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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 151 to 175 of 317. Go back in thread:
Posted by SLS on February 7, 2012, at 16:04:56
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 7, 2012, at 13:14:14
PTSD and the amygdala:
http://www.ptsd.va.gov/professional/pages/pharmacological-treatment-acute-stress.asp
"In PTSD, the normal checks and balances on amygdala activation have been impaired, so that the restraining influence on the amygdala of the medial prefrontal cortex (PFC, especially the anterior cingulate gyrus and orbitofrontal cortex) is severely disrupted (2,3). Disinhibition of the amygdala produces a vicious spiral of recurrent fear conditioning, in which ambiguous stimuli are more likely to be appraised as threatening; mechanisms for extinguishing such responses are nullified; and key limbic nuclei are sensitized, thereby lowering the threshold for fearful reactivity (2, 4-6)"
Perhaps prazosin would compensate for the PTSD-induced sensitization and thereby reduce anxiety.
- Scott
Posted by sigismund on February 7, 2012, at 17:33:15
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 7, 2012, at 16:04:56
>Disinhibition of the amygdala produces a vicious spiral of recurrent fear conditioning
Right. That could be me.
Years ago Firebreather appeared on the alternative board talking about the benefits of eating pure capsaican for this reason.
There have been a few surprises lately. Hearing that Baclofen was as good as Nardil was a surprise.
Posted by ed_uk2010 on February 8, 2012, at 6:44:30
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 7, 2012, at 13:01:27
>TCA = Potent NE alpha-1a; NE alpha-1d
>TCA = Weak NE alpha-1b
>
> My guess is that TCA does not effectively antagonize enough brain NE alpha-1b receptors to modulate brain monoaminergic neurotransmission. It just doesn't hit the right spots. NE alpha-1b receptors are known to be impaired in depression.If 1b receptors are known to be impaired in depression, would blocking them be a good thing? Perhaps 1b antagonists are useful in PTSD but not depressive illness? In clinical trials, prazosin often causes a lack of energy and weakness, and less commonly depressive symptoms and nervousness.
Posted by ed_uk2010 on February 8, 2012, at 7:59:45
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on February 7, 2012, at 17:33:15
>There have been a few surprises lately. Hearing that baclofen was as good as Nardil was a surprise.
As good for what Sigi? Baclofen is mainly used for muscle spasticity, especially in MS, for all the good it does.
Posted by SLS on February 8, 2012, at 10:20:34
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 8, 2012, at 6:44:30
> >TCA = Potent NE alpha-1a; NE alpha-1d
> >TCA = Weak NE alpha-1b
> >
> > My guess is that TCA does not effectively antagonize enough brain NE alpha-1b receptors to modulate brain monoaminergic neurotransmission. It just doesn't hit the right spots. NE alpha-1b receptors are known to be impaired in depression.> If 1b receptors are known to be impaired in depression, would blocking them be a good thing?
I don't know.
It would probably depend upon the function of the circuits that the NE alpha-1b receptor-innervated neurons modulate.
> Perhaps 1b antagonists are useful in PTSD but not depressive illness?
I have depression (probably bipolar). For me, prazosin is making a significant improvement in depression. It "feels" like a potent and clean antidepressant rather than an anxiolytic. It might depend on what were the psychosocial inducers of the depression. If abuse or neglect were conditions extant during childhood, prazosin might work specifically for the type of depression that results. Who knows? Maybe its antidepressant effects are more generalized. That would be nice. The question is: What are the antidepressants that prazosin best augments.
> In clinical trials, prazosin often causes a lack of energy and weakness,
Yup. These are well known side effects seen in general usage. They generally dissipate over time. I experienced these side effects during the first two or three weeks. They have disappeared completely. Unfortunately, prazosin can also reduce sex-drive, although it is now returning to some degree.
- Scott
Posted by SLS on February 8, 2012, at 10:29:34
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by ed_uk2010 on February 8, 2012, at 7:59:45
> > There have been a few surprises lately. Hearing that baclofen was as good as Nardil was a surprise.
> As good for what Sigi? Baclofen is mainly used for muscle spasticity, especially in MS, for all the good it does.
Baclofen is another drug that is being investigated for the treatment of PTSD as well as panic disorder. With PTSD, baclofen relieves attendant anxiety and depression.
- Scott
Posted by sigismund on February 8, 2012, at 13:38:33
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by ed_uk2010 on February 8, 2012, at 7:59:45
>As good for what Sigi?
Whoever it was didn't say. I assumed social anxiety or depression. Recently.
Posted by ed_uk2010 on February 8, 2012, at 13:39:02
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 8, 2012, at 10:20:34
>It "feels" like a potent and clean antidepressant
That's great. Are you going to try a higher dose?
Posted by ed_uk2010 on February 8, 2012, at 13:40:20
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 8, 2012, at 10:29:34
>Baclofen is another drug that is being investigated for the treatment of PTSD as well as panic disorder. With PTSD, baclofen relieves attendant anxiety and depression.
I've heard of it being used in alcohol dependence, but it's not popular.
Posted by SLS on February 8, 2012, at 13:52:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 8, 2012, at 13:39:02
> >It "feels" like a potent and clean antidepressant
>
> That's great. Are you going to try a higher dose?
You know, I hadn't even thought to do that. Duh. I was so preoccupied with the Abilify thing. My main concern would be dizziness, which I am experiencing now. It is tolerable for the most part. Considering that I am on both Parnate and prazosin, that's not too bad.I see my doctor in two weeks. I'll discuss my prazosin dosage then.
Thank you for your input, Ed. You have a talent for making objective observations and drawing logical conclusions.
- Scott
Posted by ed_uk2010 on February 8, 2012, at 13:57:31
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 8, 2012, at 13:52:33
>My main concern would be dizziness, which I am experiencing now. It is tolerable for the most part. Considering that I am on both Parnate and prazosin, that's not too bad.
How much prazosin are you taking now? If your BP drops when you stand up, it might be useful to increase your salt/fluid intake.
>You have a talent for making objective observations and drawing logical conclusions.
Thanks! You have a talent for neuroscience, and eloquent writing :)
Posted by phidippus on February 8, 2012, at 15:55:39
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 5, 2012, at 9:55:02
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgI'm sure you could go without nortriptyline and lithium
Eric
Posted by SLS on February 8, 2012, at 16:34:23
In reply to Re: Adding Parnate and prazosin., posted by phidippus on February 8, 2012, at 15:55:39
Hi Eric.
> Parnate 80 mg
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 6 mg
>
> I'm sure you could go without nortriptyline and lithium
>
> Eric
Lithium was my doctor's first choice of a drug to eliminate. I chose to continue with it because:1. It encourages hippocampal nerve growth.
2. It produces a perceptible decrease in mood lability for me.
3. It acts as a prophylaxis against Alzheimers Dementia, a disease known to occur more often with people who have MDD or BD.
I was genuinely surprised that I relapsed upon the discontinuation of Abiify.
Nortriptyline? You might be right. However, I would be reluctant to discontinue it at this point in time. The only time that I was brought into remission was when I was treated with a combination of MAOI + TCA; where neither drug alone was sufficient. Of course, I didn't take all of the other drugs in my current treatment regime at that time.
Thank you for providing your input. You might be absolutely right in your conclusions and suggestions. However, I am afraid to "rock the boat" right now.
- Scott
Posted by Beckett on February 9, 2012, at 8:47:51
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 7, 2012, at 16:04:56
I'm glad you're regaining lost ground, Scott.
Posted by SLS on February 19, 2012, at 6:53:48
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
I continue to improve.
It took two weeks to make up for the three weeks that I spent without taking Abilify. I had to recover some of the ground that I had lost. Now that I am back on Abilify, things are pretty stable. The only side effects that I experience since the addition of prazosin are some mild dizziness and a reduced sex drive. I'll have to watch my weight to see if prazosin affects it.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
- Scott
Posted by ed_uk2010 on February 19, 2012, at 9:37:59
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 19, 2012, at 6:53:48
>I continue to improve.
That's great news!
>The only side effects that I experience since the addition of prazosin are some mild dizziness and a reduced sex drive.
Excellent. That does not sound too bad at all.
>Lamictal 200 mg
I know you said >200mg causes cognitive impairment. Do you benefit from 150mg? I was wondering whether you'd be slightly more clear headed but still benefit. Of course, it might not work. Just a thought.
Posted by SLS on February 19, 2012, at 10:25:26
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 19, 2012, at 9:37:59
> >Lamictal 200 mg
> I know you said >200mg causes cognitive impairment. Do you benefit from 150mg? I was wondering whether you'd be slightly more clear headed but still benefit. Of course, it might not work. Just a thought.Yes. I tried on several occasions to reduce my dosage of Lamictal to 150 mg. I deteriorated each time. I really can't complain too much right now.
Thanks for caring.
- Scott
Posted by Beckett on February 19, 2012, at 10:49:57
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 19, 2012, at 6:53:48
:-) yea!
Posted by Phillipa on February 19, 2012, at 18:44:12
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 19, 2012, at 6:53:48
Fabulous!!!! Phillipa
Posted by SLS on February 21, 2012, at 17:41:43
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Beckett on February 19, 2012, at 10:49:57
> :-) yea!
Yes. I must say that this is rather pleasant.
I feel so much lighter.
I am very happy with my recovering an ability to socialize.
I'm gradually recovering an intellectual capacity that I thought might be lost forever.
I have a long way to go, but this is a journey to be enjoyed.
- Scott
Posted by Bob on February 21, 2012, at 17:54:43
In reply to Re: Adding Parnate and prazosin. » Beckett, posted by SLS on February 21, 2012, at 17:41:43
> > :-) yea!
>
> Yes. I must say that this is rather pleasant.
>
> I feel so much lighter.
>
> I am very happy with my recovering an ability to socialize.
>
> I'm gradually recovering an intellectual capacity that I thought might be lost forever.
>
> I have a long way to go, but this is a journey to be enjoyed.
>
>
> - ScottThat is truly awesome bro. Enjoy!
Posted by papillon2 on February 21, 2012, at 19:24:11
In reply to Re: Adding Parnate and prazosin. » Beckett, posted by SLS on February 21, 2012, at 17:41:43
> > :-) yea!
>
> Yes. I must say that this is rather pleasant.
>
> I feel so much lighter.
>
> I am very happy with my recovering an ability to socialize.
>
> I'm gradually recovering an intellectual capacity that I thought might be lost forever.
>
> I have a long way to go, but this is a journey to be enjoyed.
>
>
> - ScottI am so pleased for you and heartened by your progress.
I wish dearly to recover my brain.
Posted by sigismund on February 21, 2012, at 20:50:23
In reply to Re: Adding Parnate and prazosin. » Beckett, posted by SLS on February 21, 2012, at 17:41:43
I asked about this down below, but what you say here tells me.
>Yes. I must say that this is rather pleasant.>I feel so much lighter.
>I am very happy with my recovering an ability to socialize.
>I'm gradually recovering an intellectual capacity that I thought might be lost forever.
>I have a long way to go, but this is a journey to be enjoyed.
Posted by SLS on February 21, 2012, at 22:08:39
In reply to Re: Adding Parnate and prazosin., posted by papillon2 on February 21, 2012, at 19:24:11
> I wish dearly to recover my brain.
I understand.
Our brains betray us as our minds leave us.
I hope you recover what has been stolen from you.
- Scott
Posted by sigismund on February 22, 2012, at 0:06:52
In reply to Re: Adding Parnate and prazosin. » papillon2, posted by SLS on February 21, 2012, at 22:08:39
>Our brains betray us as our minds leave us.
Casanova was advised to his memoirs as therapy, feeling as he did that life either sent you mad or made you die of grief.
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