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Dr. Bob is Robert Hsiung, MD,
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Posted by MM on August 14, 2001, at 5:49:28
How does Serzone (SNRI's) affect Norepinephrine (basically does it raise it or lower it or what does it do, in non technical language)? What role does Norepinephrine play in ADD? If I had a better response to Serzone over SSRI's, does this suggest ADD?
Posted by Mitch on August 14, 2001, at 8:24:10
In reply to Questions (Serzone, NE and ADD), posted by MM on August 14, 2001, at 5:49:28
> How does Serzone (SNRI's) affect Norepinephrine (basically does it raise it or lower it or what does it do, in non technical language)? What role does Norepinephrine play in ADD? If I had a better response to Serzone over SSRI's, does this suggest ADD?
MM,
It does increase it (NE) somewhat, but from what I have read that effect is rather mild (in contrast to the serotonin it increases) and tends to wear with time. Nearly any med that raises NE or dopamine levels can be helpful for
ADD or ADHD.Serzone is an SSri, it just isn't as "selective" (the NE boost, etc.) What you may be finding about Serzone that you like (in contrast to the "other" SSri's) is its ability to reduce *agitation*. The other ones tend to make it worse (for me anyway). That could be why it may seem to be effective for "hyperactivity" It also reduces anticipatory anxiety quite well. I think this has more to do with its 5-HT2a antagonism (sorry for getting technical-but that is what makes it quite different from the other SSri's).
I personally liked it for generalized anxiety, and I slept well on it and my agitation was reduced significantly-but I got to itching on it and it was stopped. Some people may find it an good alternative anti-panic agent.
hope this helps,
Mitch
Posted by PaulB on August 14, 2001, at 17:05:56
In reply to Re: Questions (Serzone, NE and ADD) » MM, posted by Mitch on August 14, 2001, at 8:24:10
> > How does Serzone (SNRI's) affect Norepinephrine (basically does it raise it or lower it or what does it do, in non technical language)? What role does Norepinephrine play in ADD? If I had a better response to Serzone over SSRI's, does this suggest ADD?
>
> MM,
>
> It does increase it (NE) somewhat, but from what I have read that effect is rather mild (in contrast to the serotonin it increases) and tends to wear with time. Nearly any med that raises NE or dopamine levels can be helpful for
> ADD or ADHD.
>
> Serzone is an SSri, it just isn't as "selective" (the NE boost, etc.) What you may be finding about Serzone that you like (in contrast to the "other" SSri's) is its ability to reduce *agitation*. The other ones tend to make it worse (for me anyway). That could be why it may seem to be effective for "hyperactivity" It also reduces anticipatory anxiety quite well. I think this has more to do with its 5-HT2a antagonism (sorry for getting technical-but that is what makes it quite different from the other SSri's).
>
> I personally liked it for generalized anxiety, and I slept well on it and my agitation was reduced significantly-but I got to itching on it and it was stopped. Some people may find it an good alternative anti-panic agent.
>
> hope this helps,
> MitchI wouldnt say that because you had a better response to Nefazdone over the SRRI's(or SSRI) that you had ADD. I would look at your symptoms rather than response to medication. I thought dopamine, which Nefazadone does not enhance is indicated more in ADD.
One paper I have on Nefazadone describes that it exerts it action by:
'inhibtion of pre-synaptic reuptake of serotonin, weak inhibition of noradrenaline and strong antagonism of post-synaptic 5-HT2 receptors'Given Nefazadone weak norepinephrine activity I wouldnt read too much into it.
Good luck
PaulB
Posted by MM on August 15, 2001, at 9:08:33
In reply to Re: Questions (Serzone, NE and ADD), posted by PaulB on August 14, 2001, at 17:05:56
Thanks for your help with my previous question.
I just want to know WHY Serzone is different if it's basically another SSRI (the other SSRI's didn't help me)? If you explained why, I'm sorry I didn't quite understand. Are there meds in other categories that are similar, but not necessarily serotonergic? The good thing about it was that I felt calmer, but there were bad things about it too.
I feel kind of like I have to find my own "right" meds because my pdoc's strategy is not making sense to me (strong anti-manic/mood stabilizer (Depakote) + small amount of zoloft for predominant depression with no real hypomania. I think it could be making me depressed and therefore still/more anxious) and I'm the one who knows how *I* feel, but I don't really know what meds I'm looking for.
I'm interested in Neurontin (he said no last time), Adderal (sp?), possibly Serzone again in low doses, and would consider Lamictal after trying Neurontin. I don't know a whole lot about meds though. I want to deal with my anxiety/depression etc., but I don't want to be a lazy blob who's too tired/fatigued/nauseous to do much, can't think straight and is self unaware/numb.
I'm either BPII (at the milder/depressed end of the spectrum) or Borderline (at least I think I resemble it) depending on how you look at it. Are there any specific meds recommended for BPD (besides neurontin)?It's *possible* that I'm coming down from hypomania, and that's why I feel bad, so now I'm just normal, but *my* normalcy is what we sought a psychiatrist etc. for in the first place (SSRI's are thought to have induced BP in me after they were given to me for depression and anxiety. I guess that means I was susceptible to BP though), so now what do I do? I'm back to square one. I really feel like a lost cause and I'm desperate. I'm just BARELY an adult. My life should be *SO* different right now.
Posted by MM on August 15, 2001, at 9:16:56
In reply to Thanks. More Questions (longish) , posted by MM on August 15, 2001, at 9:08:33
> Thanks for your help with my previous question.
> I just want to know WHY Serzone is different if it's basically another SSRI (the other SSRI's didn't help me)? If you explained why, I'm sorry I didn't quite understand. Are there meds in other categories that are similar, but not necessarily serotonergic? The good thing about it was that I felt calmer, but there were bad things about it too.
> I feel kind of like I have to find my own "right" meds because my pdoc's strategy is not making sense to me (strong anti-manic/mood stabilizer (Depakote) + small amount of zoloft for predominant depression with no real hypomania. I think it could be making me depressed and therefore still/more anxious) and I'm the one who knows how *I* feel, but I don't really know what meds I'm looking for.
> I'm interested in Neurontin (he said no last time), Adderal (sp?), possibly Serzone again in low doses, and would consider Lamictal after trying Neurontin. I don't know a whole lot about meds though. I want to deal with my anxiety/depression etc., but I don't want to be a lazy blob who's too tired/fatigued/nauseous to do much, can't think straight and is self unaware/numb.
> I'm either BPII (at the milder/depressed end of the spectrum) or Borderline (at least I think I resemble it) depending on how you look at it. Are there any specific meds recommended for BPD (besides neurontin)?
>
> It's *possible* that I'm coming down from hypomania, and that's why I feel bad, so now I'm just normal, but *my* normalcy is what we sought a psychiatrist etc. for in the first place (SSRI's are thought to have induced BP in me after they were given to me for depression and anxiety. I guess that means I was susceptible to BP though), so now what do I do? I'm back to square one. I really feel like a lost cause and I'm desperate. I'm just BARELY an adult. My life should be *SO* different right now.
>
>
Posted by Mitch on August 15, 2001, at 10:34:40
In reply to Oops low dose paxil, not zoloft (N/P), posted by MM on August 15, 2001, at 9:16:56
> > I just want to know WHY Serzone is different if it's basically another SSRI (the other SSRI's didn't help me)? If you explained why, I'm sorry I didn't quite understand. Are there meds in other categories that are similar, but not necessarily serotonergic? The good thing about it was that I felt calmer, but there were bad things about it too.
You are just touchy with SSri's like a lot of people. I can't explain in detail (others here could) why the 5-HT2a antagonism which is characteristic of Serzone settles down your agitation. I just know that it did. I had some trouble with being a "zombie" like you said, and it did make me a little too foggy at work, but maybe that could subside with time?
> > I feel kind of like I have to find my own "right" meds because my pdoc's strategy is not making sense to me (strong anti-manic/mood stabilizer (Depakote) + small amount of paxil for predominant depression with no real hypomania. I think it could be making me depressed and therefore still/more anxious) and I'm the one who knows how *I* feel, but I don't really know what meds I'm looking for.
I know others will argue about this, but I *can't* take Depakote by itself as a mood stabilizer (I am too depressed), and I can't take Neurontin by itself (it doesn't control the highs well enough). So, I am taking a low dose of *both* and it works fairly well.
> > I'm interested in Neurontin (he said no last time), Adderal (sp?), possibly Serzone again in low doses, and would consider Lamictal after trying Neurontin. I don't know a whole lot about meds though. I want to deal with my anxiety/depression etc., but I don't want to be a lazy blob who's too tired/fatigued/nauseous to do much, can't think straight and is self unaware/numb.
IMHO, think that if he would *swap* a little Depakote for a little Neurontin and switch you from Paxil to Serzone (at a low dose) you *might* find yourself a little less fatigued without being agitated.
> > I'm either BPII (at the milder/depressed end of the spectrum) or Borderline (at least I think I resemble it) depending on how you look at it. Are there any specific meds recommended for BPD (besides neurontin)?
Neurontin is the one that I have heard the positive news about.
> >
> > It's *possible* that I'm coming down from hypomania, and that's why I feel bad, so now I'm just normal, but *my* normalcy is what we sought a psychiatrist etc. for in the first place (SSRI's are thought to have induced BP in me after they were given to me for depression and anxiety. I guess that means I was susceptible to BP though), so now what do I do? I'm back to square one. I really feel like a lost cause and I'm desperate. I'm just BARELY an adult. My life should be *SO* different right now.
Start mood-charting your cycling. Write down on your chart the meds and their dosages and any changes you make, and bring it in to your pdoc. That will help you figure out better what is helping and what is hindering. When you are feeling a little high or low it is tough to *remember* what it felt like when you felt the opposite because your mood is different (state-dependent memory influence). So, you get unnecessarily despondent, because it feels like you always felt like this!
Posted by MM on August 16, 2001, at 3:51:36
In reply to Re: Oops low dose paxil, not zoloft (N/P) » MM, posted by Mitch on August 15, 2001, at 10:34:40
Thanks *again* Mitch. You've been a big help with all my questions. It *is* tough to remember the "high" feelings when you're low and vice versa.
I'm definitely going to ask my pdoc about switching the paxil for serzone. Do you think that adding neurontin to my mix would help *without* lowering the depakote? I'm taking depakote ER, which only comes in 500mg pills (I only take one) because it's supposed to have less side effects than regular depakote. Do you have many side effects with such a low dose of regular depakote? Did you ever try Lamictal?
Posted by Mitch on August 16, 2001, at 9:23:31
In reply to Re: Oops low dose paxil, not zoloft (N/P) » Mitch, posted by MM on August 16, 2001, at 3:51:36
> Thanks *again* Mitch. You've been a big help with all my questions. It *is* tough to remember the "high" feelings when you're low and vice versa.
> I'm definitely going to ask my pdoc about switching the paxil for serzone. Do you think that adding neurontin to my mix would help *without* lowering the depakote? I'm taking depakote ER, which only comes in 500mg pills (I only take one) because it's supposed to have less side effects than regular depakote. Do you have many side effects with such a low dose of regular depakote? Did you ever try Lamictal?Yes, it would probably be easier to just add some Neurontin given that you are just on 500mgER of Depakote. (I didn't know what dose you were on)
I wouldn't add a *lot*, though. Lower doses tend to be a little activating, larger ones more sedating. I would just add 100mg 3x daily to start and see how you react to it. (then maybe go to 300mg 2x daily, i.e. if you get a positive response-that just happened to be the *sweet spot* dosage for me)Interestingly the first time I tried Neurontin I was on 500mg/day of depakote with 1.0mg of Klonopin and 5mg/dayof Celexa. They started me on 300mg 3x daily of N. I felt so much better after a couple of weeks I wanted to quit *all* the other meds! That turned out not to be such a good idea (real long story there).
The sfx of the low dose I take of regular Depakote now (just 125mg at bedtime) is hardly noticeable. I don't notice them until I get to 250mg and they are still mild. However if I get to 500mg with the regular formulation I do experience some nausea and GI upset, and weight gain. Haven't tried the ER 500mg.
Haven't tried Lamictal. The only AC's left that I haven't tried is Keppra, Zonegran, and Lamictal.
The ones I have tried are Tegretol, Trileptal, Gabitril, Topamax, diazepam, clonazepam, etc..
I have had skin reactions to about 1 out of 4 meds that I have ever taken. That combined with needing to take allergy shots for molds/dust mites makes me wary of Lamictal.hope this helps,
Mitch
Posted by MM on August 17, 2001, at 0:01:31
In reply to Re: Depakote+Neurontin combo » MM, posted by Mitch on August 16, 2001, at 9:23:31
So do you think you've found your "cocktail"? What does the *right* cocktail feel like? I know the meds can't do everything, but how much of an improvement does it make?
I read the above post about dopamine and serotonin deficiency, and I agree with one of the posters who said that the chemical imbalance theory doesn't seem to be the whole answer, but that is hard to accept in a way because I *want* it to be simple like that. I *want* them to be close to solving all my problems :D.
Posted by Mitch on August 17, 2001, at 9:04:32
In reply to Re: Depakote+Neurontin combo » Mitch, posted by MM on August 17, 2001, at 0:01:31
> So do you think you've found your "cocktail"? What does the *right* cocktail feel like? I know the meds can't do everything, but how much of an improvement does it make?
I think I am on the right *cocktail* as far as the mood stabilizers go: low-dose combo of Depakote-Neurontin-Klonopin. From what I have read here lately about Zonegran and Keppra they clearly don't appear any better. Also, for some people Lamictal seems to set off a lot of anxiety and some hypomanic episodes-so given that and the "rash threat" I will probably be sticking with these three for a while. Interestingly their mechanism of action are all related to GABA enhancement which makes sense since I have a lot of anxiety mixed in with it. The eternal problem is how to get some notable help with my ADHD and seasonal depressive bouts without worsening something else. Of the three the Neurontin helps the *most* with that, but not quite enough. I am also on 20mg of nortriptyline which is for that, but I can tell it is a little destabilizing (like all AD's). I really wonder if I could just add some T4 (thyroid hormone) maybe 50micrograms to the three mood stabilizers (ditch the AD) and that would be enough to quell the depression and improve my fatigue and attentional problems. But my current pdoc says NYET!. Well, it has been a while since the answer was no...maybe I will bring it up again next time??
> I read the above post about dopamine and serotonin deficiency, and I agree with one of the posters who said that the chemical imbalance theory doesn't seem to be the whole answer, but that is hard to accept in a way because I *want* it to be simple like that. I *want* them to be close to solving all my problems :D.
Ditto on that for sure. Well it could be worse! Imagine if you had all of these problems and was living in the 40's of 50's or something. I am clearly better with the Dep+Neurontin combo than I was with lithium..Mitch
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