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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 AndrewB on August 22, 2000, at 9:49:47
Ondansetron may be very effective for SSRI induced memory loss.
Myself and another person have taken it and noted it creates a clear headed arousal.
Studies on specific populations have shown it effective at ameliorating fatigue and improving memory.
Ondansetron is a 5HT3 serotonin receptor antagonist. Overstimulation of the 5HT3 receptor, I speculate, may often be at the root of SSRI induced fatigue, fogginess and memory loss.
I have not noticed any side effects with ondansetron.
It is fast acting, working within an hour.
Ondansetron's label use is for preventing nausea from, for example, chemotherapy.
There is a reason that doctors aren't already using it for SSRI side effects, the medicine is EXTREMELY expensive in the US.
However it can be purchased overseas for a reasonable price. Here is a website where people can order it from overseas without an Rx for a fairly low price: http://www.drugsrus.org/miscorder.html
I suggest those who want to trial it buy a small amount from this source, say 12 tablets.
If it works for you I can give you the name of a site where it can be purchased very cheaply in larger quantities, 30 cents per daily dose!
Daily dosage is 4mg to 8mg. normally. But some will find a dose of 16mg. even more effective.
Please report to me any of your expereinces.
AndrewB
andrewb@seanet.com
Posted by danf on August 22, 2000, at 10:25:05
In reply to Ondansetron: For SSRI fatigue and memory loss, posted by AndrewB on August 22, 2000, at 9:49:47
I had the fatigue /memory loss while on Zoloft 100 to 200 mg /day for near a year.
Changed to Celexa ( now 30 mg Q day) & a Beta Blocker ( pindolol 10mg BID ).
No more fatigue & memory is as good as ever. The mind fog cleared too. I do not know if the improved result is from the Celexa, the pindolol or the combo.
Not willing to stop the pindolol ( for a trial ) as it is /was for tremors, that it treats very well.
Posted by CarolAnn on August 23, 2000, at 9:24:05
In reply to Ondansetron: For SSRI fatigue and memory loss, posted by AndrewB on August 22, 2000, at 9:49:47
Hi AndrewB, Does the Ondansetron have a cumulative effect or could you take it as needed? I mean, do you feel improvement in fatigue levels with each dose? Because I would be interested in it as an energy booster(not that I don't need memory help too!).
Also, coincidentally, I just read in today's newspaper that this drug has been tested and found effective in helping people with early onset alcoholism, which indicates to me that it might have some anti-depressant effect as well.
What do you think? CarolAnn
Posted by AndrewB on August 24, 2000, at 14:02:43
In reply to Re: Ondansetron: » AndrewB, posted by CarolAnn on August 23, 2000, at 9:24:05
CarolAnn,
Ondansetron can be taken as needed. It is not cumulative in its effect. Don't confuse this with a classic arousal agent. It gave me and another person a mild but definate mind clearing/mental arousal effect. But it is my speculation that its effects would be much more dramatic with those with overstimulation of the 5HT3 serotonin receptor. In other words, those who are on a serotenergic drug that stimulates the 5HT3 receptor, like an SSRI. I think it may be able to dramatically help those with SSRI induced brain fog, lethargy, and memory loss. Offhand, I don't think it possesses an antidepressant effect.
AndrewB
Posted by karl@xtronics.com on August 25, 2000, at 0:52:31
In reply to Re: Ondansetron: , posted by AndrewB on August 24, 2000, at 14:02:43
> CarolAnn,
>
> Ondansetron can be taken as needed. It is not cumulative in its effect. Don't confuse this with a classic arousal agent. It gave me and another person a mild but definate mind clearing/mental arousal effect. But it is my speculation that its effects would be much more dramatic with those with overstimulation of the 5HT3 serotonin receptor. In other words, those who are on a serotenergic drug that stimulates the 5HT3 receptor, like an SSRI. I think it may be able to dramatically help those with SSRI induced brain fog, lethargy, and memory loss. Offhand, I don't think it possesses an antidepressant effect.
>
> AndrewBGlaxo also has a new med that is also a 5HT3 blocker for IBS - has anyone tried this for sexual side effects, brain fog, lethargy?
They appear to be very closely related drugs. Both of these drugs look like they may cause constipation as a side effect - possibly serious – so you might want to go slow and make sure you have fiber in your diet.
Posted by Jonathan on August 28, 2000, at 19:15:38
In reply to Ondansetron: For SSRI fatigue and memory loss, posted by AndrewB on August 22, 2000, at 9:49:47
> Ondansetron may be very effective for SSRI induced memory loss.
>
> Myself and another person have taken it and noted it creates a clear headed arousal.
>
> Studies on specific populations have shown it effective at ameliorating fatigue and improving memory.
>
> Ondansetron is a 5HT3 serotonin receptor antagonist. Overstimulation of the 5HT3 receptor, I speculate, may often be at the root of SSRI induced fatigue, fogginess and memory loss.
>
> I have not noticed any side effects with ondansetron.
>
> It is fast acting, working within an hour.
>Andrew,
Thanks. This is a fascinating idea. Where did you find this information?
I'm a little puzzled because SSRI-induced fatigue and memory impairment are slow in onset and seem to persist for weeks after discontinuation. I forget where (guess why!), but am almost sure I remember reading somewhere that this slow time-course matches an SRI-induced decline and recovery in dopamine and/or noradrenaline turnover in the pre-frontal cortex. As far as I know the 5-HT3 receptor has an immediate modulating effect on cholinergic neurotransmission, consistent with the rapid action of ondansetron. Although reducing 5-HT3 receptor activity below that normally resulting from endogenous serotonin levels undeniably enhances cognitive performance, I've not seen evidence for the reverse: a *rapid-onset* cognitive decline caused by increased 5-HT3 activity when an SRI increases serotonin above its normal endogenous level. The crucial test will come when the same person has tried ondansetron both when taking and when not taking an SSRI.
The reason I'd like to know is because my pdoc told me about a year ago (incorrectly, in my view) that Prozac cannot cause cognitive impairment: since there's also no such thing as adult ADD here in the UK, he attributed my symptoms entirely to depression. In April I discontinued venlafaxine (Effexor), and persuaded a new pdoc to prescribe reboxetine instead, because Effexor at 225 mg/day seemed to cause even greater cognitive impairment than 20 mg/day Prozac had (Effexor is supposed not to be as bad as Prozac in this respect, but we're comparing a high dose of Effexor with a low dose of Prozac, in terms of SRI activity) -- It afected me so badly that it took me no less than eight months to notice that we spell "Efexor" differently here!
Reboxetine has recently stopped working so well, so I'm seeing yet another pdoc soon (no. 5) and am concerned that he may recommend switching back to an SRI. It would be great if I could go prepared with evidence that not only can serotonin cause cognitive impairment, but this side-effect is so well characterized that we even know which receptor is responsible (namely 5HT-3?).
By the way, both my original depressive episode (Feb. '99) and the recent relapse followed a few weeks after accidental injuries which would have raised my levels of CRF, ACTH and cortisol. Do you think that an AD that elevates dopamine levels, such as low-dose amisulpride, would be a good way to get my HPA axis back to normal quickly, and perhaps even get reboxetine working again? I'm reluctant to give it up because, as well as being the only antidepressant I've tried that really works for me, it's the only one that has no significant side-effects (which probably shows how dysfunctional my noradrenergic system must be).
Jonathan.
Posted by Ant-Rock on August 29, 2000, at 15:59:35
In reply to Re: Ondansetron: For SSRI fatigue and memory loss, posted by Jonathan on August 28, 2000, at 19:15:38
Jonathan,
For what it's worth, my psychiatrist told me 2 weeks ago that quote "We now know that SSRI's do in fact cause short term memory problems". He did not elaborate, and I don't remember why we were even discussing this, since it's not really pertinent to me. Anyway, good luck.
Sincerely,
Anthony
Posted by Jonathan on August 29, 2000, at 21:29:19
In reply to Re: Ondansetron: For SSRI fatigue and memory loss » Jonathan, posted by Ant-Rock on August 29, 2000, at 15:59:35
Anthony,
Thanks for taking the time to post this. I've printed it and shall take it with me when I visit the pdoc. I could find almost nothing in the literature.
I know that this problem doesn't affect everyone on SSRI's, just as I've been lucky enough to escape many of the side-effects that others complain of. Thanks to Psycho-Babble, I also know that I'm far from being a minority of one.
It looked to me as if there might be some correlation with what would be diagnosed in the States as adult ADD, not the easiest thing to convince a British psychiatrist of! This and the slow time-course led me to suspect the involvement of noradrenergic and/or dopaminergic systems, which some meds for ADD affect, rather than cholinergic, which ondansetron seems to influence. There's so little evidence that I know of, however, that I could easily be wrong.
Best wishes,
Jonathan.
Posted by AndrewB on August 30, 2000, at 1:28:21
In reply to Re: SSRI fatigue and memory loss » Anthony, posted by Jonathan on August 29, 2000, at 21:29:19
Jonathan,
I really like it when you post. You are so well informed. Thank you for the info on 5-HT3 receptor function.
Concerning Ondansetron and fatigue, two other people other than me have noted its mental arousal effects. In a letter to the editor of Lancet (July 31, ‘99) a Dr. Jones noted that Ondansetron relieved the fatigue of a hepatitis C patient. In the letter Dr. Jones speculates that altered serotenergic transmission can be a cause of profound fatigue. In support of this idea he mentions a study where the exercise endurance of atheletes was decreased after taking Paxil. These atheletes were not depressed.
This information only suggests that Ondansetron may be able to relieve SSRI induced fatigue. Hopefully someone who has SSRI fatigue will try Ondasetron and let us know what happens.
By the way, I also had what I call partial poop out of reboxetine after 4 or so months on it. I however was using it as an arousal agent, not an AD. As I said, it lost most of its effectiveness after awhile.
This is something I know nothing about, but Jonathan have you looked into the combined serotonin/noradrenaline uptake inhibitors for your condition. I think Mirtazapine (Remeron) fits into this category. Here is a brief description of it:
Mirtazapine increases the release of norepinephrine from central noradrenergic neurons by blocking the presynaptic inhibitory alpha-2 autoreceptors. It spares the alpha-1 postsynaptic receptor and therefore results in a net increase in norandrenergic transmission. It mildly stimulates the 5-HT1A receptor while blocking the 5-HT2 and 5-HT3 receptors.
You ask me whether amisulpride or another dopaminergic AD will help get your HPA axis back to normal. I don’t remember reading of anything that mentioned that, so I guess not. I have read that high cortisol levels will downregulate the brain alpha 2-adrenoceptors, but in the longterm these receptors will upregulate in response to high cortisol.
Best wishes,
AndrewB
Posted by Sassy on September 7, 2000, at 21:03:45
In reply to Ondansetron: For SSRI fatigue and memory loss, posted by AndrewB on August 22, 2000, at 9:49:47
Andrew,
I am very interested in this posting.
You aren't kidding this is expensive. My pdoc
was willing to prescribe it, however, the insurance company would only pay for 9 pills which cost $238.If taken as prescribed, 3 x day 8 mgs, I will only be able to judge by 3 days before refilling
again.I am interested with others comments if they also find a need for something like this.
By the way, I'm having a hard time adapting to serzone. I'm on 50 mg because of the fog induced
stuff and lack of concentration, it's been over 8 weeks. Can't deal with other meds because of the weight gain issue. In particular, celexa and
effexor which seem to be toxic to my system.
I must say that effexor was fantastic for the
depression after getting past the first month.Unfortunately due to my occupation, I don't have
any time to play around with meds and can't deal
with any sedation, or lack of focus.I'm also a single mom and don't have too much free
time to do as much research as I'd like.If this is the magic pill, hope I can find a
cheaper alternative with the same chemical
effect. Never bought anything overseas and really
don't feel comfortable about it.Thanks for the information.
Sassy
> Ondansetron may be very effective for SSRI induced memory loss.
>
> Myself and another person have taken it and noted it creates a clear headed arousal.
>
> Studies on specific populations have shown it effective at ameliorating fatigue and improving memory.
>
> Ondansetron is a 5HT3 serotonin receptor antagonist. Overstimulation of the 5HT3 receptor, I speculate, may often be at the root of SSRI induced fatigue, fogginess and memory loss.
>
> I have not noticed any side effects with ondansetron.
>
> It is fast acting, working within an hour.
>
> Ondansetron's label use is for preventing nausea from, for example, chemotherapy.
>
> There is a reason that doctors aren't already using it for SSRI side effects, the medicine is EXTREMELY expensive in the US.
>
> However it can be purchased overseas for a reasonable price. Here is a website where people can order it from overseas without an Rx for a fairly low price: http://www.drugsrus.org/miscorder.html
>
> I suggest those who want to trial it buy a small amount from this source, say 12 tablets.
>
> If it works for you I can give you the name of a site where it can be purchased very cheaply in larger quantities, 30 cents per daily dose!
>
> Daily dosage is 4mg to 8mg. normally. But some will find a dose of 16mg. even more effective.
>
> Please report to me any of your expereinces.
>
> AndrewB
> andrewb@seanet.com
Posted by AndrewB on September 7, 2000, at 23:22:59
In reply to Re: Ondansetron: For SSRI fatigue and memory loss, posted by Sassy on September 7, 2000, at 21:03:45
Sassy,
Let me know how they work for you. If they work for you I will try and help you find something reasonably priced that you are comfortable buying.
AndrewB
Posted by Sassy on September 12, 2000, at 15:35:32
In reply to Re: Ondansetron: For SSRI fatigue and memory loss, posted by AndrewB on September 7, 2000, at 23:22:59
Hi Andrew,
Thanks! So far night one with 8 mg was severe
munchies, and hyper, however, this may have something to do with remeron I took for a good night sleep.So far have not noticed a difference with 4 mg.
I've been researching to see what else is comparable. The only thing was granisteron, but
haven't done price check.Sassy
>
Sassy,
>
> Let me know how they work for you. If they work for you I will try and help you find something reasonably priced that you are comfortable buying.
>
> AndrewB
This is the end of the thread.
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