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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SalArmy4me on August 29, 2001, at 19:21:48
The only foreign medications I consider viable alternatives to some U.S. FDA-approved medications:
Antipsychotic: (Solian) Amisulpride
Antidepressant: (Aurorix, Manerix) Moclobemide, (Edronax) Reboxetine, (Stablon) Tianeptine
Mineral: L-Tryptophan
Stimulant: (Adrafinil) Olmifon
If you have a drug that I didn't mention, but you think deserves our attention in the U.S., tell me which one. Thanks.
Posted by JahL on August 29, 2001, at 20:03:26
In reply to Foreign Medications, posted by SalArmy4me on August 29, 2001, at 19:21:48
> If you have a drug that I didn't mention, but you think deserves our attention in the U.S., tell me which one. Thanks.Sulpiride (Dogmatil) for social phobia/dysthymia (similar to Amisulpride tho they have dramatically different effect upon me).
J.
Posted by SLS on August 29, 2001, at 20:49:25
In reply to Re: Foreign Medications, posted by JahL on August 29, 2001, at 20:03:26
> Sulpiride (Dogmatil) for social phobia/dysthymia (similar to Amisulpride tho they have dramatically different effect upon me).
>
> J.
Hey J.How 'ya doin'?
I am quite interested to know how you would describe the differences in your reactions to sulpiride versus amisulpride.
Thank you.
On a related topic, I was dismayed this morning to learn that NeuroSearch has suspended their investigations of brasofensine, a DA reuptake inhibitor in the nomifensine series, and NS2389, a drug that potently inhibits the reuptake of all three of the major monoamines: DA, NE, 5-HT. This week, I learned that brofaromine and befloxatone, both RIMA MAO-inhibitors, will never be available anywhere. All of these drugs seemed viable to me, and I feel demoralized that there should be fewer alternatives to hope for in the future.
- Scott
Posted by Neal on August 30, 2001, at 18:32:02
In reply to Re: Foreign Medications » JahL, posted by SLS on August 29, 2001, at 20:49:25
That was interesting about the suspended medications. Is that info on the internet anywhere?
-Neal
Posted by JahL on August 30, 2001, at 19:57:40
In reply to Re: Foreign Medications » JahL, posted by SLS on August 29, 2001, at 20:49:25
>
> > Sulpiride (Dogmatil) for social phobia/dysthymia (similar to Amisulpride tho they have dramatically different effect upon me).
> >
> > J.
>
>
> Hey J.
>
> How 'ya doin'?
>
> I am quite interested to know how you would describe the differences in your reactions to sulpiride versus amisulpride.Hi Scott.
It's hard to tell what Amisulpride did, if anything. When I tried it, at 25mg & 50mg (possibly higher) I wasn't confident enough to completely stop the Sulpiride & as my social phobia became worse I can only deduce that the Amisulp. wasn't helping.
Sulpiride provides consistent, if not complete relief from social phobia symptoms & not just in the way that a benzo or beta-blocker might calm someone (not me). Paranoid thoughts; the idea that you are particularly conspicuous, and ruminations are lessened. Beyond 150mg no further benefits are accrued & sedation sets in. It's been the most helpful drug for me so far.
The drug that led me to Sulp. is interesting. Promazine, a sedative with mild antipsychotic properties would bring about say, a 20% remission from baseline within 2 hours of taking a pill. And I can replicate this time & time again. Further proof that my complaint is a biological one. Had to stop due to EPS, slurring of speech & slight paranoia. Enter Sulpiride.
> On a related topic, I was dismayed this morning to learn that NeuroSearch has suspended their investigations of brasofensine.Me too. Stahl mentions it as a promising drug in his Essential Psychophamacology... book.
> All of these drugs seemed viable to me, and I feel demoralized that there should be fewer alternatives to hope for in the future.
You're not alone on that one. Not sure if I have any options left aside from clinical trials (just been referred to the world's first Depersonalisation Research Unit) :-(
J.
Posted by Elizabeth on August 31, 2001, at 15:21:46
In reply to Re: Foreign Medications » JahL, posted by SLS on August 29, 2001, at 20:49:25
Scott,
You've tried modafinil at some point, right? I vaguely recall hearing that its therapeutic efficacy is probably due at least in part to DA reuptake inhibition.
> This week, I learned that brofaromine and befloxatone, both RIMA MAO-inhibitors, will never be available anywhere. All of these drugs seemed viable to me, and I feel demoralized that there should be fewer alternatives to hope for in the future.
The RIMAs never had a good reputation for TRD.
Sal: Deracyn (adinazolam) is one drug you left off your list. That's all I can think of off the top of my head.
-elizabeth
Posted by SalArmy4me on August 31, 2001, at 15:56:45
In reply to Re: Foreign Medications » SLS, posted by Elizabeth on August 31, 2001, at 15:21:46
I would need to have proof showing that "adinazolam" is as worthy as some of the things I mentioned (reboxetine, moclobemide, and tianeptine).... The things I mentioned have a reputation that precedes them. I have never heard of adinazolam. Have a nice night...
Posted by SLS on August 31, 2001, at 19:26:57
In reply to Re: Foreign Medications » SLS, posted by Elizabeth on August 31, 2001, at 15:21:46
Hi Elizabeth.
> Scott,
>
> You've tried modafinil at some point, right? I vaguely recall hearing that its therapeutic efficacy is probably due at least in part to DA reuptake inhibition.Yes.
You might be right about the DA, although I believe it is thought that reuptake inhibition is negligible at therapeutic dosages. Who knows? I often wonder how it is determined the amount of anything that can be neglected.
I tried modafinil last year, having added it to Lamictal and sulpiride. Within the first hour of my first dose, I experienced a substantial improvement. I was sure I was on my way to Jamaica. Actually, my initial thoughts were that it "felt" like it would be a great drug to add to Parnate or Nardil, even if the positive effects were not to continue. The improvement faded by midday, but I remained encouraged that it would have a place in my regimen.
Gosh - it is so difficult to describe to someone how such a door is opened so rarely so as to be separated by years and experienced for only minutes. The movie "Awakenings" is so much a mirror of my life - as I'm sure it is of many others'. It is gut-wrenching to watch. Of the 25 years since the onset of a severe depressive state, I have spent only one 6 month period "awake". It was like Dorothy opening up the door of her black-and-white house to the rush of technicolor that was Oz. When I began to relapse, I felt as if I was being dragged away from everything and everyone, and no amount of effort could stop it from happening. I watched the world of the living, along with my new consciousness, grow more and more distant. Eventually, all of the color was gone, and I could do nothing to again unchain myself from the bottom of my mirky ocean. I desparately and recklessly self-medicated in a frantic effort to get it back, and ended up in the hospital from a Nardil overdose. It wasn't so bad, although I was a bit upset that they didn't serve me sorbé to clear my palette before regaling me with charcoal.
Sorry for the melodramatics.
"Flowers for Algernon" is another goodie.
Meanwhile, back at the ranch...
By day 3, I was in a total fog and was without any positive effect. I experienced a great deal of anxiety and a constant headache. After 5 days, I really felt weird and somehow worse. I decided to stop taking it. To my surprise, I felt terribly worse after discontinuing it - worse than I had before starting it. This really weird exacerbation went unabated for 9 days, whereafter things gradually returned to "normal". My experience was not unique. At least two other people on PB described similar scenarios. One of those silly little thoughts that sometimes plague me prodded me into pondering if there might be a conflict between modafinil and the lamotrigine I was taking. They are reported to exert opposite effects on the levels of intercellular glutamate. Lamotrigine provides me with some benefit. Perhaps the DA stuff helped and the glutamate stuff hurt. Of course, things are rarely that simple. I try not to be too smart, but it's hard work not to be. :-) I don't want to sabotage my treatment by pretending I can figure out what's going on in the black box and reject possibly effective strategies.
> > This week, I learned that brofaromine and befloxatone, both RIMA MAO-inhibitors, will never be available anywhere. All of these drugs seemed viable to me, and I feel demoralized that there should be fewer alternatives to hope for in the future.
> The RIMAs never had a good reputation for TRD.So far, this seems to be the case. I would like to have tried brofaromine or befloxatone nevertheless. I wish I could speak to some of the doctors who used brofaromine before it was yanked. It would be great to hear how they would compare it to moclobemide. Maybe I'll look into toloxatone at some point. I wonder if amiflamine is still floating around. I still like the idea of selectively inhibiting MAO-A. I really don't care if it's reversible or not. With respect to inhibition of MAO-A, if comparing moclobemide to clorgyline represents a comparison between reversiblity and irreversibility, reversibility would equate to reduced efficacy.
> Sal: Deracyn (adinazolam) is one drug you left off your list. That's all I can think of off the top of my head.
Elizabeth, do you know where adinazolam is being sold? I tried it in 1984 or thereabouts. It was extaordinarily clean. Unfortunately, I didn't respond to it. It was completely neutral, having none of the sedating or hypnotic effects of other benzodiazepines. My doctor at the time, Baron Shopsin, had agreed to investigate it for the drug company (Upjohn?) on an open-label basis. He really didn't think it had much of a chance of being effective. Ultimately, he was surprised to see how many of his patients responded to it. I think it is interesting that both adinazolam and alprazolam are triazolobenzodiazepines and that both have demonstrated antidepressant properties. However, where does that leave Halcion?
Thanks for the suggestions.
- Scott
Posted by Alex J on September 2, 2001, at 12:11:11
In reply to Re: Foreign Medications, posted by JahL on August 29, 2001, at 20:03:26
J,
Did you experience any weight gain with Sulpiride?
Thanks,
AJ
Posted by Lorraine on September 3, 2001, at 22:11:26
In reply to Re: Foreign Medications, posted by SLS on August 31, 2001, at 19:26:57
> > > Gosh - it is so difficult to describe to someone how such a door is opened so rarely so as to be separated by years and experienced for only minutes. The movie "Awakenings" is so much a mirror of my life - as I'm sure it is of many others'. It is gut-wrenching to watch. Of the 25 years since the onset of a severe depressive state, I have spent only one 6 month period "awake". It was like Dorothy opening up the door of her black-and-white house to the rush of technicolor that was Oz. When I began to relapse, I felt as if I was being dragged away from everything and everyone, and no amount of effort could stop it from happening. I watched the world of the living, along with my new consciousness, grow more and more distant. Eventually, all of the color was gone, and I could do nothing to again unchain myself from the bottom of my mirky ocean. I desparately and recklessly self-medicated in a frantic effort to get it back, and ended up in the hospital from a Nardil overdose. It wasn't so bad, although I was a bit upset that they didn't serve me sorbé to clear my palette before regaling me with charcoal.
Scott--I just wanted to let you know how much this passage moved me.
Posted by JahL on September 5, 2001, at 10:02:37
In reply to Re: Foreign Medications » JahL, posted by Alex J on September 2, 2001, at 12:11:11
> J,
>
> Did you experience any weight gain with Sulpiride?Hi Alex.
I only take 100mg/day (for 1.5 yrs) & I've had absolutely no weight gain problems. It definitely doesn't promote appetite in the same way as say Zyprexa (which I've tried).
In fact my current problem is that I have *no* appetite whatsoever. Severity of depression+Lamictal+Wellbutrin probably don't help in this regard.
You thinking of trying it?
J.
Posted by Alex J on September 6, 2001, at 9:02:15
In reply to Re: Sulpiride. » Alex J, posted by JahL on September 5, 2001, at 10:02:37
J,
I actually tried Sulpiride some time ago and liked it very much except for the weight gain I experienced. Within two weeks I had people commenting on my weight gain so I stopped taking it. I was just curious as to whether this was a common side effect.
Thanks for the reply,
AJ
Posted by SalArmy4me on September 6, 2001, at 9:49:13
In reply to Re: Sulpiride. » JahL, posted by Alex J on September 6, 2001, at 9:02:15
Did you try it for psychosis or depression?
Posted by Elizabeth on September 8, 2001, at 21:42:50
In reply to Re: Foreign Medications » Elizabeth, posted by SalArmy4me on August 31, 2001, at 15:56:45
> I would need to have proof showing that "adinazolam" is as worthy as some of the things I mentioned (reboxetine, moclobemide, and tianeptine).... The things I mentioned have a reputation that precedes them. I have never heard of adinazolam. Have a nice night...
I'd choose it over moclobemide any day.
-e
Posted by Elizabeth on September 8, 2001, at 21:52:02
In reply to Re: Foreign Medications, posted by SLS on August 31, 2001, at 19:26:57
> You might be right about the DA, although I believe it is thought that reuptake inhibition is negligible at therapeutic dosages.
That could be a marketing claim. (They also said that Xanax wouldn't cause dependence, you know. < g >)
> Who knows? I often wonder how it is determined the amount of anything that can be neglected.
Trial and error?
> I was sure I was on my way to Jamaica.
I hope you don't mean this literally. :-)
> It was like Dorothy opening up the door of her black-and-white house to the rush of technicolor that was Oz.
Heh -- I've made that analogy (I'm sure many others have too).
> I desparately and recklessly self-medicated in a frantic effort to get it back, and ended up in the hospital from a Nardil overdose. It wasn't so bad, although I was a bit upset that they didn't serve me sorbé to clear my palette before regaling me with charcoal.
Stuff's gross, isn't it?
> To my surprise, I felt terribly worse after discontinuing it - worse than I had before starting it.
It's called "withdrawal." :-) (Ever quit MAOIs abruptly? Same idea.)
> I still like the idea of selectively inhibiting MAO-A. I really don't care if it's reversible or not. With respect to inhibition of MAO-A, if comparing moclobemide to clorgyline represents a comparison between reversiblity and irreversibility, reversibility would equate to reduced efficacy.
Yup.
> Elizabeth, do you know where adinazolam is being sold? I tried it in 1984 or thereabouts. It was extaordinarily clean.
Interesting. How so ("clean," that is)? (I mentioned in a previous post that they have it in France and Germany, Switzerland too I imagine.)
> Unfortunately, I didn't respond to it. It was completely neutral, having none of the sedating or hypnotic effects of other benzodiazepines.
I've found many ineffective drugs to be "neutral" (Zoloft, Serzone, Lamictal, ...).
> Ultimately, he was surprised to see how many of his patients responded to it. I think it is interesting that both adinazolam and alprazolam are triazolobenzodiazepines and that both have demonstrated antidepressant properties. However, where does that leave Halcion?
Too much amnesia!
-e
This is the end of the thread.
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