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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 stephano on March 15, 2006, at 0:28:43
Hello,
I have suffered from chronic fatigue syndrome for around ten years. I have no doubt that it is a neurological condition involving dysregulation of the brain and central nervous system, but I have no doubt it is different to clinical depression. My condition started after a bout of glandular fever (epstein barr virus)
Whilst various classes of anti-depressants have not helped, and in fact have made me worse, I have twice had a significant resolution of symptoms after COMING OFF antidepressants. This was not just the absence of side-effects after stopping the drugs, but a significant resolution of symptoms as the medications left my system. Of course, this good effect only lasted as long as it took the medication to clear my system, then I reverted to my previous state of poor health.
This happened with both Sertraline (Zoloft) and Venlafaxine (Effexor), both of which block the re-uptake of serotonin as their primary mode of action. (Venlafaxine's effects on noradrenaline are evidently quite weak)
My question is this: If stopping an SSRI produces this beneficial effect, how might I seek to reproduce this effect with a medication? Might it be equivalent to the acceleration of serotonin uptake (as the blocking effect of the drug starts to wear off?) I.E- The opposite of an SSRI?
If so, the drug which seems like a good candidate to try would be tianeptine (Stablon). Could anyone comment on my amateur conclusions (or does anyone have any similar expreiences?!)
Many thanks
Posted by blueberry on March 15, 2006, at 5:11:04
In reply to CFS and tianeptine, posted by stephano on March 15, 2006, at 0:28:43
The phenomenon you mention is a mystery to me. I do not know why it happens. But I have indeed experienced the same thing myself, and it is rather dramatic. Too bad it is so short lived. I have also wondered about tianeptine for the same reasons as you. Sometimes I wonder if certain depressions are not caused by an imbalance of neurotransmitters, but rather by a low flow of them.
Posted by denise1966 on March 15, 2006, at 16:17:47
In reply to CFS and tianeptine, posted by stephano on March 15, 2006, at 0:28:43
I've experienced this rebound affect too, I know that other posters on the board have, Scott (SLS) being one of them.
I suffer from depression not CFS but I'm not sure that Tianeptine would produce the same affect but it would be worth a try.
I think Scott has tried Tianeptine so it might be worth asking him.
Denise
Posted by SLS on March 19, 2006, at 9:07:50
In reply to Re: CFS and tianeptine SLS, posted by denise1966 on March 15, 2006, at 16:17:47
> I've experienced this rebound affect too, I know that other posters on the board have, Scott (SLS) being one of them.
>
> I suffer from depression not CFS but I'm not sure that Tianeptine would produce the same affect but it would be worth a try.
>
> I think Scott has tried Tianeptine so it might be worth asking him.
>
>
> Denise
Hi.I have never tried tianeptine.
Great hypothesis, though.
I have experienced antidepressant discontinuation-induced rebound improvements from tricyclics and MAOIs. They seem to last for 1-2 weeks, which is about the time it would take for membrane sensitivities to adapt. I don't know what the mechanism is behind this phenomenon, but I imagine it lies presynaptically. I guess the downregulation of presynaptic receptors resulting from chronic reuptake inhibition provokes the presynaptic neuron to manufacture and release more neurotransmitter after synaptic levels of neurotransmitter plummet following drug discontinuation. The signal-to-noise ratio would be increased under these conditions, leading to a more accurate transduction of the incoming signal. I don't know whether or not tianeptine would create a similar situation after chronic administration.
Sometimes I think that pushing the system in either direction results in accomplishing the same thing: forcing a re-regulation of synaptic dynamics to approach a phenotype more closely matched to the default expression of the genotype. In other words, you get the neurons to follow the original blueprints, albeit at a possibly different scale. It is probably more a matter of relative vectors than absolute values.
I'm pretty sure I don't know what the hell I'm talking about.
:-)
- Scott
Posted by stephano on March 19, 2006, at 18:34:03
In reply to Re: CFS and tianeptine SLS, posted by SLS on March 19, 2006, at 9:07:50
Thanks to all who have responded/posted.
Scott: "Signal to noise ratio?" Have you read Jay Goldstein's stuff by any chance? (He was a doctor with background in psychiatric medicine who was able to successfully treat alot of CFS patients. unfortunately now retired)
I know for him increasing this 'signal to noise ratio' (often involving boosting noradrenaline and dopamine) was the key to improving patients.
I wonder if coming off SSRIs causes a surge in dopamine ( I have read this somewhere) which is what helps some people.
Posted by linkadge on March 19, 2006, at 18:41:39
In reply to Re: CFS and tianeptine SLS, posted by SLS on March 19, 2006, at 9:07:50
I've personally been interested in tianeptine. It many of the rat studies tianeptine show a much more robust ability to protect certain brain structures from the consequences of unavoidable stress, than other antidepressants.
I expereineced a rebound improvement in depression after discontinuing SSRI's, TCA's and MAOI's. Infact, I went into a complete remission for about a month after stopping Parnate.
They're doing a lot of reasearch regarding the SERT molecule, and weather or not it is actually overactive in depression.
Some studies have shown that the opposite is true. Individuals carring a double short varient of the serotonin transorter, (which codes for lower serotonin reuptake) acutally had a higher lifetime prevailance of major depressive disorder.
We also have some drugs that act as serotonin uptake inhibitors, but have little to no antidepressant effect.
It's really a mystery to me.
Linkadge
Posted by SLS on March 19, 2006, at 19:36:34
In reply to Re: CFS and tianeptine SLS » SLS, posted by stephano on March 19, 2006, at 18:34:03
> Thanks to all who have responded/posted.
>
> Scott: "Signal to noise ratio?" Have you read Jay Goldstein's stuff by any chance? (He was a doctor with background in psychiatric medicine who was able to successfully treat alot of CFS patients. unfortunately now retired)
>
> I know for him increasing this 'signal to noise ratio' (often involving boosting noradrenaline and dopamine) was the key to improving patients.I came across his website while he was still actively treating people. Someone who was posting here on PB really took a liking to his methods. He had developed precise algorithms designed to choose drugs based upon drug reactions. He displayed them on his web page in a flow-chart format. I was very impressed with him. It's too bad no one inherited his practice and website to continue his work. I think he wrote a book entitled "Betrayal by the Brain" or something like that.
> I wonder if coming off SSRIs causes a surge in dopamine ( I have read this somewhere) which is what helps some people.
That sounds reasonable. It would be sort of like a disinhibition of serotonin-regulated excitatory neurons. One can make an argument for either of two oppositional forces: one pro-serotonergic (presynaptic), and the other anti-serotonergic (postsynaptic). I guess the winner is the one that predominates in the balance equation.
- Scott
Posted by stephano on March 21, 2006, at 5:34:31
In reply to Re: CFS and tianeptine SLS » stephano, posted by SLS on March 19, 2006, at 19:36:34
Regarding Jay Goldstein..Scott wrote:
>I came across his website while he was still >actively treating people. Someone who was >posting here on PB really took a liking to his >methods. He had developed precise algorithms >designed to choose drugs based upon drug >reactions. He displayed them on his web page in >a flow-chart format. I was very impressed with >him. It's too bad no one inherited his practice >and website to continue his work. I think he >wrote a book entitled "Betrayal by the Brain" >or something like that.
Yep- He's written three now.."the limbic hypothesis", "betrayal.. and his latest "Tuning the brain." It's incredibly complex stuff but certainly worth investigating if you have a treatment-resistant disorder. I think the person you mentioned who took a liking to his work might have been someone called 'franco neuro.' I read a number of posts of his from April/May of last year because they are so close to the stuff I'm investigating. Would actually really like to get in touch with him.
Anyway...I think I am going to try tianeptine...although not available here in Australia so will have to get it from O/S.
Cheers,Stephen.
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