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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by TomG on February 24, 2006, at 22:09:46
I've gotten a thumbs up and a signature from my doc to get these foreign medicines in my hand and down my throat. I'm in the U.S. and they aren't here for reasons I really don't care about. I'm treating negative and cognitive symptoms of schizophrenia or some sort of hypodopaminergic depression. I really stopped caring about the labels of diagnosis a long time ago. If someone smarter than me could answer one question that would be great. Fluanxol being a thioxanthene derivative would Navane offer the same pharmacodynamics or easier said another alternative. I'm sure they are different drugs, but I haven't read so much about Navane being used here in the U.S. as I do about Fluanxol in the U.K.. Also, I should probably try Amisulpride first it being a cleaner drug in respect to TD and all? Thoughts welcome? And my newest venture will be adding mid to low dose of Abilify to 12mg/50mg Symbyax dose. I am curious to see how Abilify will act alongside a potent D2 antagonist. Thoughts Welcome.
Tom
Posted by blueberry on February 25, 2006, at 9:40:33
In reply to Fluanxol vs. Amisulpride?, posted by TomG on February 24, 2006, at 22:09:46
I don't know anything about fluanxol, but I do have personal experience using amisulpride.
Amisulpride is like everything else...it helps some people a lot and not at all in others. But if you feel your symptoms are related to hypodopamine function then it should help a lot.
During the first few days it can sort of feel like a mild amphetamine, stimulating dopamine release. I had an immediate antidepressant effect beginning the second day. Then tolerance to the extra dopamine sets in, and you are tempted to think it has already pooped out. But then with continued use, the extra dopamine somehow causes other brain adjustments to occur to where the true longterm antidepressant effect kicks in. That is at about 3 weeks or so.
In the first few days there can be an increase of anxiety or agitation from the increased dopamine. But at about 3 weeks, amisulpride has a very nice anti-anxiety effect. It is pro-social. You may find yourself more comfortable in a crowd, confident, and relaxed.
I had two side effects. One was disturbed sleep, especially early in treatment. I slept very light and had early wakings. The second was sexual dysfunction. Amisulpride can raise the hormone prolactin levels significantly, which adversely affects sexual desire. In men it can cause impotence. That may or may not happen.
The idea of using abilify with it is interesting. It would probably worsen sleep even more, cause more anxiety in the first week or two, but could counteract the increased prolactin levels. I saw in clinical studies where they used the dopamine agonist bromocriptine to lower prolactin levels in amisulpride or risperdal patients without affecting the therapeutic benefits of the drugs.
I started at 12.5mg and worked up to 50mg. If you get the 200mg tabs, that can last you a long time and save a bunch of money and you would only have to mailorder it infrequently.
Posted by med_empowered on February 25, 2006, at 10:40:39
In reply to Re: Fluanxol vs. Amisulpride?, posted by blueberry on February 25, 2006, at 9:40:33
I'd personally try flupnethixol AFTER amisulpride, just b/c side effects are probably going to be more frequent and more pronounced with amisulpride. The TD risk with full-dose flupenthixol is probably higher than that of full-dose Amisulpride, but lower doses are used without too many problems.
Why are you combining so many antipsychotics? If you're dealing with mostly negative symptoms, you could actually get **worse** by overdoing the neuroleptics--they're good for positive symptoms (at least the most florid symptoms), but they aren't nearly as good for the negative symptoms. Have you considered a mood-stabilizer? Trileptal and Depakote both apparently help some with the negative symptoms, as do the benzos. It seems like something like Provigil or low-dose Ritalin would also help.
Good luck!
Posted by TomG on February 25, 2006, at 12:06:13
In reply to Re: Fluanxol vs. Amisulpride?, posted by med_empowered on February 25, 2006, at 10:40:39
> Why are you combining so many antipsychotics?
I wouldn't say I'm combining "so many". I"m only talking about adding a low to middle dose of Abilify and only Abilify for it's unique properties. The rationale came from here:
http://www.cpa-apc.org/Publications/Archives/CJP/2004/february/lettersCombo.asp
I haven't gone down the mood stabilizer route, but that is certainly a possibility. I responded to lithium years ago for some reason, but it only lasted for 5 days and raising the dose caused agitation.
I take Ativan PRN and that calms me somewhat, but doesn't clear my mind and help cognitively. It also doesn't provide the motivation and confidence that I'm looking for.
I have tried Provigil in and it helps when it works somewhat with cognition but it just feels so false to me if you know what I mean. I'm actually taking it right now with the Symbyax and it seemed to lose its stimulant effect after about two weeks. I take 400mgs first thing in the morning. I've taken up to 1200mgs in a single dose and that just seems to cause euphoria and I know I can't do that as a long term treament plan. Its a strange drug for me. I've been seeing the same shrink for four and a half years with little improvement and he tells me he is willing at this point to try anything so I'm sure going to the conventional stimulants won't be a problem.
Tom
Posted by ed_uk on February 25, 2006, at 12:54:55
In reply to Fluanxol vs. Amisulpride?, posted by TomG on February 24, 2006, at 22:09:46
Hi Tom
I'd definitely try the amisulpride first. The risk of TD is thought to be significantly lower with amisulpride.
>Navane vs Fluanxol
Fluanxol may be unique among the thioxanthenes. I'm not sure that Navane would be a suitable substitute.
Ed
PS. How do you respond to stimulants and noradrenergic ADs? Oh, and have you ever tried Remeron?
Posted by TomG on February 25, 2006, at 13:21:39
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 25, 2006, at 12:54:55
> PS. How do you respond to stimulants and noradrenergic ADs? Oh, and have you ever tried Remeron?
I used Adderrall, Ritalin, Dex, in college recreationlly. They were all insufflated and I had terrible reactions mainly paranoia and mild delusions. Taken with an AP it might be a different story.Nortriptyline at low dose did nothing.
Cymbalta I couldn't stand. It felt like someone had a vice around my head.
I used Strattera for about a week and it seemed to improve focus and maybe a mild calming effect but nothing signifigant. I couldn't eat a bite on it and it messed with sleep that even Ambien couldn't handle.
I took Remeron years ago by itself. I don't remember the dose but I remember being focused and I do know it produced an almost obsessive motivation in me like cleaning closets, drawers, etc.
What I'm looking for which the Geodon that breifly worked for me provided is a clearing and calming of thougths. It gave me a calm clear energy to my mind. So did lithium for five days, similar effect. Something that is unusual and probably signifigant is when I responded to the Geodon I seemed to have a craving for stimulants like caffeine etc.
Let me hear from you.
Tom
Posted by TomG on February 25, 2006, at 13:23:07
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 25, 2006, at 12:54:55
Posted by med_empowered on February 25, 2006, at 15:09:07
In reply to Re: Fluanxol vs. Amisulpride? » med_empowered, posted by TomG on February 25, 2006, at 12:06:13
hey! I know Remeron alone didn't go over well, but in combo with neuroleptics it sometimes seems to reduce negative symptoms..it might be worth a trial shot.
Buspar is sometimes added to neuroleptics; I think the idea is to reduce depression, anxiety, and EPS.
Some neuroleptics, like Geodon, have a built-in AD action. Moban (molindone) does; it tends to be high-akathisia, high-initial EPS, but apparently low-TD (its never been popular, though, so I don't think there's all that much experience with it). Higher doses apparently cause an MAOI effect. Loxapine and amoxapine also have neuroleptic/AD action.
Posted by ed_uk on February 25, 2006, at 16:54:07
In reply to Re: Fluanxol vs. Amisulpride?, posted by TomG on February 25, 2006, at 13:21:39
Hi Tom
>Nortriptyline at low dose did nothing
Might be worth a second try. Finding a dose that works can be difficult. The doses people require vary greatly. You can have your blood nortriptyline level measured to help find the optimum dose.
>I took Remeron years ago by itself. I don't remember the dose but I remember being focused and I do know it produced an almost obsessive motivation in me like cleaning closets, drawers, etc.
Would you say it was beneficial or harmful overall? It sounds like the dose was too high. Perhaps you could try it again at a lower dose.
RE the lithium. Are you gonna try adding lithium to your current medication?
Regards
Ed
Posted by Phillipa on February 25, 2006, at 21:20:13
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 25, 2006, at 16:54:07
I haven't heard navane mentioned in a long while. Didn't even know they used it anymore with the new Ap's. Fondly, Phillipa
Posted by TomG on February 25, 2006, at 21:27:26
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 25, 2006, at 16:54:07
> RE the lithium. Are you gonna try adding lithium to your current medication?
>
> Regards
>
> Ed
>Its definately on the list. I have three things in mind to add to the maximum Symbyax dose (I'm not there yet) if it turns out not to help me as monotherapy. Do you have any opinion as to the order you think I should add on to the Symbyax. (1 Low to medium dose Abilify (5-15mgs
Abilify barring any akathisia
(2 Adderall, Dexedrine, Desoxyn,
Ritalin(3 Remeron
(4 lithiumOr any other good ideas?
Provigil is just not a consistent drug with my chemistry. I mean it provides some focus, but optimally I'm looking for something that gets me up and gives me the desire to go out into life and experience it and enjoy those in it with a clear mind and basic articulation skills. Thats not asking too much is it? Whatever has taken hold of my synapses or is lacking has taken any semblance of self expression. I might should go to Hollywood if I can ever find stability, because I feel like everyday is an act and any interaction with people and words spoken is an act. The real me in still there though just waiting to get out.
Tom
Posted by TomG on February 25, 2006, at 21:28:30
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 25, 2006, at 16:54:07
Posted by xbunny on February 26, 2006, at 9:21:42
In reply to Fluanxol vs. Amisulpride?, posted by TomG on February 24, 2006, at 22:09:46
Hiya, I find flupenthixol (fluanxol, depixol) >3mg (I currently take 6mg) equally effective against negative symptoms as amisulpride 400mg. However I found amisulpride woefully ineffective against positive symptoms. Other antipsychotics I have found effective against negative symptoms are thioridazine (I took 50-100mg - good for anxiety too), stelazine (dont remember the dose - no good for anxiety), sulpride (400mg, seemed exactly the same as amisulpride = no good against +ve symptoms) and chlorpromazine (75mg - gave me really bad akathasia, good against +ve and anxiety too though). If I were taking an antipsychotic purely for negative symptoms I would start with amisulpride after trying the atypicals. I have also found that for me mirtazapine is the best antidepressant to combine with an antipsychotic. Flupenthixol really boosts and stabilizes my mood, but add mirtazapine and I get a really 'natural' feeling of wellbeing.
Hope this is of some help, Bunny
Posted by ed_uk on February 26, 2006, at 10:59:34
In reply to Re: Fluanxol vs. Amisulpride?, posted by xbunny on February 26, 2006, at 9:21:42
Hi Bunny
Will you switch your babblemail on? :)
Ed
Posted by ed_uk on February 26, 2006, at 11:07:07
In reply to Re: Fluanxol vs. Amisulpride?, posted by TomG on February 25, 2006, at 21:27:26
Hi Tom
>Do you have any opinion as to the order you think I should add on to the Symbyax
Perhaps you could consider fluoxetine + aripiprazole in the absense of olanzapine?
>Adderall, Dexedrine, Desoxyn, Ritalin
Be cautious with the dose if you do decide to try a psychostimulant. High doses can induce a paranoid psychosis as you already know!
>Remeron
Remeron can be useful for negative symptoms provided that you don't get sedated on it - as some people do. It seems like you didn't get sedated when you tried it previously though so it would make sense to try it again. If the dose is too low, drowsiness tends to be a problem. If the dose is too high, Remeron can be agitating. Did you gain weight on Remeron when you tried it before?
>lithium
I do think it would be a good idea to try lithium again, especially since you have sucessfully combined it with APs previously.
>Provigil
Provigil was no good for me either.
Regards
Ed
Posted by TomG on February 26, 2006, at 16:05:58
In reply to Re: Fluanxol vs. Amisulpride? » TomG, posted by ed_uk on February 26, 2006, at 11:07:07
> Perhaps you could consider fluoxetine + aripiprazole in the absense of olanzapine?
The reason I wanted to combine the two was because of this article:
http://www.cpa-apc.org/publications/archives/CJP/2004/february/lettersCombo.asp
Its all theory of course but I thought the administration of Abilify in an enviroment where the Zyprexa was already supressing dopamine might make Abilify function even more so as a partial agonist at dopamine receptors.
> Be cautious with the dose if you do decide to try a psychostimulant. High doses can induce a paranoid psychosis as you already know!I don't even know where to begin or what would be best to start with.
> Remeron can be useful for negative symptoms provided that you don't get sedated on it - as some people do. It seems like you didn't get sedated when you tried it previously though so it would make sense to try it again. If the dose is too low, drowsiness tends to be a problem. If the dose is too high, Remeron can be agitating. Did you gain weight on Remeron when you tried it before?
I didn't gain weight, and I don't remember the dose that I was on. I do remember that I slept well on it and was not sedated the next day though.
What I think I'm going to do before I get into all this augmentation of the Symbyax is ditch it and try Amisulpride first. I can always come back to the Symbyax. Amisulpride just seems like such a clean targeted drug and if it works it will probably be a stand alone drug.What are your thoughts about my lithium response? When I first tried it three years ago I took it by itself at 600mgs for two weeks then moved up to 900mgs and in about three days got a response that only lasted five days. Raising the dose caused this weird agitation.
Three years pass and I try it again and I'm able to reach 1350mgs with no agitation and no problems. This version was the ER Lithium Carb and the other was not so that might have made a difference. This was combined like I said with 1200mgs Neurontin and 50mgs Zoloft. When the Zoloft was added I was in a daze for the whole month before I went back to see my doc. He removed the Zoloft and started 20mgs Geodon and there was a quick robust response. I had some mild hypotension so I called my doctor and he said not to worry and told me to taper the Neurontin and lithium down to nothing.
So a great month goes by and I was only on the 20mgs Geodon. At my next appointment he keeps me at that dose and sends me on my way. Two weeks go by and the Geodon slowly lost its effect over the course of a couple of days. Then you know what happens from there. I tried playing with the dose and only got up to 40mgs with no improvement had terrible insomnia etc. It also out of no where started causing terrible anxiety and panic attacks, so it was discontinued with the help of lorazepam. If I have to try it again I think I'll start it at a higher dose and work through the anxiety and insomnia should it present.
What I'm more interested is your thoughts on the effects of the lithium somehow contributing to the response of the low 20mg dose. My doctor was convinced that it was the Geodon doing all the work, and he removed the other two drugs because so. Actually three drugs if you count the Zoloft.
I just become very suspicious when I look at my history of response to drugs and they involve lithium and a combination of lithium and other drugs however neither trial provided sustained relief.
Should Solian turn out to be a disappointment I think I'm going to try the combination of lithium, Geodon, Neurontin, and possibly Zoloft again. Its a shame the doc so abrubtly removed the drugs that could have been helping or augmenting others. Oh well. We'll see..
Posted by xbunny on February 27, 2006, at 12:14:05
In reply to Re: Fluanxol vs. Amisulpride? » xbunny, posted by ed_uk on February 26, 2006, at 10:59:34
Hi ed,
> Will you switch your babblemail on? :)
I cant remember my password to get into the settings and Im still waiting for the change password email. Until then you can email me:
xbunny at blueyonder.co.uk
if you like.
Best regards, Bunny
Posted by Dr. Bob on February 27, 2006, at 19:42:41
In reply to Re: Fluanxol vs. Amisulpride? » ed_uk, posted by xbunny on February 27, 2006, at 12:14:05
> I cant remember my password to get into the settings and Im still waiting for the change password email.
Are you sure it's not in a spam folder? FYI, it would be from dr-bob.org, not my address...
Bob
This is the end of the thread.
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