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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by torenada on February 7, 2002, at 17:37:03
After reading through a lot of posts from a lot of different people, I only have one very important comment to make. I continuously read where people are asking which antidepressent drug to take and people recommending one over another. This post asks what effects Celexa will have on her. PLEASE read this. There are three chemicals in your brain that alter mood and allow people to live normal healthy lives. They are dopamine, serotonin, and epinephrine. One or more of these chemicals out of whack can cause depression and anxiety. Here is my point though. Each and every person is DIFFERENT. Just because you lack a certain chemical and a certain drug works for you doesn't mean it is the answer for someone else. They may be lacking a different chemical. Unfortunately, right now all doctors are able to do is try and try again to find the right medicine for the right person. Please keep this in mind when you ask someone if a certain medication is good for you. No one knows until you try it. And they have different effects based on your particular chemical needs and body. For the record, I have been through several meds. Effexor, Zoloft, and now Celexa. I originally thought with Effexor that is HAD to be the answer because it increased serotonin AND epinephrine. I was like "Wow! Double the good effects!" But it turns out that my body didn't need that epinephine. Apparently I have enough of that in my brain and adding more was not a good thing, although with some people Effexor works wonders. It has taken a lot of work trying different ones, but it was worth the effort. Please work with your dr. to find which drug is right for YOU.
Posted by JohnX2 on February 7, 2002, at 18:01:33
In reply to Which antidepressant is right for you?, posted by torenada on February 7, 2002, at 17:37:03
Torenada,Did you know that almost all antidepressants
that are targeted specially at a particular brain
chemical indirectly increase the circulation of
other brain chemicals? You are correct, it is
impossible to predict which anti-depressant is
correct for someone with Major Depression, but
I think a lot of discussion on this board that
is pertinent is whether or not someone is being
diagnosed correctly and which class (anti-depressant,
anti-convulsant,benzodiazapine etc) of medicine a
person should take.Regards,
John
> After reading through a lot of posts from a lot of different people, I only have one very important comment to make. I continuously read where people are asking which antidepressent drug to take and people recommending one over another. This post asks what effects Celexa will have on her. PLEASE read this. There are three chemicals in your brain that alter mood and allow people to live normal healthy lives. They are dopamine, serotonin, and epinephrine. One or more of these chemicals out of whack can cause depression and anxiety. Here is my point though. Each and every person is DIFFERENT. Just because you lack a certain chemical and a certain drug works for you doesn't mean it is the answer for someone else. They may be lacking a different chemical. Unfortunately, right now all doctors are able to do is try and try again to find the right medicine for the right person. Please keep this in mind when you ask someone if a certain medication is good for you. No one knows until you try it. And they have different effects based on your particular chemical needs and body. For the record, I have been through several meds. Effexor, Zoloft, and now Celexa. I originally thought with Effexor that is HAD to be the answer because it increased serotonin AND epinephrine. I was like "Wow! Double the good effects!" But it turns out that my body didn't need that epinephine. Apparently I have enough of that in my brain and adding more was not a good thing, although with some people Effexor works wonders. It has taken a lot of work trying different ones, but it was worth the effort. Please work with your dr. to find which drug is right for YOU.
Posted by tammy on February 7, 2002, at 20:35:19
In reply to Re: Which antidepressant is right for you? » torenada, posted by JohnX2 on February 7, 2002, at 18:01:33
i totally agree with you, but i feel when someone is asking what should i expect, kinda gives them a secure feeling if they know what will or could happen. psychologically it helps to know u'r not alone...... that someone had an experience to share (good or bad)
i didnt know the withdrawl effects of paxil till i went off of it and thought i was dying.....
looked on the web for paxil withdrawl, and sure enough my symptoms were listed and i felt 100% relieved that i wasnt dieing just withdrawling... :):) :)
Posted by torenada on February 7, 2002, at 21:05:40
In reply to Re: Which antidepressant is right for you?, posted by tammy on February 7, 2002, at 20:35:19
I agree with you also in that these posts are good for the reasons you said. I just worry about people who tell others "hey, take this drug! It will be wonderful" and when it comes down to it, it might not be. People shouldn't expect effectiveness just because of someone else's reports. But, like you, I also feel better when I hear I am not alone with certain effects of drugs.
Posted by spike4848 on February 8, 2002, at 1:06:37
In reply to Re: Which antidepressant is right for you?, posted by torenada on February 7, 2002, at 21:05:40
I will ask somebody which antidepressant is working for them if my symptoms resemble their own. I have atypical depression and when I read someone's post who also has atypical depression, I will ask what has worked for them. I think most individuals on the board are very intellgent and informed and do not blindly ask anyone which drug they should take. Most people on the board have tried all the conventional meds and need advice on experimental meds.
We know of about 10 out of a total of 200 neurotransmitters in the human brain. I don't think we can assume that current antidepressants work just on dopamine, serotonin and norepinephrine. It is more likely they work on one or more of the 190 neurotransmitters we don't know about .... even more likely that neurotransmitters have nothing to do with the antidepressant response and that it is some second messanger/RNA transcription effect responsible.
Spike
Posted by Elizabeth on February 9, 2002, at 1:15:32
In reply to Which antidepressant is right for you?, posted by torenada on February 7, 2002, at 17:37:03
First let me second what Spike says.
Torenada:
Hi there.
The three neurotransmitters you named are the only ones *that we know of* that are affected *directly* by the *standard* antidepressants. As Spike pointed out, we don't know of that many neurotransmitters. A drug may have effects that we don't know about, even effects on neurotransmitter systems that we didn't even know existed (and therefore couldn't look for).
Some people get antidepressant effects from drugs that are not monoaminergic (that don't have direct effects on serotonin, dopamine, or norepinephrine). These drugs exert their primary effects in other ways -- on other neurotransmitters that are not monoamines (e.g., gamma-aminobutyric acid; acetylcholine; neuropeptides such as endorphins and enkephalins), or in ways that are completely different and don't involve neurotransmitters (or that involve second messengers instead of first messengers). Some people find relief with hormones such as estrogens or triiodothyronine.
A drug that affects one neurotransmitter directly is likely to be having indirect effects on other neurotransmitter systems. It may also have different long-term effects on the system that it affects directly than the primary effect. So for example, I can't conclude that if Prozac works for me, I must be deficient in serotonin -- there could be any number of explanations why Prozac would work (and in fact, we don't know why *any* antidepressant works in the people for whom it works).
So in short, it's all even more complicated than we think, and there's pretty much no hope of figuring out what will work except by trial and error. (Not trying to be pessimistic or cynical or anything... :-) )
-elizabeth
Posted by torenada on February 10, 2002, at 12:12:52
In reply to Re: Which antidepressant is right for you? » torenada, posted by Elizabeth on February 9, 2002, at 1:15:32
But, that is exactly my point. =) There are so many unknowns involved that we can't possibly know except by trial and error. That is why I said I don't believe it is right to ask someone if a particular drug will work for you or to recommend one to someone else. There is just no way of knowing until you try it.
Posted by Elizabeth on February 14, 2002, at 16:01:49
In reply to Re: Which antidepressant is right for you?, posted by torenada on February 10, 2002, at 12:12:52
> But, that is exactly my point. =) There are so many unknowns involved that we can't possibly know except by trial and error. That is why I said I don't believe it is right to ask someone if a particular drug will work for you or to recommend one to someone else. There is just no way of knowing until you try it.
I agree; one person's experience alone doesn't predict anything about how another person will respond to a drug, and I do often find myself having to point that out to people here. It especially troubles me when one person tries to scare someone else out of trying a medication that could help because of a potential bad reaction that really isn't that common.
I thought you might be interested to know that the theoretical reasons that you suggested don't really predict drug response, either. Let's say that person A has major depressive disorder and responds well to drug X, a drug that primarily affects, say, norepinephrine (for example, a tricyclic antidepressant -- a NE reuptake inhibitor). Now, person B might have major depressive disorder too, but as you've said, that doesn't mean person B will respond to drug X. Now let's say that person B tries drug X and it doesn't help much. Person B might find that drug Y, a drug that has a different effect on the same neurotransmitter (for example, an autoreceptor antagonist, such as Remeron) works better. Person B might even respond drug Z, a different drug that seems to have similar effects to drug X (for example, a selective NE reuptake inhibitor like reboxetine, or a different tricyclic AD). So it's not simply a question of which neurotransmitter to target. Drugs X, Y, and Z may have other effects that we don't know about, including effects on other neurotransmitters -- perhaps even ones that we don't know exist (so we can't study the drugs' effects on them, obviously). Or person B might need a drug that works differently on the same neurotransmitter because persons A and B have two different problems with the same system. Their responses may not even indicate that either of them has a problem with NE -- the effects of the drugs on NE might have different *indirect* effects on other neurotransmitters (perhaps on two different neurotransmitters). Persons A and B may even present with the same symptoms (e.g., a particular subtype of depression, such as melancholic depression) but respond best to different drugs.
Serotonin, norepinephrine, and dopamine definitely aren't the only neurotransmitters involved in the regulation of mood and other things that become dysfunctional in depression (such as sleep rhythms, psychomotor activity, ability to experience pleasure, basic drives or appetites (for food, sex, etc.), levels of energy and motivation, and so forth.
To give an example: I have recurrent major depression, and by my symptoms, it would be expected that I would respond best to a tricyclic antidepressant, MAOI, Effexor, or Remeron (these share the property that all of them are noradrenergic drugs; they've also been tested in depression that has symptoms like mine and found to work well, probably better than SSRIs). I had partial responses to a tricyclic (desipramine) and monoamine oxidase inhibitors (phenelzine, tranylcypromine, isocarboxazid). I'm taking 225 mg of Effexor now, and so far it seems to be working about as well as the TCA and MAOI drugs worked for me. The type of drug that really alleviates my symptoms is not a monoaminergic drug at all, but one which activates "mu" [the Greek letter] opioid receptors, an action shared by certain natural neuropeptides called endorphins and enkephalins (the "endogenous opioid system" or EOS). This drug and other mu agonists have a "paradoxical" stimulant-like effect on me and help with several symptoms that the monoaminergic drugs haven't seemed to do much about: anhedonia (a core symptom of depression), motivation, and concentration, in particular. I've been taking this drug along with Effexor for a couple months now, and the combination seems to be the best treatment I've come across. Perhaps I don't have enough endorphins or enkephalins, or perhaps there's some other problem with my EOS. On the other hand, it might be that whatever's wrong with my brain may not have anything to do with the EOS or with monoamines; it may just be corrected or compensated for *indirectly* by modifying these systems.
(I don't think that there are any drugs available that are known to activate the EOS in other ways. I know that there were once some efforts to find "enkephalinase inhibitors," drugs which would inhibit the metabolism of enkephalins, analogous to the action of MAOIs on monoamines. This idea was blown to pieces when the researchers discovered that the "enkephalinase" enzymes which catalyze the metabolism of enkephalins are involved in the metabolism of many other neuropeptides and would be unusable as medications due to these extremely widespread, global effects.)
My understanding is that, most likely, the problem in psychiatric conditions has to do with neural pathways in specific parts of the brain, and not with a global lack of any specific neurotransmitter. For whatever reason, taking medications that increase the amount of different neurotransmitters (or otherwise affect neurotransmission) corrects these pathways (just how or which pathways, we don't know), but because the effect is global, other pathways are also altered, which can lead to unwanted effects (e.g., the abnormal stereotyped movements often caused by dopamine antagonist drugs, which are the result of blockade of extrapyramidal neurons that control rhythmic movements). Because we don't have the technology to make medications affect only the desired parts of the brain, the effects of antidepressants and other psychotropic drugs are often widespread. There has been some research on treatments that target a specific location (or send medication to a specific location) using electrical stimulation, magnets, and the like, but this isn't something that we can use to treat psychiatric disorders at this time. There are also some medications that have relatively specific effects, but we don't yet know just how to design medications to target specific receptors, much less specific receptor subtypes that are thought to be involved with particular conditions. Simply increasing the amount of a naturally occurring chemical (by triggering release, blocking reuptake, inhibiting metabolism, etc.) won't target a particular receptor subtype, since these substances are nonselective agonists at their own receptors (for example, serotonin activates all the subtypes of serotonin receptors).
(Incidentally, it certainly hasn't been proven, as many people seem to believe, that a "chemical imbalance" is responsible for such mental disorders as depression, bipolar disorder, anxiety disorders, and schizophrenia. The expression "chemical imbalance" doesn't even have a clear meaning. I love those goofy Paxil commercials that claim the drug corrects a "chemical imbalance" which "could be to blame" for generalized anxiety.)
Okay, that was just another diatribe. We now return to your regularly scheduled posts.
-elizabeth
Posted by spike4848 on February 14, 2002, at 18:42:41
In reply to Re: Which antidepressant is right for you? » torenada, posted by Elizabeth on February 14, 2002, at 16:01:49
Very well said Elizabeth. Antidepressants probable work through some other mechanism than norepinephrine, dopamine or serotonin. It probably has nothing to do with neurotransmiters ... maybe the second messanger system, maybe stopping apoptosis or maybe altering mRNA transcription. But I know my brain is alot different from a rat neuron in a test tube, where much of this data comes from.
I personally feel that cluster of symptoms may predict which med will work for an individual. If I have a person with panic attacks and social avoidance, a benzo will probably work. When I read peoples stories, and they have a cluster of symptoms similar to mine own, usually I find I respond to the same drugs as that individual. So I think it is very helpful to inquire about what med a person maybe taking. I alway say, let someone else take the long road .... learn from others sucesses and failures.
Come to think it, I wanted to ask Mitch/Ritch his meds .... I think we have common symptoms.
Spike
Posted by spike4848 on February 15, 2002, at 19:15:41
In reply to What Med are you on PLEASE! » Elizabeth, posted by spike4848 on February 14, 2002, at 18:42:41
If you read the post above, you might have seen me wanting to ask about your med combo. I have panic, social phobia, depression and a family history of bipolar disorder. I think you have said you have some social phobia, panic and bp II. I have read many of your prior posts. And I think you are on neurontin 300mg, zoloft 25mg and a stimulant or klonopin?
Can you tell which meds you take and what symptoms the meds help (like neurontin helps with panic and social phobia. And, have you ever had depression?
Thanks
Spike
Posted by Ritch on February 16, 2002, at 1:00:22
In reply to Mitch/Ritch .... Some advice!, posted by spike4848 on February 15, 2002, at 19:15:41
> If you read the post above, you might have seen me wanting to ask about your med combo. I have panic, social phobia, depression and a family history of bipolar disorder. I think you have said you have some social phobia, panic and bp II. I have read many of your prior posts. And I think you are on neurontin 300mg, zoloft 25mg and a stimulant or klonopin?
>
> Can you tell which meds you take and what symptoms the meds help (like neurontin helps with panic and social phobia. And, have you ever had depression?
>
> Thanks
>
> SpikeHi Spike,
Got it mostly right, BPII, ADHD, GAD/SP/panic. The BPII depression is a seasonal depression which is very much like an ADD-type depressive.
Currently on:
Neurontin 300-400mg/day
Klonopin .50-1.0mg/day
Celexa 2.5mg 4-5x week
Wellbutrin 18.75-37.5mg amI would like to switch the WB for low-dose Focalin, Dexedrine, or Provigil (for an experimental trial for ADHD sx). The Celexa (and all SSRI's) worsen dystonia problems I have (noone has confirmed any Parkinsons like stuff yet)--I would like to be able to ditch them if possible because of that. I can't take ANY DA antagonists (any antipschotics) EVER again. I had some really BAD situations with the newer atypicals, NEVER going back to those or anything that binds to a DA receptor EVER again. In fact, panic episodes in the past have accompanied the use of DA-antagonists.
Bottomline: I am going to keep the Neurontin+Klonopin, switching from gabapentin to pregabalin (when it is available). Possibly switching from clonazepam to clobazam (when and if it is ever available here in the US). Switching from Celexa to escitalopram when it becomes available (just for increased tolerability-unless I can ditch SSRI's altogether), and combined with a different pstim for ADHD and bipolar depression (mentioned above).
Hope this clarifies things,
Mitch
Posted by spike4848 on February 16, 2002, at 4:11:10
In reply to Re: Mitch/Ritch .... Some advice! » spike4848, posted by Ritch on February 16, 2002, at 1:00:22
> > If you read the post above, you might have seen me wanting to ask about your med combo. I have panic, social phobia, depression and a family history of bipolar disorder. I think you have said you have some social phobia, panic and bp II. I have read many of your prior posts. And I think you are on neurontin 300mg, zoloft 25mg and a stimulant or klonopin?
> >
> > Can you tell which meds you take and what symptoms the meds help (like neurontin helps with panic and social phobia. And, have you ever had depression?
> >
> > Thanks
> >
> > Spike
>
> Hi Spike,
>
> Got it mostly right, BPII, ADHD, GAD/SP/panic. The BPII depression is a seasonal depression which is very much like an ADD-type depressive.
>
> Currently on:
> Neurontin 300-400mg/day
> Klonopin .50-1.0mg/day
> Celexa 2.5mg 4-5x week
> Wellbutrin 18.75-37.5mg am
>
> I would like to switch the WB for low-dose Focalin, Dexedrine, or Provigil (for an experimental trial for ADHD sx). The Celexa (and all SSRI's) worsen dystonia problems I have (noone has confirmed any Parkinsons like stuff yet)--I would like to be able to ditch them if possible because of that. I can't take ANY DA antagonists (any antipschotics) EVER again. I had some really BAD situations with the newer atypicals, NEVER going back to those or anything that binds to a DA receptor EVER again. In fact, panic episodes in the past have accompanied the use of DA-antagonists.
>
> Bottomline: I am going to keep the Neurontin+Klonopin, switching from gabapentin to pregabalin (when it is available). Possibly switching from clonazepam to clobazam (when and if it is ever available here in the US). Switching from Celexa to escitalopram when it becomes available (just for increased tolerability-unless I can ditch SSRI's altogether), and combined with a different pstim for ADHD and bipolar depression (mentioned above).
>
> Hope this clarifies things,
>
> MitchThank you so much Mitch. You have helped alot. I think I want to try neuronton again.
Spike
Posted by Hildi on July 1, 2002, at 12:36:02
In reply to Re: Which antidepressant is right for you? » torenada, posted by Elizabeth on February 14, 2002, at 16:01:49
>
The type of drug that really alleviates my symptoms is not a monoaminergic drug at all, but one which activates "mu" [the Greek letter] opioid receptors, an action shared by certain natural neuropeptides called endorphins and enkephalins (the "endogenous opioid system" or EOS). This drug and other mu agonists have a "paradoxical" stimulant-like effect on me and help with several symptoms that the monoaminergic drugs haven't seemed to do much about: anhedonia (a core symptom of depression), motivation, and concentration, in particular. I've been taking this drug along with Effexor for a couple months now, and the combination seems to be the best treatment I've come across.Elizabeth, what is this med that you take along with Effexor? I am very curious to know what it is .
Thanks, Hildi
This is the end of the thread.
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