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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 183. Go back in thread:
Posted by ed_uk on April 14, 2005, at 10:00:54
In reply to Survector (amineptine), tianeptine's cousin, posted by sukarno on April 14, 2005, at 7:16:44
Hi Paul!
>imipramine 25mg
Imipramine was very effective at only 25mg/day??? I wonder whether you are a slow metaboliser of tricyclic antidepressants ie. low activity of the enzyme CYP2D6. Most ADs are metabolised by CYP2D6, not just TCAs. Slow metabolisers may need very low doses of most ADs, 'standard' doses may cause severe side effects.
>She then prescribed nortriptyline 25mg. I was ok on that for a few months and put up with the "skipped beats" and finally decided to taper off it.
In terms of effectiveness and side effects, did you prefer nortriptryline or imipramine?
>When I quit nortriptyline my panic did not return for at least 10 days.........
It seems that you only need very low doses of TCAs. Perhaps you would do well on an extremely low dose of nortriptyline eg. 10mg/day. Even after you discontinued nortriptyline, it was still effective for several days, perhaps you had a high serum level on 25mg and it took several days to drop below the therapeutic range. If you decided to try nort, your doctor could monitor your nortriptyline serum concentration and also your ECG.
>Later on I tried desipramine (Norpramin) in 1990 but it made me feel faint all of the time.
What dose did you try?
If you are a slow metaboliser of TCAs, you are also likely to be a slow metaboliser of certain SSRIs such as paroxetine. Many people are slow metabolisers of TCAs, people who are slow metabolisers will have high drug serum levels at low doses. Slow metabolisers can often be effectively treated with unusally low doses, 'standard' doses may cause severe side effects. You might actually do well on a micro-dose of Paxil, you could use the oral solution.
>Ativan..........
Yes, I've tried Ativan. I found it less sedating than Valium but it did seem to cause a lot of amnesia.
>The only problem I had with it was elevation of my liver enzymes.
Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again.
I'm not sure whether your elevation of liver enzymes on diazepam was important. With many drugs, mild elevation of LFTs occurs in the absense of any evidence of liver disease. Did you see a liver specialist?
>Xanax is very short-acting and much easier on the liver, although I have read in the BNF and other books that Serax (oxazepam) is the easiest on it.
AFAIK, it's not really a case of oxazepam being easier on the liver, it's more a case of oxazepam being safer than diazepam in patients with established liver disease because it is more rapidly eliminated. Serious liver damage is very rare with benzodiazepines, including diazepam.
>The cognitive effects I did feel from Valium only occurred during the beginning of treatment.
Did the sedation wear off? You said you found it very sedating at first.
>What benzos have you tried so far?
I've mainly used diazepam 10-15mg when required. I've also tried lorazepam and alprazolam. Alprazolam isn't available on the National Health Service in the UK, a friend gave me a few Xanax tablets that he bought on the internet! I didn't like Xanax at all- it made me feel extremely dumb and it didn't seem to treat my anxiety very well! I prefer Valium to be honest. Lorazepam was effective but only at high doses, 3mg 'when required' seemed to work ok. I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension.
>For physical side effects, I would rank it like this:
Valium
Tranxene
Ativan
XanaxWhat physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation.
>I was in a great mood today and laughing at jokes I was reading online.......
:-)
>Should I try Survector, or will that make me more nervous than tianeptine?
It's hard to predict. Have you ever taken a stimulant such as Ritalin or an amphetamine? Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore.
>The reason I am interested in Survector is because of low libido and lack of motivation/ambition/drive. Despite not feeling depressed one bit, I just don't have any motivation or libido. Is Xanax doing this to me perhaps?
Possibly :-(
>I had read that Xanax can also cause hyperprolactinaemia.
Various benozos have rarely been implicated in causing hyperprolactinemia. Diazepam can cause mild hyperprolactinemia at very high doses, I don't think it's generally significant.
>My doctor is willing to give me Survector but I forgot to ask her if I can take Stablon and Survector at the same time.
I don't know whether they interact, I've never heard of anyone taking them together.
Kind regards,
Ed.
Posted by sukarno on April 15, 2005, at 2:04:40
In reply to Panic » sukarno, posted by ed_uk on April 14, 2005, at 10:00:54
Hi Ed! :-)
My imipramine level was monitored once by my psychiatrist and she had said it was low. Maybe I am a slow metaboliser nevertheless. I found nortriptyline to have less side effects.. that's the reason she put me on that after the cardiac events triggered by imipramine. Both were very sedating in the beginning and although she had warned me that those medications could worsen my panic disorder before it became better, I only got better after beginning treatment. With despramine, I had tried the lowest possible dose. I forgot what the dosage was..maybe 10mg? Definitely it was less than 25mg.
With SSRIs she told me that panic disorder patients just cannot tolerate standard doses and must be started out on low doses and maybe gradually increase it over time. She gave me Prozac elixir and told me to take 5mg/day, but I only took 1mg/day because of my previous experience with Prozac in 1990 where I felt like my body was on fire at the standard dose of 20mg.
Within 36 hours after taking 1mg Prozac in 1995 for seasonal depression, the depression began to lift and a few days later I was normal. It was very nice. I had to lower the dose to 0.5mg/day because I would get heart palpitations at only 1mg/day. It still maintained a strong antidepressant effect and made me nauseated in the beginning and briefly exacerbated my anxiety and panic attacks.The unfortunate thing about Prozac, even in such a low dose, was that it killed my libido. Other than that, I was ok, but gradually began to feel a burning sensation in my stomach which persisted for several weeks.
One night I felt nauseated and weak and was passing black, tarry stools, so I went to the hospital and the nurse did some tests and said my blood levels were dropping. The GI doc came in the next day and I underwent endoscopy where he diagnosed gastritis. He couldn't find H. Pylori bacteria and then couldn't understand why I had gastritis, since I didn't take aspirin or other NSAIDs, didn't eat black pepper, etc...didn't drink or smoke or fit any of the risk factors.Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
I also had developed a rash and fevers during that time. I quit Prozac and it disappeared. Three months later I tried Prozac once more and had a worse reaction: purplish-red rash on both arms and legs along with itchy throat. I would also feel chills in the morning. That was the last time I ever took that. It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy, but I am not sure or willing to try it again to find out. hehheh.The bad experience with Prozac could have been the symptoms of Serum Sickness Syndrome, which has been reported rarely with fluoxetine. It too begins with a rash and is followed by multiple organ failure. After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions. The only one I tried after Prozac was Effexor in 2002 but it gave me hypertension even at an extremely low dose of 6.25mg (1/4 of 25mg tablet).
(I had also tried Paxil in 1993 but forgot to mention that I experienced "zaps" for several days after that single 1/2 tablet dose. Zaps weren't documented at that time and neither was SSRI dependence...I was worried that I was having seizures but my pdoc had no idea what was going on. I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions? I'm afraid to start Paxil even on a low dose due to the possibility of having those zaps...and of course the sexual side effects.)
That is a good idea though about trying the TCAs at a lower dose. Maybe I should try nortriptyline at 10mg/day and see what happens.
Is there a way to find out if I am a slow metaboliser?
I've never tried amphetamines or Ritalin. Is it fair to compare caffeine to amphetamine? I know that for panic disorder patients, caffeine is one of the most offending substances. I wonder if poor response to caffeine (e.g. palpitations, severe anxiety) predicts future response to amphetamines. Have you ever tried Survector or other CNS stimulants?
Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?"Were your LFTs elevated on Tranxene as well? Perhaps you could try Tranxene again."
Yes, unfortunately they were elevated each time I had a LFT over the years. In 1996 they were elevated, but not by much. In 2000 they were elevated (I took a glance at my chart) and couldn't figure out why the doctor didn't make mention of it, so I asked her if it was ok to take paracetamol and she told me to avoid that due to the elevated liver enzymes.
My GGT was quite high in 2002... approximately 205 and ALT was roughly double the normal limit. The Malaysian doctors weren't interested in those values. The only thing they said to me was that I must be a heavy drinker, but I told them I don't drink at all. This really puzzled one of my doctors when I was there as an inpatient. He couldn't understand why my GGT was so high. Maximum limit of normal is 50. I did eat a high fat, fast-food diet on a daily basis and have learned that high fat diets are hard on the liver and can cause fatty liver.
My last LFT was in 2003 and I had been on Xanax for several months at that time. The results were near normal then.
Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them? I haven't seen a liver specialist, but I remember asking many doctors about my LFT and they didn't think it was much to worry about. They kept thinking that I must be a drinker. hehheh.I requested a test for Hepatitis B and C and both came back negative, so that was ruled out as the cause.
If high GGT is not dangerous, then I would rather be back on Valium. I liked the muscle relaxant effect and rapid onset of action. I could see Valium being useful as PRN for panic attacks. Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
"Did the sedation wear off? You said you found it very sedating at first."
At first it made me feel quite "out of it" or sometimes "high". lol... but after a few days it wasn't sedating in that way anymore. I could still enjoy the muscle relaxation and anxiolytic effects in the long term."What physical side effects did Valium cause? It sometimes makes me feel weak due to the muscle relaxation."
Mostly ataxia..feeling a bit uncoordinated, but nothing major. The kind of feeling you get in your muscles when you've had a few beers, but not yet drunk. :-) I preferred to take 10mg in the morning since my level of anxiety in the morning has always been higher, even prior to medication. I would take the remaining two 5mg tablets in the late afternoon and before falling asleep.
"I also once tried clobazam (Frisium) which was rubbish, it didn't make me drowsy but it made me feel confused and my anxiety got worse! I like diazepam's muscle relaxant, it relieves the tension."
I was prescribed that here from an Indonesian psychiatrist, but I had never heard of it, although I suspected it was a benzo. I never filled the prescription and instead sought a second opinion. How much Frisium did you try? Have you ever tried Rivotril (Klonopin)? I wonder if they are similar since they are both anticonvulsants.
"Survector is often said to be quite stimulant-like. I not sure how long the supply of amineptine will last, I don't think it's being manufactured anymore."
I've been told that Survector is now out-of-patent and is available in Brazil, perhaps being manufactured by a generic drug company. Here in Indonesia I am not sure who makes it...it might be the brand name or it could be a generic. I guess I could try it once and find out what it's like.
I am just afraid of the liver toxicity associated with it. Maybe the FDA and media blew it out of proportion. I'm not sure how high the incidence of liver dysfunction/damage is with amineptine use.
I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
With my lack of motivation, I was thinking that dopamine agonists and/or norepinephrine reuptake inhibitors might be useful for me. Tianeptine is making me feel good, but still isn't helping with motivation.
With all these antidepressants there are so many positives and negatives. It's difficult to figure out which one is the appropriate one for treatment. I would go to a psychiatrist here, but I have a feeling they are on the SSRI bandwagon and I just don't want to risk dependence or loss of libido again. I've heard of them losing efficacy in long-term use too. They are great for some folks though, I admit.
So, I have Stablon, Survector and nortriptyline on my list. I guess I'll just have to give Stablon another month or so to find out if it will really work for more than just depression. If not, then it will be on to Survector....and then nortriptyline as a last resort. :)
Here you can buy prescription drugs without a prescription at some pharmacies..that's what I do, but with the exception of Xanax, which definitely requires a prescription as that is controlled.
I'm interested to hear more about Survector from people who have tried it. It seems that information on it (and even Stablon) is very limited. It might be that if I got on Valium or Klonopin/Rivotril that I could handle any stimulant effects from Survector and yet still feel motivated. It surely has been a miracle for some people where other antidepressants have failed.
:-)
My email is hunstad2@yahoo.com
Paul
Posted by ed_uk on April 15, 2005, at 9:43:29
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 2:04:40
Hi Paul!
>My imipramine level was monitored once by my psychiatrist and she had said it was low.
Some people only need low levels :-)
>Later on, evidence has been shown that SSRIs increase by 7 times the risk of haemorrhaging in the GI tract. I'm not sure how they do that.
It's thought that it might be related to the effects that SSRIs can have on platelet aggregation. Since SSRIs inhibit the uptake of serotonin into platelets, platelet function is disturbed and the risk of bleeding may be increased.
'A case-control study has suggested that treatment with SSRIs produces a moderately increased risk of upper gastrointestinal bleeding (adjusted relative risk 3.0).'
>I also had developed a rash and fevers during that time.
It certainly sounds like some kind of hypersensitivity reaction. Prozac has been associated with vasculitis. What starts out as a rash can turn into a very serious condition if Prozac is continued.
>After that experience I never tried another SSRI since my pdoc was afraid that all of other SSRIs could provoke similar reactions.
Since the various SSRIs are chemically/structurally unrelated, it seems unlikely that you would be hypersensitive to another SSRI. Rarely, cross-sensitivity has been reported...........
Ann Pharmacother. 2002 Apr;36(4):631-3.
Cross-sensitivity between paroxetine and sertraline.Warnock CA, Azadian AG.
Department of Pharmaceutical Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. caroline_warnock@camh.net
OBJECTIVE: To report a case of possible cross-sensitivity between selective serotonin-reuptake inhibitors (SSRIs). CASE SUMMARY: A 20-year-old Southeast Asian man developed a maculopapular rash soon after starting paroxetine. Following resolution of this rash, another skin reaction with the same distribution and appearance occurred after sertraline therapy was started. DISCUSSION: Cross-reactivity between drugs with similar structures has been reported; however, cross-reactivity among SSRI antidepressants is unexpected given their differences in chemical structure. CONCLUSIONS: The possibility of cross-reactivity between SSRI antidepressants should be considered by clinicians who wish to switch from one SSRI to another due to a dermatologic reaction.
>It is possible it could have been an ingredient in the elixir and not the Prozac which caused the allergy........
AFAIK, quite a lot of hypersensitivity reactions to fluoxetine (capsules) have been reported. I think you probably reacted to the fluoxetine itself.
>I wonder if the "zaps" are evidence of neurotoxicity rather than true withdrawal reactions?
I once had withdrawal symptoms (mild vertigo) after taking paroxetine 20mg for only five days! I didn't taper, I wasn't expecting withdrawal symptoms after I'd only been on it for five days!
Previously, after taking 40-60mg/day paroxetine for several years, I didn't have any withdrawal symptoms when I withdrew. I tapered to 20mg and then subsituted fluoxetine 20mg without a washout period. I didn't have any withdrawal symptoms when I abruptly d/ced the fluoxetine several months later. It would have been nice to have some fluoxetine caps lying around when I was having withdrawal symptoms from venlafaxine!
>Maybe I should try nortriptyline at 10mg/day and see what happens.
Perhaps you could start at 5mg/day, especially if you want to combine it with tianeptine. I don't expect that they'll interact but I don't think their interaction (or absense of interaction) has been studied.
>Is there a way to find out if I am a slow metaboliser?
I wondered whether you had low CYP2D6 activity.
There are many different variants of the CYP2D6 gene- genetic tests can be performed to identify which gene is present. These genetic tests can identify poor metabolisers.
Another way to find out whether a person is a poor metaboliser (in relation to CYP2D6) is to administer a 'probe' drug such as debrisoquine, dextromethorphan, metoprolol or sparteine. After the drug has been given, a urine sample is collected. The urine is assayed for the parent drug and metabolites. The ratio of parent drug to metabolite can be calculated in order to determine whether the person is a........
Poor metabolizer,
Intermediate metabolizer,
Extensive (normal) metabolizer,
Ultrarapid metabolizer.Even if a person is taking medication which affects CYP2D6, the genetic test is still accurate. The 'probe drug' test only works if a person is not taking any medication which affects CYP2D6.
>Even if the benzos do raise your liver enzymes, do you think it is ok to continue on them?
If you were able to take diazepam and clorazepate for many years without developing any signs of liver disease, I would imagine that it would be safe for you to take them in future. I'm not sure though. If you were to take either of these drugs in future, it might be best to have your liver function assessed by a specialist.
>Is it fair to compare caffeine to amphetamine?
Not really, their effects can differ considerably.
>Have you ever tried Survector or other CNS stimulants?
No, stimulants are rarely prescribed in the UK, I would like to try one though. Most adult psychiatrists in the UK never prescribe stimulants at all. The number of people taking prescribed stimulants is VASTLY greater in American than it is in the UK.
>Don't amphetamines make you more nervous or anxiety-prone than caffeine, or do you think caffeine is worse?
People respond very variably. Some people certainly find stimulants very anxiogenic. Certain people on this board have apparantly found amphetamines helpful in the treatment of social anxiety disorder. Several people have told me that they find methylphenidate more anxiety-inducing than amphetamines such as Dexedrine.
>Somehow I think marketing is what influenced doctors to prescribe Xanax for panic attacks as PRN, since Xanax is of much slower onset than Valium.
LOL, many doctors are very susceptible to marketing!
>How much Frisium did you try?
I tried 10mg, 20mg and 30mg doses.
>Have you ever tried Rivotril (Klonopin)?
I once took 2mg, I think it made me a bit drowsy but that's about it!
>I wonder if they are similar since they are both anticonvulsants.
Many of the major benzodiazepines are anticonvulsants. Diazepam and lorazepam are very powerful anticonvulsants, at least in the short term. Tolerance to the anticonvulsant properties of benzos often develops quite fast.
When clonazepam was introduced, Roche, the manufacturer, already marketed several benzos for anxiety and insomnia- why not invent another benzo to sell as an anticonvulsant lol!
Diazepam, clonazepam, lorazepam and clorazepate are 1,4-benzodiazepines. Clobazam (Frisium) is a 1,5-benzodiazepine, it is structurally different from the other benzos. Clobazam is claimed to cause less drowsiness than the other benzos. I didn't like it- you might like it though!
>Here in Indonesia I am not sure who makes it...
I think it would be a good idea to find out whether amineptine is still being manufactured in Indonesia. It has been discontinued in most countries but stocks may still remain.
If you are interested in the effects of amineptine, you could email Dave at HedWeb. He lives in the UK but has been importing amineptine for some time. He combines it with selegiline. I don't know what he's going to do when he can't get hold of amineptine anymore :-S
>I wanted to try Dostinex (cabergoline) as an antidepressant because I've heard good things about it and it is good for low-libido...but maybe that's anecdotal. Seems to have a favourable side-effect profile but isn't available in Indonesia.
You could consider trying an alternative dopamine agonist such as ropinirole or pramipexole. Are they available in Indonesia?
>Here you can buy prescription drugs without a prescription at some pharmacies....
I wish it was like that here, I've given up on NHS psychiatrists. All they are willing to do is prescribe another SSRI or venlafaxine. I don't have any intention of going back on an SSRI or venlafaxine!
>My email is hunstad2@yahoo.com
Mine is edward@stablefordbirkby.fsnet.co.uk
Kind regards,
Ed.
Posted by sukarno on April 15, 2005, at 20:54:11
In reply to Re: Panic » sukarno, posted by ed_uk on April 15, 2005, at 9:43:29
Hi Ed! :-)
Wow, thanks for the information. I really appreciate that.
I wonder though, is it safe for Dave to take amineptine, a TCA, with selegiline, an MAO-b inhibitor? In doses over 10mg/day, selegiline has been shown to also inhibit MAO-a and patients have experienced hypertensive crisis.
I've read that TCAs are contraindicated with MAO inhibitors. I know that my Stablon package insert says it is.
Have you heard of Parlodel? We have that here. What's your opinion of that drug?Do you have panic disorder? I've been wondering why several people, including myself, with this disorder often experience ADD-like symptoms even prior to being started on medication. 18 months before my first panic attacks, my grades began to suffer and I remember taking caffeine pills to help restore my concentration.
One of the good things about benzos I can say is that they are good for filtering out lots of background "noise" so you can concentrate more on the task at hand. If I'm walking through a shopping mall unmedicated, I will feel quite anxious and be distracted by my anxiety. Under the influence of Xanax or Valium I'll feel almost "normal" and be able to concentrate more, but usually only on one task at a time.
I suppose the stimulants such as amineptine and amphetamine could enable you to do multiple tasks?I had read a study recently that suggested that benzos might be of use in the elderly, since they can filter out the "noise" because as we age our brains are less and less able to filter out various auditory stimuli, etc.
Overall though if I had to take any drug, I would prefer stimulants or "smart drugs". I don't feel that any CNS depressant would be good for intellect.
About the nortriptyline, since it is can inhibit the reuptake of serotonin, would that conflict with tianpetine, since it does the opposite? (accelerates/enhances the reuptake of serotonin)
I'll ask a doctor about the supply of amineptine here and see if it is still being produced locally or not. :)
What do you think of the risks of amineptine with regards to hepatotoxicity? It has been said that there is a genetic susceptibility to hepatotoxicity with that drug. Some study mentioned rapid vs. slow metabolisers, and talked about giving dextromethorphan as you suggested to try to predict if it would be dangerous or not to take amineptine.
If I am indeed a slow metaboliser, does that put me at increased or decreased risk for hepatotoxicity from amineptine?What frightens me, is the study which revealed that tianeptine is reduced to the same reactive metabolites as amineptine and there are cases of hepatitis and liver damage associated with this drug too.
I guess is my eyes and/or skin start turning yellow or I start becoming nauseated or develop a rash, I'll surely stop taking it just to be safe and in the meantime have a LFT.
I'll be emailing you with what I find out about the amineptine. I think it would be disallowed on Dr. Bob's website to post any source information here. hehheh.
Have a good day! :-)
Paul
Posted by sukarno on April 15, 2005, at 21:05:36
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 20:54:11
Tuesday, 10 July, 2001, 10:04 GMT 11:04 UK
Sex drive claim in £8m action
A businessman is suing for £8m after he was given drugs which, he says, resulted in a dramatic increase in his sex drive and changed his personality.
Richard Davis, 53, was diagnosed with a non-malignant pituitary gland tumour in 1989.
The High Court in London heard that Mr Davis, who founded magazine publishers, Parkway Publications Ltd, became bankrupt with criminal convictions and no business.
Novartis Pharmaceuticals (UK) Ltd; Camden and Islington Health Authority (sued as managers of Middlesex Hospital where Mr Davis was treated) and consultant Professor Howard Saul Jacobs, now retired, all deny liability.
Until 1993, Mr Davis, from Mill Hill in London, was prescribed a class of drugs known as dopamine agonists.
Psychiatric effects
His counsel, Roger Henderson QC, said these were known to have psychiatric effects on some patients.
Initially prescribed a drug called bromocriptine, which goes under the proprietary label Parlodel, he also took part in clinical trials of an experimental drug - known as CV205-502 - which had at that time not been licensed for sale in the UK.
Bromocriptine also brought on a "marked and sometimes dramatic increase in libido" that made his sexual behaviour "incontinent and inappropriate", said Mr Henderson.
Mr Davis was convicted of dishonesty on two occasions, in December 1992 and March 1995 and was made bankrupt in 1993.
The hearing is expected to last up to eight weeks.
====================
Now, that bromocriptine (Parlodel) sounds good to me! lol. Is it good as an antidepressant too?
Posted by sukarno on April 15, 2005, at 21:30:25
In reply to Dopamine agonists as antidepressants, posted by sukarno on April 15, 2005, at 21:05:36
I forgot to mention that I remember taking dextromethrophan in the past for coughing years ago and it was quite strong. It made me feel drowsy, foggy-headed and a bit "spaced-out" like mild marijuana intoxication. That was with the standard dose...of course, I was also on Xanax at that time too (or Tranxene).
I wonder if this was a drug interaction with the benzo or because I could be a slow metaboliser.
Posted by sukarno on April 16, 2005, at 8:28:49
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Heh. I was feeling pretty good most of the day but in the evening I started feeling anxious along with difficulty concentrating and a slowness of thinking... somewhat similar to what happens when one goes without a cigarette.
I took Stablon and then 30-45 minutes later felt a relaxation along with a restoration of my mental function.
I am guessing this is due to its short half-life.
Posted by ed_uk on April 16, 2005, at 19:54:06
In reply to Re: Panic, posted by sukarno on April 15, 2005, at 20:54:11
Hi Paul!
I've read your posts and also your email. I'll reply as soon as possible :-)
Ed.
Posted by ed_uk on April 17, 2005, at 18:23:56
In reply to Tianeptine withdrawal?, posted by sukarno on April 16, 2005, at 8:28:49
Hi Paul!
How are you doing???
>I wonder though, is it safe for Dave to take amineptine, a TCA, with selegiline, an MAO-b inhibitor?
I think he's been taking the combination for quite some time, I expect that if there was going to be an interaction he would have had symptoms shortly after combining :-)
>I've read that TCAs are contraindicated with MAO inhibitors. I know that my Stablon package insert says it is.
Some TCAs are contra-indicated with MAOIs, most notably clomipramine. Clomipramine + MAOI = serotonin syndrome because clomipramine is a potent serotonin reuptake inhibitor. Imipramine is rarely combined with MAOIs due to the risk of serotonin syndrome. Some TCAs such as desipramine do not usually appear to interact with MAOIs, desipramine is a norepinephrine reuptake inhibitor. There is no information on Stablon + MAOI, the manufacturer has therefore contra-indicated the combination.
>Have you heard of Parlodel? We have that here. What's your opinion of that drug?
Bromocriptine and other ergot alkaloids have (rarely) resulted in various fibrotic reactions after long-term use. As a result, many neurologists prefer the newer non-ergot dopamine agonists such as ropinirole.
>Do you have panic disorder?
No, I have multiple difficult-to-classify mental health problems!
>I suppose the stimulants such as amineptine and amphetamine could enable you to do multiple tasks?
Some people find that. Other people find that stimulants tend to make them 'hyper-focus' on one task for a long period of time.
>About the nortriptyline, since it is can inhibit the reuptake of serotonin, would that conflict with tianpetine, since it does the opposite? (accelerates/enhances the reuptake of serotonin)
Nortriptyline is predominantly a norepinephrine reuptake inhibitor, it has little effect on serotonin reuptake. I find it difficult to say what would happen if you combined it with Stablon.... AFAIK, no info is available on the interaction.
If you were to take nortriptyline again, do you think you would consult a cardiologist? I don't know whether the arrhythmias that you experienced on TCAs were serious- you didn't have an ECG done during the episode. If you were to take nort in future, I think you would need to be very closely monitored- possibly by a cardiologist. You could have your serum nort level monitored at each dose eg. 5mg, 10mg etc. Regular ECGs could be performed to monitor the QTc interval. You could have an ECG before treatment, several days after initiation of treatment, and a few days after each dose increase. I do think that you might find a low dose of nort very effective but there are risks involved..... considering your previous experience. I am concerned that you might experience serious ventricular arrhythmias on nort. Certain TCA-induced arrhythmias may be relatively benign but ventricular arrhythymias can be life-threatening.
I wonder how you would respond to a different NRI such as reboxetine. I know several people who have responded badly to reboxetine so I am cautious to recommend it. Nevertheless, you might find it effective. Although, reboxetine commonly causes sinus tachycardia, serious arrhythmias are unlikely.
>What do you think of the risks of amineptine with regards to hepatotoxicity?
I think you'd need to have regular monitoring of liver function- before treatment and at regular intervals during treatment. Make sure that your doc is knowledgeable about liver tests!
>If I am indeed a slow metaboliser (CYP2D6) does that put me at increased or decreased risk for hepatotoxicity from amineptine?
It probably doesn't make any difference. The only relevent study suggested that amineptine liver toxicity was *not* related to CYP2D6 status.
'These results show that hepatotoxicity of several drugs, including amineptine.........is related neither to an impairment in dextromethorphan oxidation capacity nor to an unusually high capacity to oxidize this drug.'
>Now, that bromocriptine (Parlodel) sounds good to me! lol. Is it good as an antidepressant too?
I think it's been found effective in a few case reports- it's not been well studied in depression.
>I forgot to mention that I remember taking dextromethrophan in the past for coughing years ago and it was quite strong. It made me feel drowsy, foggy-headed and a bit "spaced-out" like mild marijuana intoxication.
Dextromethorphan has been reported to be more sedating in poor metabolisers. It produces greater psychomotor impairment in PMs.
>I took Stablon and then 30-45 minutes later felt a relaxation along with a restoration of my mental function.
>I am guessing this is due to its short half-life.Do you take one tablet once daily? Can you cut the tablets and take it in divided doses? I'm not even sure
Kind regards,
Ed.
Posted by sukarno on April 18, 2005, at 2:09:34
In reply to Re: Many things! » sukarno, posted by ed_uk on April 17, 2005, at 18:23:56
Well, last night I was feeling just great. :-) Went to bed feeling fine and relaxed, then had the most intense dream of my life and woke up in a cold sweat and panicked. My wife really thought I was about to lose my mind.. her opinion of these drugs just keeps getting lower. The word "Stablon" already makes her cringe.
What is interesting is that I actually had a panic attack (hyperventilation attack actually) inside the dream.
I was quite shaken up by it and thought I would end up in a psychiatric hospital, but 5 hours later the trauma of the dream wore off.
I read that nightmares are a common side effect of Stablon. Perhaps I should switch to Survector. Does it cause nightmares too?
Seems like most antidepressants cause dream abnormalities. Maybe they interfere with REM sleep or increase the amount of time spent in REM sleep?
"Nortriptyline is predominantly a norepinephrine reuptake inhibitor, it has little effect on serotonin reuptake."
Ahh...no wonder I felt so motivated on nortriptyline! :-) I've been told that serotonin is not the key, but rather, norepinephrine when it comes to increasing ambition and drive/motivation.
I'm afraid to try it now though because of my reaction to Effexor (venlafaxine). Did Effexor raise my blood pressure because of its norepinephrine reputake inhibition or because of some other mechanism? I wonder if nortriptyline would do the same thing since it acts on NE.
I hope that Survector won't cause horrible dreams. Well, my dream wasn't horrible, but just too intense and I felt very shaken up by it.
Prior to being on drugs of any sort, I had a lot of panic attacks, but strangely enough, my dreams were just fine and I didn't have severe problems with depression or agoraphobia.
It could just be coincidence. Perhaps the panic disorder would have worsened in the future anyway. It did worsen after significant life events (marriage, divorce, moving to another city, etc).
Ed, are you sure you are not a doctor? lol.. you really know what you are talking about. Come on over to Dr. Shipko's website if you haven't already been there.Panic Disorders Institute
http://www.algy.com/pdi/ikonboard/ikonboard.cgi
Take care!
Paul :-)
Posted by sukarno on April 18, 2005, at 4:53:38
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
I've noticed that Xanax is not half as effective as it was prior to taking Stablon (tianeptine).
When I feel nervous from tianeptine, I usually don't take an extra Xanax, but I did a few days ago and also today and noticed very little additional anxiolytic effect from it.
Overall I'd say that for me, Stablon is not an anxiolytic, but is good for depression (in my case anyway).
I thought about adding or switching to Klonopin/Rivotril since it is very long-acting (one tablet seems to last about 12 hours) to counter the nervousness caused by Stablon.
Posted by ed_uk on April 18, 2005, at 11:17:07
In reply to Tianeptine decreasing effects of Xanax, posted by sukarno on April 18, 2005, at 4:53:38
Hi Paul!
>What is interesting is that I actually had a panic attack (hyperventilation attack actually) inside the dream.
I'm sorry to hear that :-(
I have heard of tianeptine causing nightmares. I've never heard of amineptine causing nighmares but I would imagine that it is possible!>I'm afraid to try it now though because of my reaction to Effexor (venlafaxine).
Was your BP normal when you tried nortriptyline before?
>Did Effexor raise my blood pressure because of its norepinephrine reputake inhibition or because of some other mechanism?
Possibly. Nortriptyline is more likely to decrease blood pressure because it blocks alpha-1 receptors.
>Come on over to Dr. Shipko's website if you haven't already been there.
I'd like to but I really mustn't- I already spend such a vast amount of time on the internet. If I go to a new site I will probably become addicted to it!!
>Xanax
Do you take the Xanax four times a day? Do you ever suffer from anxiety/withdrawal symptoms between doses? Do you have Xanax XR in Indonesia?
Kind regards,
Ed.
Posted by sukarno on April 18, 2005, at 21:54:19
In reply to Re: Tianeptine » sukarno, posted by ed_uk on April 18, 2005, at 11:17:07
Hi Ed! :-)
"Was your BP normal when you tried nortriptyline before?"
Back in those days I never checked my BP, but my psychiatrist did when I was on imipramine or nortriptyline (forgot which) and she said, "Your blood pressure could be a bit lower. You should take up some exercise."
I think she didn't want to scare me...maybe my BP was high.So I took up exercise and apparently it came down to normal, but that was back in the days when they didn't have BP machines in the supermarkets and shopping malls.
I'm still surprised how such a minute dose of Effexor could have raised my blood pressure and caused such symptoms. How did you like Effexor?
"Do you take the Xanax four times a day? Do you ever suffer from anxiety/withdrawal symptoms between doses? Do you have Xanax XR in Indonesia?"
Yep, four times a day, so I take it every 6 hours to keep the level as even as possible. At 0.5mg 4x/day I had rebound anxiety between doses, so I raised the dose gradually to 1mg 4x/day... at that point there was no more rebound anxiety.
Good thing about Xanax is that it's easy to reach steady-state! :-) Sometimes with Valium it takes a while to reach that "peak" and then "fine-tuning" the dose isn't easy as it can take days to feel any difference.
I wish there was Xanax XR here, but can't find it. I also asked a friend of mine up in Malaysia that works at Pfizer if they have it there, but she said there are no plans to market it in Malaysia.
Here in Indonesia we are further behind when it comes to meds (I think), so we probably won't ever see Xanax XR here.
What meds do you take now? Are they working well?
Posted by ed_uk on April 20, 2005, at 7:13:37
In reply to Re: Tianeptine, posted by sukarno on April 18, 2005, at 21:54:19
Hi Paul!!
>BP
I think you'd have to be sure to get your BP monitored regularly if you were to take nortriptyline again.
>reboxetine
It's possible that reboxetine might raise your BP quite a lot (considering your reaction to Effexor). It might actually be considerably worse than Effexor! - just a hypothesis....
>How did you like Effexor?
It made me drowsy and lazy like an SSRI. It didn't help my depression. I only took 150mg but I didn't want to increase the dose because of the side effects.
>At 0.5mg 4x/day I had rebound anxiety between doses, so I raised the dose gradually to 1mg 4x/day... at that point there was no more rebound anxiety.
Perhaps you'd have less side effects if you reduced your dose to 0.5mg six times a day. Hopefully this would avoid inter-dose anxiety.
>We probably won't ever see Xanax XR here.
I'm certain that we won't ever see it here either. 'Regular' Xanax isn't available on the National Health Service so it's virtually never prescribed.
>What meds do you take now? Are they working well?
I was taking lofepramine up until last week, I've been on it for about 2 years. I stopped taking it when I ran out! I'm not sure whether I'll get another prescription or not.
Kind regards,
Ed.
Posted by sukarno on April 24, 2005, at 9:51:19
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
This is scary. I hope it isn't that dangerous to take tianeptine, since it is metabolised by beta-oxidation? I've been on it for one month and have remained depression-free, and feel a more anxiolytic effect from it now, although in the morning I sometimes feel a bit "down"...I assume this is because of the short half-life of tianeptine.
1: Pharmacol Ther. 1995;67(1):101-54.
Inhibition of mitochondrial beta-oxidation as a mechanism of hepatotoxicity.Fromenty B, Pessayre D.
Institut National de la Sante et de la Recherche Medicale Unite 24, Hopital Beaujon, Clichy, France.
Severe and prolonged impairment of mitochondrial beta-oxidation leads to microvesicular steatosis, and, in severe forms, to liver failure, coma and death. Impairment of mitochondrial beta-oxidation may be either genetic or acquired, and different causes may add their effects to inhibit beta-oxidation severely and trigger the syndrome. Drugs and some endogenous compounds can sequester coenzyme A and/or inhibit mitochondrial beta-oxidation enzymes (aspirin, valproic acid, tetracyclines, several 2-arylpropionate anti-inflammatory drugs, amineptine and tianeptine); they may inhibit both mitochondrial beta-oxidation and oxidative phosphorylation (endogenous bile acids, amiodarone, perhexiline and diethylaminoethoxyhexestrol), or they may impair mitochondrial DNA transcription (interferon-alpha), or decrease mitochondrial DNA replication (dideoxynucleoside analogues), while other compounds (ethanol, female sex hormones) act through a combination of different mechanisms. Any investigational molecule should be screened for such effects.
Publication Types:
* Review
PMID: 7494860 [PubMed - indexed for MEDLINE]
Posted by ed_uk on April 24, 2005, at 12:00:30
In reply to Stablon (tianeptine) and hepatotoxicity, posted by sukarno on April 24, 2005, at 9:51:19
Hi Paul!
Take care not to combine tianeptine with other drugs which may increase it's hepatotoxicity- such as aspirin and the tetracycline antibiotics.
I think you should consider having regular LFTs, including a prothrombin time/INR, as is recommended for valproate.
Kind regards,
Ed.
Posted by sukarno on April 25, 2005, at 3:43:30
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Seems like a few people have taken large doses, in some cases up to 240 tablets/day, of tianeptine without serious consequences.
Tricyclic antidepressants are well known for their toxicity in overdose with serious cardiac complications.
Why is this (supposedly) lacking in tianeptine? It is a TCA, eh?
I took 3 tablets yesterday and did notice a few heart palpitations and when I stood up I felt like I would faint (orthostatic hypotension), but nothing like imipramine or other classic TCAs.
Posted by sukarno on April 26, 2005, at 4:35:35
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Seems like the longer I take this, the better I feel. The one thing I've noticed the past few days is a feeling like I am so "comfortable".. hard to describe and relaxed and want to hug everyone. Weird. Well, I read about Ecstasy and it has those effects.
Some sort of psychostimulant "hug-drug" effect.. I can definitely feel it. Mild euphoria. In the mornings I feel a bit down, but after taking Stablon I can feel it kick in about 30-60 minutes later.
Now I can see why a few people might abuse it. Very nice, clean drug. :) I just hope it continues to work!
:)
Posted by ed_uk on April 26, 2005, at 8:03:59
In reply to Stablon an entactogen? hehheh, posted by sukarno on April 26, 2005, at 4:35:35
Hi Paul!
>Why is this (supposedly) lacking in tianeptine? It is a TCA, eh?
Yes, it's a TCA. Most TCAs can cause arrhythmias in overdose because they block specific ion channels in the heart. Perhaps this effect is much less marked with tianeptine.
>Seems like the longer I take this, the better I feel. The one thing I've noticed the past few days is a feeling like I am so "comfortable".. hard to describe and relaxed and want to hug everyone.
Sounds good to me!
Regards,
Ed.
Posted by Declan on April 26, 2005, at 23:24:29
In reply to Stablon an entactogen? hehheh, posted by sukarno on April 26, 2005, at 4:35:35
Very interesting. Keep us posted.
Declan
Posted by sukarno on April 28, 2005, at 2:42:36
In reply to Developing side effects to tianeptine (Stablon), posted by sukarno on March 25, 2005, at 5:30:58
Hi, I have some Valium and Klonopin (Rivotril) which are 2 1/2 and 4 years old respectively.
Do these medications become toxic with age? I thought I had read that Klonopin can become toxic to the kidneys when it is expired, but a pharmacist I asked wasn't sure if it will become toxic or not.
What's the general consensus on expired benzodiazepines?
Reason I ask is because I'm almost out of Xanax and it isn't working well enough to stop my night terrors (nocturnal panic attacks), so I was thinking of substituting either Valium or Klonopin for my nighttime Xanax dose.
Thanks very much in advance! :)Paul
Posted by pro_social_soon on April 30, 2005, at 7:37:59
In reply to Expired medications... safe to take?, posted by sukarno on April 28, 2005, at 2:42:36
> Hi, I have some Valium and Klonopin (Rivotril) which are 2 1/2 and 4 years old respectively.
>
> Do these medications become toxic with age? I thought I had read that Klonopin can become toxic to the kidneys when it is expired, but a pharmacist I asked wasn't sure if it will become toxic or not.I used to take Valium which was 4 years expired and was working like normal Valium. Just my 2 cents.
Oh btw. what dose of Stablon are you on? Do you take any other meds?
Take care
Posted by sukarno on April 30, 2005, at 10:35:49
In reply to Re: Expired medications... safe to take? » sukarno, posted by pro_social_soon on April 30, 2005, at 7:37:59
Hi there. :-)
I'm back up to the manufacturer's recommended dose of 12.5mg 3x a day.
Other meds I take are Xanax 1mg 3x/day and 1.5 to 2mg at bedtime; famotidine (Pepcid) 20mg every 6 hours for acid reflux.
I've found Stablon to reduce the effectiveness of Xanax and have had headaches and nightmares which haven't gone away with prolonged use (of Stablon).
I'm about to give up on the Stablon "experiment" because of the headaches (a chronic, vascular headache in the temples and front part of the head that starts up after my 2nd pill of the day in the late afternoon and goes away by morning) and nightmares/vivid dreams.
It also hasn't lifted me out of my amotivational syndrome despite its antidepressant effect.The good side is that I feel better in terms of less anxiety/worry, less asthma symptoms and no depression whatsoever.
I think the headaches are just too much, so I'm going to try Survector (amineptine) next at a low dose (maybe 25 to 50mg to start) and have a liver function test.
I'm also contemplating a Xanax withdrawal via gradual Valium substitution and taper.
Xanax just isn't effective enough on Stablon. Even higher doses don't do much good. I feel I probably need a longer acting benzo if I'm going to be on antidepressants.
I just hope Survector doesn't give me headaches! :-)
Overall, I'd say Stablon is excellent for depression and also somatic complaints or accompanied excessive worrying..and possibly even good for panic attacks!
Has anyone else here had headaches on Stablon? You know how a caffeine withdrawal headache is eh? It's exactly like that, except I don't drink coffee or any caffeinated beverages.
Thanks for writing. I hope others can find Stablon useful. I don't think taking paracetamol or ibuprofen on a daily basis would be a good idea just to reduce the headaches caused by it.
Paul
Posted by ed_uk on April 30, 2005, at 14:07:30
In reply to Stablon experiment coming to an end., posted by sukarno on April 30, 2005, at 10:35:49
Hi Paul!
It's seems you've had a love-hate relationship with Stablon! I hope Survector works well :-) Did you ever find out whether it is still being manufactured in Indonesia?
When will you be starting Survector?
Kind regards,
Ed.
Posted by sukarno on April 30, 2005, at 15:14:10
In reply to Re: Stablon experiment coming to an end. » sukarno, posted by ed_uk on April 30, 2005, at 14:07:30
Hi Ed! :-) Great to see you back here again. How are you doing? Are you still on lofepramine?
Yeah, too bad about the headaches. The headache did seem to dissipate quite a bit when I took another Xanax. Maybe I should try taking more benzos if that will help the headaches and night terrors?
Maybe I should just go straight to Survector though.
I still haven't heard from that doctor friend of mine. She is so busy. I did call the pharmacy that she recommended, but just got voice mail, so I sent her an SMS (text message) to ask the pharmacist for some Survector.
I'll just try my best to speak the local language with the pharmacist and find out if it is being locally produced. That would be great if it was! :-)
Putting things into perspective, abuse and liver damage are quite rare when compared to the possible millions of prescriptions which were filled for Survector over a 20 year period.
I really need something to give me a healthy motivation. Survector seems to be good at doing that from what I've read.
I hate to be my own doctor, but the pdocs here, just as in the US, are all on the SSRI bandwagon. When it comes to panic disorder, they are even less knowledgeable.
I know what I'll do... I'll ask my wife to translate into Indonesian language what I need to ask the pharmacist about whether it is being produced locally. That oughta do the trick! Or just go there in person. :-)
I'm really looking forward to having a normal life for once... it has been 17 years of a somewhat non-existance. :(
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