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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Sigolene on May 19, 2000, at 14:23:52
I experienced something new last week. My doc. told me to try Magnesium for tiredness, what I did. And I immediately "fell" in deep depression. When I stopped Magnesium, depression desapeared.
Did anyone already experienced this ? or have an explaination ? (I usually have a too high turnover of DA and 5HT)
Sigolene
Posted by AndrewB on May 19, 2000, at 15:14:00
In reply to Magnesium and depression, posted by Sigolene on May 19, 2000, at 14:23:52
> I experienced something new last week. My doc. told me to try Magnesium for tiredness, what I did. And I immediately "fell" in deep depression. When I stopped Magnesium, depression desapeared.
> Did anyone already experienced this ? or have an explaination ? (I usually have a too high turnover of DA and 5HT)
> SigoleneSigolene,
I've never had that experience. Magnesium is supposed to help with depression if anything.
What does it mean to have a high turnover of DA and 5HT.
I haven't heard from you in a long time. Are you doing ok. What are you taking?
AndrewB
Posted by SLS on May 19, 2000, at 22:02:51
In reply to Magnesium and depression, posted by Sigolene on May 19, 2000, at 14:23:52
> I experienced something new last week. My doc. told me to try Magnesium for tiredness, what I did. And I immediately "fell" in deep depression. When I stopped Magnesium, depression desapeared.
Did anyone already experienced this ? or have an explaination ? (I usually have a too high turnover of DA and 5HT)
> Sigolene
Hi there.
Question: How do you know that you have too high a rate of turnover of DA and 5-HT. Have you ever had a spinal tap?
I don't know exactly what's what, but I believe magnesium may play a regulatory role in the release of neurotransmitters from presynaptic vesicles. A change in the voltage (depolarization) of the neuronal membrane at the terminal causes calcium channels to open and allows calcium ions to rush in. This event somehow induces the neuron to release its neurotransmitter into the synaptic cleft. A high concentration of extracellular magnesium Mg+2 ions prevents this calcium influx. The Ca++/Mg++ ratio seems to be important. Magnesium ions influence neurotransmission in other ways as well.Nifedipine, a calcium-channel blocker, has been known to reverse an antidepressant response to tricyclics.
I think it is conceivable that increasing your blood levels of magnesium could have been responsible for the exacerbation of your depression, if not through an increase of extracellular magnesium inhibiting calcium influx (necessary for neurotransmitter release), then perhaps by a perturbation of some other function influenced by magnesium ion.
One time, I tried taking a large amount of calcium supplement (I don't recall the amount). Within a few hours, I became very much more depressed. After this effect wore off, I was afraid to try it again. I read one post here describing exactly the same thing.
- Scott
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High serum and cerebrospinal fluid Ca/Mg ratio in recently hospitalized acutely depressed patients.Levine J, Stein D, Rapoport A, Kurtzman L
Beersheva Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel. levinej@msx.upmc.edu
Calcium (Ca) and magnesium (Mg) are involved in many processes related to depression. Evaluations of serum and plasma Ca and Mg levels in depressive disorders do not show consistent results. The few studies that examined their cerebrospinal fluid (CSF) levels tended to find no differences between depressed patients and controls. Because both hypercalcemia and hypomagnesemia are associated with depression, and as Mg may function as a Ca antagonist, it is suggested that the relationship between these cations could be different in depressed patients and controls. We examined CSF and serum Ca and Mg in acutely depressed patients diagnosed as having major depressive disorder or being in a depressive episode of bipolar disorder. Controls were subjects undergoing lumbar puncture as part of an evaluation for headache or suspected meningitis and found to demonstrate no physical or mental disorder. Serum and CSF Ca/Mg ratios were found to be elevated in the depressed patients compared with the controls. A retrospective analysis of previous trials assessing serum/plasma or CSF Ca and Mg does not seem to refute the findings of this study. We further discuss our findings in their relation to the acuteness of the depressive disorders.
PMID: 10072661, UI: 99172254
Posted by Sigolene on May 20, 2000, at 3:18:08
In reply to Re: Magnesium and depression, posted by AndrewB on May 19, 2000, at 15:14:00
I'm OK thank you.
The medication I take now is one that you don't have in the US, it's a atypical tryciclic: substance is "mianserine". It works only on NE (and not 5HT or DA). I wonder why you don't have this in US, because it's well known here (switzerland).
I don't know if I'm able to explain what "too high turover in DA and 5-HT" mean. That's what doctors said. And maybe my translation is not good, but it means that these two neurotransmitters are "destroyed" too fast in the sysnapse (connection between neurotransmitters) I think. And in consequence, the activity of DA and 5HT has to be increased, to compensate the loss. I hope you understand something because it's nor easy with these technical terms !
Sigolene
Posted by Sigolene on May 20, 2000, at 3:35:06
In reply to Re: Magnesium and depression, posted by SLS on May 19, 2000, at 22:02:51
Hi Scott,
how do I know that I have a too high turnover in 5-HT and DA you asked :
It 's because there's too much "metabolites" (residue from metabolism) of DA and 5-HT in my urine. (this can be measured to know wich med to take)
Sigolene.
Posted by AndrewB on May 20, 2000, at 8:19:05
In reply to Re: Magnesium and depression, posted by Sigolene on May 20, 2000, at 3:35:06
Sigolene,
If you get a chance would you be able to ask your p-doc how they use amisulpride in your country. I am very interested in knowing what types of depressions (i.e. atypical) it is used for and whether it is used with other antidepressants very much.
I hope I am not being too forward.
AndrewB
Posted by C.M. on May 20, 2000, at 8:36:54
In reply to Magnesium and depression, posted by Sigolene on May 19, 2000, at 14:23:52
Hi Sigolene,
I too have tried Magnesium supplements, and although whether I was depressed or not I do not know, but I do know that it made me very fatigued.
One option you might try is to just get a multi vitamin/mineral supplement. I have found it easier to tolerate the magnesium that way. However, I have only found one product called Theragram-M to be tolerable. I tried Centrum, and it bothered me. You might have to try different brands.
C.M.
Posted by SLS on May 20, 2000, at 11:53:24
In reply to Re: Magnesium and depression, posted by Sigolene on May 20, 2000, at 3:35:06
> Hi Scott,
> how do I know that I have a too high turnover in 5-HT and DA you asked :
> It 's because there's too much "metabolites" (residue from metabolism) of DA and 5-HT in my urine. (this can be measured to know wich med to take)
> Sigolene.
This is interesting. I believe this is the first time I have heard of a clinician currently using urinary levels of neurotransmitter metabolites as a an indicator of which drugs to use. I hope it works.Which drugs does your doctor suggest for people with low 5-HT and DA? Which are you taking? How do you feel?
In the past, depression has been associated with *low* levels of urinary metabolites. This is an indicator of low turnover.
Regardless of which is which, it would be very interesting to know how successful your doctor has been using these lab results to determine treatment.
Anyway, I hope you found some of the magnesium/calcium information interesting.
History:Investigations looking for associations between neurotransmitter metabolites in urine, blood, and cerebrospinal fluid (CSF) have not yielded consistent results.
Over the years, studies have often linked low levels of certain neurotransmitter metabolites (products of chemical break-down) with depression. The metabolites most often studied are: MGPG (norepinephrine), 5-HIAA (serotonin / 5-HT), and HVA (dopamine). MHPG seems to be the one that most consistently demonstrates an associated with depression. Some studies observed that when urinary levels of MHPG were low, patients were more likely to respond to an antidepressant known increase norepinephrine activity, tricyclics in particular (NE reuptake inhibition). The low levels of MHPG found in the urine are an indicator of reduced norepinephrine turnover. Low MHPG has also been shown to predominate in melancholic depression and sometimes act as an indicator of severity. The lower the MPHG, the more severe the depression.
Similar associations have been proposed for the serotonin metabolite, 5-HIAA. Some studies suggest that low CSF levels of 5-HIAA (indicating low turnover of serotonin) are associated with an increased risk of suicide. It is also suggested an individual who has low levels of 5-HIAA is more likely to respond to an SSRI. Some suggest that low 5-HIAA is indicative of atypical depression.
Again, the results of the many studies performed have been equivocal. They are inconsistent and often contradict each other.
I included a few abstracts below.I think the first helps put some of the pieces together regarding NE levels in the blood versus the urine. In summary, it suggests that in depressed individuals, NE turnover is reduced while certain NE systems are hyperresponsive (oversensitive). I don't know, but perhaps this is a function of the upregulation of NE receptors that has been observed in depression.
- Scott
------------------------------------------------------------
Psychiatry Res 1999 Jul 30;87(1):21-7 Related Articles, Books, LinkOut
Catecholamines in depression: a cumulative study of urinary norepinephrine and its major metabolites in unipolar and bipolar depressed patients versus healthy volunteers at the NIMH.Grossman F, Potter WZ
Lilly Corporate Center, Indianapolis, IN 46285, USA. fgrossman@lilly.com
Studies comparing urinary norepinephrine (NE) and its metabolites in unipolar or bipolar depressed patients and healthy volunteers have not yielded consistent findings. However, in unipolar depressed patients, most studies in non-elderly populations consistently report elevated concentrations of plasma NE, at least following an orthostatic challenge. Expanding upon previous studies which showed elevated plasma NE in depression, we compared the urinary excretion of NE, normetanephrine (NMN), 3-methoxy-4-hydroxyphenylglycol (MHPG), and vanillylmandelic acid (VMA) in age- and sex-matched unipolar and bipolar depressed patients versus healthy volunteers hospitalized at an inpatient unit at the National Institute of Mental Health. Only depressed subjects with a minimum 4-week drug-free period were included. Total turnover (NE + NMN + MHPG + VMA) was reduced in this sample of unipolar and bipolar depressed patients. MHPG concentration did not distinguish unipolar from bipolar depressed patients and was not significantly different from that in healthy volunteers. A construct of the average fractional extraneuronal concentration of NE (NE + NMN/NE + NMN + MHPG + VMA) was significantly higher in unipolar and bipolar depressed patients than in healthy volunteers. This finding extends data suggesting that unmedicated unipolar and bipolar depressed patients have a 'hyperresponsive' noradrenergic system and provides a framework which ties together plasma and urinary findings.
PMID: 10512151, UI: 99440702
------------------------------------------------------
Ann N Y Acad Sci 1997 Dec 29;836:158-81 Related Articles, Books, LinkOut
Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies.Asberg M
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. mariea@psyk.ks.se
Studies of neurotransmitter metabolites in cerebrospinal fluid (CSF) were initially focused on depressive illness. Although several studies have demonstrated low concentrations of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), and the dopamine metabolite, homovanillic acid (HVA), in depressed patients, these early studies may have been biased by concomitant administration of antidepressant drugs (which tend to lower CSF 5-HIAA), amount of CSF drawn (there is a concentration gradient for both metabolites), and selection of control subjects. Once these methodological details are controlled for, the differences between depressed patients and controls are unimpressive. However, there is a remarkably consistent association between low concentrations of CSF 5-HIAA and suicidal behavior, as evidenced by over 20 studies. The association is not confined to depressive illness but has also been found in schizophrenia, personality disorder, and certain impulse control disorders (but, interestingly, not in bipolar disorder). A low concentration of CSF 5-HIAA in a suicide attempter is associated with a substantial increase in short-term suicide risk. CSF studies in violent criminals, and in nonhuman primates, suggest that aggression dyscontrol may partly explain the association between suicide and serotonin, which is of considerable theoretical interest. CSF 5-HIAA determinations may also be helpful in the clinical assessment of suicide risk.
Publication Types:
Review
Review, academicPMID: 9616798, UI: 98279770
Posted by SLS on May 20, 2000, at 14:14:14
In reply to AndrewB Re: Magnesium and depression, posted by Sigolene on May 20, 2000, at 3:18:08
Dear Sigolene (are you a boy or a girl?) :-),
I hope you are doing well on mianserin.
Mianserin (Norval) was first released for marketing in the early 1980's. I believe it first appeared in the U.K., but I'm not sure. At the time, some researchers thought it was more effective than the tricyclics. I'm not sure why it was not introduced into the U.S. That it is very sedating and impairs cognitive performance (due to potent blockade of histamine H1 receptors) may have had something to do with it.
Mianserin is chemically related to mirtazapine (Remeron, Zipsin). Like Remeron, it is an antagonist of both norepinephrine and serotonin receptors. It does not inhibit the reuptake of any neurotransmitter at therapeutic dosages. Unlike Remeron, it does not block 5-HT3 receptors. In addition, mianserin does not promote an increase in the levels of serotonin in certain areas as does Remeron. I don't think Remeron is as potent a H1 receptor antagonist as mianserin, and is probably more tolerable with respect to sedating side effects, especially at higher dosages. Both mianserin and Remeron often cause weight gain.
Pharmacodynamics of mianserin (Norval):NE alpha-2 antagonist
5-HT1c antagonist
5-HT2a antagonist
5-HT2c antagonist
H1 antagonist
- Scott
Posted by Sigolene on May 21, 2000, at 14:16:27
In reply to Re: Sigolene, posted by AndrewB on May 20, 2000, at 8:19:05
> Sigolene,
>
> If you get a chance would you be able to ask your p-doc how they use amisulpride in your country. I am very interested in knowing what types of depressions (i.e. atypical) it is used for and whether it is used with other antidepressants very much.
>
> I hope I am not being too forward.>In the discussion about "sulpiride vs amisulpride" above, I put a link to informations about amisulpride. I don't know if you saw it. My doc can't tell more than what is written on this paper, because she uses this information to prescribe amisulpride. And in switzerland, they rarely give amisulpride for depression as far as I kow, it's more for schizophrenia , especially negative symtoms. If you understand french, you can also search on the name "BIAM" (with yahoo). This is the french general informations for doctors about meds.
Sigolene
Posted by Sigolene on May 21, 2000, at 14:41:49
In reply to Re: Levels of neurotransmitter metabolites, posted by SLS on May 20, 2000, at 11:53:24
>
>
> This is interesting. I believe this is the first time I have heard of a clinician currently using urinary levels of neurotransmitter metabolites as a an indicator of which drugs to use. I hope it works.
> Which drugs does your doctor suggest for people with low 5-HT and DA? Which are you taking? How do you feel?
For high 5 HT and DA turnover, I should take a neuroleptic wich decrease these two neurotransmitters. But I'm not taking it, because too much side effects, and also I would like to have a baby, it's not good to take neuroleptics in that case. I'm just taking E vitamin as antioxydant (to decrease the over destruction of neurotransmitters in synapses) and AD (mianserin).
I think it's an interesting thing to measure metabolites, because for example, I know now why I feel very very bad if I take SSRI's AD for my depression. It's because I already have a too high 5 HT turnover, there's no need to increase more 5 HT. My depression is probably due to low NE, because "mianserin" (which works firstly on NE) is effective.
>
> > In the past, depression has been associated with *low* levels of urinary metabolites. This is an indicator of low turnover.Yes when it's "normal" depression, but mine is atypical depression, associated with personality desorder. So, maybe it's deferent.
>
> Regardless of which is which, it would be very interesting to know how successful your doctor has been using these lab results to determine treatment.> Anyway, I hope you found some of the magnesium/calcium information interesting.
>
Yes thank you very much, and for the articles on metabolites as well. I just printed it.
>
Sigolene>
>
Posted by SLS on May 22, 2000, at 14:42:47
In reply to Re: Levels of neurotransmitter metabolites SLS, posted by Sigolene on May 21, 2000, at 14:41:49
Dear Sigolene,
Thank-you very much for your explanation. Now I understand the method your doctor uses. I think this is the first time that I have seen it. It sounds good.Thank-you for writing in English. You speak very, very well.
> For high 5 HT and DA turnover, I should take a neuroleptic wich decrease these two neurotransmitters. But I'm not taking it, because too much side effects, and also I would like to have a baby, it's not good to take neuroleptics in that case. I'm just taking E vitamin as antioxydant (to decrease the over destruction of neurotransmitters in synapses) and AD (mianserin).J'espere que vous avez un infant comme vous voulez. (I tried).
> I think it's an interesting thing to measure metabolites, because for example, I know now why I feel very very bad if I take SSRI's AD for my depression. It's because I already have a too high 5 HT turnover, there's no need to increase more 5 HT. My depression is probably due to low NE, because "mianserin" (which works firstly on NE) is effective.
This is so cool.
> > > In the past, depression has been associated with *low* levels of urinary metabolites. This is an indicator of low turnover.
> Yes when it's "normal" depression, but mine is atypical depression, associated with personality desorder. So, maybe it's deferent.
Votre explanacion est tres completement. Merci.Good luck and stay well. I just said a little prayer for you to have a healthy baby. Au revoir.
Sincerely,
Scott
J'ai oublie tout. Il y a trop des annes que je ne parle pas le langue.
This is the end of the thread.
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