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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by pro_social_soon on May 6, 2005, at 5:55:09
Why only this drug is a GABA transaminase inhibitor ??? I think that any other drug that would do the same with GABA would be social-anxiety killer.
Posted by BIGDaddyachmed69 on May 6, 2005, at 8:10:27
In reply to Nardil-why only this drug is a GABA transaminase.., posted by pro_social_soon on May 6, 2005, at 5:55:09
> Why only this drug is a GABA transaminase inhibitor ??? I think that any other drug that would do the same with GABA would be social-anxiety killer.
I thought Depakote did that too, though I would hardly call it a social anxiety killer. I know it does something to raise GABA levels, which I'm not too happy about considering I'm going on Nardil...too much of anything can backfire. My psychiatrist doesn't seem to think it should be a problem, though. Sorry for going off on a rant.
Posted by Chairman_MAO on May 6, 2005, at 8:29:15
In reply to Nardil-why only this drug is a GABA transaminase.., posted by pro_social_soon on May 6, 2005, at 5:55:09
-Depakote is an SSADH inhibitor, and also a GABA-T inhibitor at high doses. It also induces glutamic acid decarboxylase to increase GABA synthesis. Unfortunately (for our purposes), it's an Na+ blocker, and also has a whole host of side effects that make it really unpleasant to take for most people.
-Sabril (vigabatrin) is an irreversible GABA-T inhibitor, but it can cause vision defects that may be irreversible.
-Gastrodin, a component monomer of gastrodia elata tuber extract, is an SSADH inhibitor, which has a similar effect to a GABA-T inhibitor. It also may inhibit GABA-T via an indirect mechanism at higher doses.
--Vanillin is a low-potency GABA-T inhibitor (3g/day in divided doses is a good dose to try
If any of the information here is incorrect, please correct me; I think it's all correct, however.
Posted by Declan on May 6, 2005, at 9:05:48
In reply to Re: Nardil-why only this drug is a GABA transamina » pro_social_soon, posted by Chairman_MAO on May 6, 2005, at 8:29:15
Vanillin's from vanilla, right? Where do you get it?
Declan
Posted by Chairman_MAO on May 6, 2005, at 10:34:42
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by Declan on May 6, 2005, at 9:05:48
> Vanillin's from vanilla, right? Where do you get it?
> DeclanYou can get it from any chemical supply house "on the cheap". Try looking in catalogs.google.com. It's a ubiquitous stock item for any purveyor of organic chemicals.
Posted by KaraS on May 6, 2005, at 18:20:01
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by Chairman_MAO on May 6, 2005, at 10:34:42
> > Vanillin's from vanilla, right? Where do you get it?
> > Declan
>
> You can get it from any chemical supply house "on the cheap". Try looking in catalogs.google.com. It's a ubiquitous stock item for any purveyor of organic chemicals.
How do you know if a particular company is legit if you find them that way?
Posted by cache-monkey on May 7, 2005, at 1:18:30
In reply to Re: Nardil-why only this drug is a GABA transamina » pro_social_soon, posted by Chairman_MAO on May 6, 2005, at 8:29:15
Hey Chairman_Mao,
A couple of questions for you: What's SSADH? Also, what is the drawback of blocking the voltage-gated sodium channels "for our purposes" (presumably social anxiety?) ?
Thanks,
cache-monkey
> -Depakote is an SSADH inhibitor, and also a GABA-T inhibitor at high doses. It also induces glutamic acid decarboxylase to increase GABA synthesis. Unfortunately (for our purposes), it's an Na+ blocker, and also has a whole host of side effects that make it really unpleasant to take for most people.
>
> -Sabril (vigabatrin) is an irreversible GABA-T inhibitor, but it can cause vision defects that may be irreversible.
>
> -Gastrodin, a component monomer of gastrodia elata tuber extract, is an SSADH inhibitor, which has a similar effect to a GABA-T inhibitor. It also may inhibit GABA-T via an indirect mechanism at higher doses.
>
> --Vanillin is a low-potency GABA-T inhibitor (3g/day in divided doses is a good dose to try
>
> If any of the information here is incorrect, please correct me; I think it's all correct, however.
>
Posted by BIGDaddyachmed69 on May 7, 2005, at 2:38:14
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by cache-monkey on May 7, 2005, at 1:18:30
> Hey Chairman_Mao,
>
> A couple of questions for you: What's SSADH? Also, what is the drawback of blocking the voltage-gated sodium channels "for our purposes" (presumably social anxiety?) ?
>
> Thanks,
> cache-monkey
>
>I'd like to know the answers to these questions too. I posted yesterday and stated that Depakote didn't seem to be doing much of anything for my social anxiety. Interestingly, I had a positive experience last night without needing to take a benzo. I'm also currently going through Paxil withdrawal, which is supposed to be one of the worst...so apparently the Depakote IS helping.
Posted by The Resistance on May 7, 2005, at 7:41:13
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by BIGDaddyachmed69 on May 7, 2005, at 2:38:14
Vigabatrin sounds like an interesting drug
Has anyone had any experience with it?I know it can cause visual field loss, but lots of drugs have the risk of serious side effects.
I remeber seeing one study where Vigabatrin was used for cocain deppendence.
I wonder if it has any effect on dopamine
Posted by The Resistance on May 7, 2005, at 8:19:52
In reply to Re: Vigabatrin, posted by The Resistance on May 7, 2005, at 7:41:13
Safety and efficacy of gamma-vinyl GABA (GVG) for the treatment of methamphetamine and/or cocaine addiction.
Brodie JD, Figueroa E, Laska EM, Dewey SL.
Department of Psychiatry, NYU School of Medicine, New York, New York 10016, USA. brodij01@gcrc.med.nyu.edu
This study examined the safety and efficacy of gamma vinyl-GABA (GVG, vigabatrin) for the treatment of methamphetamine and/or cocaine addiction. A total of 30 subjects, who met DSM-IV criteria for methamphetamine and/or cocaine dependence, were enrolled in an open label 9-week safety study. The protocol was specifically designed to include extensive visual field monitoring as well as outcome measures of therapeutic efficacy. Patients were screened twice weekly for the presence of urinary cocaine, methamphetamine, heroin, alcohol, and marijuana. In total, 18/30 subjects completed the study and 16/18 tested negative for methamphetamine and cocaine during the last 6 weeks of the trial. GVG did not produce any visual field defects or alterations in visual acuity. Furthermore, it did not produce changes in vital signs even with continued use of methamphetamine and cocaine. Thus, under conditions that appear to be appropriate for the successful treatment of methamphetamine and/or cocaine addiction, GVG is safe.
Publication Types:
Clinical Trial
Posted by ed_uk on May 7, 2005, at 9:40:41
In reply to Re: Vigabatrin-Cocain study, posted by The Resistance on May 7, 2005, at 8:19:52
Hi Tom!
The study is interesting :-)
'About one-third of patients treated with vigabatrin have suffered visual field defects; counselling and careful monitoring for this side-effect are required (see also Visual Field Defects under Cautions below). Vigabatrin has prominent behavioural side-effects in some patients.'
Ed.
Posted by Chairman_MAO on May 7, 2005, at 13:10:54
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by cache-monkey on May 7, 2005, at 1:18:30
Well, you don't want to block Na+ channels for no particular reason because that tends to produce a cognitive slowing, emotional blunting, etc., esp. for those who don't have a strong need for such an effect, e.g. bipolars.
SSADH is succinic semialdehyde dehydrogenase. It is one of two enzymes involved in GABA catabolism (the other is GABA-T). I wish I had more to tell you, but I've only recently started to figure out the details of this for myself recently.
Posted by cache-monkey on May 7, 2005, at 16:16:34
In reply to Re: Nardil-why only this drug is a GABA transamina » cache-monkey, posted by Chairman_MAO on May 7, 2005, at 13:10:54
Thanks for the info! I did a quick search on SSDH, and the relationship between SSADH inhibition and GBH elevation is definitely intriguing.
~cache-monkey
> Well, you don't want to block Na+ channels for no particular reason because that tends to produce a cognitive slowing, emotional blunting, etc., esp. for those who don't have a strong need for such an effect, e.g. bipolars.
>
> SSADH is succinic semialdehyde dehydrogenase. It is one of two enzymes involved in GABA catabolism (the other is GABA-T). I wish I had more to tell you, but I've only recently started to figure out the details of this for myself recently.
Posted by BIGDaddyachmed69 on May 7, 2005, at 19:22:15
In reply to Re: Nardil-why only this drug is a GABA transamina » Chairman_MAO, posted by cache-monkey on May 7, 2005, at 16:16:34
> Thanks for the info! I did a quick search on SSDH, and the relationship between SSADH inhibition and GBH elevation is definitely intriguing.
>
> ~cache-monkey
>I think you mean GHB elevation...I looked up the relationship between the two like you did and came up with a website for GHB withdrawal. It claims that Sodium Divalproate (Depakote) increases endogeneous GHB levels. What this means, as far as I'm concerned, I have no idea. All I know about GHB is that it's a "date rape" drug that has since been marketed as a treatment for some form of narcolepsy.
Posted by cache-monkey on May 7, 2005, at 22:59:37
In reply to Re: Nardil-why only this drug is a GABA transamina, posted by BIGDaddyachmed69 on May 7, 2005, at 19:22:15
You're right, I did mean GHB. When I wrote that (late at night) I remembered reading posts from a number of people who had tried GHB in low doses and gotten a strong benefit in terms of their depression and anxiety (particularly of the social variety).
But now that I think about it more, I also remember quite a few folks saying that GHB just sort of knocked them out. So maybe not so useful of an effect after all. Plus, makes we worry a little bit about going off Depakote (which I'm on, as well), since I've heard about problems of withdrawal from freebase GBH.
> > Thanks for the info! I did a quick search on SSDH, and the relationship between SSADH inhibition and GBH elevation is definitely intriguing.
> >
> > ~cache-monkey
> >
>
> I think you mean GHB elevation...I looked up the relationship between the two like you did and came up with a website for GHB withdrawal. It claims that Sodium Divalproate (Depakote) increases endogeneous GHB levels. What this means, as far as I'm concerned, I have no idea. All I know about GHB is that it's a "date rape" drug that has since been marketed as a treatment for some form of narcolepsy.
Posted by cache-monkey on May 7, 2005, at 23:15:20
In reply to Re: Nardil-why only this drug is a GABA transamina » BIGDaddyachmed69, posted by cache-monkey on May 7, 2005, at 22:59:37
Er, I mean GHB. GHB.
Wow. Typing's been a bit more tricky since going on Depakote. Kind of odd. But so has been my whole experience with that particular drug.
Actually, thinking about the Depakote-GHB connection, my sleep has worsened dramatically since starting Depakote. Both getting to sleep and staying asleep. Wonder if this this has to do with the anti-narcoleptic effects of GHB.
Posted by BIGDaddyachmed69 on May 8, 2005, at 9:41:24
In reply to Darned dyslexic fingers, Depakote, GHB and sleep, posted by cache-monkey on May 7, 2005, at 23:15:20
> Er, I mean GHB. GHB.
>
> Wow. Typing's been a bit more tricky since going on Depakote. Kind of odd. But so has been my whole experience with that particular drug.
>
> Actually, thinking about the Depakote-GHB connection, my sleep has worsened dramatically since starting Depakote. Both getting to sleep and staying asleep. Wonder if this this has to do with the anti-narcoleptic effects of GHB.
>
>That's interesting now that you mention it because GHB is supposed to knock you out, like you said...and then it causes some kind of rebound (dopamine release I think). As far as falling asleep, that's definately not the problem...I experience significant fatigue throughout the day. It's staying asleep...I wake up every couple hours if I don't take a Lunesta. So maybe that's the Depakote, I dunno...
Posted by cache-monkey on May 8, 2005, at 14:47:13
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep, posted by BIGDaddyachmed69 on May 8, 2005, at 9:41:24
<< As far as falling asleep, that's definately not the problem...I experience significant fatigue throughout the day. It's staying asleep...I wake up every couple hours if I don't take a Lunesta. So maybe that's the Depakote, I dunno... >>
Thanks for bringing up the dopamine rebound idea. That might explain some of my daily cycle in response to Depakote. I'm on the ER version and take my dose a couple of hours before bed. I tend to start feeling better and better around the time I take my dose, and that continues further for a while. I usually have trouble getting to sleep and staying asleep. I feel like I just sort of skim the surface of sleep the whole night. And wake up feeling like crap.
The thing about the ER version is that my Depakote levels should be falling around dosing time. But the ER version kicks in slowly with the peak after a single dose occuring 4-17 hours later.
If I'm at the longer end of that, I'd imagine my blood level to continue decline for a while after taking the dose. Upshot could be that I'm getting the dopamine rebound around the time that I'm trying to sleep.
Maybe I'll switch to the non-ER version and see if that makes a difference...
Posted by BIGDaddyachmed69 on May 9, 2005, at 0:06:35
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep, posted by cache-monkey on May 8, 2005, at 14:47:13
> << As far as falling asleep, that's definately not the problem...I experience significant fatigue throughout the day. It's staying asleep...I wake up every couple hours if I don't take a Lunesta. So maybe that's the Depakote, I dunno... >>
>
> Thanks for bringing up the dopamine rebound idea. That might explain some of my daily cycle in response to Depakote. I'm on the ER version and take my dose a couple of hours before bed. I tend to start feeling better and better around the time I take my dose, and that continues further for a while. I usually have trouble getting to sleep and staying asleep. I feel like I just sort of skim the surface of sleep the whole night. And wake up feeling like crap.
>
> The thing about the ER version is that my Depakote levels should be falling around dosing time. But the ER version kicks in slowly with the peak after a single dose occuring 4-17 hours later.
>
> If I'm at the longer end of that, I'd imagine my blood level to continue decline for a while after taking the dose. Upshot could be that I'm getting the dopamine rebound around the time that I'm trying to sleep.
>
> Maybe I'll switch to the non-ER version and see if that makes a difference...It's worth a shot. I probably forgot to mention I also take the extended-release version, but in the morning rather than at night. I used to take it at night, but had trouble falling asleep like you...at least I only have trouble staying asleep now (I guess).
Posted by theo on May 9, 2005, at 13:31:21
In reply to Darned dyslexic fingers, Depakote, GHB and sleep, posted by cache-monkey on May 7, 2005, at 23:15:20
What dose of Depakote ER are you currently taking, 500mg? Did you feel any theraputic benefits at 250mg? My doc just prescribed it to me and wouldn't even start me at 250mg, said 500mg of the ER was still a small dose.
I still wish he would have given me the opportunity to try 250mg but docs sometimes just don't listen because they aren't the ones having to deal with side effects!!
Le me know if Depakote ER is helping you and at what dose.
Posted by cache-monkey on May 10, 2005, at 1:26:39
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep, posted by BIGDaddyachmed69 on May 9, 2005, at 0:06:35
> > Maybe I'll switch to the non-ER version and see if that makes a difference...
>
> It's worth a shot. I probably forgot to mention I also take the extended-release version, but in the morning rather than at night. I used to take it at night, but had trouble falling asleep like you...at least I only have trouble staying asleep now (I guess).I didn't realize you took the dose early in the day. Maybe I'll try the same and see if that helps first. (Since I have a bunch of the pills on hand.)
Best,
cache-monkey
Posted by cache-monkey on May 10, 2005, at 1:32:44
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep » cache-monkey, posted by theo on May 9, 2005, at 13:31:21
Hi theo,
I'm currently at 750 mg ER, having just reduced from 1000. I haven't really experienced any therapeutic benefit to speak of. For a while it felt as if the Depakote was making me worse off. Trouble sleeping. More depression.
Thing is that I'm not really on the manic end of the BP spectrum, spending most of my time in various down states (dysthymia, depression, dysphoria).
Only after reducing my Depakote dose to 750 and adding Seroquel (25 mg) for sleephave I actually started to feel mentally better . Physically, my appetite's still way up and my libido way down, though.
I know what you mean about the pdocs not listening. Mine tends to insist on pushing and pushing the dose of a med regardless of how I'm responding. I'm in the process of trying to find a new pdoc...
Good luck, and let me know if you have any further questions.
Best,
cache-monkey> What dose of Depakote ER are you currently taking, 500mg? Did you feel any theraputic benefits at 250mg? My doc just prescribed it to me and wouldn't even start me at 250mg, said 500mg of the ER was still a small dose.
>
> I still wish he would have given me the opportunity to try 250mg but docs sometimes just don't listen because they aren't the ones having to deal with side effects!!
>
> Le me know if Depakote ER is helping you and at what dose.
Posted by ed_uk on May 10, 2005, at 5:33:07
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep » theo, posted by cache-monkey on May 10, 2005, at 1:32:44
Hi :-)
>Mine tends to insist on pushing and pushing the dose of a med regardless of how I'm responding.
Why is it that so many doctors don't understand the basic principles of dose titration?!
Ed.
Posted by BIGDaddyachmed69 on May 10, 2005, at 9:38:31
In reply to Re: Darned dyslexic fingers, Depakote, GHB and sleep » theo, posted by cache-monkey on May 10, 2005, at 1:32:44
> Hi theo,
>
> I'm currently at 750 mg ER, having just reduced from 1000. I haven't really experienced any therapeutic benefit to speak of. For a while it felt as if the Depakote was making me worse off. Trouble sleeping. More depression.I know this post isn't directed towards me, but I'm bored so I'm gonna weigh in. Same here as far as the Depakote making you feel worse...but I stand by the fact that it's helped control my outbursts, and seems to be doing something for my social anxiety.
> Thing is that I'm not really on the manic end of the BP spectrum, spending most of my time in various down states (dysthymia, depression, dysphoria).
When you were off the Depakote, was mania EVER a problem? If so you might want to consider Lithium...in my opinion it's better than Depakote for depression, and works to treat mania as well though to a lesser extent. I think I've read that Lamictal can sometimes cause hypomanic episodes...but if the depression is really the primary issue you could mention that to your pdoc, too.
> Only after reducing my Depakote dose to 750 and adding Seroquel (25 mg) for sleephave I actually started to feel mentally better . Physically, my appetite's still way up and my libido way down, though.I know my appetite's way up...but I'm on what appears to be a very high dose (I haven't run into anywhere here that's been above like 1000mg). On the other hand, I'm experiencing no sexual side-effects whatsoever...it's almost to the point where it's a little too much.
> I know what you mean about the pdocs not listening. Mine tends to insist on pushing and pushing the dose of a med regardless of how I'm responding. I'm in the process of trying to find a new pdoc...
My pdoc does the exact same thing...luckily I like the guy. I trust him, he's the only psychiatrist I've ever seen and he's even treated my father for the past 15 years. But sometimes I come to him with a problem, and he'll just be like "let's go higher on the Paxil"...in the past he's gone well above the FDA maximum recommended dose. That was before I started reading those package inserts that list the full prescribing information...I just feel more comfortable keeping the dose within the FDA-approved range. I know they're allowed to go higher at their own discretion.
Anyway, hang in there buddy.
Posted by cache-monkey on May 10, 2005, at 13:42:16
In reply to Dose titration » cache-monkey, posted by ed_uk on May 10, 2005, at 5:33:07
<< Why is it that so many doctors don't understand the basic principles of dose titration?! >>
Or even basic empathy toward their patients' responses!
~cache-monkey
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