![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 45. Go back in thread:
Posted by scott-d-o on January 29, 2004, at 15:01:24
In reply to Re: doxepin, remeron, whatever.. thread is off-top, posted by katrina1 on January 29, 2004, at 12:02:47
> Just my two cents: I take addrall and I take low dose zyprexa (2.5mg) & might add abilify (2.5 mg, tops), but boy do I get the stimulant resistance and low blood pressure thing...I could take 60 mgs. of adderall and still sleep like a cat at night. It's like the first 20mgs. does nothing. I've seen Dr. Dubovosky-he's insightful...
> I'm gonna buy some magnesium...we were hoping the AP's could help with my profile that looks like the neg. side of scizophrenia (I'm not)??? It's such a crap shoot sometimes, I've never gotten remission-I'm even on subutex (partial opiate)...it helps take the teeth out of depression.
maybe it's time to take a little break from adderall and see if that helps.. the drug they use in cough syrups, dextromethorphan, is also a NMDA antagonist.. some people use it recreationally cause it feels like ketamine or PCP at high doses (disassociative).. normally you can only get it by itself in the disgusting syrups but I stumbled upon new "Robitussin CoughGels" at the pharmacy the other day.. not sure how they got it fda approved considering abuse potential.. liquid gelcaps with Dextromethmorphan 15mg as the only active ingredient.. I may have to try them out ;-) Not sure if it will do anything for my stim tolerance, which was so bad some years ago that at one point I fell asleep like 15 mins after doing 100mg of pure meth..
Posted by Sad Panda on January 31, 2004, at 9:12:21
In reply to Re: doxepin, remeron, whatever.. thread is off-top, posted by scott-d-o on January 29, 2004, at 14:44:47
>
> you're prob right about that abstract, like most abstracts, it is poorly worded.;-) I think doxepin has only slightly higher affinity than mirtazapine for h1 (I think mirtazapine binds with a pKi value around 9 and doxepin has a pKi around 10), but doxepin is not as selective and has much stronger h2 antagonism, so I think overall it is much more antihistaminic.. but then again I'm already sick of talking about it.. i guess a lot of it depends on where u get your data from also.
>
> scottHi Scott,
I'm not sick of talking about it yet :)
I don't know how strong Mirtazapine is at H2 antagonism, AFAIK H2 antagonism controls acid in the stomach, I'm only interested in H1 because of what it does for sleep. Stomach juice talk would be getting way off topic. ;)
Here is an article that says Mirtazapine is a potent H1 blocker & references the exact same paper by Fawcett J & Barkin RL. You can read it all at http://www.medscape.com/viewarticle/410902_print Here is a snip:
"Mirtazapine is also a potent antagonist at central and peripheral histamine (H1) receptors, which may explain its sedative effects. Unlike maprotiline, mirtazapine has little activity at muscarinic or peripheral a1adrenergic receptors.[1-4]
References
1. Holm KJ, Markham A. Mirtazapine: a review of its use in major depression. Drugs 1999;57:607-31.
2. Tetracyclic antidepressants. In: Olin BR, ed. Drug Facts and Comparisons. St. Louis: Facts and Comparisons. 2000:900-3.
3. Remeron® product information. Organon. April 1996.
4. Fawcett J, Barkin RL. A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety. J Clin Psychiatry 1998;59:123-7."
Here is another snip from: http://www.psychotropical.com/notes/637.html"Mirtazapine (6-azamianserin) was, for good reasons***, first tested as a sedative around 1982 - 1985. It is of significance and interest to note one of the earliest papers in 1985; the title introduced it as a "new antidepressant" even though there was no evidence at that time of any antidepressant efficacy in humans. The paper actually investigated only the sedative effect. There is nothing like establishing the idea before the facts.
***good reasons:-- we now know it is the most potent anti-histamine on the world market, eclipsing even doxepin.""Like mianserin, mirtazapine is a potent H1 blocker (anti-histamine) and thus inevitably causes sedation and weight gain; indeed H1 blockade is the most potent property of both these drugs, mirtazapine being even more potent than doxepin."
"It is claimed to give relief from the ubiquitous anxiety symptoms of depression better and sooner than SSRIs, this is convincingly accounted for by its extremely potent sedative (and therefore anxiolytic) anti-histamine action. Indeed the first trial in 1985 was as a "pre-med" comparing its sedative / anxiolytic properties to diazepam. Mirtazapine 15 mg was equal to diazepam 10 mg."
Some receptor affinites from: http://www.psychotropical.com/notes/253.html
"Potency for blocking H1 and (A1) post-synaptic receptors
H1 blockade relates to a) sedation, and b) weight gain
A1 relates to postural hypotension and reflex tachycardiamirtazapine 0.12 (-)
Doxepin 0.2 (23)
Mianserin 0.4 (34)
Amitriptyline 1 (24)
Dothiepin 3.6 (450)
Nortriptyline 6.3 (55)
Clomipramine 15 (50)
Imipramine 37 (32)
Desipramine 60 (100)
Nefazodone 24000 (48)
trazodone 1100 (42)
Sertraline 24000 (380)
venlafaxine 35000 (35000)
Doxepin and mirtazapine are the most potent antihistamines on the world market, indeed, because of this doxepin has been marketed as a topical skin preparation."Mirtazapine is getting close to 2x stonger than Doxepin. People I have spoken with who have taken both say 15mg of Mirtazapine is about as potent as 25mg of Doxepin for sleep.
Here is another snip from http://www.biopsychiatry.com/
"Mirtazapine (Remeron) is a structural analogue of the off-patent mianserin (Bolvidon). It is a comparatively new drug - a so-called NaSSA. By blocking the inhibitory presynaptic alpha2 adrenergic autoreceptors and stimulating only the 5-HT1A receptors, mirtazapine enhances noradrenaline and serotonin release while also blocking two specific (5-HT2 and 5-HT3) serotonin receptors implicated in dark moods and anxiety. By contrast, stimulation of the 5-HT2A receptors accounts for the initial anxiety, insomnia and sexual dysfunction sometimes reported with the SSRIs; stimulation of the 5-HT3 receptors causes nausea. Unfortunately, mirtazapine is a potent blocker of the histamine H1 receptors too. So it tends to have a somewhat sedative effect. This profile may be good for agitated depressives and insomniacs."
Let me know if you want me to find some more info for you.Cheers,
Panda.
Posted by scott-d-o on February 1, 2004, at 1:31:33
In reply to Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on January 31, 2004, at 9:12:21
wow, you must have a lot of time on your hands :-)
keep in mind panda, doxepin is usually prescribed anywhere from 75mg all the way up to a max of 300mg, where as remeron has a *max* dose of 75mg.
according to your data, at the max dose that a pdoc will prescribe, u will get an overall sedative effect that is over 2 times as powerful from the doxepin than the remeron.
so if u have a h1 antagonism fetish, u best go ask your pdoc for doxepin.. ;p
anyhow, thanks for the info..
scott
Posted by Karen Moore on February 2, 2004, at 0:25:06
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by scott-d-o on February 1, 2004, at 1:31:33
Hi folks,
Thanks for the in depth discussion here, I'm thinking that I've become a bit of a pharmacology nerd these days, I never thought I'd find these things so amusing and engrossing. But when it looks like there might be some solutions in this morass of information it seems like it might actually be worth spending all of this time trying to figure it all out! If it means there might be a possibility of "taming the beast", why not!
Funny thing is I tried Mirtazapine a few months ago, for exactly some of the reasons you two were debating. But on day three of a very low dose I ended up in the ER on oxygen and a saline drip! Still don't know what the hell that was...
Thanks,
KM
Posted by Karen Moore on February 2, 2004, at 0:40:54
In reply to Re: doxepin, remeron, whatever.. thread is off-top » katrina1, posted by scott-d-o on January 29, 2004, at 15:01:24
Hey Scott,
Yup, went off the Adderall for a while. That's partially why it took me so long to respond to your note. I was only on 10mg but my brain shuts down so violently it's just amazing (and a bit demoralizing).
As for NMDA antagonists, I'm also curious. I talked to Stephen Dubovsky a few days ago about a variety alternatives and included that in my list(his pets are thyroid hormone and Ca channel blockers). He mentioned using an NMDA antagonist called Memantine, but cautioned me (the bipolar "me") that it might just destabilize me more. Nonetheless, I got the feeling he had atleast some good results with TR patients.
I admit remembering one desperate evening of gulping Robitussin. I remember a vague high, but that was years ago, before I had any clue what bipolar was. Or NMDA antagonists, for that matter! Let me know if you try the gel caps...
KM
Posted by scott-d-o on February 2, 2004, at 22:47:30
In reply to Re: doxepin, remeron, whatever.. thread is off-top » scott-d-o, posted by Karen Moore on February 2, 2004, at 0:40:54
> Hey Scott,
> Yup, went off the Adderall for a while. That's partially why it took me so long to respond to your note. I was only on 10mg but my brain shuts down so violently it's just amazing (and a bit demoralizing).
> As for NMDA antagonists, I'm also curious. I talked to Stephen Dubovsky a few days ago about a variety alternatives and included that in my list(his pets are thyroid hormone and Ca channel blockers). He mentioned using an NMDA antagonist called Memantine, but cautioned me (the bipolar "me") that it might just destabilize me more. Nonetheless, I got the feeling he had atleast some good results with TR patients.
> I admit remembering one desperate evening of gulping Robitussin. I remember a vague high, but that was years ago, before I had any clue what bipolar was. Or NMDA antagonists, for that matter! Let me know if you try the gel caps...
> KMhey karen,
I did give the gel caps a try, just for fun thou.. I took the whole bottle, which was 300mg; not all that high for a recreational dose. it reminds me most of ketamine ("special k", also a nmda antagonist), due to the same type of mind/body disassociation effect; it's somewhat amusing every once in a while but nothing I'd want to do on a regular basis. Also, it enhances music somewhat, which was the only thing I liked about weed (but could never tolerate it cause of extreme paranoia and panic).. I've only used DXM on one other occasion (syrup) and I much preferred the experience with the gel caps..
It could just be my imagination, but I think my dexedrine did produce a little euphoria the next day (it never usually does.) NMDA antagonists administered by themselves indirectly cause dopamine release so there's no doubt DXM and amphetamine would complement each other well. They come in 15mg gelcaps, I think one per day could do a lot for amphetamine tolerance and if you do a search on this board I think you will find some people have had success using DXM and for this purpose..
however, I don't know exactly how bipolars react to nmda antagonists so perhaps you should look into that before doing any experimenting.. my intuition tells me that, if anything, it would help stabilize you, since most bipolar meds act strikingly similar to DXM in the brain. I wonder why this person thinks memantine could destabilize a bp?
scott
Posted by Sad Panda on February 3, 2004, at 5:02:28
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by scott-d-o on February 1, 2004, at 1:31:33
> wow, you must have a lot of time on your hands :-)
>
> keep in mind panda, doxepin is usually prescribed anywhere from 75mg all the way up to a max of 300mg, where as remeron has a *max* dose of 75mg.
>
> according to your data, at the max dose that a pdoc will prescribe, u will get an overall sedative effect that is over 2 times as powerful from the doxepin than the remeron.
>
> so if u have a h1 antagonism fetish, u best go ask your pdoc for doxepin.. ;p
>
> anyhow, thanks for the info..
>
> scott
>It doesn't work like that. 15mg of Mirtazapine saturates all the H1 receptors, having extra doesn't cause more sedation, the excess then starts to go to the other receptors that it is attracted too such as 5-HT2A, alpha-2 adrenic, etc. That's why it has the wierd effect of becoming more stimulating as you increase the dose.
Cheers,
Panda.
Posted by scott-d-o on February 3, 2004, at 16:52:08
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 3, 2004, at 5:02:28
>
> It doesn't work like that. 15mg of Mirtazapine saturates all the H1 receptors, having extra doesn't cause more sedation, the excess then starts to go to the other receptors that it is attracted too such as 5-HT2A, alpha-2 adrenic, etc. That's why it has the wierd effect of becoming more stimulating as you increase the dose.
>
> Cheers,
> Panda.
>where did u get your info that 15mg of mirtazapine occupies 100% of h1 receptors? I do agree that more stimulation would occur as the dose increases with mirtazapine due to alpha-2 antagonism (not a good kind of stimulation at that.) doxepin however is an alpha-1 antagonist so I would expect the opposite adrenergic response to an increased dose, althou it does block reuptake of NE as well which may balance this somewhat.
scott
Posted by Sad Panda on February 3, 2004, at 23:55:43
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by scott-d-o on February 3, 2004, at 16:52:08
> >
> > It doesn't work like that. 15mg of Mirtazapine saturates all the H1 receptors, having extra doesn't cause more sedation, the excess then starts to go to the other receptors that it is attracted too such as 5-HT2A, alpha-2 adrenic, etc. That's why it has the wierd effect of becoming more stimulating as you increase the dose.
> >
> > Cheers,
> > Panda.
> >
>
> where did u get your info that 15mg of mirtazapine occupies 100% of h1 receptors? I do agree that more stimulation would occur as the dose increases with mirtazapine due to alpha-2 antagonism (not a good kind of stimulation at that.) doxepin however is an alpha-1 antagonist so I would expect the opposite adrenergic response to an increased dose, althou it does block reuptake of NE as well which may balance this somewhat.
>
> scott
>>where did u get your info that 15mg of mirtazapine occupies 100% of h1 receptors?
http://www.preskorn.com and http://www.psychotropical.com
Two great websites written by Psychiatrists.>I do agree that more stimulation would occur as the dose increases with mirtazapine due to alpha-2 antagonism (not a good kind of stimulation at that.)
Norepinephrine Alpha-2 blockade is a good thing, it is believed to give an anti-depressant effect, increase libido & help reverse SSRI induced anorgasmia.
>doxepin however is an alpha-1 antagonist so I would expect the opposite adrenergic response to an increased dose
Norepinephrine Alpha-1 blockade is a bad thing, all the tricyclics do it. It causes Orthostatic Hypotension. One of the biggest difference between Mirtazapine & it's parent Mianserin is most of the A-1 blockade was removed that causes this bad side-effect.
Cheers,
Panda.
Posted by scott-d-o on February 4, 2004, at 0:48:48
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 3, 2004, at 23:55:43
> >where did u get your info that 15mg of mirtazapine occupies 100% of h1 receptors?
>
> http://www.preskorn.com and http://www.psychotropical.com
> Two great websites written by Psychiatrists.damn, I was hoping for a direct link ;-)
> >I do agree that more stimulation would occur as the dose increases with mirtazapine due to alpha-2 antagonism (not a good kind of stimulation at that.)
>
> Norepinephrine Alpha-2 blockade is a good thing, it is believed to give an anti-depressant effect, increase libido & help reverse SSRI induced anorgasmia.
>depends on what you mean by "good thing.".. I think the whole idea here is to make the compounds as *selective* as possible, in that regard it is a bad thing.. yes, alpha2 blockade causes catecholamines to be released but in my opinion there are much better ways to achieve the same result. alpha2 antagonists do not act very centrally at all, they act peripherally causing increased adrenaline levels in the blood. if I wanted an antidepressant that worked on DA/NE I would much rather take a selective reuptake inhibitor, MAO-B inhibitor, a psychostimulant or even an antipsychotic at low dose. take a potent alpha-2 antagonist like yohimbine and see how it makes u feel, it's not very fun and I imagine if alpha-2 antagonism was that great then yohimbine would be prescribed as an antidepressant since it's not a very abusable substance..
calling the sexual effects of alpha-2 antagonism a "good thing" is also way too generalized.. good for someone with anorgasmia, but bad for someone with premature ejaculation.. also alpha-2 antagonists are notorious for causing a ton of anxiety.. in fact, they can easily induce panic attack's in people.. that's a bad thing for anyone. btw, alpha2 antagonism can also cause hypertension, just as you state that alpha1 antagonism can cause hypotension.. are you rating these actions at receptors based on what is a good/bad thing for *you*?
> >doxepin however is an alpha-1 antagonist so I would expect the opposite adrenergic response to an increased dose
>
> Norepinephrine Alpha-1 blockade is a bad thing, all the tricyclics do it. It causes Orthostatic Hypotension. One of the biggest difference between Mirtazapine & it's parent Mianserin is most of the A-1 blockade was removed that causes this bad side-effect.
>never said it was a good or a bad thing.. I was merely stating that it would have the opposite effect on adrenergic receptors than an increased dose of remeron.
scott
Posted by Sad Panda on February 4, 2004, at 1:35:50
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by scott-d-o on February 4, 2004, at 0:48:48
> > >where did u get your info that 15mg of mirtazapine occupies 100% of h1 receptors?
> >
> > http://www.preskorn.com and http://www.psychotropical.com
> > Two great websites written by Psychiatrists.
>
> damn, I was hoping for a direct link ;-)
>
> > >I do agree that more stimulation would occur as the dose increases with mirtazapine due to alpha-2 antagonism (not a good kind of stimulation at that.)
> >
> > Norepinephrine Alpha-2 blockade is a good thing, it is believed to give an anti-depressant effect, increase libido & help reverse SSRI induced anorgasmia.
> >
>
> depends on what you mean by "good thing.".. I think the whole idea here is to make the compounds as *selective* as possible, in that regard it is a bad thing.. yes, alpha2 blockade causes catecholamines to be released but in my opinion there are much better ways to achieve the same result. alpha2 antagonists do not act very centrally at all, they act peripherally causing increased adrenaline levels in the blood. if I wanted an antidepressant that worked on DA/NE I would much rather take a selective reuptake inhibitor, MAO-B inhibitor, a psychostimulant or even an antipsychotic at low dose. take a potent alpha-2 antagonist like yohimbine and see how it makes u feel, it's not very fun and I imagine if alpha-2 antagonism was that great then yohimbine would be prescribed as an antidepressant since it's not a very abusable substance..
>
> calling the sexual effects of alpha-2 antagonism a "good thing" is also way too generalized.. good for someone with anorgasmia, but bad for someone with premature ejaculation.. also alpha-2 antagonists are notorious for causing a ton of anxiety.. in fact, they can easily induce panic attack's in people.. that's a bad thing for anyone. btw, alpha2 antagonism can also cause hypertension, just as you state that alpha1 antagonism can cause hypotension.. are you rating these actions at receptors based on what is a good/bad thing for *you*?
>
> > >doxepin however is an alpha-1 antagonist so I would expect the opposite adrenergic response to an increased dose
> >
> > Norepinephrine Alpha-1 blockade is a bad thing, all the tricyclics do it. It causes Orthostatic Hypotension. One of the biggest difference between Mirtazapine & it's parent Mianserin is most of the A-1 blockade was removed that causes this bad side-effect.
> >
>
> never said it was a good or a bad thing.. I was merely stating that it would have the opposite effect on adrenergic receptors than an increased dose of remeron.
>
> scottScott,
We are comparing Doxepin to Mirtazapine.
Doxepin blocks A1 receptors, which is bad.
Doxepin blocks A2 receptors, which is I say is good & you say is bad.
Mirtazapine blocks A2 receptors, which is I say is good & you say is bad.
So in this case, Mirtazapine is superior to Doxepin.
If you suffer from premature ejaculation I would say neither drug is good for you.Cheers,
Panda.
Posted by scott-d-o on February 4, 2004, at 2:30:57
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 4, 2004, at 1:35:50
>
> Scott,
>
> We are comparing Doxepin to Mirtazapine.
> Doxepin blocks A1 receptors, which is bad.
> Doxepin blocks A2 receptors, which is I say is good & you say is bad.
> Mirtazapine blocks A2 receptors, which is I say is good & you say is bad.
> So in this case, Mirtazapine is superior to Doxepin.
> If you suffer from premature ejaculation I would say neither drug is good for you.
>
> Cheers,
> Panda.
>I think you missed my point which was that nothing is inherently bad.. da antagonism: bad for people with parkinson's, good for schizophrenics. The whole point of pharmacology is to correct imbalances and/or dysfunctions in these neurological systems, which occur in different forms for different people..
scott
Posted by Sad Panda on February 4, 2004, at 3:01:37
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by scott-d-o on February 4, 2004, at 2:30:57
> >
> > Scott,
> >
> > We are comparing Doxepin to Mirtazapine.
> > Doxepin blocks A1 receptors, which is bad.
> > Doxepin blocks A2 receptors, which is I say is good & you say is bad.
> > Mirtazapine blocks A2 receptors, which is I say is good & you say is bad.
> > So in this case, Mirtazapine is superior to Doxepin.
> > If you suffer from premature ejaculation I would say neither drug is good for you.
> >
> > Cheers,
> > Panda.
> >
>
> I think you missed my point which was that nothing is inherently bad.. da antagonism: bad for people with parkinson's, good for schizophrenics. The whole point of pharmacology is to correct imbalances and/or dysfunctions in these neurological systems, which occur in different forms for different people..
>
> scottNo Scott, you missed your own point. Anything Doxepin can do, Mirtazapine can do better. Neither drug has any dopamine effects, so why are you talking about Parkinson's & Schizophrenia?? Mirtazapine is a mild anti-depressant that can reverse SSRI induced side-effects & give a good nights sleep, Doxepin is similar, but not as good.
Cheers,
Panda.
Posted by Karen Moore on February 4, 2004, at 15:51:11
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 4, 2004, at 3:01:37
OK. I've been watching you guys debate this for quite some time now. Reminds me of the arguments I've had with my psychiatrist sister (though yours have been slightly more civil, I think...) It's interesting to watch how two people with different cognitive styles can interprete the same data set and end up on two radically different roads (to enlightenment or befuddlement?!)=?
I will say that philosophically, when discussing meds I think it is important not to take that final step to generalization and judgement as to whether or not one drug is better than another. Though 90% of the time that generalization may be true, all too often there is a subgroup of individuals who fit into the 10% and do better with the "inferior" drug. Since I usually find myself in the 0.05% subgroup I've had to always research "how things work" and dismiss "which one works better". This certainly increases the level of complexity necessary for the given problem, but that's just nature of the beast.Thanks, your discussions prompted me to finally order the newest edition of my fave pharmacology book at amazon. When it gets here I'll start popping some reminyl and see if I can get some of that concentration/intellect back...
chrs,
KMP.S. re: Scott << "da antagonism: bad for people with parkinson's, good for schizophrenics. The whole point of pharmacology is to correct imbalances and/or dysfunctions in these neurological systems, which occur in different forms for different people..."
Point well taken. Different drugs, different applications, different successes and problems. For that matter, one person's unbearable side-effect is another's panacea...
Posted by scott-d-o on February 4, 2004, at 16:00:07
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 4, 2004, at 3:01:37
> No Scott, you missed your own point. Anything Doxepin can do, Mirtazapine can do better. Neither drug has any dopamine effects, so why are you talking about Parkinson's & Schizophrenia?? Mirtazapine is a mild anti-depressant that can reverse SSRI induced side-effects & give a good nights sleep, Doxepin is similar, but not as good.
>
> Cheers,
> Panda.
>
>how can you say they are similar when one is a tricyclic that works by blocking reuptake of serotonin and norepinephrine, and the other works by antagonising postsynaptic serotonin receptors? they are hardly alike at all..
I brought up dopamine antagonism as an *example* of how the same action at a receptor can harm one person and help another.
Posted by Sad Panda on February 4, 2004, at 18:14:40
In reply to Re: Doxepin v Mirtazapine, posted by scott-d-o on February 4, 2004, at 16:00:07
> > No Scott, you missed your own point. Anything Doxepin can do, Mirtazapine can do better. Neither drug has any dopamine effects, so why are you talking about Parkinson's & Schizophrenia?? Mirtazapine is a mild anti-depressant that can reverse SSRI induced side-effects & give a good nights sleep, Doxepin is similar, but not as good.
> >
> > Cheers,
> > Panda.
> >
> >
>
> how can you say they are similar when one is a tricyclic that works by blocking reuptake of serotonin and norepinephrine, and the other works by antagonising postsynaptic serotonin receptors? they are hardly alike at all..
>LOL, You reckoned Efexor & Doxepin where very similiar in a previous post when Doxepin hardly has any effect on Serotonin at all. Doxepin is far closer to Mirtazapine then it will ever be to Efexor.
Cheers,
Panda.
Posted by scott-d-o on February 4, 2004, at 19:30:39
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 4, 2004, at 18:14:40
> > > No Scott, you missed your own point. Anything Doxepin can do, Mirtazapine can do better. Neither drug has any dopamine effects, so why are you talking about Parkinson's & Schizophrenia?? Mirtazapine is a mild anti-depressant that can reverse SSRI induced side-effects & give a good nights sleep, Doxepin is similar, but not as good.
> > >
> > > Cheers,
> > > Panda.
> > >
> > >
> >
> > how can you say they are similar when one is a tricyclic that works by blocking reuptake of serotonin and norepinephrine, and the other works by antagonising postsynaptic serotonin receptors? they are hardly alike at all..
> >
>
> LOL, You reckoned Efexor & Doxepin where very similiar in a previous post when Doxepin hardly has any effect on Serotonin at all. Doxepin is far closer to Mirtazapine then it will ever be to Efexor.
>
> Cheers,
> Panda.
>umm, huh? yes that's true, doxepin is much more like effexor than mirtazapine.. both block reuptake of serotonin and norepinephrine, I simply said doxepin has a bit higher affinity for the NE transporter, while effexor has a higher affinity for the serotonin transporter.. all the tricyclics do this.. mirtazapine does not block the reuptake of either, therefore it is not similar to either effexor or doxepin. ugh, I'm done w/this thread..
Posted by scott-d-o on February 4, 2004, at 19:39:44
In reply to Re: Doxepin v Mirtazapine, posted by Karen Moore on February 4, 2004, at 15:51:11
> I will say that philosophically, when discussing meds I think it is important not to take that final step to generalization and judgement as to whether or not one drug is better than another. Though 90% of the time that generalization may be true, all too often there is a subgroup of individuals who fit into the 10% and do better with the "inferior" drug. Since I usually find myself in the 0.05% subgroup I've had to always research "how things work" and dismiss "which one works better". This certainly increases the level of complexity necessary for the given problem, but that's just nature of the beast.
>
> P.S. re: Scott << "da antagonism: bad for people with parkinson's, good for schizophrenics. The whole point of pharmacology is to correct imbalances and/or dysfunctions in these neurological systems, which occur in different forms for different people..."
> Point well taken. Different drugs, different applications, different successes and problems. For that matter, one person's unbearable side-effect is another's panacea...thanks karen, at least someone is on the same wavelength as me ;)
scott
Posted by Sad Panda on February 4, 2004, at 21:47:11
In reply to Re: Doxepin v Mirtazapine, posted by scott-d-o on February 4, 2004, at 19:30:39
>
> umm, huh? yes that's true, doxepin is much more like effexor than mirtazapine.. both block reuptake of serotonin and norepinephrine, I simply said doxepin has a bit higher affinity for the NE transporter, while effexor has a higher affinity for the serotonin transporter.. all the tricyclics do this.. mirtazapine does not block the reuptake of either, therefore it is not similar to either effexor or doxepin. ugh, I'm done w/this thread..
>Scott, not all tricyclics block the reuptake of serototin, Doxepin is extremely weak & clinically insignificant at serotonin reuptake blocking. Trimipramine, another tricyclic, does not block the reuptake of serotonin or norepinephrine. To say Doxepin & Efexor are similar would be nonsense, Efexor is a stimulating med closest to SSRI's while Doxepin is a heavily sedating tertiary tricyclic. Do you remember discussing H1 blockade? Doxepin is the 2nd most powerfull H1 blocker on the market, Mirtazapine is the only thing that is stronger, this is why I say they are similar, their strongest action is on H1 blockade which makes them heavily sedating, other characteristics of these 2 meds take a back seat to this.
Karen, I haven't used Doxepin for sleep, it would be my 2nd choice after Mirtazapine. I have tried up to 80mg of Temazepam consumed with a stiff scotch & still stayed awake to watch the sunrise yet again. 30mg of Mirtazapine, OTOH, just turns off my mind & stops all the stupid thoughts from going around & around. It doesn't knock me out, but after I have swallowed it I can go to sleep whenever I want.
Sorry for my obsessive ramblings.
Cheers,
Panda.
Posted by Karen Moore on February 4, 2004, at 21:49:55
In reply to Re: doxepin, remeron, whatever.. thread is off-top » Karen Moore, posted by scott-d-o on February 2, 2004, at 22:47:30
> hey karen,
>
> I did give the gel caps a try, just for fun thou.. I took the whole bottle, which was 300mg; not all that high for a recreational dose. it reminds me most of ketamine ("special k", also a nmda antagonist), due to the same type of mind/body disassociation effect; it's somewhat amusing every once in a while but nothing I'd want to do on a regular basis. Also, it enhances music somewhat, which was the only thing I liked about weed (but could never tolerate it cause of extreme paranoia and panic).. I've only used DXM on one other occasion (syrup) and I much preferred the experience with the gel caps..
>
> It could just be my imagination, but I think my dexedrine did produce a little euphoria the next day (it never usually does.) NMDA antagonists administered by themselves indirectly cause dopamine release so there's no doubt DXM and amphetamine would complement each other well. They come in 15mg gelcaps, I think one per day could do a lot for amphetamine tolerance and if you do a search on this board I think you will find some people have had success using DXM and for this purpose..
>
> however, I don't know exactly how bipolars react to nmda antagonists so perhaps you should look into that before doing any experimenting.. my intuition tells me that, if anything, it would help stabilize you, since most bipolar meds act strikingly similar to DXM in the brain. I wonder why this person thinks memantine could destabilize a bp?
>
> scott
Hey scott,
Hmm...interesting, but I definitely could do without the dissociative effect, I get that from my own naturally wacked chemistry. Though for a short time it might be entertaining, I don't usually have anxiety about such things. Something to keep in mind w. adderall/dex, if I could get by with a smaller dose I'm guessing that would mean less side-effects. Interesting...
As for memantine, dubovsky specializes in treatment resistance and bipolar. He indicated that his clinical experience was that it could destabilize (very sensative patients) but specified that the research did not yet show this. So, either it's just random or it's one of those pesky gaps between research, theory, and reality! Who knows, it could be some secondary effect unrelated to NMDA. Memantine appears to have significant antagonistic effects at the 5HT3 receptor, but I can't focus long enough to remember or figure out how that might effect a bipolar...
later,
KM
Posted by Karen Moore on February 4, 2004, at 23:19:37
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Sad Panda on February 4, 2004, at 1:35:50
> If you suffer from premature ejaculation I would say neither drug is good for you.
>
> Cheers,
> Panda.
>As for premature ejaculation, I took care of that problem years ago, in a manic fit of lucidity, when "Kraig" became "Karen"...;>
Posted by scott-d-o on February 4, 2004, at 23:46:03
In reply to Re: Doxepin v Mirtazapine » Sad Panda, posted by Karen Moore on February 4, 2004, at 23:19:37
>
> > If you suffer from premature ejaculation I would say neither drug is good for you.
> >
> > Cheers,
> > Panda.
> >
>
> As for premature ejaculation, I took care of that problem years ago, in a manic fit of lucidity, when "Kraig" became "Karen"...;>
>
>umm, tell me you're not serious? ;-). not that there's anything wrong with that.. anyhow, some women can ejaculate too; not so sure about the premature part thou.
panda, i'm curious, why do you say neither drug could be good for a premature ejaculator?
scott
Posted by Karen Moore on February 5, 2004, at 0:11:17
In reply to Re: Doxepin v Mirtazapine » Karen Moore, posted by scott-d-o on February 4, 2004, at 23:46:03
> >
>
> umm, tell me you're not serious? ;-). not that there's anything wrong with that..Hmm. If I were serious I guess I'd have to change my name to "Karen Less"...or "Karen Moore-or-Less"...or better yet "Karen Less-is-Moore?!
Posted by scott-d-o on February 5, 2004, at 0:37:27
In reply to Re: Doxepin v Mirtazapine » scott-d-o, posted by Karen Moore on February 5, 2004, at 0:11:17
> > >
> >
> > umm, tell me you're not serious? ;-). not that there's anything wrong with that..
>
> Hmm. If I were serious I guess I'd have to change my name to "Karen Less"...or "Karen Moore-or-Less"...or better yet "Karen Less-is-Moore?!
>
>how about "Karen Moore-than-most-guys-expected" ?
Posted by Karen Moore on February 6, 2004, at 15:06:46
In reply to Re: Doxepin v Mirtazapine » Karen Moore, posted by scott-d-o on February 5, 2004, at 0:37:27
> >
>
> how about "Karen Moore-than-most-guys-expected" ?
>
>Hehe...hehehe...OK. I'll resist temptation to escalate, this time. But I think this (formerly random) username is now a keeper (#>
This is the end of the thread.
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