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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by ihatedrugs on August 31, 2008, at 12:12:21
Is Ixel available in the US? If not how do you guys get it and does your dr. monitor this drug or do you do it by yourself? I went off Cymbalta 2 months ago. I'm still taking Wellbutrin XL and added Deplin but I'm beginning to sink fast. I've taken pretty much everything in the SSRI family but everything poops out. I'm so tired of this but I don't want to complaint anymore- it's useless.
I have done a little research online about Ixel and it seems to be a life saver for some. What are its main side effects (on females)? I read it is one of the top antidepressants in Japan. How long have they been using it?
When you submit your answer please keep it in layman terms. My brain is so tired, it doesn't comprehend much.Thanks
ihatedrugs
Posted by Phillipa on August 31, 2008, at 12:40:49
In reply to Questions about Ixel, posted by ihatedrugs on August 31, 2008, at 12:12:21
Don't know sounds a bit like cymbalta. This looked easy to read hope it helps. Phillipa
and noradrenaline reuptake inhibitor: an overview of its antidepressant activity and clinical tolerability
by
Puech A, Montgomery SA,
Prost JF, Solles A, Briley M
Groupe Hospitalier Pitie-Salpetriere,
Paris, France.
Int Clin Psychopharmacol 1997 Mar; 12(2):99-108ABSTRACT
Milnacipran (Ixel) is a new antidepressant with essentially equal potency for inhibiting the reuptake of both serotonin and noradrenaline, with no affinity for any neurotransmitter receptor studied. A review of the studies comparing milnacipran, placebo and active comparator antidepressants provides clear-cut evidence of its efficacy in both severe and moderate depression in hospitalized and community settings. Meta-analyses of the original data of controlled trials involving 1032 patients, comparing milnacipran with imipramine or selective serotonin reuptake inhibitors (SSRIs), show that milnacipran provides antidepressant efficacy similar to that of imipramine and significantly superior to that of the SSRIs. An analysis of a database of over 3300 patients shows that both the general and cardiovascular tolerability of milnacipran are superior to those of the tricyclic antidepressants (TCAs) with fewer cholinergic side-effects. The tolerability of milnacipran was comparable to that of the SSRIs, with a higher incidence of dysuria with milnacipran, and a higher frequency of nausea and anxiety with the SSRIs. Milnacipran is a new therapeutic option in depression, which offers a clinical efficacy in the range of the TCAs combined with a tolerability equivalent to that of the SSRIs.
Options
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Milnacipran
Milnacipran v imipramine
Milnacipran and cognition
Antidepressant metabolism
Antidepressant mechanisms
Milnacipran (Ixel) : structure
Milnacipran versus fluvoxamine
Milnacipran and the dopamine system
Milnacipran for post-stroke depression
Milnacipran for depression after brain injury
Milnacipran (Ixel): dosage and antidepressant response
Cabergoline plus milnacipram (Ixel) for refractory depressionRefs
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Posted by ihatedrugs on August 31, 2008, at 12:51:00
In reply to Re: Questions about Ixel » ihatedrugs, posted by Phillipa on August 31, 2008, at 12:40:49
Thank you Phillipa,
Is this available in the US? I does sound like Cymbalta. However I read somewhere that its serotonin vs. norepinephrine ratio is lower than Cymb. 3:1 or something like that. I wonder if it produces the same side effects.
Also what do you know about alpha Stim? It is a device that delivers cranial electrotherapy stimulation? Is this just another scam?greetings
ihatedrugs
Posted by Racer on August 31, 2008, at 14:06:17
In reply to Re: Questions about Ixel, posted by ihatedrugs on August 31, 2008, at 12:51:00
Hi, here are some answers for you:
>
> Is this available in the US?No, it's not approved in the US. US laws are actually pretty vague on importation of unapproved medications for personal use. My doctor "prescribed" a medication not approved here, and we both did some research on how to get it. The best answer we could find seemed to be, "y'ain't s'posedta do that, but the guy who checks out the package at Customs gets to decide whether or not to do anything." Those of us who have tried medications not approved here have ordered online, usually after having searched for online review sites to help us find a source.
That said, here on Babble, the rules prevent anyone from telling you anything that could enable you to obtain medication without a prescription. Period. We can't even offer you a link to the review sites. Sorry.
And yes, my doctor and therapist both supervised my trial of the unapproved medication. I was exactly as medication compliant with it as I am with every other medication he prescribes. The only difference was where I got the stuff from.
> I does sound like Cymbalta. However I read somewhere that its serotonin vs. norepinephrine ratio is lower than Cymb. 3:1 or something like that. I wonder if it produces the same side effects.
Well, that's hard to say -- just as Zoloft and Paxil produced almost exactly opposite side effects for me, the same is likely to be true with any other medication related in mechanism. Some side effects are a direct result of the mechanism of action, but others are idiosyncratic. Maybe the side effects will be the same, maybe they won't.
The 3:1 ratio is cited in Wikipedia, but Medscape shows it to be 9:1, which is also the ratio listed for Cymbalta. (Effexor, on the other hand, shows as 30:1.)
> Also what do you know about alpha Stim? It is a device that delivers cranial electrotherapy stimulation? Is this just another scam?
>Unless it's prescribed by your doctor, it's unlikely to have had extensive research done on safety, let alone efficacy. I won't say it's a scam, but that's only based on my policy of trying to remember not to offer a definitive statement like that if I don't actually know anything about the subject I'm commenting on.
I will say that if it's sold directly to consumers, outside of reputable pharmacies, it's unlikely to provide any significant electrical stimulation. Additionally, ECT and TMS are applied at certain specific points on the brain in order to affect certain specific regions of the brain. Unless you are confident enough in your knowledge of neuroanatomy, I would advise you to consider whether you're willing to risk the potential adverse effects that lack of specificity might lead to. Those are just general comments, though, since I have never heard of this device before.
I hope that helps.
Posted by Racer on August 31, 2008, at 14:13:02
In reply to Re: Questions about Ixel » ihatedrugs, posted by Racer on August 31, 2008, at 14:06:17
I looked up Alpha Stim, and it is a prescription product, with actual studies and post marketing information available. So, no -- I don't think it's a scam, I think it's very likely another effective tool in the treatment of anxiety/depression/insomnia/and whatever else they're marketing it for.
And I realize someone -- can't remember who -- actually suggested this to me. It was a number of years ago now, and it went nowhere, so I don't remember much more about it.
Posted by bulldog2 on August 31, 2008, at 14:31:36
In reply to Questions about Ixel, posted by ihatedrugs on August 31, 2008, at 12:12:21
> Is Ixel available in the US? If not how do you guys get it and does your dr. monitor this drug or do you do it by yourself? I went off Cymbalta 2 months ago. I'm still taking Wellbutrin XL and added Deplin but I'm beginning to sink fast. I've taken pretty much everything in the SSRI family but everything poops out. I'm so tired of this but I don't want to complaint anymore- it's useless.
> I have done a little research online about Ixel and it seems to be a life saver for some. What are its main side effects (on females)? I read it is one of the top antidepressants in Japan. How long have they been using it?
> When you submit your answer please keep it in layman terms. My brain is so tired, it doesn't comprehend much.
>
> Thanks
> ihatedrugsWhat makes Milnacipran(ixel) different from the Selective Serotonin Reuptake Inhibitors (SSRIs) drugs like Prozac® and Selective Norepinephrine Reuptake Inhibitors (SNRIs) drugs like Effexor is that Milnacipran affects two neurotransmitters, norepinephrine and serotonin, almost equally (a 3:1 norepinephrine to serotonin balance). In contrast a SNRI, tends to act much more on serotonin than norepinephrine, (Effexor has a 1:30 norepinephrine to serotonin ratio).
So ixel same drug as milnaciprine is 3:1 ne to se
cymbalta is 1:9 ne to se
so they are not the similar as one poster stated
Much more action on ne (norepinephrine) than cymbalta and a much better ad for some that failed on cymbalta
Look for posts from atmlady who uses this drug and has responded well to it.
Posted by Phillipa on August 31, 2008, at 15:05:11
In reply to Re: Questions about Ixel, posted by bulldog2 on August 31, 2008, at 14:31:36
That's One person and if it's not used in the US the poster needs to have permission from her doc. Can you please post the link to the site with you info on ratios? Would be very helpful to initial poster. Thanks so much Phillipa ps she could print it out and give it to her doc. Thanks again.
Posted by Racer on August 31, 2008, at 15:43:53
In reply to Re: Questions about Ixel, posted by bulldog2 on August 31, 2008, at 14:31:36
> >>
> So ixel same drug as milnaciprine is 3:1 ne to se
> cymbalta is 1:9 ne to se
> so they are not the similar as one poster stated
>I'm curious about where these numbers came from, only because I found both the 3:1 and the 9:1 ratios listed for milnaciprine. (And I didn't do the calculations on the raw data I found, which would probably answer my question regarding which is the more accurate number...)
Thanks!
Posted by ihatedrugs on August 31, 2008, at 17:23:55
In reply to Doh! Reversal on some of my last post, posted by Racer on August 31, 2008, at 14:13:02
I'm going to talk to my dr. about this medication and see if she is willing to help me with it. Racer do you have an email address so I could contact you in case the dr. gives me an unofficial go ahead.
Do you have any idea why it hasn't been marketed in the US? I think I read somewhere that Forest labs is conducting research on it.
Also about Alpha stim, I've done a little research and the jury is still out on this treatment but I'm also going to talk about it with my dr.Greeting,
ihatedrugs
Posted by ihatedrugs on August 31, 2008, at 17:32:48
In reply to Re: Questions about Ixel, posted by bulldog2 on August 31, 2008, at 14:31:36
Thanks for the info. I have read some post by ATM lady and that is how I came across the info. I have also read that this drug is widely prescribed in Japan and Europe. I'm going to talk to my dr. and see how open she is to the idea. I live in an university town where a lot of research is conducted and maybe she has heard of it.
One question I have is, if the ser to norep ratio is about 3:1 are the side effects similar to those of a SSRI drug? My main concerns are decrease libido and weight gain.greetings,
ihatedrugs
Posted by Larry Hoover on August 31, 2008, at 17:51:15
In reply to Re: Questions about Ixel » bulldog2, posted by Racer on August 31, 2008, at 15:43:53
> I'm curious about where these numbers came from, only because I found both the 3:1 and the 9:1 ratios listed for milnaciprine. (And I didn't do the calculations on the raw data I found, which would probably answer my question regarding which is the more accurate number...)
>
> Thanks!According to the PDSP database, the milnacipran Ki's for the serotonin and norepinephrine transporters are 151 nm and 68 nm respectively. That would give a norepinephrine to serotonin affinity ratio of 2.22 in favour of NE.
For duloxetine, the serotonin and norepinephrine Ki's are 3.7 and 20 nm, respectively. That would give a ratio of 5.4 in favour of serotonin.
Those are very different, as one modestly favours NE inhibition, and the other somewhat more strongly favours 5-HT inhibition.
Both sets of values arise from one reference (http://www.ncbi.nlm.nih.gov/pubmed/14744476), suggesting that similar laboratory conditions and methodology were used.
Lar
Posted by Larry Hoover on August 31, 2008, at 18:10:50
In reply to Re: Doh! Reversal on some of my last post, posted by ihatedrugs on August 31, 2008, at 17:23:55
> Also about Alpha stim, I've done a little research and the jury is still out on this treatment but I'm also going to talk about it with my dr.
I'm glad you're skeptical about the Alpha-Stim. The research conducted on its efficacy is very weak. The vast majority of the studies are: a) very old (conducted in the early 1970's); b) open (subject to both patient and doctor bias); c) conducted on patients with disorders other than anxiety and depression; d) all of the above. The owner of Alpha-Stim, one Dr. Daniel Kirsch, keeps publishing bizarre and scientifically fallacious articles about how effective his device is, all based on inappropriate meta-analyses of all these poor studies mentioned above.
Alpha-Stim, and its many copycats on the market, are FDA/CDRH Class 3 devices. That puts them in a category that meets the definition "which present a potential, unreasonable risk of illness or injury." Because a similar device was on the market prior to the passing of product safety laws in 1976, any device which can demonstrate that is substantially similar to such device can be marketed without testing or proof of efficacy. That's a so-called "grandfather clause" loophole, a flaw through which all such devices pass. That's also most likely why the device presents risks.....it's never been tested, either for safety or for efficacy.
For the full blurb, see: http://www.fda.gov/cdrh/devadvice/3132.html
Far be it for me to say the device doesn't work, but I have found little convincing evidence that it does.
Lar
Posted by ricker on August 31, 2008, at 18:14:56
In reply to Questions about Ixel, posted by ihatedrugs on August 31, 2008, at 12:12:21
Here's the thing I don't get, why is the ratio so important? It's a number that can not be proven so other than placebo, it really has no value?
I can find 10 different ratio's for pretty much most of the newer meds out there, why, cause it's pretty much a crap shoot and no one can really call the other's bluff.I started a thread a while back about wanting that magic bullit that everynoe else is on, it's got to be the best ,so I must get it, geez!
I would bet my life that it has as many con's as it does pro's and after reading some of the male side effects, ahem, I donno?
Zoloft and nortriptyline can be dosed to meet one ratio requirement, heck most ssri's in small smaller amount's along with the right NE med would probably work quite well.
I just don't understand why we keep falling for all these new wonder drugs, yes, I'm one of them.
Maybe it's the new fancy names or the fancy packaging. Or is it because, at times, we are consumers of desperation?
Hey, it be nice if Ixel landed in North America and performed at a 99% cure/remission with minimal side effects.
Smart money is on "More of the same". Hmm, sounds like an Obama attack statement! LOL.
Rick
Posted by ihatedrugs on August 31, 2008, at 19:04:31
In reply to Re: Questions about Ixel, posted by ricker on August 31, 2008, at 18:14:56
I guess that despite all our bad experiences with meds, we still need to believe on an miracle cure. That is what keeps me going.
Greetings,
ihatedrugs
Posted by bleauberry on August 31, 2008, at 19:31:01
In reply to Questions about Ixel, posted by ihatedrugs on August 31, 2008, at 12:12:21
Ixel is available through overseas mailorder pharmacies. Due to policies here, we are not allowed to give out the sources. I can say from experience they are as legit as your neighborhood pharmacy. Easy to find if you just google search Ixel.
There is no law that says you have to go to a doctor to get care or to have one oversee your medication. It is wise, definitely, but not required. Millions of people choose to be their own best caretakers with things like herbs, supplements, 5htp, OTC meds, and FDA overseas meds and non-FDA overseas meds. Diligent research by the person is a good idea. Not cool to blindly jump into something, anything.
The generally accepted practice is that it is allowed to import up to a 90 day supply in one shipment. I'm sure lawyers could bicker about whether it is actually legal or not, but for all practical purposes it is. Customs allows this stuff through all the time. They consider them supplements. I've had Customs intercept my mail several times, open it, seal it back up, stamp a "supplements" label on it, and send it to my mailbox. What they are looking for are amphetamines, opioids, benzos, pot, cocaine, and such. From what I've seen, they could care less about any routine medication.
Just to clarify, Ixel has no resemblence to cymbalta. I've taken both meds, and believe me, they are vastly different in how they feel.
Ixel reminds me vaguely of ritalin more than an antidepressant. The mood boost of ritalin, without the stimulant part of it, is kind of how Ixel feels to me. I swear it somehow works on dopamine, though it is claimed not. Studying every pubmed abstract on Ixel, it appears probably the best add-on to it if needed is low dose risperdal.
I have been on many many meds and cocktails. I have also failed 12 rounds of bilateral ECT. But Ixel works. Go figure. Cymbalta doesn't.
All meds are too complicated to armchair quarterback based on what ratios they affect neurotransmitters. It's interesting, but in the end all that matters is what happens when you take the medicine.
I think males get worse side effects than females. Mostly urinary for males. For everyone, maybe some initial slightly increased anxiety, lighter sleep, and diminished appetite, followed in about 3 days by rapid antidepressant effects beginning, anxiety almost gone, deep sleep, and more daytime energy, unless the dose is too high.
Strange to think that someone who failed so many meds and ECT can actually feel dramatic improvement on a ridiculous 18mg Ixel (25mg capsule emptied out, divided into 4 piles, loaded into 4 empty gelcaps, dosed 1 capsule 3 times per day).
Posted by Bob on August 31, 2008, at 23:48:49
In reply to Re: Questions about Ixel, posted by ricker on August 31, 2008, at 18:14:56
>
> Hey, it be nice if Ixel landed in North America and performed at a 99% cure/remission with minimal side effects.Can't imagine how that would happen since this isn't technically a new drug, but one that has been available in other parts of the world for years. It doesn't have a 99% cure rate there, so it won't here either.
Posted by bulldog2 on September 1, 2008, at 7:53:28
In reply to Re: Questions about Ixel » bulldog2, posted by Racer on August 31, 2008, at 15:43:53
> > >>
> > So ixel same drug as milnaciprine is 3:1 ne to se
> > cymbalta is 1:9 ne to se
> > so they are not the similar as one poster stated
> >
>
> I'm curious about where these numbers came from, only because I found both the 3:1 and the 9:1 ratios listed for milnaciprine. (And I didn't do the calculations on the raw data I found, which would probably answer my question regarding which is the more accurate number...)
>
> Thanks!here's the link
Posted by Racer on September 1, 2008, at 15:53:24
In reply to Re: Questions about Ixel, posted by ricker on August 31, 2008, at 18:14:56
> Here's the thing I don't get, why is the ratio so important? It's a number that can not be proven so other than placebo, it really has no value?
Another point to remember is that most of the ratio information was determined in vitro or in small animal testing. There are numerous examples of treatments which have shown no problems in animals, yet been disastrous for humans.
>
> I would bet my life that it has as many con's as it does pro's ...
>
> Zoloft and nortriptyline can be dosed to meet one ratio requirement ...
Rick, you make such good points -- not only in this thread, but much of what you've posted on this subject -- and many of them are things I try very hard to keep in mind when considering medications. I'm going to add one more consideration that I think supports your point:Similarity of mechanism does not necessarily correlate to similarity of the subjective experience of treatment. We can use our response patterns to medications to speculate about the biochemical underpinnings of our disorders, but it's still speculation. It's often very helpful speculation, but that still doesn't make it evidence. Knowing the serotonin-norepinephrine reuptake inhibition ratio of one medication and expecting that recreating that ratio as closely as possible by combining other medications will produce the same results really is too facile -- all of this is more complex and more subtle than that.
I certainly agree that response patterns can be a very good guide for selecting medications. Response patterns are a great tool -- although I'd like to note that I think it unfortunate that we all seem to know our response patterns, since it indicates a lot of failed med trials. I know from my own history of failed medication trials that I respond better to medications which affect norepineprhine. I don't know that that fact means I am deficient in norepinephrine -- I only know that, on average, I respond better to medications that affect NE than I do to meds which don't.
I'm obviously interested in this subject, or I wouldn't be here. I am just concerned that sometimes speculation leads to unrealistic expectations, which can lead to disappointment.
Posted by bulldog2 on September 1, 2008, at 18:05:37
In reply to Re: Questions about Ixel » ricker, posted by Racer on September 1, 2008, at 15:53:24
> > Here's the thing I don't get, why is the ratio so important? It's a number that can not be proven so other than placebo, it really has no value?
>
> Another point to remember is that most of the ratio information was determined in vitro or in small animal testing. There are numerous examples of treatments which have shown no problems in animals, yet been disastrous for humans.
>
> >
> > I would bet my life that it has as many con's as it does pro's ...
> >
> > Zoloft and nortriptyline can be dosed to meet one ratio requirement ...
>
>
> Rick, you make such good points -- not only in this thread, but much of what you've posted on this subject -- and many of them are things I try very hard to keep in mind when considering medications. I'm going to add one more consideration that I think supports your point:
>
> Similarity of mechanism does not necessarily correlate to similarity of the subjective experience of treatment. We can use our response patterns to medications to speculate about the biochemical underpinnings of our disorders, but it's still speculation. It's often very helpful speculation, but that still doesn't make it evidence. Knowing the serotonin-norepinephrine reuptake inhibition ratio of one medication and expecting that recreating that ratio as closely as possible by combining other medications will produce the same results really is too facile -- all of this is more complex and more subtle than that.
>
> I certainly agree that response patterns can be a very good guide for selecting medications. Response patterns are a great tool -- although I'd like to note that I think it unfortunate that we all seem to know our response patterns, since it indicates a lot of failed med trials. I know from my own history of failed medication trials that I respond better to medications which affect norepineprhine. I don't know that that fact means I am deficient in norepinephrine -- I only know that, on average, I respond better to medications that affect NE than I do to meds which don't.
>
> I'm obviously interested in this subject, or I wouldn't be here. I am just concerned that sometimes speculation leads to unrealistic expectations, which can lead to disappointment.I seem to respond immediately to norepineprhine meds but unfortunately cannot tolerate them due to urinary difficulties and blood pressure rise.But they make me feel better from day 1. I have adhd in addition to depression so that could be the reason I respond to them.
This is the end of the thread.
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