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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by ronaldo on December 19, 2006, at 13:55:19
In reply to Re: Tianeptine, posted by ronaldo on December 19, 2006, at 13:43:42
Posted by psychobot5000 on December 19, 2006, at 14:58:50
In reply to Re: Tianeptine, posted by saturn on December 19, 2006, at 7:39:14
> >>>>... there isn't much money in studying it.
>
> Why is this? It's not an herb or naturally occuring substance, is it?No, it's not natural. Tianeptine isn't very profitable because (I don't understand why) it's not cleared for use--primarily in the US, but also in some European countries. Its risks seem low, but for whatever reason, its manufacturer, Servier, either hadn't the resources to spend hundreds of millions to get it approved in the US, or didn't realize what a good agent it was until it had too few years left on the patent, or thought the risks of it not getting approved were too high, for whatever reason. None of these make too much sense to me, really, but now its patent is too old for it to make financial sense to take it through the approval process...unless something actually comes from its (apparently separate) patent for development to treat IBS.
It's too bad. Perhaps it was largely its relationship with amineptine that made people in the approval process wary of pursuing it. But as someone said, there is a lot of research on it--only not some of the more organized research and clinical reports on drug-interactions, side-effects and etc, as far as I can tell.
Posted by djmmm on December 19, 2006, at 17:26:03
In reply to Re: Tianeptine » saturn, posted by psychobot5000 on December 19, 2006, at 14:58:50
> > >>>>... there isn't much money in studying it.
> >
> > Why is this? It's not an herb or naturally occuring substance, is it?
>
> No, it's not natural. Tianeptine isn't very profitable because (I don't understand why) it's not cleared for use--primarily in the US, but also in some European countries. Its risks seem low, but for whatever reason, its manufacturer, Servier, either hadn't the resources to spend hundreds of millions to get it approved in the US, or didn't realize what a good agent it was until it had too few years left on the patent, or thought the risks of it not getting approved were too high, for whatever reason. None of these make too much sense to me, really, but now its patent is too old for it to make financial sense to take it through the approval process...unless something actually comes from its (apparently separate) patent for development to treat IBS.
>
> It's too bad. Perhaps it was largely its relationship with amineptine that made people in the approval process wary of pursuing it. But as someone said, there is a lot of research on it--only not some of the more organized research and clinical reports on drug-interactions, side-effects and etc, as far as I can tell.
>It's not available because it decreases serotonin--since all the major drug companies are pushing SSRIs, and the "serotonin" theory of depression. Tianeptine simply does not fit in with the current trend in treatment. Millions are spent in research, promoting a "serotonin deficiency" theory. Tianeptine effectivly disproves this, and ultimately brings into question the role of SSRIs in depression.
Posted by saturn on December 19, 2006, at 17:37:12
In reply to Re: Tianeptine, posted by djmmm on December 19, 2006, at 17:26:03
>>> It's not available because it decreases serotonin--since all the major drug companies are pushing SSRIs, and the "serotonin" theory of depression. Tianeptine simply does not fit in with the current trend in treatment. Millions are spent in research, promoting a "serotonin deficiency" theory. Tianeptine effectivly disproves this, and ultimately brings into question the role of SSRIs in depression.That had crossed my mind, and what a shame if it's true.
Posted by Quintal on December 19, 2006, at 17:43:14
In reply to Re: Tianeptine, posted by djmmm on December 19, 2006, at 17:26:03
>It's not available because it decreases serotonin--since all the major drug companies are pushing SSRIs, and the "serotonin" theory of depression. Tianeptine simply does not fit in with the current trend in treatment. Millions are spent in research, promoting a "serotonin deficiency" theory. Tianeptine effectively disproves this, and ultimately brings into question the role of SSRIs in depression.
I sprung that argument on my first pdoc after he tried to tell me SSRIs were considered more appropriate for social anxiety and depression because they 'boost a deficiency' of serotonin which is seen to be the root cause of these conditions. He'd never heard of tianeptine and asked me for some research papers. He was gracious enough to admit the serotonin deficiency hypothesis sounded unlikely in the face of tianeptine though and supervised me on a trial of it.Q
Posted by saturn on December 19, 2006, at 17:46:11
In reply to Re: Tianeptine, posted by Quintal on December 19, 2006, at 17:43:14
So is tianeptine purported to work by ultimately lowering serotonin?Or is there perhaps an alleged compensatory increase of serotonin production?
Or other???
Posted by Quintal on December 19, 2006, at 18:06:58
In reply to Re: Tianeptine MOA, posted by saturn on December 19, 2006, at 17:46:11
Here's a few links that may provide some helpful info:
http://www.mindhacks.com/blog/2005/11/depression_and_the_l.html
http://www.hdlighthouse.org/TreatmentNow/updates/1210ssri.php
Q
Posted by blueberry1 on December 19, 2006, at 19:01:19
In reply to Re: Tianeptine MOA, posted by saturn on December 19, 2006, at 17:46:11
>
> So is tianeptine purported to work by ultimately lowering serotonin?
>
> Or is there perhaps an alleged compensatory increase of serotonin production?
>
> Or other???No one really knows. It is my own theory that as serotonin is taken out of circulation faster, the brain makes up for it by firing/releasing more of it. Compared to ssris, I kind of look at it as a stagnant pool of serotonin versus a fast flowing stream of fresh serotonin. But, that's purely a guess and could be way wrong.
Tianeptine does not lower serotonin levels.
Tianeptine does have minor effects on norepinephrine and dopamine. But they aren't well researched, just known to exist. And it has other functions throughout the body on stress systems. And who knows what affinity it might have as say for example an agonist at 5HT1a receptors or whatever. I imagine it is probably a combination of all its mysterious actions that makes it what it is, and that the serotonin reuptake enhancement is just a trigger or just one link in the chain.
Posted by linkadge on December 19, 2006, at 19:47:10
In reply to Re: Tianeptine MOA » saturn, posted by blueberry1 on December 19, 2006, at 19:01:19
My psychiatrist never heard of the drug either. Any he's the head psychiatrist at Waterloo University, Canada.
I don't know what to think. Because of the so called "sucess" with the SSRI's there has been a great deal of research into the individual variations in the functionality of the serotonin transporter in depression.
It is increasingly turning out, that in people with a history of depression following stressfull events the activity of the serotonin transporter is actually lower.
So, if this research is at all accurate, you won't make a depressed person's brain be any more resemblant of a healty brain by giving it an SSRI.
There is a lot of research at: (most of which is very contradictory)
http://www.neurotransmitter.net/serotoningenetic.html
The idea that serotonin is the "calming" neurotransmitter isn't all that accurate. It depends on the part of the brain. In the dorsal raphia neucleus (sp.) excessive serotonergic firing is highly anxiogenic (hence the use of buspar which actually supresses serotonin firing as an anxiolotic). People with lower activity of the serotonin transporter also respond to frightening stimuli with greater activation of the amygdala.In my opinion, the reason SSRI's are antidepressants has nothing or little to do with uptake inhibition of serotonin. Tianeptine shares a similar opioid pathway as the SSRI's as an example of a possable alternative mechanism.
Its just like you have the TCA's and you have the TCA trimipramine (surmontil). Well, surmontil is an effective TCA antidepressant but has no affinity for serotonin or noradrenaline uptake.
I personally don't know if the fact that it is a serotonin uptake acellerator has anything to do with why it is not approved. I suppose its possable, but you'd have to be pretty damn low to keep a drug off the market just because it happens to make psychiatrists look like fools.
I tell ya though, it would be pretty funny to see my doctor taking down those pictures of the luvox molecule interfering with the reuptake of serotonin!
Linkadge
Posted by saturn on December 19, 2006, at 21:36:44
In reply to Re: Tianeptine MOA, posted by linkadge on December 19, 2006, at 19:47:10
Posted by Quintal on December 19, 2006, at 23:18:54
In reply to Please post tianeptine experiences (nm), posted by saturn on December 19, 2006, at 21:36:44
I can't remember much about my tianeptine trial. It had no side effects for me, that's one positive thing I can say about it. Unfortunately I was also taking large doses of clonazepam and I started reboxetine (Edronax) two weeks after starting tianeptine. Reboextine was a *very* anxiogenic drug for me. I think this screws the results of my tianeptine experience and I wish I could try it again now I'm med free.
Q
Posted by Pluto on December 20, 2006, at 6:10:13
In reply to Please post tianeptine experiences (nm), posted by saturn on December 19, 2006, at 21:36:44
Hi Sat,
I have just started my tianeptine (Stablon) trial. Am already on 20mg of Prozac plus 25mg Solian (amisulpride) I take 1.5mg of Klonopin too.
My doc won't allow me to take more than one tab of tianeptine, because I am on prozac. I take half of 12.5mg in the morning and another half at noon. It has been three days and all I can say now is good things about this drug. It refreshed my mood, a feeling like I am quite young a guy now with a lot of life ahead. Previously it was not like that. I had almost resigned to the hardships of life. Now, this small dose of Stablon gives me energy to face the life with more bravery.It will be too early to say everything. But sooner or later, I will get rid off Prozac which will allow me to take my full stablon dose. (12.5mg three times daily)Now, for the time being, I am just trying to get adjusted to this med.
One more thing: NO SIDE EFFECTS except some vivid dreams. It is manageable.Cheers
PLS
Posted by zmg on December 20, 2006, at 16:40:16
In reply to Re: Tianeptine, posted by ronaldo on December 19, 2006, at 13:43:42
Hey Ronaldo,
I've been on it for about a week now, but today I've gone off it. The first few days it was mildly stimulating, but I wouldn't say mood elevating. I'd been taking 600 mgs in the morning. I generally take Phenibut at night (something I should probably stop) but I don't *think* it would have kept me from sleeping (say after the first 2 days).Yesterday I was starting to get more interested in the results, but I decided to take a break for different reasons (work has been a little nutty so I'll be taking Valium through Thursday, which aside from being listed as contradicted seems to nullify the effects anyway).
Sorry I've got kind of a limited and muddle experience so far. For the first 3 days I'd say it definitely didn't improve my mood and although it did impact my motivation (I found myself a little more obsessively absorbed in work) it didn't improve the qualitative experience while performing tasks (I didn't find myself working on projects I enjoyed, just knuckling down on the ones I been doing already).
It did seem to be building into something. I'll start taking it Friday and continue even if my nerves feel a little fried.
As a side-note: it is the asparagus of medications. Slightly odd. :)
Posted by ronaldo on December 20, 2006, at 16:53:33
In reply to Re: Tianeptine -- Adrafinil follow-up » ronaldo, posted by zmg on December 20, 2006, at 16:40:16
Thanks zmg,
I would like to hear how it goes next week if there are any new developments.
ronaldo
Posted by blueberry1 on December 20, 2006, at 17:15:36
In reply to Re: Please post tianeptine experiences » saturn, posted by Pluto on December 20, 2006, at 6:10:13
I saw one report at pubmed.com where someone got well with a combination of an antidepressant and tianeptine. Of course, on paper, in theory, that shouldn't work. I think it just goes to show tianeptine is doing other stuff besides what it is touted of doing.
Anyway, it's cool I now actually have heard from a real person combining a serotonin reuptake inhibitor and a serotonin reuptake enhancer and liking it. Very interesting. I wish you great success. Please offer us some updates in the coming days and weeks.
Posted by psychobot5000 on December 20, 2006, at 17:46:46
In reply to Re: Tianeptine MOA » saturn, posted by blueberry1 on December 19, 2006, at 19:01:19
Re:"Tianeptine does not lower serotonin levels.
Tianeptine does have minor effects on norepinephrine and dopamine. But they aren't well researched, just known to exist. And it has other functions throughout the body on stress systems. And who knows what affinity it might have as say for example an agonist at 5HT1a receptors or whatever. I imagine it is probably a combination of all its mysterious actions that makes it what it is, and that the serotonin reuptake enhancement is just a trigger or just one link in the chain. "
____________________________According to what I've read, tianeptine does lower synaptic serotonin levels. For sure. It also raises platelet serotonin levels, and these two bits of information are apparently not at all contradictory. I have read multiple abstracts and articles that -say- it has been confirmed synaptic serotonin is lower. I have not read anything indicating that serotonin release was increased in response, however I suppose it might be possible.
Also, according to an academic article I've read, it has no effects on 5HT1 receptors. It does apparently have some mild MAO-A inhibition, but probably too low to have and AD effect. I can't vouch for any of this information--just repeating what I'v read.
One can do a google search or go to www.biopsychiatry.com to find study abstracts or academic articles--there are several out there examining its properties.
Posted by zmg on December 20, 2006, at 18:08:34
In reply to Re: Tianeptine -- Adrafinil follow-up » zmg, posted by ronaldo on December 20, 2006, at 16:53:33
Sure thing. I was thinking it wasn't going to prove useful, but yesterday the effects definitely started to shift. I'd like to see where they were headed.
Posted by blueberry1 on December 20, 2006, at 18:14:19
In reply to Re: Tianeptine MOA » blueberry1, posted by psychobot5000 on December 20, 2006, at 17:46:46
I don't remember exactly what abstracts I saw, but they were at pubmed.com and they said tianeptine did not change serotonin levels. ??? I think it is a mysterious drug.
Posted by linkadge on December 20, 2006, at 20:17:07
In reply to Re: Tianeptine MOA » psychobot5000, posted by blueberry1 on December 20, 2006, at 18:14:19
I read somewhere that theraputic doses of tianeptine only lead to a ~35% increase in the activity of the serotonin tansporter. SSRI's on the other hand (at theraputic doses) inhibit the activity of SERT like 60-80%. So its not like tianeptine would completely cancel out an SSRI.
Isn't tianeptine related to amineptine? Its probably got more do do with the molecule itself than the presently known actions of the molecule.
They just classify the drug by how they can quantify its actions.
The herb gingko biloba is a serotonin uptake acellerator, at about the same magnitude as tianeptine.
I always wanted to try a tianeptine/ginkgo combination, as ginkgo too has a fairly strong ability to prevent stress induced hippocampal atrophy.
Linkadge
Posted by elanor roosevelt on December 20, 2006, at 20:18:10
In reply to Re: Tianeptine MOA » psychobot5000, posted by blueberry1 on December 20, 2006, at 18:14:19
> I don't remember exactly what abstracts I saw, but they were at pubmed.com and they said tianeptine did not change serotonin levels. ??? I think it is a mysterious drug.
all the drugs we take are mysterious drugs
the pharma companies just hire very good spin doctors to convince us otherwise when they have something they want to sell.are benzos and tianeptine okay together?
i hesitate to combine tianeptine with the one ssri i like as i dream of having just two ad's i can switch back and forth to
the effectiveness of combining ssri's and ssre's proves we don't know jack sh*t about either
Posted by linkadge on December 20, 2006, at 20:48:00
In reply to Re: Tianeptine MOA, posted by elanor roosevelt on December 20, 2006, at 20:18:10
Not all SSRI's are antidepressants. I remember reading about a few investiagational serotonin uptake inhibitors that displayed no antidepressant potential.
One study showed that the SSRIs we have increased the activity of an enzyme that produces allopregnanalone (sp.), a potent gabaergic neurosteroid by some 20x.
So, it might not be the serotonin that calming at all, but allopregnanalone.
Linkadge
Posted by psychobot5000 on December 21, 2006, at 2:32:53
In reply to Re: Tianeptine MOA » psychobot5000, posted by blueberry1 on December 20, 2006, at 18:14:19
I agree that it's a mysterious drug, and I suppose that at least one of the articles I read (stating its opinion that stablon lowered 5ht levels) sounded like they were stating a 'correction' of something to the contrary that had been believed. The article I'm thinking of was from about 2004, I believe. I do feel like I've read one abstract indicatin serotonin levels were unchanged, but maybe it was older (?)...
It's so frustrating finding contradictory information!
Best,
P-bot
Posted by psychobot5000 on December 21, 2006, at 2:40:06
In reply to Tianeptine, posted by saturn on December 18, 2006, at 21:29:50
"the effectiveness of combining ssri's and ssre's proves we don't know jack sh*t about either"
Word.
Also, Sibutramine is a fairly powerful serotonin (and NA) reuptake inhibitor that (we are told) 'ha; not demonstrated any AD effect.' (Of course, didn't Chairman MAO or someone use it successfully?) Maybe in a hundred years we'll actually know how these drugs act.
Posted by linkadge on December 21, 2006, at 10:40:54
In reply to Re: Tianeptine, posted by psychobot5000 on December 21, 2006, at 2:40:06
I think theres little doubt that tianeptine is infact a serotonin uptake acellerator. Enough studies have confirmed that.
The net effect on serotonin though it unknown. Maybe its inhibitor effect on MAO is counteracting its facilitatory effect on SERT.
(I don't even know if thats a word...facilitatory :) )
Linkadge
Posted by Quintal on December 21, 2006, at 10:43:56
In reply to Re: Tianeptine, posted by psychobot5000 on December 21, 2006, at 2:40:06
>Also, Sibutramine is a fairly powerful serotonin (and NA) reuptake inhibitor that (we are told) 'ha; not demonstrated any AD effect.' (Of course, didn't Chairman MAO or someone use it successfully?) Maybe in a hundred years we'll actually know how these drugs act.
I used sibutramine once and it had a definite antidepressant effect on me.
Q
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