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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by willyee on May 25, 2006, at 11:36:22
I know this medication at low doses can have possable anti-depressant effects and actualy increase dopamine trasmission?? unlike what its intended to do at normal doses which is as u know be a anti-psychotic drug.
So this being true?.....what i id like to know simply is this.......at the low dose is it acutaly a stimulant at all?
Also is any form of it,a cousin available here in the U.S
Posted by flip_flop on May 25, 2006, at 16:02:47
In reply to Amisulpride..??, posted by willyee on May 25, 2006, at 11:36:22
When I first started taking amisulpride, I could feel a dopamine rush for several weeks, but after that only the anxiolytic and antidepressant effects remained.
Unfortunately, amisulpride can cause raised prolactin levels. This is something you really don't want, especially if you are male (it can lead to gynecomastia). Adding a drug that normalizes prolactin levels is highly recommended.
Posted by blueberry on May 25, 2006, at 18:46:40
In reply to Amisulpride..??, posted by willyee on May 25, 2006, at 11:36:22
I took amisulpride for a few months with prozac, and have tried it several times since then. The same pattern always happens...
It starts with a definite stimulant effect. The first couple days especially. Then tolerance to the dopamine develops rapidly, and the stimulation fades. Then it feels like it isn't doing anything at all. Then at about 3 or 4 weeks, the antidepressant and anti-anxiety and prosocial stuff kicks in nicely.
But as was mentioned, the increased prolactin can be a real problem. I had the worst sexual side effects on amisulpride than anything. Bad. That has always been the reason I stopped it. Had I known about the clinical studies, I would have added bromocriptine to it to normalize prolactin without affecting the therapeutic benefits.
I started at 25mg, went up to 50mg, tested the 75mg and 100mg range, but liked the 25mg to 50mg range better. It's weird with this one how less is more. But like all antidepressants, it does take time. The initial stimulation will fade quickly and then you just have to hang in there and wait.
Posted by willyee on May 25, 2006, at 22:38:40
In reply to Re: Amisulpride..?? » willyee, posted by blueberry on May 25, 2006, at 18:46:40
Cool that is what i actualy meant,from what i understand it needs to be kept under 50,around 10 mg prefably to have the opposite effect than what it is intended for at the higher doses,meaning at lower doses under 50 it increases dopamine whereas over 50 its a anti-psychotic.
Raising the dose is said to definatly change the action of the drug,and your better of taking a break from it at around ten mg than raising it,IF a stimualtive anti-depressant effect is desired,im not familiar with it as a anti-psychotic just that the dose can be well in the hundred mg .
I see my new doc tommorrow and i have no idea what to even ask about,i know i need parnate/klonopin but at best that gets me back to square one ,at the top of the pit,wheres as im just kinda dangling on a branch seconds away from falling totaly in now.
Its not a lot to look forward to when u waited almost two months.
I guess it could be worse,as i hear the branch just about ready to crack.
I just cant foresee her bringing anything to the table,i know its a bad attitude to have,and my im cocky,well i know i am,not good,but i feel as if i have researeched every avenue,it would be a blessing to have a doc shock me.
Posted by TomG on May 26, 2006, at 11:28:00
In reply to Re: Amisulpride..??, posted by flip_flop on May 25, 2006, at 16:02:47
> When I first started taking amisulpride, I could feel a dopamine rush for several weeks, but after that only the anxiolytic and antidepressant effects remained.
>
This is exactly what happened to me. I started ami about two months ago. If you look at a list of negative symptoms of schizophrenia I have all of them. Sorry I *had* all of them. Amisulpride has been a miracle for me so far.I started out at 25mgs for a week and noticed more obsessive thinking. I started going up in dosage every week until I got to 150mgs, and I noticed a worsening of my symptoms. I quit the drug alltogether for about two days and restarted at 12.5mgs and WHAM! Within two to three hours I could tell that it was going to work. Like flip_flop said I got somewhat of a stimulant effect the first few weeks at the low dose. It was subtle but nonetheless it was definatley stimulant-like. I had insomnia during this time. Right now the stimulant properties seem to be waning and I still have a nice antidepressant and anxiolytic effect. I'm sleeping like a baby now too. No side effects. Completely calm and cool around people and able to express thoughts and emotion. Just normal. It's a great drug for me.
Posted by blueberry on May 26, 2006, at 17:32:43
In reply to Re: Amisulpride..??, posted by TomG on May 26, 2006, at 11:28:00
Tom,
I wonder why you aren't having sexual side effects? I tell you, when I took amisulpride the sexual side effects were fierce. Way worse than any ssri.Did you have any sexual side effects in the first couple weeks that later went away? Diminished interest, inability, anything like that?
I have never taken amisulpride all by itself. I used it once with prozac and remeron. I used it with zyprexa. Sexual side effects were so bad. I'm wondering if I should someday try it all by itself. That would be a very hard transition though to stop zyprexa and start amisulpride, even though my zyprexa dose is very low.
Anyway, I am curious about the sexual side effects. Comments on that?
> I started out at 25mgs for a week and noticed more obsessive thinking. I started going up in dosage every week until I got to 150mgs, and I noticed a worsening of my symptoms. I quit the drug alltogether for about two days and restarted at 12.5mgs and WHAM! Within two to three hours I could tell that it was going to work. Like flip_flop said I got somewhat of a stimulant effect the first few weeks at the low dose. It was subtle but nonetheless it was definatley stimulant-like. I had insomnia during this time. Right now the stimulant properties seem to be waning and I still have a nice antidepressant and anxiolytic effect. I'm sleeping like a baby now too. No side effects. Completely calm and cool around people and able to express thoughts and emotion. Just normal. It's a great drug for me.
>
Posted by TomG on May 27, 2006, at 17:56:32
In reply to Re: Amisulpride..?? » TomG, posted by blueberry on May 26, 2006, at 17:32:43
What up blue?
If anything amisulpride has enhanced feeling during sex. I've noticed more of a firm erection. Better climax too. I think its just that since my symptoms have abated I have more feeling all around hence my sex life has improved. Hope thats not too much information for ya :^D!
I say give ami a whirl by itself. It all depends on how well you're doing with your current meds. I say if all is well don't rock the boat, but if you're not doing so well common sense says to try something new.
I don't want to say I have a complaint about amisulpride, but I sort of miss that initial stimulant effect. It was nice to have the extra energy for a few weeks, but I wasn't really sleeping all that well. I'm euthymic now so I really shouldn't make a fuss over anything.
Have you ever heard of anyone combining low dose Adderall or another stim with amisulpride? That might be a way to combat your sexual side effects.
Tom
Posted by neo on June 4, 2006, at 8:17:23
In reply to Re: Amisulpride..?? » willyee, posted by blueberry on May 25, 2006, at 18:46:40
Hi Blueberry, you sayd about Amisulpride:
> It starts with a definite stimulant effect. The first couple days especially.... ....Then it feels like it isn't doing anything at all. Then at about 3 or 4 weeks, the antidepressant and anti-anxiety and prosocial stuff kicks in nicely.<
The good effect you had after 3/4 weeks was the same you had in the first couple of days (stimulant effect)? Or there was any difference between the two effects?
Thanks very much for your share!
neo
Posted by marcus75 on September 20, 2007, at 6:53:23
In reply to Re: Amisulpride..??, posted by TomG on May 26, 2006, at 11:28:00
I'd like to know what is the risk of developing tardive dyskinesia taking 50 mg/day, does anyone know this? For what I rembember, according to a study, at 100-200 mg the risk is about 1%. I am not sure whether the fact that at low doses it stimulates dopamine release, tardive dyskinesia is not possible. In fact the actual cause of TD is not known, there are various theories to explain it.
Posted by Amigan on September 21, 2007, at 6:57:47
In reply to Re: Amisulpride..??, posted by flip_flop on May 25, 2006, at 16:02:47
> Unfortunately, amisulpride can cause raised prolactin levels. This is something you really don't want, especially if you are male (it can lead to gynecomastia). Adding a drug that normalizes prolactin levels is highly recommended.
Damn.. :(
I thought that females were mostly affected by increased prolacting. Disruption of menstruation, galactoria and everything.
But wait! It shouldn't raise prolactin in low dosage, as this is a result of dopamine blockage and amisulpiride doesn't act as a dopamine antagonist in low dosages... right??...
Posted by Darwin on September 21, 2007, at 21:29:07
In reply to Re: Amisulpride and prolactin » flip_flop, posted by Amigan on September 21, 2007, at 6:57:47
>
> Damn.. :(
> I thought that females were mostly affected by increased prolacting. Disruption of menstruation, galactoria and everything.
> But wait! It shouldn't raise prolactin in low dosage, as this is a result of dopamine blockage and amisulpiride doesn't act as a dopamine antagonist in low dosages... right??...
>Sorry, amisulpride does raise prolactin levels even at low dosages. Amisulpride does not cross the blood brain barrier very well but, the pituitary gland, which controls prolactin levels, is not protected by the blood-brain barrier. 50 mg of amisulpride may be a low dosage to those areas of the brain protected by the blood-brain barrier but it is a potent dosage to the unprotected pituitary gland.
Too bad that amisulpride increases prolactin. If it weren't for this side-effect, it would be a great antidepressant for many sufferers (especially those suffering from dysthymia).
Posted by rina on September 22, 2007, at 2:50:04
In reply to Re: Amisulpride and prolactin » Amigan, posted by Darwin on September 21, 2007, at 21:29:07
Unfortunately Amisulpride isn't the only one in that category.
In general, second-generation antipsychotics produce lower increases in prolactin than conventional agents.[3] Some agents, including olanzapine,[29,35] quetiapine,[36,37] ziprasidone[38,39] and clozapine[40,41] have been shown to produce no significant or sustained increase in prolactin in adult patients.However, in adolescents (age 9-19 years) treated for childhood-onset schizophrenia or psychotic disorder, it has been shown that after 6 weeks of olanzapine treatment prolactin levels were increased beyond the upper limit of the normal range in 70% of patients.
The authors concluded that further studies involving second-generation antipsychotics in adolescent patients, with longer observation intervals and bigger samples, were required.[42]
Second-generation antipsychotics that have been associated with increases in prolactin levels are amisulpride, zotepine and risperidone[43- 45]. An analysis of double-blind studies of risperidone in schizophrenic patients showed that this drug dose-dependently increased prolactin concentrations in both men and women.
However, the increase was not associated with the occurrence of adverse events.[43] Furthermore, a significant prolactin increase was observed in an open study in which patients were switched from haloperidol to risperidone.[46] In schizophrenia patients treated with amisulpride for 12 months, prolactin secretion was significantly increased over baseline after 1 month of high dosing (1000 mg/day) during the acute phase.
Prolactin levels remained elevated above baseline for the 12-month dosing period but gradually declined during the maintenance phase (amisulpride 200-600mg/day).[44] However, a review of 11 studies, which involved a total of 1247 patients treated with amisulpride, concluded that the incidence of endocrine-related adverse events was similar for amisulpride, haloperidol, risperidone and placebo (Figure 3).
Furthermore, the study concluded that the safety profile of amisulpride was comparable to that of risperidone and superior to conventional antipsychotics, including haloperidol.[47] Finally, Fleischhacker and colleagues[45] found increased prolactin levels investigating the efficacy of zotepine in the treatment of negative symptoms.
http://www.medscape.com/viewarticle/468929_4
Posted by Amigan on September 27, 2007, at 18:52:41
In reply to Re: Amisulpride..??, posted by marcus75 on September 20, 2007, at 6:53:23
> I'd like to know what is the risk of developing tardive dyskinesia taking 50 mg/day, does anyone know this? For what I rembember, according to a study, at 100-200 mg the risk is about 1%. I am not sure whether the fact that at low doses it stimulates dopamine release, tardive dyskinesia is not possible. In fact the actual cause of TD is not known, there are various theories to explain it.
Highly unlikely! As you said, even at normal dosage, the risk is about 1%.
The exact mechanism that causes TD might not be known, but it is clear that it has to do with the post-synaptic antagonism of dopamine and (ami)sulpiride doesn't do that in low doses.
This is the end of the thread.
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