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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by linkadge on December 23, 2004, at 11:46:28
I think that the main drawback to long term treatment of depression with SSRI's, is the prefrontal hypofunction they induce.
What we need it a potent clean, selective 5-ht2a/c antagonist.
Linkadge
Posted by tensor on December 23, 2004, at 12:46:33
In reply to Its all about the frontal cortex, posted by linkadge on December 23, 2004, at 11:46:28
> What we need it a potent clean, selective 5-ht2a/c antagonist.
What makes you think it's so? It's interesting because i seem to need a med with 5-ht2a antagonism, e.g. mirtazapine or clomipramine. Please gives us more info on this.
/Mattias
Posted by linkadge on December 23, 2004, at 15:12:18
In reply to Re: Its all about the frontal cortex » linkadge, posted by tensor on December 23, 2004, at 12:46:33
Blocking the 2a/c receptors causes dopamine and norephinephrine to be released in the frontal cortex. If these receptors are agonized like with an SSRI, there is a tendancy to induce prefrontal hypofunction.
Linkadge
Posted by bark2323 on December 25, 2004, at 15:10:08
In reply to Its all about the frontal cortex, posted by linkadge on December 23, 2004, at 11:46:28
Well, if you want to activate the prefrontal Cx, remeron, as the other poster mentioned, is pretty ideal. Along with the properties you mentioned, being an alpha-2 antagonist increases noradrenergic and dopaminergic transmission in that area. But I realize it is not selective (H1 antagonism). Maybe low dose olanzapine (maybe some other atypicals, but I think most of them are much more active at the 5HT2a than 2c receptor, although many have that alpha-2 antagonism)? Again, I know, not selective, but they get the job done. (and Im bored)
matt
Posted by bark2323 on December 25, 2004, at 15:22:30
In reply to Re: Its all about the frontal cortex, posted by bark2323 on December 25, 2004, at 15:10:08
Disclaimer: Like I said, Im bored (midday xmas lull)
just wanted to add, that maybe mirtazapine also might not be ideal since it is also a 5HT3 antagonist, but I think (correct me if Im wrong) that that would only decrease dopaminergic transmission in limbic areas, which some people highly value. I used to be one of them (what, no fun in the nucleus accumbens???) but I think that whole thing is a bit overrated, besides the fact that eventually most, if not all, ADs eventually do increase dopamine receptor expression/sensitivity in that area anyway.
matt
Posted by linkadge on December 25, 2004, at 15:41:11
In reply to Re: Its all about the frontal cortex, posted by bark2323 on December 25, 2004, at 15:22:30
There is a bit of controversy over weather the atypicals actually do increase fcuntional dopamine in the prefrontal cortex. They do increase dopamine release there, but they also block the d1,d2 receptors in the frontal cortex hence nullifying some of the effect.
I have been on a combination of celexa/remeron before and hope to be able to return to that.
Linkadge
Posted by bark2323 on December 26, 2004, at 11:00:23
In reply to Re: Its all about the frontal cortex, posted by linkadge on December 25, 2004, at 15:41:11
I think some of them do not block to a significant extent the D1 receptor (olanzapine I beleive does not, but you get a different affinity everywhere you look so who knows), and the D1 receptor is the most abundant in the frontal cortex. Anyways, are you considering adding remeron because the celexa isnt working too well, or for sleep, or some other reason? I seem to remember reading you are still not where you want to be (happy), but Im not sure, although I suppose if you were feeling good again you probably wouldnt be adding meds in the first place. Are you still on lithium, and if so what is it doing for you? I think I remember you saying it made you less depressed, or at least less suicidal, but that it made the world pretty "grey". (sorry I read this board a lot, but sporadically, and I dont post much if youre wondering who the hell this guy is)
matt
Posted by linkadge on December 26, 2004, at 13:37:56
In reply to Re: Its all about the frontal cortex, posted by bark2323 on December 26, 2004, at 11:00:23
The lithium is somewhat useful, but I am currently in university and lithium makes me as smart as a bag of nails. Continuing with my education would not be possable on lithium.
Linkadge
Posted by tensor on December 26, 2004, at 13:57:07
In reply to Re: Its all about the frontal cortex, posted by linkadge on December 26, 2004, at 13:37:56
Hi Link,
it would nice if you could describe more detailed what you mean. Does it impair your learning skills, poor memory? I had this dream that lithium would make me a healthy, stable individual and perhaps i would be able to return to university sometime.
Thanks,
Mattias
Posted by jparsell82` on December 28, 2004, at 0:12:52
In reply to Re: Its all about the frontal cortex, posted by bark2323 on December 26, 2004, at 11:00:23
> I think some of them do not block to a significant extent the D1 receptor (olanzapine I beleive does not, but you get a different affinity everywhere you look so who knows), and the D1 receptor is the most abundant in the frontal cortex. Anyways, are you considering adding remeron because the celexa isnt working too well, or for sleep, or some other reason? I seem to remember reading you are still not where you want to be (happy), but Im not sure, although I suppose if you were feeling good again you probably wouldnt be adding meds in the first place. Are you still on lithium, and if so what is it doing for you? I think I remember you saying it made you less depressed, or at least less suicidal, but that it made the world pretty "grey". (sorry I read this board a lot, but sporadically, and I dont post much if youre wondering who the hell this guy is)
> mattYeah, but if you have Social Anxiety Problems olanzapine blocks D2 and people with social anxiety already have low binding potential for the D2 receptor. Like you said there's Remeron... but it effects Histamine which I couldn't stand... the 5ht3-antagonist properties were welcome though as they help get rid of nausea. What about Mianserin??
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