months and I feel so discouraged, I jsut want a day to come where I peacefully wake up, look around, and say "what a great day!"
>
>
> > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> > >
> > >
> >
> > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> >
> > Cheers,
> > Panda.
> >
>
>
Posted by chemist on July 12, 2004, at 15:45:42
In reply to Re: Sounds like a question for CHEMIST! » cpallen79, posted by BarbaraCat on July 12, 2004, at 14:47:30
see, chris? just as i finsh my post mentioning ambien, i see that barbara has already gone down that path. barbara's point in re: preserving stage 4 sleep might be amended with the following: benzos/benzo-derivatives don't, so if you're offered ambien over halcion, go with ambien, in my opinion.....see you on the next board, and all the best, chemist
> HI Chris,
> Let's pursue this one. I'm right there with ya and will post a separate question to Chemist. In the meantime, have you tried Ambien for sleep? It's what I'm currently on and find it very helpful. I have fibromyalgia along with bipolar depression and I NEED my sleep and can't take anything that interferes with Stage IV delta sleep. Ambien is great for this and there is absolutely no hangover. It does occasionally poop and I have to take more, but it hasn't been a problem.
>
> As with your experience, my recent foray into Seroquel was a nightmare, but a real good clue into what my personal chemistry is doing. It might have something to do with histamines. Keep you posted on anything interesting I dig up. - Barbara
Posted by cpallen79 on July 12, 2004, at 16:42:51
In reply to okay, here we go... » cpallen79, posted by chemist on July 12, 2004, at 15:36:55
Hi Chemist,
Thanks for the information! I've been on Lexapro at 12.5 for about a month or so now, so hopefully the anxiety isn't from that. My PDoc wants me to titrate up to 15 mgs. I'm a fan of the Lexapro because it's supposedly "cleaner" than other SSRIS, though I wish it was one that caused more sedation. I went back to a lower dose of adderall XR at 5mgs. I'm ditching the Buspar and will try Trazodone for sleep (PDOC called it in for me). I've also heard that it has mild anti-anxiety properties, but at this point I'm not keeping my fingers crossed. I just want some darn sleep and to have the agitation/anxiety stop. I was also given some ativan on hand but have had negative experiences with rebound anxiety from xanax so I'm a bit weary of them, plus there's the addiction potential of course.
What do you guys think? Think that I'll be able to actually settle down one of these days? ugh
Posted by BarbaraCat on July 12, 2004, at 16:46:26
In reply to Re: Sounds like a question for CHEMIST! » Sad Panda, posted by chemist on July 12, 2004, at 15:22:35
Must respectfully differ with you, Most Esteemed Chemist, but I don't think it has to do with too small a Seroquel dose and breakthrough anxiety. I had an experience similar to Chris' with Seroquel just last week and a few years back with Zyprexa. Was doing pretty darn good on lithium and pharmaceutical St. John's Wort and decided to go with Seroquel mainly for sleep and any additional benefits an AP might provide for my mixed-states bipolar bane.
Took 12.5mg/night for 4 nights and it was like I woke up on the far side of the Styx after the first dose. Agitated woozy weepy dysphoric clumsy hell. Plus a very uncharacteristic lust/frenzy for anything that hinted of cake or cookie. Kept expecting it to get better but it was getting worse. And I gained 5 lousy pounds for the priviledge.
I realize that 12.5mg is more sedating than higher doses and this dysphoria might have eventually gone away, but the point is that something hit hard and very quickly. A very rapid switch into agitated depression and total relief after stopping. What jumps out at me is histamine. For one, the groggy sedation felt much like an anti-histamine, plus I understand that unbalanced histidine and therefore histamine levels have been implicated in depression. Mainly H3, and Seroquel seems to target H1 but jeez, mere technicalities. Perhaps I'm one of those 'histadelics' (it does feel like hysterical psychedelics for that matter). Perhaps methylation is a factor. I dunno. I only know that something caused this rapid switch into dysphoric agitation. There's a profound clue waiting to be discovered here. Just hope I don't have to go through any further personal testing to find out. I welcome any and all thoughts. - Barbara
> ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
>
>
> > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> > >
> > >
> >
> > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> >
> > Cheers,
> > Panda.
> >
>
Posted by cpallen79 on July 12, 2004, at 16:57:36
In reply to Re: Sounds like a question for CHEMIST! » cpallen79, posted by BarbaraCat on July 12, 2004, at 14:47:30
Hey barbara, I haven't tried AMbien yet, I think I'll try Trazodone first (don't mind a good hangover every now and again), if that doesn't work, onto Benzos most likely, we'll see. I was sooo surprised by what the Seroquel did to me, I felt sooo good for a few days (except at nights- which would make sense as the adderall wore off- my doapmine levels would drop). This is why my PDOC suspects akathisia, even at uch a small dose.. because my dopamine levels weren't too great, initially she wanted me to increase the adderall ans spread it out, I just said forget the seroquel!
Posted by chemist on July 12, 2004, at 17:05:23
In reply to Re: okay, here we go... » chemist, posted by cpallen79 on July 12, 2004, at 16:42:51
> Hi Chemist,
> Thanks for the information! I've been on Lexapro at 12.5 for about a month or so now, so hopefully the anxiety isn't from that. My PDoc wants me to titrate up to 15 mgs. I'm a fan of the Lexapro because it's supposedly "cleaner" than other SSRIS, though I wish it was one that caused more sedation. I went back to a lower dose of adderall XR at 5mgs. I'm ditching the Buspar and will try Trazodone for sleep (PDOC called it in for me). I've also heard that it has mild anti-anxiety properties, but at this point I'm not keeping my fingers crossed. I just want some darn sleep and to have the agitation/anxiety stop. I was also given some ativan on hand but have had negative experiences with rebound anxiety from xanax so I'm a bit weary of them, plus there's the addiction potential of course.
> What do you guys think? Think that I'll be able to actually settle down one of these days? ughhello there, chemist here....i think your plan - and i highly endorse and commend your consultation with your pdoc, by the way - has all the potential to work just fine. lexapro is pretty clean, in that it is a pure, single active enantiomer rather than the more side-effect prone racemate that is celexa, and i think maybe more than one month is called for in re: getting adjusted. remember, these things take time. you're right about anti-depressant activity of trazodone (pardon my earlier typos), lovingly dispensed in the 1970s and 1980s as Desyrel for depression. your worries about ativan are, in my estimation, a little bit overblown, and if you keep it to prn dosing, you'll do fine. xanax is a real tough one to bounce back from (see my post to Buckeye Fan) and you can rest assured (literally) that trazodone will have you slumbering away. please keep us informed, will you? all of this information is of great value to all of us, as we jump from med to med to med......all the best, chemist
Posted by BarbaraCat on July 12, 2004, at 17:11:07
In reply to Re: Sounds like a question for CHEMIST! » BarbaraCat, posted by cpallen79 on July 12, 2004, at 16:57:36
That's great news that your pdoc is prescribing the traz. I think you'll find it to be very helpful. You'll sleep well and your anxiety level will improve greatly. It might be the perfect med for you. Just be willing to put up with the bonked on the head feeling for a little while. And don't forget the morning situps and pushups. This is the secret to de-fuzzing yourself in the morning. Also, Traz tends to be in the pork-o-genic category so the more exercise you can force yourself to get, the better.
> Hey barbara, I haven't tried AMbien yet, I think I'll try Trazodone first (don't mind a good hangover every now and again), if that doesn't work, onto Benzos most likely, we'll see. I was sooo surprised by what the Seroquel did to me, I felt sooo good for a few days (except at nights- which would make sense as the adderall wore off- my doapmine levels would drop). This is why my PDOC suspects akathisia, even at uch a small dose.. because my dopamine levels weren't too great, initially she wanted me to increase the adderall ans spread it out, I just said forget the seroquel!
Posted by cpallen79 on July 12, 2004, at 17:16:26
In reply to Re: okay, here we go... » cpallen79, posted by chemist on July 12, 2004, at 17:05:23
Hey Chemist, I will definetely keep you informed. I think you're right about the Lexapro, I've been very slow in my titration of it. I started in April, and have gone reallly slow, the most recent titration going up to 12.5 from 10. One tihng I've noticed is that adderall can kind of "poop out" my SSRI so to speak, so tweaking the adderall has been a real pain. I can't begin to emphasize how comforting this has been for me. Thank you for taking the time to help me with this! I will keep you guys posted on how this all works out.
Chris
> > Hi Chemist,
> > Thanks for the information! I've been on Lexapro at 12.5 for about a month or so now, so hopefully the anxiety isn't from that. My PDoc wants me to titrate up to 15 mgs. I'm a fan of the Lexapro because it's supposedly "cleaner" than other SSRIS, though I wish it was one that caused more sedation. I went back to a lower dose of adderall XR at 5mgs. I'm ditching the Buspar and will try Trazodone for sleep (PDOC called it in for me). I've also heard that it has mild anti-anxiety properties, but at this point I'm not keeping my fingers crossed. I just want some darn sleep and to have the agitation/anxiety stop. I was also given some ativan on hand but have had negative experiences with rebound anxiety from xanax so I'm a bit weary of them, plus there's the addiction potential of course.
> > What do you guys think? Think that I'll be able to actually settle down one of these days? ugh
>
> hello there, chemist here....i think your plan - and i highly endorse and commend your consultation with your pdoc, by the way - has all the potential to work just fine. lexapro is pretty clean, in that it is a pure, single active enantiomer rather than the more side-effect prone racemate that is celexa, and i think maybe more than one month is called for in re: getting adjusted. remember, these things take time. you're right about anti-depressant activity of trazodone (pardon my earlier typos), lovingly dispensed in the 1970s and 1980s as Desyrel for depression. your worries about ativan are, in my estimation, a little bit overblown, and if you keep it to prn dosing, you'll do fine. xanax is a real tough one to bounce back from (see my post to Buckeye Fan) and you can rest assured (literally) that trazodone will have you slumbering away. please keep us informed, will you? all of this information is of great value to all of us, as we jump from med to med to med......all the best, chemist
Posted by cpallen79 on July 12, 2004, at 17:20:33
In reply to Re: Sounds like a question for CHEMIST! » cpallen79, posted by BarbaraCat on July 12, 2004, at 17:11:07
Hey Barbara,
thanks for the reply, My PDOC is cool that way, I think she hears from me too much tho LOL. She knows I know my meds and If I suggest something, she's usually pretty open to it. LOL, I can jsut see the trazodone packing some pounds on, the Paxil sure did. Luckily I was scrawny to begin with so it just filled me out a bit, and I was able to lose some of it.> That's great news that your pdoc is prescribing the traz. I think you'll find it to be very helpful. You'll sleep well and your anxiety level will improve greatly. It might be the perfect med for you. Just be willing to put up with the bonked on the head feeling for a little while. And don't forget the morning situps and pushups. This is the secret to de-fuzzing yourself in the morning. Also, Traz tends to be in the pork-o-genic category so the more exercise you can force yourself to get, the better.
>
> > Hey barbara, I haven't tried AMbien yet, I think I'll try Trazodone first (don't mind a good hangover every now and again), if that doesn't work, onto Benzos most likely, we'll see. I was sooo surprised by what the Seroquel did to me, I felt sooo good for a few days (except at nights- which would make sense as the adderall wore off- my doapmine levels would drop). This is why my PDOC suspects akathisia, even at uch a small dose.. because my dopamine levels weren't too great, initially she wanted me to increase the adderall ans spread it out, I just said forget the seroquel!
>
>
Posted by chemist on July 12, 2004, at 17:39:35
In reply to Re: Sounds like a question for CHEMIST! » chemist, posted by BarbaraCat on July 12, 2004, at 16:46:26
differing welcomed and addition information insightful.....i'm just a chemist, remember...i will point out (you know i always have to point something out.....) that it is H_{1} that is hit hardest by seroquel, and (stealing from my PDR) of all the receptors it hits, the IC_{50} for H_{1} is the lowest (!!!), at 30 nM, so no wonder the sedation. a few comments on histidine/histamine. the process of decarboxylating histidine is undertaken by an enzyme that more or less depends on your intake of vitamin B6. also, histidine at physiological pH can be protonated at both the delta and epsilon nitrogens, although the delta form dominates. there might be some correlation in your (i am using the collective ``your'') biochemistry (including stomach acids, lest we forget) that favors the doubly-protonated form and thus the production of a histamine (assuming it stays doubly-protonated after decarboxylation by PLP-powered enzymes) is deficient. alternatively, you might - and i need Larry's help here, so please page him - somehow be overproducing b6, thus making more histamine than ``normal,'' and any introduction of additional histamine will hit you like a brick. enough. all the best, chemist
> Must respectfully differ with you, Most Esteemed Chemist, but I don't think it has to do with too small a Seroquel dose and breakthrough anxiety. I had an experience similar to Chris' with Seroquel just last week and a few years back with Zyprexa. Was doing pretty darn good on lithium and pharmaceutical St. John's Wort and decided to go with Seroquel mainly for sleep and any additional benefits an AP might provide for my mixed-states bipolar bane.
>
> Took 12.5mg/night for 4 nights and it was like I woke up on the far side of the Styx after the first dose. Agitated woozy weepy dysphoric clumsy hell. Plus a very uncharacteristic lust/frenzy for anything that hinted of cake or cookie. Kept expecting it to get better but it was getting worse. And I gained 5 lousy pounds for the priviledge.
>
> I realize that 12.5mg is more sedating than higher doses and this dysphoria might have eventually gone away, but the point is that something hit hard and very quickly. A very rapid switch into agitated depression and total relief after stopping. What jumps out at me is histamine. For one, the groggy sedation felt much like an anti-histamine, plus I understand that unbalanced histidine and therefore histamine levels have been implicated in depression. Mainly H3, and Seroquel seems to target H1 but jeez, mere technicalities. Perhaps I'm one of those 'histadelics' (it does feel like hysterical psychedelics for that matter). Perhaps methylation is a factor. I dunno. I only know that something caused this rapid switch into dysphoric agitation. There's a profound clue waiting to be discovered here. Just hope I don't have to go through any further personal testing to find out. I welcome any and all thoughts. - Barbara
>
>
> > ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
> >
> >
> > > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> > > >
> > > >
> > >
> > > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> > >
> > > Cheers,
> > > Panda.
> > >
> >
>
>
Posted by chemist on July 12, 2004, at 17:46:33
In reply to Re: okay, here we go..., posted by cpallen79 on July 12, 2004, at 17:16:26
please do keep us up to date, as so many folks seem to vaporize, and it's nice to hear if things work/don't work, as it is abundantly clear that few if any of us are satisfied with our med cocktails. every bit of information counts. thanks in advance, and best of luck, keep those posts coming, and take it slow: all these chemical are psychoactive, and i try to keep that in mind, being an impatient person myself (not implying that you are), and sometimes long trials are called for (lexapro seems like a candidate in your case) while others bomb immediately (such as seroquel and the lifeless buspar).....looking forward to your progress, chemist
> Hey Chemist, I will definetely keep you informed. I think you're right about the Lexapro, I've been very slow in my titration of it. I started in April, and have gone reallly slow, the most recent titration going up to 12.5 from 10. One tihng I've noticed is that adderall can kind of "poop out" my SSRI so to speak, so tweaking the adderall has been a real pain. I can't begin to emphasize how comforting this has been for me. Thank you for taking the time to help me with this! I will keep you guys posted on how this all works out.
> Chris
>
>
> > > Hi Chemist,
> > > Thanks for the information! I've been on Lexapro at 12.5 for about a month or so now, so hopefully the anxiety isn't from that. My PDoc wants me to titrate up to 15 mgs. I'm a fan of the Lexapro because it's supposedly "cleaner" than other SSRIS, though I wish it was one that caused more sedation. I went back to a lower dose of adderall XR at 5mgs. I'm ditching the Buspar and will try Trazodone for sleep (PDOC called it in for me). I've also heard that it has mild anti-anxiety properties, but at this point I'm not keeping my fingers crossed. I just want some darn sleep and to have the agitation/anxiety stop. I was also given some ativan on hand but have had negative experiences with rebound anxiety from xanax so I'm a bit weary of them, plus there's the addiction potential of course.
> > > What do you guys think? Think that I'll be able to actually settle down one of these days? ugh
> >
> > hello there, chemist here....i think your plan - and i highly endorse and commend your consultation with your pdoc, by the way - has all the potential to work just fine. lexapro is pretty clean, in that it is a pure, single active enantiomer rather than the more side-effect prone racemate that is celexa, and i think maybe more than one month is called for in re: getting adjusted. remember, these things take time. you're right about anti-depressant activity of trazodone (pardon my earlier typos), lovingly dispensed in the 1970s and 1980s as Desyrel for depression. your worries about ativan are, in my estimation, a little bit overblown, and if you keep it to prn dosing, you'll do fine. xanax is a real tough one to bounce back from (see my post to Buckeye Fan) and you can rest assured (literally) that trazodone will have you slumbering away. please keep us informed, will you? all of this information is of great value to all of us, as we jump from med to med to med......all the best, chemist
>
>
Posted by BarbaraCat on July 12, 2004, at 19:42:15
In reply to Re: Sounds like a question for CHEMIST! » BarbaraCat, posted by chemist on July 12, 2004, at 17:39:35
Thanks Mr. (or is it Dr.) Chemist! That gives me a whole bunch of info to keep me busy. Ties in with the under-over methylation theories as well. Much appreciated. - BCat
> differing welcomed and addition information insightful.....i'm just a chemist, remember...i will point out (you know i always have to point something out.....) that it is H_{1} that is hit hardest by seroquel, and (stealing from my PDR) of all the receptors it hits, the IC_{50} for H_{1} is the lowest (!!!), at 30 nM, so no wonder the sedation. a few comments on histidine/histamine. the process of decarboxylating histidine is undertaken by an enzyme that more or less depends on your intake of vitamin B6. also, histidine at physiological pH can be protonated at both the delta and epsilon nitrogens, although the delta form dominates. there might be some correlation in your (i am using the collective ``your'') biochemistry (including stomach acids, lest we forget) that favors the doubly-protonated form and thus the production of a histamine (assuming it stays doubly-protonated after decarboxylation by PLP-powered enzymes) is deficient. alternatively, you might - and i need Larry's help here, so please page him - somehow be overproducing b6, thus making more histamine than ``normal,'' and any introduction of additional histamine will hit you like a brick. enough. all the best, chemist
>
>
> > Must respectfully differ with you, Most Esteemed Chemist, but I don't think it has to do with too small a Seroquel dose and breakthrough anxiety. I had an experience similar to Chris' with Seroquel just last week and a few years back with Zyprexa. Was doing pretty darn good on lithium and pharmaceutical St. John's Wort and decided to go with Seroquel mainly for sleep and any additional benefits an AP might provide for my mixed-states bipolar bane.
> >
> > Took 12.5mg/night for 4 nights and it was like I woke up on the far side of the Styx after the first dose. Agitated woozy weepy dysphoric clumsy hell. Plus a very uncharacteristic lust/frenzy for anything that hinted of cake or cookie. Kept expecting it to get better but it was getting worse. And I gained 5 lousy pounds for the priviledge.
> >
> > I realize that 12.5mg is more sedating than higher doses and this dysphoria might have eventually gone away, but the point is that something hit hard and very quickly. A very rapid switch into agitated depression and total relief after stopping. What jumps out at me is histamine. For one, the groggy sedation felt much like an anti-histamine, plus I understand that unbalanced histidine and therefore histamine levels have been implicated in depression. Mainly H3, and Seroquel seems to target H1 but jeez, mere technicalities. Perhaps I'm one of those 'histadelics' (it does feel like hysterical psychedelics for that matter). Perhaps methylation is a factor. I dunno. I only know that something caused this rapid switch into dysphoric agitation. There's a profound clue waiting to be discovered here. Just hope I don't have to go through any further personal testing to find out. I welcome any and all thoughts. - Barbara
> >
> >
> > > ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
> > >
> > >
> > > > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> > > > >
> > > > >
> > > >
> > > > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> > > >
> > > > Cheers,
> > > > Panda.
> > > >
> > >
> >
> >
>
Posted by chemist on July 12, 2004, at 19:53:57
In reply to Re: Sounds like a question for CHEMIST! » chemist, posted by BarbaraCat on July 12, 2004, at 19:42:15
> Thanks Mr. (or is it Dr.) Chemist! That gives me a whole bunch of info to keep me busy. Ties in with the under-over methylation theories as well. Much appreciated. - BCat
no, thank you (and the other posters), it's interesting and rewarding to delve into new areas (i speak of myself)...please do keep us informed about the methylation business...let me throw another bone your way: when doubly-protonated, the side chain carries a formal charge. from my work with alkaloids that bind to ligand-gated ion channels of a certain flavor, i know that the binding affinity is greatly increased if one protonates the compound in question. i wonder if a similar antagonism is instigated if the epsilon nitrogen is protonated, and thus competitive binding to H_{1} become more non-competitive? food for thought.........let us know what you discover.......and since you asked, it is chemist, Ph.D. (that and $2.00 gets me a cup of coffee.......).....all the best, chemist
>
>
> > differing welcomed and addition information insightful.....i'm just a chemist, remember...i will point out (you know i always have to point something out.....) that it is H_{1} that is hit hardest by seroquel, and (stealing from my PDR) of all the receptors it hits, the IC_{50} for H_{1} is the lowest (!!!), at 30 nM, so no wonder the sedation. a few comments on histidine/histamine. the process of decarboxylating histidine is undertaken by an enzyme that more or less depends on your intake of vitamin B6. also, histidine at physiological pH can be protonated at both the delta and epsilon nitrogens, although the delta form dominates. there might be some correlation in your (i am using the collective ``your'') biochemistry (including stomach acids, lest we forget) that favors the doubly-protonated form and thus the production of a histamine (assuming it stays doubly-protonated after decarboxylation by PLP-powered enzymes) is deficient. alternatively, you might - and i need Larry's help here, so please page him - somehow be overproducing b6, thus making more histamine than ``normal,'' and any introduction of additional histamine will hit you like a brick. enough. all the best, chemist
> >
> >
> > > Must respectfully differ with you, Most Esteemed Chemist, but I don't think it has to do with too small a Seroquel dose and breakthrough anxiety. I had an experience similar to Chris' with Seroquel just last week and a few years back with Zyprexa. Was doing pretty darn good on lithium and pharmaceutical St. John's Wort and decided to go with Seroquel mainly for sleep and any additional benefits an AP might provide for my mixed-states bipolar bane.
> > >
> > > Took 12.5mg/night for 4 nights and it was like I woke up on the far side of the Styx after the first dose. Agitated woozy weepy dysphoric clumsy hell. Plus a very uncharacteristic lust/frenzy for anything that hinted of cake or cookie. Kept expecting it to get better but it was getting worse. And I gained 5 lousy pounds for the priviledge.
> > >
> > > I realize that 12.5mg is more sedating than higher doses and this dysphoria might have eventually gone away, but the point is that something hit hard and very quickly. A very rapid switch into agitated depression and total relief after stopping. What jumps out at me is histamine. For one, the groggy sedation felt much like an anti-histamine, plus I understand that unbalanced histidine and therefore histamine levels have been implicated in depression. Mainly H3, and Seroquel seems to target H1 but jeez, mere technicalities. Perhaps I'm one of those 'histadelics' (it does feel like hysterical psychedelics for that matter). Perhaps methylation is a factor. I dunno. I only know that something caused this rapid switch into dysphoric agitation. There's a profound clue waiting to be discovered here. Just hope I don't have to go through any further personal testing to find out. I welcome any and all thoughts. - Barbara
> > >
> > >
> > > > ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
> > > >
> > > >
> > > > > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
> > > > > >
> > > > > >
> > > > >
> > > > > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> > > > >
> > > > > Cheers,
> > > > > Panda.
> > > > >
> > > >
> > >
> > >
> >
>
>
Posted by Sad Panda on July 13, 2004, at 3:53:34
In reply to Re: Ooops, Seroquel doesn't block M1 » Sad Panda, posted by chemist on July 12, 2004, at 15:00:55
> > > > Got a burning question for you Panda. After my recent bad experience with Seroquel, I have to agree with you. AP's are a bit overkill if all one wants is to get some sleep, and who knows what else is brewing in the chemical soup. I'm very curious as to my extreme and immediate reaction. Very difficult waking up, much like when I was taking trazodone. I felt quite depressed and out of it the 4 days I was on 6.25 or 12.5 pm. Very lethargic but jittery at the same time.
> > > >
> > > > My first thought was 'oh, I'm having a bad reaction to a reduction of dopamine - I need that dopamine'. Now, I realize that AP's reduce dopamine as part of their antipsychotic action, but I was under the impression Seroquel was not a heavy dopamine hitter. Also, none of these meds change neurotransmitter/receptor functionality that quickly, so dopamine doesn't seem a likely candidate. So perhaps the path is a similar 5Ht2-a blockade as w/trazodone and remeron, but we're still talking serotonin receptors and there's a lag time. It doesn't happen that quickly. My question is, is there also a histamine release which could account for the groggyness? Might this tie in with a possible dysfunction in my histamine levels? I haven't been tested for any of this but have been following the histadine/methylation theories. I'm also taking lithium and St. John's Wort (which is working surprisingly well). What could be at the root of the severe depression and restlessness I experienced immediately from Seroquel? After not taking it last night, I woke this morning fresh as a daisy and feeling sooooo much better. - Barbara
> > > >
> > > >
> > >
> > > Seroquel block Alpha-1 NE receptors the most, so I would possibly blame that. Coming in a close second is it's H1 blockade. At low doses I would say that's all it does as the next receptor is blocks is actually M1, so you'd probably notice a little dry mouth & constipation before 5-HT2A & D2 blockade ever comes to the party.
> > >
> > > On this page is a pretty good table showing the differences: http://www.vh.org/adult/provider/psychiatry/CPS/04.html#table2
> > >
> > > Cheers,
> > > Panda.
> > >
> >
> > Ooops, Ignore what I said about Seroquel probably causing antimuscarinic dry mouth & constipation. Most other websites say it doesn't block M1.
> >
> > Cheers,
> > Panda.
> >
> >
> >
> panda, i'm not letting you off the hook so easily, having recently pronounced you the expert. my PDR white-sheet from astrazeneca says ``no appreciable affinity at cholinergic muscarinic and benzodiazepine receptors (IC_{50s} > 5000 nM).'' given an IC_{50} for D_{1} at 1268 nM and IC_{50} of 329 nM for D_{2}, what's an order of magnitude or two among friends? you're still in charge...... :) all the best, chemist
>
>Hi Chemist,
Looks like I am half-wrong or half-right, Seroquel's monograph says it has no affinity for muscarinic receptors, yet constipation is high on the list of side effects straight after dry mouth. I know Alpha-1 blockade produces dry mouth, but what causes constipation beside M1 blockade?
Cheers,
Panda.
Posted by chemist on July 13, 2004, at 8:22:48
In reply to Re: Ooops, Seroquel doesn't block M1 » chemist, posted by Sad Panda on July 13, 2004, at 3:53:34
> > > > > Got a burning question for you Panda. After my recent bad experience with Seroquel, I have to agree with you. AP's are a bit overkill if all one wants is to get some sleep, and who knows what else is brewing in the chemical soup. I'm very curious as to my extreme and immediate reaction. Very difficult waking up, much like when I was taking trazodone. I felt quite depressed and out of it the 4 days I was on 6.25 or 12.5 pm. Very lethargic but jittery at the same time.
> > > > >
> > > > > My first thought was 'oh, I'm having a bad reaction to a reduction of dopamine - I need that dopamine'. Now, I realize that AP's reduce dopamine as part of their antipsychotic action, but I was under the impression Seroquel was not a heavy dopamine hitter. Also, none of these meds change neurotransmitter/receptor functionality that quickly, so dopamine doesn't seem a likely candidate. So perhaps the path is a similar 5Ht2-a blockade as w/trazodone and remeron, but we're still talking serotonin receptors and there's a lag time. It doesn't happen that quickly. My question is, is there also a histamine release which could account for the groggyness? Might this tie in with a possible dysfunction in my histamine levels? I haven't been tested for any of this but have been following the histadine/methylation theories. I'm also taking lithium and St. John's Wort (which is working surprisingly well). What could be at the root of the severe depression and restlessness I experienced immediately from Seroquel? After not taking it last night, I woke this morning fresh as a daisy and feeling sooooo much better. - Barbara
> > > > >
> > > > >
> > > >
> > > > Seroquel block Alpha-1 NE receptors the most, so I would possibly blame that. Coming in a close second is it's H1 blockade. At low doses I would say that's all it does as the next receptor is blocks is actually M1, so you'd probably notice a little dry mouth & constipation before 5-HT2A & D2 blockade ever comes to the party.
> > > >
> > > > On this page is a pretty good table showing the differences: http://www.vh.org/adult/provider/psychiatry/CPS/04.html#table2
> > > >
> > > > Cheers,
> > > > Panda.
> > > >
> > >
> > > Ooops, Ignore what I said about Seroquel probably causing antimuscarinic dry mouth & constipation. Most other websites say it doesn't block M1.
> > >
> > > Cheers,
> > > Panda.
> > >
> > >
> > >
> > panda, i'm not letting you off the hook so easily, having recently pronounced you the expert. my PDR white-sheet from astrazeneca says ``no appreciable affinity at cholinergic muscarinic and benzodiazepine receptors (IC_{50s} > 5000 nM).'' given an IC_{50} for D_{1} at 1268 nM and IC_{50} of 329 nM for D_{2}, what's an order of magnitude or two among friends? you're still in charge...... :) all the best, chemist
> >
> >
>
> Hi Chemist,
>
> Looks like I am half-wrong or half-right, Seroquel's monograph says it has no affinity for muscarinic receptors, yet constipation is high on the list of side effects straight after dry mouth. I know Alpha-1 blockade produces dry mouth, but what causes constipation beside M1 blockade?
>
> Cheers,
> Panda.
>
>
>
hey panda the only thing i can think of would implicate smooth muscle. this would involve adenosine (and the ATP cycle) in some way, although i can't seem to get from ``here to there.'' i think we need to call larry hoover in on this one......all the best, chemist
Posted by cpallen79 on July 13, 2004, at 12:13:49
In reply to Re: okay, here we go... » cpallen79, posted by chemist on July 12, 2004, at 17:46:33
Hey Chemist,
I went to my PDOC today! here's the new "cocktail" we are going to try.Luvox- probably get upt to around 200 MGS
Trazedone- around 25 mgs
Adderall XR- 5 mgs
Ativan as neededI am reluctant to take ativan, but my PDOC is very concerned about my anxiety and agitation of course, both of have been major cornerstones of my depression. We've also discussed the posssiblity of using an anticonvulsant/mood stabilizer to help with anxiety and agitation. Lamitcal came up, I told her I'd consider it.... just gotta watch out for that pesky rash of course! :)
Posted by BarbaraCat on July 13, 2004, at 13:57:09
In reply to Re: okay, here we go... (new cocktail) » chemist, posted by cpallen79 on July 13, 2004, at 12:13:49
I have my own very strong feelings on Lamictal, having come down with Stevens Johnson Syndrome rash and worse. Was sick, sick, sick for 5 weeks. It was not directly due to Lam, although I'm sure it predisposed and sensitized me to sulfa meds (where I'd never had a problem before) because I was getting weird little itches and skin sensitivities the whole time I was taking it, but ignoring those signs as I was looking for 'rash'. Lamictal is not an antianxiety by a long shot. It was activating at each new dose, although it did help with depression. But it did nothing for my agitation except to perhaps reframe the feeling into a 'buzz'.
I have had good luck on Gabapentin, although others may disagree. It's short acting and works on GABA receptors in a different manner than benzos. As long as I don't take it all the time I can get a very nice gentle relaxer from it at around 900mg.
Another thing worth trying is the amino acid L-Taurine. it's had good press as a mood stabilizer and I've found it to be very relaxing and helpful with bipolar symptoms. I take 2M twice a day (if you opt to try Gabapentin, don't take it at the same time since they compete). IMHO, anyone who is taking an antidepressant should consider taking a mood stabiliser. Potentiates their action and smooths the effect. I happen to LOVE lithium, but I'm probably in the minority. And don't hesitate to take a benzo when you really need one. The shorter half-lifers like Serax and ativan shouldnt' product any addiction problems. They won't leave you a smiling blissed out yogi, that's for certain, but they will take the edge off without worrying about developing a jones from them. Ativan is a very good benzo and will allow you to function so treat it like a security blanket. It's there if you need it and that's sometimes enough to take the edge off. - Barbara
> Hey Chemist,
> I went to my PDOC today! here's the new "cocktail" we are going to try.
>
> Luvox- probably get upt to around 200 MGS
> Trazedone- around 25 mgs
> Adderall XR- 5 mgs
> Ativan as needed
>
> I am reluctant to take ativan, but my PDOC is very concerned about my anxiety and agitation of course, both of have been major cornerstones of my depression. We've also discussed the posssiblity of using an anticonvulsant/mood stabilizer to help with anxiety and agitation. Lamitcal came up, I told her I'd consider it.... just gotta watch out for that pesky rash of course! :)
Posted by BarbaraCat on July 13, 2004, at 14:41:36
In reply to Re: Sounds like a question for CHEMIST! » BarbaraCat, posted by chemist on July 12, 2004, at 19:53:57
I realized after posting this that I made a serious gender blunder. You may be a Ph.D. (which you are), but here I am assuming you're a Mr., whereas nothing in your posts gives me reason to believe you are not a Ms!. No biggie, just amusing to catch myself hoisted on my own 'liberated' petard.
Thanks for your thorough replies to my and all of our questions. You are truly a blessing on this board and always so responsive. I speak for us all when I say we've learned much from you and you're a great asset.
I am going to be delving into methylation land for the next bit. There is a common thread that's appearing to all this, first with the histamine hypothesis and the tie with with possible methyl doner malfunctioning. The reason it jangled my bells is that I had a serious reaction to Lamictal all the while I was taking it and eventually stopped. Stevens Johnson developed from taking DMPS, a heavy metal chelator with a high affinitiy to thiol groups (in my case trying to chelate mercury) so there could be a possible tie in with the histimine/methylation relation, if there is one, and a possible breakdown of sulfur/thiol metabolism.
The other clue is that I have fibromyalgia and some recent studies have identified a epithelial mast cell inflammatory involvment which may account for the heightened skin nerve pain response. But also, ta-da, a malfunctioning histamine response at skin receptor sites seems to be involved, which would predispose one towards an inflamed skin pain sensitivity but also a heightened alergic response resulting in the erythema multiforme 'rash' (which is a severe separation of mast cells from the epithelial substrate). Mast cells -> histimine. There it is again.
So I will be busy with all my books and papers following the tail of methyl doners, histamines and into all the caverns and crannies this will lead me to. Any pointers would be appreciated. But mercy! I have some organic chemistry and neurobiology under my belt, but am by no means 'Mrs. Science'. Take care and thanks. - Barbara
> > Thanks Mr. (or is it Dr.) Chemist! That gives me a whole bunch of info to keep me busy. Ties in with the under-over methylation theories as well. Much appreciated. - BCat
>
> no, thank you (and the other posters), it's interesting and rewarding to delve into new areas (i speak of myself)...please do keep us informed about the methylation business...let me throw another bone your way: when doubly-protonated, the side chain carries a formal charge. from my work with alkaloids that bind to ligand-gated ion channels of a certain flavor, i know that the binding affinity is greatly increased if one protonates the compound in question. i wonder if a similar antagonism is instigated if the epsilon nitrogen is protonated, and thus competitive binding to H_{1} become more non-competitive? food for thought.........let us know what you discover.......and since you asked, it is chemist, Ph.D. (that and $2.00 gets me a cup of coffee.......).....all the best, chemist
> >
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> > > differing welcomed and addition information insightful.....i'm just a chemist, remember...i will point out (you know i always have to point something out.....) that it is H_{1} that is hit hardest by seroquel, and (stealing from my PDR) of all the receptors it hits, the IC_{50} for H_{1} is the lowest (!!!), at 30 nM, so no wonder the sedation. a few comments on histidine/histamine. the process of decarboxylating histidine is undertaken by an enzyme that more or less depends on your intake of vitamin B6. also, histidine at physiological pH can be protonated at both the delta and epsilon nitrogens, although the delta form dominates. there might be some correlation in your (i am using the collective ``your'') biochemistry (including stomach acids, lest we forget) that favors the doubly-protonated form and thus the production of a histamine (assuming it stays doubly-protonated after decarboxylation by PLP-powered enzymes) is deficient. alternatively, you might - and i need Larry's help here, so please page him - somehow be overproducing b6, thus making more histamine than ``normal,'' and any introduction of additional histamine will hit you like a brick. enough. all the best, chemist
> > >
> > >
> > > > Must respectfully differ with you, Most Esteemed Chemist, but I don't think it has to do with too small a Seroquel dose and breakthrough anxiety. I had an experience similar to Chris' with Seroquel just last week and a few years back with Zyprexa. Was doing pretty darn good on lithium and pharmaceutical St. John's Wort and decided to go with Seroquel mainly for sleep and any additional benefits an AP might provide for my mixed-states bipolar bane.
> > > >
> > > > Took 12.5mg/night for 4 nights and it was like I woke up on the far side of the Styx after the first dose. Agitated woozy weepy dysphoric clumsy hell. Plus a very uncharacteristic lust/frenzy for anything that hinted of cake or cookie. Kept expecting it to get better but it was getting worse. And I gained 5 lousy pounds for the priviledge.
> > > >
> > > > I realize that 12.5mg is more sedating than higher doses and this dysphoria might have eventually gone away, but the point is that something hit hard and very quickly. A very rapid switch into agitated depression and total relief after stopping. What jumps out at me is histamine. For one, the groggy sedation felt much like an anti-histamine, plus I understand that unbalanced histidine and therefore histamine levels have been implicated in depression. Mainly H3, and Seroquel seems to target H1 but jeez, mere technicalities. Perhaps I'm one of those 'histadelics' (it does feel like hysterical psychedelics for that matter). Perhaps methylation is a factor. I dunno. I only know that something caused this rapid switch into dysphoric agitation. There's a profound clue waiting to be discovered here. Just hope I don't have to go through any further personal testing to find out. I welcome any and all thoughts. - Barbara
> > > >
> > > >
> > > > > ahhh, the buck has been passed....thank you, panda...remind me not to play poker with you next time i'm down under.....the answer to the post is that, in my opinion, the seroquel dose was too small (i have to read the next one, so don't hold to this just yet) and it sounds like breakthrough anxiety. that said, i still think panda's answer is better than mine in that maybe yes, maybe no (what dose?) and what other drugs are on board that can inhibit/induce/act as substrates for isoenzymes that are also part of the seroquel metabolic route. see, i told you panda's the expert.....on to the next post, where i believe i glimpsed the meds list.....see you there, all the best, chemist
> > > > >
> > > > >
> > > > > > > Hi Panda, I was taking a tiny dose of Seroquel for sleep and a dab during the dayfor anxiety. I did well at first, but then after about a week I became very very restless and my anxiety levels really increased. Was this akathisia? I stopped takign the Seroquel Saturday but still have not felt well, what in the world happened?
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> > > > > >
> > > > > > Possibly, Akathesia is said to be a feeling of inner agitation which makes you fidgety & unable to sit still. Perhaps there was a drug interaction involved? Some drugs can raise the levels of other drugs & vice versa if they share the same liver enzyme. It's an ideal question for Chemist. :)
> > > > > >
> > > > > > Cheers,
> > > > > > Panda.
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>
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