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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Phillipa on August 18, 2006, at 20:05:39
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 19:59:56
Scott yes please do. Love Phillipa
Posted by SLS on August 18, 2006, at 20:41:14
In reply to Re: Sibutramine (Meridia) - Day 12 » SLS, posted by mayzee on August 18, 2006, at 19:59:56
> 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)?
At some point, the neuron must control the amount of the monoamine neurotransmitter it stores and prevent too much from collecting. It therefore uses an enzyme to metabolize and break-down the excess. This enzyme is known as monoamine oxidase. If this enzyme is inhibited by the MAOI drug and prevented from performing its task, the levels of the neurotransmitter are permitted to rise. It is thought that this increase in the availability of monoamine neurotransmitters is important in the mechanism of action of MAOI antidepressants.
There are two forms of the MAO enzyme. There is MAO-A and MAO-B. MAO-A is responsible for metabolizing norepinephrine and serotonin while MAO-B is responsible for metabolizing dopamine. Some MAOI drugs are selective for one type over the other. Emsam (selegiline) is selective for MAO-B at lower dosages, but becomes non-selective at higher dosages. Moclobemide is selective for MAO-A. Some researchers believe that MAO-A is more important for treating depression. A MAOI can be either reversible or irreversible. Most of the MAOIs in current use are irreversible. Once they attach themselves to the MAO enzyme, the enzyme is permanently destroyed. The body must synthesize a new enzyme to replace it. This is why one must wait 2 weeks after discontinuing an irreversible MAOI before beginning another antidepressant. Moclobemide is different. It is reversible. It does not damage the enzyme while it is attached. When the drug concentration decreases, the drug detaches from the enzyme and allows it to function again. Also, other molecules competing for the MAO enzyme can bump into the drug and knock it off. This allows users of moclobemide to eat modest amounts of tyramine without provoking a hypertensive reaction.
- Scott
Posted by mayzee on August 18, 2006, at 21:17:50
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 20:41:14
Scott, thank you again for the explanations. I think I get it!!! I guess most of the stuff I'd read assumed a base knowledge, so didn't explain basics like that.
Now back to your Sibutramine diary!
Wishing you all the best,
mayzee
Posted by Phillipa on August 18, 2006, at 22:00:40
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 20:41:14
Like low dose EMSAM. Moclom whatever is the same? Love Phillipa Scott why not teach online?
Posted by SLS on August 19, 2006, at 6:35:20
In reply to Re: Sibutramine (Meridia) - Day 12, posted by SLS on August 18, 2006, at 4:26:12
7 days @ 10mg
6 days @ 20mgNo improvement in depression.
It is getting close to the time when I sometimes experience an antidepressant response to medication.
It is difficult to evaluate sibutramine for anticholinergic side effects since I am also taking nortriptyline. However, the drug is not suppose to have any. My guess is that it does increase heart rate. There might be a tendency for an increase in anxiety, but that is difficult to segregate due to the personal issues I've had to deal with. There may be some reduction in libido, but it has not been abolished as often happens with SSRIs. There is no impairment in sexual function otherwise. Unlike SSRIs, there has not yet been the appearance of apathy and amotivation. Sibutramine seems to be a pretty clean drug.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg
- Scott
Posted by ed_uk on August 19, 2006, at 9:18:27
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 6:35:20
Hi Scott
Do you feel any less breathless on the lower dose of Topamax?
Ed
Posted by SLS on August 19, 2006, at 10:30:28
In reply to Re: Sibutramine (Meridia) - Day 13 » SLS, posted by ed_uk on August 19, 2006, at 9:18:27
> Hi Scott
>
> Do you feel any less breathless on the lower dose of Topamax?
I'm not sure yet. I haven't done anything to test myself. I know the risk of kidney stone formation is dosage dependent. What about metabolic acidosis?
- Scott
Posted by SLS on August 19, 2006, at 19:55:43
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 6:35:20
7 days @ 10mg
7 days @ 20mgNo improvement in depression.
Nothing remarkable to report. There has been some appetite suppression, but I have still been eating regularly. This drug makes it easier to exercise portion control.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg- Scott
Posted by ed_uk on August 20, 2006, at 8:13:10
In reply to Re: Sibutramine (Meridia) - Day 13, posted by SLS on August 19, 2006, at 10:30:28
Hi Scott
>What about metabolic acidosis?
Yes, I have read that it is dose-dependent.
Ed
Posted by ed_uk on August 20, 2006, at 8:14:36
In reply to Re: Sibutramine (Meridia) - Day 14, posted by SLS on August 19, 2006, at 19:55:43
Hi Scott
I'm sorry you haven't gained any relief yet. How long a trial do you plan to give sibutramine?
Ed
Posted by SLS on August 20, 2006, at 8:59:24
In reply to Re: Sibutramine (Meridia) - Day 14 » SLS, posted by ed_uk on August 20, 2006, at 8:14:36
Hi Ed.
Thanks for the info on the metabolic acidosis.
> I'm sorry you haven't gained any relief yet.I am trying to resign myself to the probability that sibutramine won't work, even though I haven't yet entered the time window for treatment response.
> How long a trial do you plan to give sibutramine?
I haven't given it enough thought. I don't think I will go beyond 6 weeks, though.
- Scott
Posted by SLS on August 21, 2006, at 6:18:34
In reply to Re: Sibutramine (Meridia) - Day 14, posted by SLS on August 19, 2006, at 19:55:43
7 days @ 10mg
8 days @ 20mgNo improvement in depression.
I can still feel a slight cognitive "muddiness". It is annoying.
Currently:
nortriptyline 100mg
Lamictal 150mg
Topamax 50mg
Abilify 10mg
sibutramine 20mg- Scott
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