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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by iforgotmypassword on February 13, 2009, at 8:45:14
(I couldn't add the question mark a the end of the title.)
Now, I am at 600mg of nefazodone, I think I will stay on for another 7 days just in case, but I don't expect anything. All I experienced from 200mg-500mg was fatigue, more instability, even duller spontenaeity, frequent unexpected sleep, and constant dreams.
After the 7 days are over, my next idea is to try buspirone with rasagiline possibly added. Buspirone, I believe, may be worth an extended try at slowly raising doses, as I believe depleting serotonin to bring back dopaminergic function may be what I need both for treating the permanent EPS I have, and for my mind and capacity to experience fully.
There may be problems with this, I will list them:
- I have tried buspirone, relatively low dose I think, at that time I did not notice much. I could have easily given up on it too early, as apparently buspirone is noted for taking a while even though it at acts directly at receptors. I plan to deal with this by maybe starting at 5mg q.i.d. (or 20mg daily) and leaving open the possibility to go as high as 60mg if neccessary, but with caution, which leads to the next problem...
- Like nefazodone, it isn't very clean. Nefazodone has its possibly counterproductive (in my case) "weak" SRI effect, and the nebulous effects at 5-HT2c; Buspirone has it's very creepy D2 antagonism, and that alpha-2 blocking metabolite I don't know the significance of (i.e. how strong it is, I don't want a pro-attention deficit effect).
- More on D2. Buspirone has several reported cases of dystonia in journals, including both acute cases and lasting cases. My clear EPS that seems to be akathisia and dystonia based, also with very unhelpful stiffness and frequent physical and mental block of initiation, are already very much a problem. Lorazepam works to some degree, I can do a bit more on it, and sometimes I can't do without it, but using it has taken it's toll, I have a tolerance and worsening symptoms.
I do not need any more of this from buspirone hence my decision to choose q.i.d. dosing, which I am imagining will keep D2 occupancy the lowest given its short half life. BUT I HAVE NO IDEA IF THIS IS GOOD REASONING, OR IF IT MAY WEAKEN THE 5-HT1a effect, and contribute to a non-response.
-Finally, buspirone, on google seems to list that use with an MAOI is strictly contraindicated, can me and my doctor just ignore this. Rasagiline is only an MAO-B inhibitor in any case, and I don't know what effect buspirone would have in concert with MAO-A blockade in any case. In my mind, harmful interaction, or a dangerous event, seems very unlikely, if not impossible though the typical pathways MAOI emergencies are known for. But still, I could be wrong, can anyone help me here?
Any comments and advice would be greatly appreciated.
Thanks.
(and sorry this is long, I think this was nearly as short as i could make it.)
Posted by SLS on February 14, 2009, at 7:25:54
In reply to nefazodone failure, next step buspirone+rasagiline, posted by iforgotmypassword on February 13, 2009, at 8:45:14
I have seen it suggested here that Remeron is compatable with MAOIs. This would support the idea that NE-alpha2 antagonism of the buspirone metabolite, 1PP, would not be a problem. I can' think of any other compatability. I am currently combining a 5-HT1a partial agonist (Abilify) with Parnate.
It is obvious to me that you have put together this plan with sufficient backgound information and logic. I would just do a bit of extra research to see if Remeron is indeed compatable with MAOIs. Then you should feel more confident in your choices.
- Scott
Posted by bleauberry on February 14, 2009, at 17:12:47
In reply to nefazodone failure, next step buspirone+rasagiline, posted by iforgotmypassword on February 13, 2009, at 8:45:14
Before you ditch Serzone completely, you might want to add Buspar to it first, since you are planning on Buspar anyway. I don't remember his name, but some doctor has what is said to be a powerful bomb against difficult depression which is a combination of serzone, buspar, and tryptophan.
And perhaps lower the dose of serzone to reduce the negative side of it.
It just seems to me it would be a lot easier to add buspar to what you are already doing, rather than go through the horrific trauma of discontinuing it. Severe anxiety is a commonly expected transition when weaning off serzone. If the buspar doesn't help, then a bigger change may be in order.
Just a thought. I wouldn't have even mentioned it except that I saw at pubmed somewhere the report about the effectiveness of that combination.
Posted by iforgotmypassword on February 14, 2009, at 23:38:48
In reply to Re: nefazodone failure, next step buspirone+rasagiline » iforgotmypassword, posted by bleauberry on February 14, 2009, at 17:12:47
for some reason i was under the impression that their metabolism involved the same liver enzymes, maybe i should just look into that. i think i may have overassociated trazodone, nefazodone, and buspirone due their often assoicated mentions, by their metabolites, the grapefruit thing (i don't even know if the grapefruit thing is related to one or multiple enzymes), and liver related studies. (the stress to liver is, nefazodone > buspirone > trazodone thing.)
i'll definately look into this now, but i am very cautious of any other factors that may complicate buspirone dosing, the movement disorder risk threshold already worries me a lot due to my susceptibility, and current several lasting issues from other drugs that are movement and akathisia related.
do you think my concern is warranted? i find it very hard to estimate by reading articles. i can't determine what level of frequency may be implied due to the seemingly drastic fluctution(s) the popuarity of this drug has been through.
due to this whole liver enzyme thing i had figured i would potentially have to wait week(s) after discontinuing nefazodone before starting buspirone.
Posted by Questionmark on February 18, 2009, at 20:17:12
In reply to nefazodone failure, next step buspirone+rasagiline, posted by iforgotmypassword on February 13, 2009, at 8:45:14
The only thing that would be a possible concern if you were going to take buspirone with nefazadone (or enough nefazadone still in your system) is serotonin syndrome or at least excessive stimulation of certain serotonin receptors, but i'm not sure if that is a risk or not since buspirone is only a partial 5ht1a agonist and not full agonist. But the alpha2NE antagonism should be non-dangerous although it may combine with the rasagiline MAO-B inhibition to produce some potentially sigNIFicant anxiety or other overstimulated-type effects, but most likely nothing dangerous inmyopinion.
> (I couldn't add the question mark a the end of the title.)
>
> Now, I am at 600mg of nefazodone, I think I will stay on for another 7 days just in case, but I don't expect anything. All I experienced from 200mg-500mg was fatigue, more instability, even duller spontenaeity, frequent unexpected sleep, and constant dreams.
>
> After the 7 days are over, my next idea is to try buspirone with rasagiline possibly added. Buspirone, I believe, may be worth an extended try at slowly raising doses, as I believe depleting serotonin to bring back dopaminergic function may be what I need both for treating the permanent EPS I have, and for my mind and capacity to experience fully.
>
> There may be problems with this, I will list them:
>
> - I have tried buspirone, relatively low dose I think, at that time I did not notice much. I could have easily given up on it too early, as apparently buspirone is noted for taking a while even though it at acts directly at receptors. I plan to deal with this by maybe starting at 5mg q.i.d. (or 20mg daily) and leaving open the possibility to go as high as 60mg if neccessary, but with caution, which leads to the next problem...
>
> - Like nefazodone, it isn't very clean. Nefazodone has its possibly counterproductive (in my case) "weak" SRI effect, and the nebulous effects at 5-HT2c; Buspirone has it's very creepy D2 antagonism, and that alpha-2 blocking metabolite I don't know the significance of (i.e. how strong it is, I don't want a pro-attention deficit effect).
>
> - More on D2. Buspirone has several reported cases of dystonia in journals, including both acute cases and lasting cases. My clear EPS that seems to be akathisia and dystonia based, also with very unhelpful stiffness and frequent physical and mental block of initiation, are already very much a problem. Lorazepam works to some degree, I can do a bit more on it, and sometimes I can't do without it, but using it has taken it's toll, I have a tolerance and worsening symptoms.
>
> I do not need any more of this from buspirone hence my decision to choose q.i.d. dosing, which I am imagining will keep D2 occupancy the lowest given its short half life. BUT I HAVE NO IDEA IF THIS IS GOOD REASONING, OR IF IT MAY WEAKEN THE 5-HT1a effect, and contribute to a non-response.
>
> -Finally, buspirone, on google seems to list that use with an MAOI is strictly contraindicated, can me and my doctor just ignore this. Rasagiline is only an MAO-B inhibitor in any case, and I don't know what effect buspirone would have in concert with MAO-A blockade in any case. In my mind, harmful interaction, or a dangerous event, seems very unlikely, if not impossible though the typical pathways MAOI emergencies are known for. But still, I could be wrong, can anyone help me here?
>
> Any comments and advice would be greatly appreciated.
>
> Thanks.
>
> (and sorry this is long, I think this was nearly as short as i could make it.)
This is the end of the thread.
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