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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Cairo on August 5, 2006, at 8:05:40
Variation in 5-HT2a receptors may be more important than whether you are a slow metabolizer in causing adverse drug reactions, according to this article:
http://ajp.psychiatryonline.org/cgi/content/full/160/10/1830
I can never get to therapeutic doses of SSRIs due to severe adverse reactions, I get so many cognitive side effects that I cannot function with other meds such as amitriptyline, nortriptyline, and meds such as Effexor or Cymbalta cause elevated blood pressure, anxiety, etc. Giving other meds to counteract these side effects cause problems of their own.
What is the practical use of the information in the article? Would genotyping be useful at all and could it be used to select certain meds that block the 5-HT2a receptor? On the other hand, Topamax, which I don't believe affects the 5-HT2a receptor at all, caused so many severe side effects that I am still reeling from the side effects it induced over a year ago. Lyrica causes noticeable unsteadiness if I increase the dose to counter dosage tolerance and weight gain is a major issue with it.
HOW DOES ONE CHOOSE MEDS WHEN YOU GET SO MANY SIDE EFFECTS? I feel spacey all the time and it is affecting my day to day functioning, especially driving. I think I need CRH augmentation, but Wellbutrin and anything else that is stimulating exacerbate the panic attacks and anxiety (as do caffeine and chocolate). Exercise is tricky as it makes my myofascial problems worse.
Cairo
Posted by SLS on August 5, 2006, at 8:20:22
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by Cairo on August 5, 2006, at 8:05:40
Hi Cairo.
Thanks for the info.
> Variation in 5-HT2a receptors may be more important than whether you are a slow metabolizer in causing adverse drug reactions, according to this article:
>
> http://ajp.psychiatryonline.org/cgi/content/full/160/10/1830> I can never get to therapeutic doses of SSRIs due to severe adverse reactions,
What about using Remeron to offset 5-HT2a stimulation?
Tianeptine? It's sort of like a reverse SSRI.
Nefazodone? Sort of a yucky drug, but works for some people. Some mild SRI combined with 5-HT2a blockade.
Have you ever tried an MAOI?
What happens when you take a stimulant?
Emsam looks interesting. It seems to have energizing and anxiolytic properties at the same time.
- Scott
Posted by Cairo on August 5, 2006, at 10:51:50
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by SLS on August 5, 2006, at 8:20:22
Never tried an MAOI, tianeptine, nefazodone or EMSAM. I rely on my pdoc to prescribe, but frankly he doesn't seem to know what to do with me. Since I'm exquisitely sensitive to caffeine (even decaf coffee can bring about 2-3 hour sweat fests), I haven't tried the Strattera that was prescribed for me since I'm afraid to take the 10mg dose. I've never tried other stims as Wellbutrin upped the panic attacks and my gut says to avoid anything that stimulates. Modafinil works only marginally, but taking too much increases anxiety. It makes me more alert, but not really awake, if that makes sense.
I used Remeron years ago when my fibromyalgia was first diagnosed and my symptoms were not as advanced and it was a good sleep aid at 15mg, but weight gain was prominant and they switched me to trazodone and the march to find an AD that worked for pain and atypical depression began.
Come to think of it, amitriptyline 50mg at bedtime for sleep was the very first med I tried back then and I tolerated it (except for weight gain). A recent trial of 5mg amitriptyline made me into a walking zombie. Could this point to a problem with receptor function or other pharmacodynamic issue or one of drug interaction (such as enzyme inhibition)? If I were a poor metabolizer, it would have shown up back then on these drugs, me thinks. Maybe all the meds I've tried have messed up my receptors and made things worse.
Once I tried low dose risperidone for one week or so and it nipped some of my fibromyalgia flare symptoms in the bud. My very smart Rheumatologist agreed to prescribe it, but she has since closed her practice. Increasing the dose made symptoms worse, but 0.5mg was the golden ticket. I tried it a second time several months later, but it didn't seem to work. Would this point to a 5HT2a receptor problem?
http://ajp.psychiatryonline.org/cgi/content/full/160/10/1830
I almost feel as if a long washout period would be beneficial for me to "reset" everything. Is that possible? The only thing I must have is for sleep as I simply can't manage without it.
I would greatly appreciate any insight.
Thanks!
Cairo
> What about using Remeron to offset 5-HT2a stimulation?
>
> Tianeptine? It's sort of like a reverse SSRI.
>
> Nefazodone? Sort of a yucky drug, but works for some people. Some mild SRI combined with 5-HT2a blockade.
>
> Have you ever tried an MAOI?
>
> What happens when you take a stimulant?
>
> Emsam looks interesting. It seems to have energizing and anxiolytic properties at the same time.
>
>
> - Scott
Posted by SLS on August 5, 2006, at 11:22:59
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by Cairo on August 5, 2006, at 10:51:50
> I used Remeron years ago when my fibromyalgia was first diagnosed and my symptoms were not as advanced and it was a good sleep aid at 15mg, but weight gain was prominant and they switched me to trazodone and the march to find an AD that worked for pain and atypical depression began.
People with fibromyalgia often have depression as a secondary condition rather than the other way around. I am wondering whether or not focusing on the fibromyalgia wouldn't remedy both problems at once. That would indicate things like nortriptyline, Effexor, Cymbalta, Neurontin, Lyrica, Emsam, and possibly Meridia. I watched a video recently demonstrating some pretty impressive stuff with Meridia treating fibromyalgia and attendant depression.
- Scott
Posted by Phillipa on August 5, 2006, at 11:24:13
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by Cairo on August 5, 2006, at 10:51:50
The Mayo Clinic is doing genotyping to see what meds might work. I got something with my lymes info letter yesterday saying this. Love Phillipa
Posted by linkadge on August 5, 2006, at 20:37:21
In reply to Re: 5HT2a receptor variation and adverse reactions » Cairo, posted by Phillipa on August 5, 2006, at 11:24:13
I suppose the one varient has increased expression of 5-ht2a receptors and could therefore benifit from blockade of this receptor(?)
I've also heard that 5-ht2a receptor is overexpressed in suicide victoms. I'd wonder if those who experience worsening suicidal ideation in response to SSRI's, have this varient.
I've heard that fibro might be associated with altered expression of 5-ht3 receptors.You could try ginger root, which has direct 5-ht3 antagonst properties in addition to substance-p blockade. I've heard a few case reports.
Linkadge
Posted by Jay on August 6, 2006, at 0:37:38
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by SLS on August 5, 2006, at 11:22:59
Scott...we unfortunately don't have nefazodone/Serzone available to us here in Canada...even the generic.
:( Serzone with Effexor *was* helping me, then Serzone got pulled. We tried Desryl(sp?), a similar drug as you know, but completely *no* response, even at many different doses timed all out during the day. Does Remeron have enough 5HT2a receptor blocking that it might be a good combo...or does it have too much..or..? I am on 3mg a day of Risperdal, for my rapid cycling, which (knock on wood) does help somewhat. I take 80mg of Prozac a day, 100mg of Nortiptyline, 4mg clonazepam, 200mg of Topomax (which, contrary to any other reports...does nothing for weight gain..and I've taken up to 400mg..)) and 5mg Zyprexa. Ya, it's a lot, but I am pretty big guy. This has enabled me to get out in the world when my dread was at it's worse....and, man, I never want that back in my life ever again. But, I seem to have some *fine tuning* issues with sleep and still (beyond ordinary) daily spikes of anxiety and depression that counselling isn't reaching.Thanks..
Jay
Posted by linkadge on August 6, 2006, at 1:20:26
In reply to Re: 5HT2a receptor variation and adverse reactions » SLS, posted by Jay on August 6, 2006, at 0:37:38
Remeron would have 5-ht2a blockade effects similar to nefazedone, but remeron has an additional effect that *may* interact negitively with nortryptaline or effexor.
Remeron blocks the alpha-2 adrendorecptors, which results in norepinephrine release. This, in combination with the norepeinephrine reuptake inhibition could lead to very high levels of norepinehprine.
The combination of effexor and Remeron has been dubbed "california rocket fuel". It can be very stimulating.
Linkadge
Posted by SLS on August 6, 2006, at 5:39:33
In reply to Re: 5HT2a receptor variation and adverse reactions » SLS, posted by Jay on August 6, 2006, at 0:37:38
> :( Serzone with Effexor *was* helping me,
You are the second person I know of for whom this combination was the only thing that helped.
> Does Remeron have enough 5HT2a receptor blocking that it might be a good combo...or does it have too much..or..?
Remeron might be exactly the right drug for you or exactly the wrong drug for you for precisely the reason Linkadge describes. I would definitely try it. Remeron + Effexor is the ultimate California Rocket Fuel as is promoted primarily by Stephen Stahl, MD. It would be the conservative thing to do to discontinue the nortriptyline. However, if it were me, and I were *sure* that it was contributing significantly to my feeling better, I would keep it. I found nortriptyline + Effexor to be a partially effective combination. Still, I advise caution. If upon adding Remeron, anything weird starts happening (tremulousness, mydriasis, palpitations, tachycardia, diaphoresis, etc.), you'll need to discontinue the Remeron. At this point, you can discontinue the nortriptyline, and then restart the Remeron if you still want to pursue trying it. I doubt this would be a problem, though.
You are on a lot of junk. You might have to rethink your current strategy and justify each drug at some point by attempting to withdraw those you suspect are not contributing to your wellbeing.
Rapid cycling? Where is Lamictal?
Why Zyprexa? If this component is necessary, why not Abilify? I imagine the Zyprexa helps with the feelings of dread. If it doesn't, what does it do? Anti-manic?
Have you tried to d/c the Prozac? 80mg? OCD issues?
- Scott
Posted by linkadge on August 6, 2006, at 6:13:55
In reply to Re: 5HT2a receptor variation and adverse reactions » Jay, posted by SLS on August 6, 2006, at 5:39:33
I agree, you might gain grounds with some consolodation.
Linkadge
Posted by Cairo on August 6, 2006, at 10:36:46
In reply to Re: 5HT2a receptor variation and adverse reactions, posted by linkadge on August 5, 2006, at 20:37:21
I tried ondansetron a couple years back with no results. Studies show 50% of FMS patients benefited. I'm in the wrong half.
Cairo
> I've heard that fibro might be associated with altered expression of 5-ht3 receptors.
>
> You could try ginger root, which has direct 5-ht3 antagonst properties in addition to substance-p blockade. I've heard a few case reports.
>
>
> Linkadge
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This is the end of the thread.
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