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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by zero on April 16, 2002, at 9:21:26
Have read such promising things re. Amisulpride & Sulpiride for Social Phobia, dysthmia and depression not responding well to standard antidepressants (all of which is part of my own situation, that plus "soft bipolar").
As Ami. & Sulp. aren't available here, I was wondering what the closest US available comparable drug(s) would be.
Any info. would be appreciated.
Thanks,
zero
Posted by jonh kimble on April 16, 2002, at 17:19:01
In reply to Amisulpride/Sulpiride - nearest US equivalent?, posted by zero on April 16, 2002, at 9:21:26
> As Ami. & Sulp. aren't available here, I was wondering what the closest US available comparable drug(s) would be.
well im looking into amisulpride myself, but i wonder if mirapex, a parkinsons drug, would have a similar effect. it would make sense since they both act on dopamine d2 or d3. i have read posts in which people have reported benefits with dythymia/anhedonia type depression on mirapex, and a recent study confirmed that mirapex has antidepressant qualities similar to those of other antidepressants, although ive never heard anything about mirapex for social anxiety which is my biggest problem, but this is simply because of heard so little about it. what do u think?
jon
Posted by kregpark@yahoo.com on April 21, 2002, at 15:40:01
In reply to Re: Amisulpride/Sulpiride - nearest US equivalent?, posted by jonh kimble on April 16, 2002, at 17:19:01
I tried amisulpride low dose for 3.5 weeks, for mild dysthymia which accomanies my otherwise well treated primary generalized social phobia.
I had dystonic reactions at low dose. I was somewhat illiterate that I was "at risk", and my overeagerness to act on the research I *had* done was in retrospect a mistake. I did develop some ongoing dystonia which is fading after 3 months. No-one has noticed any of this I don't think other than those I have shown - thus it is mild and hopefully will entirely abate.
Nevertheless, I would be *very* careful with any antipsychotic at low dose for anyone with affective disorders, since their dopamine function may be compromised already, in addition they may be taking other medication(s) affecting dopamine (as I was). My Dr. actually prescribed amilsulpride for me and knew all my meds. If my symtpoms were significant enough and were to persist - likely he could be sued. But by intent is simply to regain full health.
It is scary stuff - I do not recommend amisulpride for people with affective disorders unless you really know what you are doing first.
I would say that olanzapine is probably significantly safer than amilsulpride in low dose and provides similar dysthymia relief generally speaking. Amisulpride is very effective, and I was highly impressed by the results ... BUT ... this is the only reaction I've ever had like this and I've went through a lot of trial in prior years. I never considered antipsychotics and was stunned by posts here about amisulpride and some quick research supports the claims, but dystonic reactions are common.
I would say that no antipsychotics is best. zyprexa is shown safer (amisulpride is not in USA because of safety concerns) - but is still not totally safe. Because I doubt long term antipsychotic use (including zyprexa) is wise, I would no longer suggest these to any with affective disorders. Preloading with selegeline may be helpful - but over long run who knows outcome when you go off ?
Finally, check out the related sulpride and also notably METACLOPRAMIDE which are 2 drugs in the same "substitute benzamide" class. Check out all of the orofacial dystonias and dyskinesias associated in these mediations. And think again before you act.
Ray... (not kregpark, my old fake name)
Posted by jonh kimble on April 23, 2002, at 14:31:52
In reply to Re: Amisulpride/Sulpiride - nearest US equivalent? » jonh kimble, posted by kregpark@yahoo.com on April 21, 2002, at 15:40:01
sorry to hear that. never heard like this before with amisulpride. supose i havent done enough research. any way, you said it was quite effective. how so? do you think its still worth a trial but maybe combined with deprenyl? id appreciate any feedback. thanks
jon
Posted by JohnQ on April 23, 2002, at 15:31:18
In reply to Re: Amisulpride/Sulpiride - nearest US equivalent? » jonh kimble, posted by kregpark@yahoo.com on April 21, 2002, at 15:40:01
>>I tried amisulpride low dose for 3.5 weeks, for mild dysthymia which accomanies my otherwise well treated primary generalized social phobia.
I had dystonic reactions at low dose. I was somewhat illiterate that I was "at risk", and my overeagerness to act on the research I *had* done was in retrospect a mistake.<<
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I'm not trying to challenge you Ray, but I'm wordering why you now think people with compromised dopamine systems are at a greater risk for dystonic reactions? Are you basing this solely on your own reaction, or have you found new research to support your claim? Studies done on Amisulpride for dysthymia seem to support it's effectiveness and safety, and I think it would be pretty safe to assume that the people who receive most benefit from this med have compromised dopamine systems. Reason I ask is I've been very interested in Amisulpride, as it seems like it would be a great med for me, and I was thinking of ordering it soon. I'd hate to turn away a med that may benefit me, but I think I'd hate dystonia a lot more. Can you give me all the info you have on this subject, if you have the time? Thanks Ray.
Posted by kregpark@yahoo.com on April 24, 2002, at 12:59:05
In reply to Re: Amisulpride/Sulpiride - nearest US equivalent?, posted by jonh kimble on April 23, 2002, at 14:31:52
My opinion is of course that none of these atypicals is best in those with primary mood disorders.
My personal experience is with amisulpride (3.5 weeks 50mg tapered down to 0), and 1 year prior to that a Dr. gave me sample Zyprexa (I did not ask - and almost threw them away before I did try 1/3 of 1 tablet - 2mg zyprexa) - even that sedated me immediately, I added 150mg Wellbutrin and response (acutely was excellent). Very effective.
I don't think there is any question amisulpride and olanzapine and perhaps some other USA atypicals are effective for negative type symptoms like dysthymia and social withdrawal.
However amisulpride is a benzamide like METECLOPRAMIDE and is not the same category as the USA "atypicals" (some of which do not appear very safe either - but still safer).
I think (and studies suggest) that Zyprexa is probably significantly safer than amisulpride such as amisulpride. And I think it has some similar benefits for dysthymia.
If you take any other drugs concurrently with amisulpride your risk of getting dystonia or dyskinesia will change - SSRI's for example will likely increase your risk.
I think augmenting something that boosts d2 in striatum is a good idea - eldepryl perhaps best for this.
Still - over long term use, affective patients are still highest risk (Parkinson's patients do not take those drugs for example, for obvious reasons - their dopamine being so low). Amisulpride like other antipsychotics also frequently causes Parkinsonism (see METECLOPRAMIDE Parkinsonsism, akathesia, dystonia, dyskinesia, etc).
Thus when you come off of olanzapine after taking it for 6 months or 1 years - then you will be new ground for case studies whether you have developed masked TD or dystonia which became visible on discontinuing the drug.
I do not read a whole lot here, but have noticed that some here mention having EPS - and they have mood disorders. You might query them how their situations got screwed up a bit....
Posted by kregpark@yahoo.com on April 24, 2002, at 13:23:31
In reply to Re: Amisulpride/Sulpiride - nearest US equivalent?, posted by JohnQ on April 23, 2002, at 15:31:18
Hi John,
My post previous to this may cover a lot of this but what it doesn't I will try to answer here...
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> I'm not trying to challenge you Ray, but I'm wordering why you now think people with compromised dopamine systems are at a greater risk for dystonic reactions? Are you basing this solely on your own reaction, or have you found new research to support your claim?
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To be more clear, by "comprised" I actually meant dopamine depleted (generally speaking since that's all we really can do including the Dr's for the most part). Abnormally low dopamine levels are characteristic of affective disorders, some more than others. Social Phobics for example, are 5 times more likely to develop Parkinson's in later life and have been shown to have abnormally low d2 receptor density in striatum. They also respond best to the MAOI antidressants (compared to other antidepressants) - which unique boost dopamine generally globally in brain - and particularly so in striatum since MAOI-B is striatum selective.It is also well known than some patients such as bipolar low for example are highly sensitive to developing dystonia / dyskinesia from antipsychotics at any dose - thought to be because of their lowered dopamine levels in the "low" depressed state. They exhibit characteristics overlapping atypical depression and social phobia.
Interestingly when bipolar patients develop tardive dystonia - their symtpoms usually either go away entirely or are significantly reduced when they switch to the "manic" or "hypomanic" state (when their dopamine levels switch from too low to too high).The info is out there on all this stuff. It is better to stick with PubMed and so forth as your primary information - case studies are hard to use in terms of evaluating safety. You will save a lot of time also...time off the computer.
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Reason I ask is I've been very interested in Amisulpride, as it seems like it would be a great med for me, and I was thinking of ordering it soon. I'd hate to turn away a med that may benefit me, but I think I'd hate dystonia a lot more. Can you give me all the info you have on this subject, if you have the time?
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Is your call. I would discourage it. This is a good place to post any findings.
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Ray
ray_3888@yahoo.com
http://www.socialfear.com/
Posted by Quintal on November 16, 2006, at 10:55:43
In reply to Re: Amisulpride safety , posted by kregpark@yahoo.com on April 24, 2002, at 13:23:31
After taking nearly all available drugs to treat my SA amisulpride was a wonder drug. I would encourage anybody who is in a similar position to try low dose amisulpride to gauge for themselves its effectiveness at treating dysthymia and social anxiety.
I must be honest and say I'm irritated by the tone of finality in the last post. This would, as intended, discourage many naive people from ever considering this drug, and for what? One person's self-diagnosed and apparently barely perceptible dystonic reaction? Dystonia does indeed occur with atypical antipsychotics, is a serious problem (and I too must stress that I am not challenging you over this Ray), but it does seem wrong to me to use that to deter other people from trying this treatment which I know greatly relieves the suffering of many people, myself included.
Amisulpride is approved for use here in the UK and according to my last pdoc, is considered safer in terms of movement disorders than most other antipsychotics, especially at low doses. He described the risk as negligible, which is open to interpretation of course.
I know how annoying it is to have these reactions as I had a similar problem with Paxil, believe it or not, my pdoc did not so I helped myself. Having said that, I would not discourage anyone who was truly suffering from trying Paxil, nor encourage people who have found Paxil effective and tolerable (:-o)?????? to discontinue it.
Selegiline made me feel much worse.
Q
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