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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 105. Go back in thread:
Posted by SLS on August 11, 2006, at 6:27:52
In reply to Re: Sibutramine (Meridia) - Day 5, posted by SLS on August 9, 2006, at 20:23:23
6 days @ 10mg
I am experiencing some dysphoria that I attribute to the sibutramine. It is not a normal feature of my depression. There is also a sort of "muddiness" to the way I am feeling. I don't like it. Hopefully, it will pass. I will probably increase the dosage to 20mg tomorrow.
Currently:
nortripyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 10mg
- Scott
Posted by ed_uk on August 11, 2006, at 13:29:34
In reply to Re: Sibutramine (Meridia) - Day 6, posted by SLS on August 11, 2006, at 6:27:52
Hi Scott
>I will probably increase the dosage to 20mg tomorrow.
Why Scott? If you think you're having side effects it might be best not to increase the dose.
Regards
Ed
Posted by SLS on August 11, 2006, at 14:13:54
In reply to Re: Sibutramine (Meridia) - Day 6 » SLS, posted by ed_uk on August 11, 2006, at 13:29:34
> > I will probably increase the dosage to 20mg tomorrow.
> Why Scott? If you think you're having side effects it might be best not to increase the dose.
I guess I'm just being impatient. I was hoping to be at 20mg for two weeks before my next doctor's visit. I am doing better today. I'm not sure what I'll do yet.
Thanks for your concern.
What's up with you? Things still going OK? How's work?
- Scott
Posted by SLS on August 11, 2006, at 23:44:00
In reply to Re: Sibutramine (Meridia) - Day 6, posted by SLS on August 11, 2006, at 6:27:52
7 days @ 10mg
I continue to experience some dysphoria. However, it is not as acute today as it was yesterday. I will wait until tomorrow to increase the dosage to 20mg.
Currently:
nortripyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 10mg
- Scott
Posted by SLS on August 13, 2006, at 7:57:01
In reply to Re: Sibutramine (Meridia) - Day 7, posted by SLS on August 11, 2006, at 23:44:00
7 days @ 10mg
1 days @ 20mgI took the second daily dose of sibutramine last night for a total of 20mg for the day. I am experiencing an increase in dysphoria and anergia this morning. I'm not too happy about this. I am quickly losing hope that this drug will prove effective for me. I'm not giving up just yet, though.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by Racer on August 13, 2006, at 12:31:47
In reply to Re: Sibutramine (Meridia) - Day 8, posted by SLS on August 13, 2006, at 7:57:01
Scott, I know you have a history of responding for a couple of days, only to lose the response. Have you ever had it the other way around? That you feel worse for a few days as you titrate up, but get a better response later in treatment? Do you think there's a chance of such a thing happening this time around?
You know I'm really pulling for you on this one, and you know why, so I admit freely that I'm biassed in favor of giving it a good chance...
Still, I'm sorry you're not having a great ride. I hope it gets better.
Remind me again: have you ever had a good response that lasted for any length of time?
xoxo
Posted by SLS on August 13, 2006, at 13:10:29
In reply to Re: Sibutramine (Meridia) - Day 8 » SLS, posted by Racer on August 13, 2006, at 12:31:47
> Scott, I know you have a history of responding for a couple of days, only to lose the response. Have you ever had it the other way around? That you feel worse for a few days as you titrate up, but get a better response later in treatment?
Actually, my most recent trial of Wellbutrin followed that sort of pattern. It produced some mild dysphoria for about a week before I responded well to it.
> Do you think there's a chance of such a thing happening this time around?
Yes. I have this very silly little piece of brain tissue that always thinks there's a chance of something good happening. After all this time, I don't know why.
> You know I'm really pulling for you on this one, and you know why, so I admit freely that I'm biassed in favor of giving it a good chance...
Much of the dysphoria that I experienced this morning seems to have passed. There is still a little there, but that I am not feeling worse is a good thing.
> Still, I'm sorry you're not having a great ride. I hope it gets better.
Thanks.
> Remind me again: have you ever had a good response that lasted for any length of time?Yes. In 1987, at age 27, a combination of Parnate 60mg and desipramine 150mg produced a complete remission that lasted six months until the drugs were discontinued due to the appearance of mania. After being without medication for two months, I relapsed into depression. Without getting into the particulars of what transpired subsequently, I no longer respond to the same combination.
- Scott
Posted by ed_uk on August 14, 2006, at 15:34:33
In reply to Re: Sibutramine (Meridia) - Day 8 » Racer, posted by SLS on August 13, 2006, at 13:10:29
Hi Scott
Do you feel worse on 20mg than you did on 10mg?
Ed
Posted by SLS on August 14, 2006, at 20:02:49
In reply to Re: Sibutramine (Meridia) - Day 8, posted by SLS on August 13, 2006, at 7:57:01
7 days @ 10mg
2 days @ 20mg
I am experiencing less dysphoria today. There is a certain "muddiness" to the way I feel, but I believe this will pass. I thought I felt a little brighter first thing in the morning. It was encouraging.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by Phillipa on August 14, 2006, at 20:15:53
In reply to Re: Sibutramine (Meridia) - Day 9, posted by SLS on August 14, 2006, at 20:02:49
Go Scott!!!!!! Prove the meds can work . I'm routing for you. Go Go you can do it!!!!!Love Phillipa
Posted by TJO on August 15, 2006, at 6:04:08
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by Phillipa on August 14, 2006, at 20:15:53
Hi Scott,
I'll keep my fingers crossed that this is the right drug for you, and the brightness in the am continues. You really deserve to get well! :-).Love, Tam
Posted by ed_uk on August 15, 2006, at 14:23:28
In reply to Re: Sibutramine (Meridia) - Day 9, posted by SLS on August 14, 2006, at 20:02:49
Hi Scott
Do you think there is any reason to continue the Topamax? I got the impression that it wasn't really helping. I wonder whether you could reduce your nortriptyline dose......with sibutramine being an SNRI.
Ed
Posted by SLS on August 15, 2006, at 15:28:40
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by ed_uk on August 15, 2006, at 14:23:28
> Hi Scott
>
> Do you think there is any reason to continue the Topamax? I got the impression that it wasn't really helping.It seems that Topamax provides me with a bit more mental energy. I can get a few more things done while taking it. Right now, it is difficult to say whether or not it is still helping, but I think it is worth continuing with until I complete the trial of sibutramine.
> I wonder whether you could reduce your nortriptyline dose......with sibutramine being an SNRI.
I'm pretty sure that thought had entered my doctor's mind. However, without really knowing for sure how nortriptyline performs its role, I think we were both reluctant to reduce its dosage. What adverse effects might you expect from this combination?
Thanks, Ed.
- Scott
Posted by SLS on August 15, 2006, at 18:19:19
In reply to Re: Sibutramine (Meridia) - Day 9, posted by SLS on August 14, 2006, at 20:02:49
7 days @ 10mg
3 days @ 20mg
I am experiencing little, if any, drug-induced dysphoria today.It is difficult for me to evaluate how the sibutramine is affecting me otherwise. I had a very stressful day dealing with emotional issues, so there has been some sadness and anxiety to deal with. I think there is still a muddy feeling, but it seems to be disappearing.
Overall, I cannot report any improvement in depression.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by Racer on August 16, 2006, at 4:46:41
In reply to Re: Sibutramine (Meridia) - Day 10, posted by SLS on August 15, 2006, at 18:19:19
> It is difficult for me to evaluate how the sibutramine is affecting me otherwise. I had a very stressful day dealing with emotional issues, so there has been some sadness and anxiety to deal with.
>
> Overall, I cannot report any improvement in depression.
>Could the sibutramine be protecting you from going further down because of the emotional stress? Sometimes that's all I get from a "successful" A/D: it gives me a sort of emotional floor, that keeps me from going farther down into the darkness.
That's obviously a rather warped definition of success, but there have been times when that was enough. (Of course, it kinda had to be, since there weren't a lot of alternatives...)
I'm still doing whatever I do that passing for praying for you, Scott. I really hope this ends up helping you.
Any adverse effects? Any weight loss? (I know, I have a problem with that...) Is it improving cognition do you think?
And about the Topomax: I've read so much about the cognitive dulling from it, the "Dopomax" effects, and you say that it's actually improved cognition for you. Any idea why that might be? Any hair loss? Basically, since that's an option that's been brought up for me -- "Well, if you start to gain weight, we'll just put you on Topomax" -- I'm curious about adverse effects from it. And, of course, beneficial effects as well...
Posted by SLS on August 16, 2006, at 8:26:08
In reply to Re: Sibutramine (Meridia) - Day 10 » SLS, posted by Racer on August 16, 2006, at 4:46:41
> > It is difficult for me to evaluate how the sibutramine is affecting me otherwise. I had a very stressful day dealing with emotional issues, so there has been some sadness and anxiety to deal with.
> >
> > Overall, I cannot report any improvement in depression.
> >
> Could the sibutramine be protecting you from going further down because of the emotional stress?I don't think so. For me, the two types of depression usually feel different enough so that I can tell the difference as to their relative contributions to my current state. I did have to work hard to reduce my anxiety stress level and emotional depressive pressure so that I didn't spiral downward too far. I don't want to sabotage the drug's chances of working.
> Sometimes that's all I get from a "successful" A/D: it gives me a sort of emotional floor, that keeps me from going farther down into the darkness.
> That's obviously a rather warped definition of success,
I'm sure that my emotional floor is dependent on how bad my biological depression is. So I guess in that way, your definition of success is very appropriate.
> I'm still doing whatever I do that passing for praying for you, Scott. I really hope this ends up helping you.
I feel very fortunate that there are people whom care enough about me that they should do such things on my behalf. I don't really have many friends IRL. Depression has pretty much removed me from society. PB has provided an important component of my support system over these last few years.
> Any adverse effects?
Some initial dysphoria. I think this is an idiosyncracy of my biology that I would not expect to see in the majority of people. A wierd feeling of "muddiness" that has persisted for a few days. I guess this would be considered to be a cognitive side effect of sorts.
> Any weight loss?
Actually, I think my appetite has increased somewhat. I haven't stepped on the scale. One of the mechanisms by which this drug produces weight loss is the increase of metabolism. It turns on the BAT furnace.
> Is it improving cognition do you think?
Not yet.
> And about the Topomax: I've read so much about the cognitive dulling from it, the "Dopomax" effects, and you say that it's actually improved cognition for you. Any idea why that might be?
Well, I guess it is true that using a very gradual titration schedule can eliminate or at least minimize cognitive adverse effects. I am under the impression that once they appear, they tend to linger, so it is best not to provoke them in the first place. Regarding pharmacodynamics, I cannot guess as to why Topamax has provided me with an improvement in mental energy and focus.
> Any hair loss?
None that I have noticed. I didn't know that this was a possible side effect.
> Basically, since that's an option that's been brought up for me -- "Well, if you start to gain weight, we'll just put you on Topomax" -- I'm curious about adverse effects from it. And, of course, beneficial effects as well...
I have found Topamax to produce two bothersome side effects:
1. Taste perversion. Soda tastes particularly bad.
2. Fatigue and breathlessness. My muscles fatigue quickly, and even the slightest of exertion produces breathlessness. This is extremely displeasing. The added mental energy had provided me with incentive to return to the gym, but these side effects pretty much discourage me.
- Scott
Posted by SLS on August 17, 2006, at 1:41:08
In reply to Re: Sibutramine (Meridia) - Day 10, posted by SLS on August 15, 2006, at 18:19:19
7 days @ 10mg
4 days @ 20mg
No improvement in depression.I still experience that strange cognitive "muddy" feeling, but it has been dissipating. Today was again stressful. Sadness and anxiety were present for most of the day, as I am dealing with a personal issue. These are not normally prominent features of my depression, and are different from the dysphoria that I experienced last week. They are the reactions that one would normally expect given the events that have unfolded in my personal life.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by ed_uk on August 17, 2006, at 16:43:46
In reply to Re: Sibutramine (Meridia) - Day 9 » ed_uk, posted by SLS on August 15, 2006, at 15:28:40
Hi Scott
>Right now, it is difficult to say whether or not it is still helping....
I was wondering whether the side effects of fatigue and breathlessness are symptoms of metabolic acidosis. Metabolic acidosis is common with Topamax because it's a carbonic anhydrase inhibitor. Your doc might do a blood test.
>What adverse effects might you expect from this combination?
Perhaps too much NE reuptake inhibition is bad for depression? Perhaps this is the problem with reboxetine, and why too high a dose of nortriptyline might be ineffective.
Ed
Posted by SLS on August 17, 2006, at 17:04:21
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by ed_uk on August 17, 2006, at 16:43:46
Hi Ed.
> I was wondering whether the side effects of fatigue and breathlessness are symptoms of metabolic acidosis. Metabolic acidosis is common with Topamax because it's a carbonic anhydrase inhibitor. Your doc might do a blood test.
Those damned carbonic anhydrase inhibitors will do it to you every time! Thanks. That hadn't occurred to me. Someone else on the board has reported having the same side effects on Topamax.
> >What adverse effects might you expect from this combination?
> Perhaps too much NE reuptake inhibition is bad for depression?> Perhaps this is the problem with reboxetine, and why too high a dose of nortriptyline might be ineffective.
These are good thoughts. I had considered this as a possibility for reboxetine, but not for nortriptyline.
I'm going to try lowering the dosage of Topamax to 50mg. I think it was at this dosage that I first noticed the subtle improvement in mental energy that I experienced, so I might as well go with the minimum effective dosage and see if the side effects subside. At least it will reduce my risk of developing kidney stones.
- Scott
Posted by Phillipa on August 17, 2006, at 20:46:37
In reply to Re: Sibutramine (Meridia) - Day 9 » ed_uk, posted by SLS on August 17, 2006, at 17:04:21
Scott I'm sorry about you life right now it doesn't help a med trial. you know where to reach me if ever you want to talk. Love Phillipa
Posted by jealibeanz on August 17, 2006, at 21:10:04
In reply to Re: Sibutramine (Meridia) - Day 9 » SLS, posted by Phillipa on August 17, 2006, at 20:46:37
So this is an SNRI, like Cymbalta or Effexor, right? That explains possible antidepressants effetcs, but I don't understand how this is a weight loss drug. Cymbalta and Effexor are both known to induce large amounts of weight gain in certain populations susceptible to this side effect. Is it in a way like Wellbutrin, which was marketed as likely to help people shed a few? ha, but not me:)
Posted by SLS on August 18, 2006, at 4:26:12
In reply to Re: Sibutramine (Meridia) - Day 11, posted by SLS on August 17, 2006, at 1:41:08
7 days @ 10mg
5 days @ 20mg
No improvement in depression.
Today was less stressful. Sadness and anxiety were significantly less problematic, as I continue to process personal emotional issues.I am becoming less optimistic regarding the likelihood that I may respond favorably to sibutramine. I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
I reduced the dosage of Topamax from 100mg to 50mg in an attempt to reduce side effects. The minimal improvement in mental energy produced by Topamax first appeared at 50mg and was not made greater by increasing the dosage beyond this.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by mayzee on August 18, 2006, at 12:44:09
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 4:26:12
> I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
>
Hi Scott,Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)
Thanks,
mayzee
Posted by SLS on August 18, 2006, at 12:58:46
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 12:44:09
Hi Mayzee.
> > I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
> Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)No.
A monoamine is a type of neurotransmitter, and includes norepinephrine, dopamine, and serotonin.
A monoamine reuptake inhibitor is any drug that blocks the membrane transporter on the sending neuron from recycling the neurotransmitter once it has been released into the synapse. The transporter acts as a sort of vacuum cleaner to allow the sending neuron to clean up after itself. If it is blocked by a reuptake inhibitor, a greater amount of neurotransmitter gets trapped in the synapse, thus increasing the stimlation of the receiving neuron across the synaptic gap.
Drugs in this class include TCAs, SSRIs, SNRIs, and NARIs.
- Scott
Posted by mayzee on August 18, 2006, at 19:59:56
In reply to Re: Sibutramine (Meridia) - Day 12 » mayzee, posted by SLS on August 18, 2006, at 12:58:46
Scott, thanks for the explanation; I didn't know that all those neurotransmitters were monoamines! If you don't mind continuing... so what is the "monoamine oxidase" that's in MAOI (vs. the monoamine you just described to me)?
Hope it's not too annoying to be asked for explanations.
Gratefully,
mayzee
> Hi Mayzee.
>
> > > I guess I don't have much faith that a simple monoamine reuptake inhibitor will produce lasting results for me.
>
> > Is a monoamine reuptake inhibitor the same as an MAOI? (is sibutramine an MAOI?)
>
> No.
>
> A monoamine is a type of neurotransmitter, and includes norepinephrine, dopamine, and serotonin.
>
> A monoamine reuptake inhibitor is any drug that blocks the membrane transporter on the sending neuron from recycling the neurotransmitter once it has been released into the synapse. The transporter acts as a sort of vacuum cleaner to allow the sending neuron to clean up after itself. If it is blocked by a reuptake inhibitor, a greater amount of neurotransmitter gets trapped in the synapse, thus increasing the stimlation of the receiving neuron across the synaptic gap.
>
> Drugs in this class include TCAs, SSRIs, SNRIs, and NARIs.
>
>
> - Scott
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