![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by SadSuzie on July 15, 2000, at 16:23:47
I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
Your input is greatly appreciated.
ss
p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.
Posted by AndrewB on July 16, 2000, at 8:54:18
In reply to Calling Andrew B (and other babblers), posted by SadSuzie on July 15, 2000, at 16:23:47
Dear Sad,
KarenB is now trying amisulpride without Zyprexa. Her comparison between the two ought to shed a lot of light on wihich med. might be better for you since she shares a lot of our symptoms. Her early impression is that amisulpride has less side effects.
Adrafinil sounds to me like it may combine well with either amisulpride or Zyprexa.
Both amisulpride and Zyprexa are atypical antipsychotics. Amisulpride antagonizes the presynaptic dopamine D2/D3 receptors while Zyprexa antagonizes the presynaptic dopamine D2 receptor and, in a stronger fashion if I remember right, the serotonin 5HT2 recpetor.
AndrewB
Posted by JohnL on July 16, 2000, at 9:38:19
In reply to Calling Andrew B (and other babblers), posted by SadSuzie on July 15, 2000, at 16:23:47
> I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
>
> A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
>
> Your input is greatly appreciated.
>
> ss
>
> p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.
SadSuzie (but not for long :-)),
I have tried mixing Amisulpride with Adrafinil. I thought it was an awesome combination. And for the diagnosis and symptoms you describe, it could be perfect. Either one alone might be real good, but one added to the other really rounds out the whole thing. So just in case you were wondering if anyone's ever tried it, yes, I have, and it was real good. Tons better than SSRIs or Moclobemide (the only MAOI I've tried) or anything else.I think I may add 25mg or 50mg Amisulpride back into my ongoing Adrafinil. Adrafinil alone is real good, and Amisulpride alone was good too (but not as good as Adrafinil), but the two together are really good. I really liked that combination.
I've tried Zyprexa too. It was one of the best meds I've ever tried. I had two complaints with it that really bothered me, 1)My legs were sore, crampy, and weak all the time; 2)that early morning hangover feeling just got to me. I also gained some weight, which was no big deal since I'm overly skinny anyway. But to someone else that might be a concern. Overall I think Zyprexa is a wonderful med with few side effects for some people, but a couple nuisance side effects for other people. Neither Amisulpride or Adrafinil have affected my weight one way or the other.
Zyprexa does have the advantage of being easier to get. I would guess Zyprexa+Adrafinil could be considered.
Amisulpride is different than Zyprexa in that Amisulpride is more specific in its mechanism of action. It only works on dopamine receptors, and only on very specific dopamine receptors. Zyprexa on the other hand has all kinds of mechanisms on various dopamine receptors, noradrenergic, histaminic, and serotonin receptors. AndrewB is real good at explaining this kind of thing. I'm just generalizing with a wide brush.
I don't know if any of this helps, but I thought I would pass it along.
John
Posted by SadSuzie on July 16, 2000, at 13:20:58
In reply to Re: Calling Andrew B (and other babblers), posted by JohnL on July 16, 2000, at 9:38:19
Thanks so much for the response guys. I'm going to try the amisulpride with adrafinil combo.
> > I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
> >
> > A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
> >
> > Your input is greatly appreciated.
> >
> > ss
> >
> > p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.
>
>
> SadSuzie (but not for long :-)),
> I have tried mixing Amisulpride with Adrafinil. I thought it was an awesome combination. And for the diagnosis and symptoms you describe, it could be perfect. Either one alone might be real good, but one added to the other really rounds out the whole thing. So just in case you were wondering if anyone's ever tried it, yes, I have, and it was real good. Tons better than SSRIs or Moclobemide (the only MAOI I've tried) or anything else.
>
> I think I may add 25mg or 50mg Amisulpride back into my ongoing Adrafinil. Adrafinil alone is real good, and Amisulpride alone was good too (but not as good as Adrafinil), but the two together are really good. I really liked that combination.
>
> I've tried Zyprexa too. It was one of the best meds I've ever tried. I had two complaints with it that really bothered me, 1)My legs were sore, crampy, and weak all the time; 2)that early morning hangover feeling just got to me. I also gained some weight, which was no big deal since I'm overly skinny anyway. But to someone else that might be a concern. Overall I think Zyprexa is a wonderful med with few side effects for some people, but a couple nuisance side effects for other people. Neither Amisulpride or Adrafinil have affected my weight one way or the other.
>
> Zyprexa does have the advantage of being easier to get. I would guess Zyprexa+Adrafinil could be considered.
>
> Amisulpride is different than Zyprexa in that Amisulpride is more specific in its mechanism of action. It only works on dopamine receptors, and only on very specific dopamine receptors. Zyprexa on the other hand has all kinds of mechanisms on various dopamine receptors, noradrenergic, histaminic, and serotonin receptors. AndrewB is real good at explaining this kind of thing. I'm just generalizing with a wide brush.
>
> I don't know if any of this helps, but I thought I would pass it along.
> John
Posted by KarenB on July 20, 2000, at 12:35:59
In reply to Calling Andrew B (and other babblers), posted by SadSuzie on July 15, 2000, at 16:23:47
> I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
>
> A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
>
> Your input is greatly appreciated.
>
> ss
>
> p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.Suzie,
In my opinion, Zyprexa is GREAT in it's mental benefits but it is almost guaranteed that you will gain weight during therapy. It would be very unusual if you didn't. So, it's up to you how important that will be. If you are thin and could stand to gain a few pounds, it could be very nice. Call me vain if you will but fitting into jeans like a sausage does not do much for my mental/emotional well being. I recently lost the weight I had put on from uneffective meds and am right where I want to be. Because of this, I opted to stop the Zyprexa and start Amisulpride which is working better than I even imagined.
There is a new drug that is supposed to be just like Zyprexa, minus the weight gain and should be approved very soon (?) When that happens, it would be an option for me.
For the time being, I have found Amisulpride to be a superior med, for whatever is wrong with me. I take it with Adderall and Adrafinil and am feeling more sane, stable and "well" than I have in a long, long time.
Hope you are doing well.
Karen
Posted by michael on July 21, 2000, at 13:12:09
In reply to Re: Zyprexa or Amisulpride? » SadSuzie, posted by KarenB on July 20, 2000, at 12:35:59
Hi Karen -
Just wondering how you'd compare amisulpride & sulpiride? Sounds like the aderall/adrafinil/amisulpride somewhat paralells the amineptine/sulpiride combo from the philippenes? Not quite as good? michael
> > I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
> >
> > A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
> >
> > Your input is greatly appreciated.
> >
> > ss
> >
> > p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.
>
> Suzie,
>
> In my opinion, Zyprexa is GREAT in it's mental benefits but it is almost guaranteed that you will gain weight during therapy. It would be very unusual if you didn't. So, it's up to you how important that will be. If you are thin and could stand to gain a few pounds, it could be very nice. Call me vain if you will but fitting into jeans like a sausage does not do much for my mental/emotional well being. I recently lost the weight I had put on from uneffective meds and am right where I want to be. Because of this, I opted to stop the Zyprexa and start Amisulpride which is working better than I even imagined.
>
> There is a new drug that is supposed to be just like Zyprexa, minus the weight gain and should be approved very soon (?) When that happens, it would be an option for me.
>
> For the time being, I have found Amisulpride to be a superior med, for whatever is wrong with me. I take it with Adderall and Adrafinil and am feeling more sane, stable and "well" than I have in a long, long time.
>
> Hope you are doing well.
>
> Karen
Posted by michael on July 21, 2000, at 13:31:36
In reply to Re: Zyprexa or Amisulpride? » SadSuzie, posted by KarenB on July 20, 2000, at 12:35:59
When I tried amisulpride alone at 50mg/day, it was as if I was taking a sleeping pill-slept at least 10-12 hours a day. Anyone else have that type of a response?
I'm also wondering if anyone who has tried amisulpride has also tried sulpiride, and could compare them (subjective effects). michael
> > I've been considering trying a combination of amisulpride and adrafinil. However, having read Karen and Kerry's postings on their tremendous success with Zyprexa, I am tempted to approach my psy about the possibility of a trial. Any thoughts on these med combos? What is the difference in Zyprexa and Amisulpride?
> >
> > A quick reminder: I have social phobia, ADD, and atypical depression Tried a multitude of ADs. SSRI’s are a nightmare for me and I've had my "best" results with MAOIs.
> >
> > Your input is greatly appreciated.
> >
> > ss
> >
> > p.s. I’ve had my thyroid thoroughly tested and all results fall right in the middle of the normal ranges.
>
> Suzie,
>
> In my opinion, Zyprexa is GREAT in it's mental benefits but it is almost guaranteed that you will gain weight during therapy. It would be very unusual if you didn't. So, it's up to you how important that will be. If you are thin and could stand to gain a few pounds, it could be very nice. Call me vain if you will but fitting into jeans like a sausage does not do much for my mental/emotional well being. I recently lost the weight I had put on from uneffective meds and am right where I want to be. Because of this, I opted to stop the Zyprexa and start Amisulpride which is working better than I even imagined.
>
> There is a new drug that is supposed to be just like Zyprexa, minus the weight gain and should be approved very soon (?) When that happens, it would be an option for me.
>
> For the time being, I have found Amisulpride to be a superior med, for whatever is wrong with me. I take it with Adderall and Adrafinil and am feeling more sane, stable and "well" than I have in a long, long time.
>
> Hope you are doing well.
>
> Karen
Posted by AndrewB on July 21, 2000, at 16:14:15
In reply to Amisulpride Question?, posted by michael on July 21, 2000, at 13:31:36
Good questions Micheal.
It seemed like the target presynaptic D2/D3 receptor wasn't getting stimulated by the amisulpride in your case. I wonder why. Maybe it has something to do with individual differences in receptor binding affinities.
I also wonder if someone who doesn't respond to amisulpride may respond to Pramipexole (Mirapex). Both amisulpride's and pramipexole's ultimate action is to correct D2/D3 hypofunction. But, while I respond robustly to amisulpride, I didn't respond to a fairly good trial with pramipexole. So I'm just wondering if the reverse can be true; someone who doesn't respond to amisulprride may respond to pramipexole.
AndrewB
Posted by KarenB on July 22, 2000, at 16:30:38
In reply to Re: Zyprexa or Amisulpride? » KarenB, posted by michael on July 21, 2000, at 13:12:09
> Hi Karen -
>
> Just wondering how you'd compare amisulpride & sulpiride? Sounds like the aderall/adrafinil/amisulpride somewhat paralells the amineptine/sulpiride combo from the philippenes? Not quite as good? michaelmichael,
It's just as good, if not better - really. In my opinion, Adderall plus low dose Adrafinil is very much like Amineptine. Add the Amisulpride and...I am well and happy. Hee hee!!!!!
Karen
Posted by KarenB on July 22, 2000, at 16:53:08
In reply to Amisulpride Question?, posted by michael on July 21, 2000, at 13:31:36
> When I tried amisulpride alone at 50mg/day, it was as if I was taking a sleeping pill-slept at least 10-12 hours a day. Anyone else have that type of a response?
>
> I'm also wondering if anyone who has tried amisulpride has also tried sulpiride, and could compare them (subjective effects). michaelmichael,
For me, amisulpride and sulpiride work best when used with a stimulant. I have no problem with sleepiness and get all the benefits of the neuroleptic that way.
I like amisulpride even better than sulpiride.
This is what I am taking: 30-45 min before arising, 10mg Adderall, 300mg Adrafinil and 50mg Amisulpride. 5 hours later, same dosage minus the Adrafinil.
I found what works for me but as you say, michael, it is almost exactly what worked so well for me before. My quest to find a comparable med combo stateside, however, has failed.
If I ever need to gain 30-50 lbs., (ha ha - NOT!) Zyprexa may be an option. Their ad slogan should read, "...mental enhancement and physical augmentation - Thanks, Zyprexa!"
Karen
Posted by shellie on July 22, 2000, at 20:27:07
In reply to Re: Amisulpride Question? » michael, posted by KarenB on July 22, 2000, at 16:53:08
Hi Karen.Another question. Basically are you saying that the Amisulpride is the main antidepressant in your cocktail. I'm wondering (along with ADD and lack of motivation, etc.) if you ever experienced severe depression. I don't have ADD; and I have major depression. I have been combining all my trials of stimulents with Nardil, (Nardil has not been working very well, but is still helping me to not bottom out.) Is Amisulpride a drug that is being tried for major depression, or more for atypical depression. Thanks, Shellie
Posted by AndrewB on July 23, 2000, at 19:28:52
In reply to Re: Amisulpride Question? -- KarenB, anyone, posted by shellie on July 22, 2000, at 20:27:07
Shellie,
Shellie,
I have included below the abstracts of two studies that indicate that amisulpride is effective for major depression in partial remission.
To my knowledge, in actual practice amisulpride is normally reserved for use in social anxiety, dysthymia and atypical depression.
It may have a place as an adjunct (add-on) medicine in major depression. Maybe it can play a role similar that Zyprexa plays as an adjunct.
At some point you may wish to discuss with your doctor having a trial with Zyprexa, a week should do. If you experience improvement, aside from any side effects such as sedation or hunger, it is an indication you may respond well to amisulpride.
The good thing about a trial with either amisulpride or Zyprexa is that they can be done quickly and side effects, if they do occur, are quite tolerable over the short term.
A poster here has combined amisulpride with Parnate without ill effect. The combo of amisulpride and Nardil may increase hypotension. I wonder how often a neuroleptic is combined with an MAOI with good results.
AndrewB
===========================Title: Amisulpride versus fluoxetine in patients with dysthymia or major depression in partial remission: a double-blind, comparative study.
Author Smeraldi E
Address Istituto Scientifico Ospedale San Raffaele, Department of Neuropsychiatric Sciences, University of Milan-School of Medicine, Italy.
Source J Affect Disord, 48(1):47-56 1998 FebIn a multicentre, double blind, parallel group study 281 patients with DSM III-R diagnosis of dysthymia or a single episode of major depression in partial remission were randomised to 3 months of treatment with amisulpride 50 mg/day or fluoxetine 20 mg/day. The baseline Montgomery and Asberg Depression Rating Scale (MADRS) total score was reduced by at least 50% in 74.1% of patients (103/139) with amisulpride and 67.4% (87/129) with fluoxetine (P =0.230). No significant differences between treatment groups were found in the reductions in mean total score with the MADRS, Widl¨ocher psychomotor retardation scale, Sheehan disability scale, and CGI. Anxiety measured by HAM-A total mean score decreased significantly more with amisulpride (63%) than with fluoxetine (54%; P = 0.021). There were 13 dropouts due to adverse events with amisulpride and ten with fluoxetine. The number of patients reporting at least one adverse event was similar in the two groups (amisulpride 47.5%; fluoxetine 40.9%). As expected, in the amisulpride group endocrine-like adverse events in female patients were the most common, while nausea, dyspepsia, anorexia and insomnia occurred more frequently with fluoxetine.
--------------------------------------------------------------------------------------
Title Amisulpride versus imipramine and placebo in dysthymia and major depression. Amisulpride Study Group.Author Lecrubier Y; Boyer P; Turjanski S; Rein W
Address Unit´e INSERM 302, H^opital Salpetri`ere, Paris, France.
Source J Affect Disord, 43(2):95-103 1997 AprAmisulpride, a selective antagonist of D2 and D3 dopamine receptors, acts preferentially on presynaptic receptors increasing dopaminergic transmission at low doses. In a multicentre, 6 months, placebo-controlled trial, amisulpride (50 mg/daily) was compared to imipramine (100 mg/daily) in the treatment of patients with DSM-III-R criteria for primary dysthymia, dysthymia with major depression or major depression in partial remission. A total of 219 patients were included. Both analyses (intention-to-treat and "per protocol' analysis) detected significant differences between groups (active treatment vs. placebo) on all main rating scales (CGI, MADRS, ERD, and SANS). The number of patients reporting at least one adverse event was higher in the imipramine group than in the two other, mainly due to anticholinergic effects. Endocrine symptoms were more frequent in female patients treated with amisulpride. These results confirm the interest of a drug acting on dopaminergic transmission such as amisulpride in the treatment of depressed patients.
Posted by shellie on July 23, 2000, at 19:50:00
In reply to Re: Amisulpride Question? -- Shellie, posted by AndrewB on July 23, 2000, at 19:28:52
>
Posted by michael on July 24, 2000, at 13:10:00
In reply to Re: Amisulpride Question? » michael, posted by KarenB on July 22, 2000, at 16:53:08
Hi Karen -
Thanks for the replies/info. You mention that you like amisulpride even better than sulpiride. Not to beat a dead horse, but is the difference that you note between them something that can be put into words (qualitative?) - I'm guessing that they're pretty similar...
I'm thinking of trying one of them (or both) again, this time in addition to adrafinil, hoping to avoid the sedative effects I experienced the first time. Thanks for any input. michael
> > When I tried amisulpride alone at 50mg/day, it was as if I was taking a sleeping pill-slept at least 10-12 hours a day. Anyone else have that type of a response?
> >
> > I'm also wondering if anyone who has tried amisulpride has also tried sulpiride, and could compare them (subjective effects). michael
>
> michael,
>
> For me, amisulpride and sulpiride work best when used with a stimulant. I have no problem with sleepiness and get all the benefits of the neuroleptic that way.
>
> I like amisulpride even better than sulpiride.
>
> This is what I am taking: 30-45 min before arising, 10mg Adderall, 300mg Adrafinil and 50mg Amisulpride. 5 hours later, same dosage minus the Adrafinil.
>
> I found what works for me but as you say, michael, it is almost exactly what worked so well for me before. My quest to find a comparable med combo stateside, however, has failed.
>
> If I ever need to gain 30-50 lbs., (ha ha - NOT!) Zyprexa may be an option. Their ad slogan should read, "...mental enhancement and physical augmentation - Thanks, Zyprexa!"
>
> Karen
Posted by KarenB on July 24, 2000, at 14:32:27
In reply to Re: Amisulpride Question? -- KarenB, anyone, posted by shellie on July 22, 2000, at 20:27:07
>
> Hi Karen.
>
> Another question. Basically are you saying that the Amisulpride is the main antidepressant in your cocktail. I'm wondering (along with ADD and lack of motivation, etc.) if you ever experienced severe depression. I don't have ADD; and I have major depression. I have been combining all my trials of stimulents with Nardil, (Nardil has not been working very well, but is still helping me to not bottom out.) Is Amisulpride a drug that is being tried for major depression, or more for atypical depression. Thanks, ShellieShellie,
Atypical depression is what I have had for years. Sometimes just apathetic nothingness, then occasionally I take an unexpected dive into a deep, dark, apathetic, life sucking, suicidal depression.
I was previously diagnosed with Major Depression, then Bipolar Disorder, until, through research on this forum and others, I finally found out what was wrong with me: I have had ADD all my life.
Yes, the Amisulpride works as an antidepressant/antianxiety agent for me but the stimulant (Adderall) keeps me out of the pit, as well.
Karen
Posted by KarenB on July 24, 2000, at 14:42:11
In reply to Re: Amisulpride Question? » KarenB, posted by michael on July 24, 2000, at 13:10:00
> Hi Karen -
>
> Thanks for the replies/info. You mention that you like amisulpride even better than sulpiride. Not to beat a dead horse, but is the difference that you note between them something that can be put into words (qualitative?) - I'm guessing that they're pretty similar...
>
> I'm thinking of trying one of them (or both) again, this time in addition to adrafinil, hoping to avoid the sedative effects I experienced the first time. Thanks for any input. michaelmichael,
FOR ME...Sulpiride helped with my physical symptoms of apathy and heaviness, and social anxiety. Amisulpride does that PLUS seems to have a mild antidepressant action that the Sulpiride did not. Give Adrafinil plus Amisulpride a try BUT if you do not get the desired response, I think you may want to try lowering the Adrafinil dose to just 300mg per day and adding Adderall (10mg, 2x a day), before making a final judgement on it's efficacy.
Keep us posted, OK?
Karen
Posted by michael on July 24, 2000, at 17:11:44
In reply to Re: Amisulpride Question? » michael, posted by KarenB on July 24, 2000, at 14:42:11
Karen -
Thanks once again for the reply. I like your idea, but I'll have to see if I can get my pdoc to go along. I had asked about trying some other stims, since adrafinil's been the only real help I've found so far. So far her opinion has been that I don't have the "classic" ADD diagnosis, so she doesn't want to prescribe stimulants - "that would just be treating the symptoms" (i.e. the fatigue, etc) not the underlying promblem.
Whatever... that's why I'm going w/the adrafinil for now... Anyway, thanks again. I'll see how the amisulpride & adrafinil do togethe. `michael
> Hi Karen -
> >
> > Thanks for the replies/info. You mention that you like amisulpride even better than sulpiride. Not to beat a dead horse, but is the difference that you note between them something that can be put into words (qualitative?) - I'm guessing that they're pretty similar...
> >
> > I'm thinking of trying one of them (or both) again, this time in addition to adrafinil, hoping to avoid the sedative effects I experienced the first time. Thanks for any input. michael
>
> michael,
>
> FOR ME...Sulpiride helped with my physical symptoms of apathy and heaviness, and social anxiety. Amisulpride does that PLUS seems to have a mild antidepressant action that the Sulpiride did not. Give Adrafinil plus Amisulpride a try BUT if you do not get the desired response, I think you may want to try lowering the Adrafinil dose to just 300mg per day and adding Adderall (10mg, 2x a day), before making a final judgement on it's efficacy.
>
> Keep us posted, OK?
>
> Karen
Posted by shellie on July 25, 2000, at 7:35:32
In reply to Re: Amisulpride Question? » shellie, posted by KarenB on July 24, 2000, at 14:32:27
>.
This is the end of the thread.
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