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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 michael45 on April 12, 2009, at 11:05:09
ive figured it out every ssri/srni/and antipsychs and even some others all cause increased akathisia for me
benzos + plus inderal barely take the edgee off akathisia but worsen depression
its like a circle i cant get out of :[
any powerful AD that can help treat both? or at least target depression w/o worsening tension from akathisia
im so losttttttt and imma try this thing called neurontin in a few days, but dont know if will do anything
ughhhhh:[[[[[[[[[[[[[[[
Posted by SLS on April 12, 2009, at 11:22:23
In reply to akathisia + depression is impossible to treat :[, posted by michael45 on April 12, 2009, at 11:05:09
> ive figured it out every ssri/srni/and antipsychs and even some others all cause increased akathisia for me
How about a tricyclic?
- Scott
Posted by michael45 on April 12, 2009, at 11:31:34
In reply to Re: akathisia + depression is impossible to treat :[, posted by SLS on April 12, 2009, at 11:22:23
ive heard that there about the same as ssri just not as selective...you im guessing that would induce more tension/akathisia...but i'll just ask my docotr i guess:/
thanks though
Posted by SLS on April 12, 2009, at 11:46:36
In reply to Re: akathisia + depression is impossible to treat :[ » SLS, posted by michael45 on April 12, 2009, at 11:31:34
> ive heard that there about the same as ssri just not as selective...you im guessing that would induce more tension/akathisia...but i'll just ask my docotr i guess:/
>
> thanks though
I would say that TCAs are much different than SSRIs. The only real serotonergic TCA that might reproduce your akathisia symptoms would be clomipramine (Anafranil). Desipramine has no serotonergic activity at all.
- Scott
Posted by Phillipa on April 12, 2009, at 12:05:16
In reply to Re: akathisia + depression is impossible to treat :[ » michael45, posted by SLS on April 12, 2009, at 11:46:36
Seriously from others have heard that anafranil is full of side effects great for horrible OCD but how would it help akathesia? I really don't know? Phillipa
Posted by michael45 on April 12, 2009, at 19:01:20
In reply to Re: akathisia + depression is impossible to treat :[ » michael45, posted by SLS on April 12, 2009, at 11:46:36
wait im confused, so which TCA that you mentioned above are you saying that would be better for a person with some akathisia?
Posted by michael45 on April 12, 2009, at 19:01:43
In reply to Re: akathisia + depression is impossible to treat :[ » SLS, posted by Phillipa on April 12, 2009, at 12:05:16
who knows:[
Posted by sowhysosad on April 12, 2009, at 19:56:42
In reply to Re: akathisia + depression is impossible to treat :[ » SLS, posted by Phillipa on April 12, 2009, at 12:05:16
Here's a thought: one theory is that akathisia is caused by high levels of serotonin over-stimulating the 5HT2A/C receptors...
So how about trying an SSRI/SNRI + mirtazapine (Remeron) combo? Mirtazapine is an antagonist for those two receptors.
California Rocket Fuel (Effexor + Mirtazapine) maybe?
Posted by SLS on April 12, 2009, at 20:55:22
In reply to Re: akathisia + depression is impossible to treat :[ » SLS, posted by michael45 on April 12, 2009, at 19:01:20
> wait im confused, so which TCA that you mentioned above are you saying that would be better for a person with some akathisia?
If you are sure that serotonin reuptake inhibition is causing your akathisia, then desipramine would be an alternative because it doesn't inhibit serotonin reuptake. It is a very selective norepinephrine reuptake inhibitor.
- Scott
Posted by michael45 on April 12, 2009, at 22:28:55
In reply to Re: akathisia + depression is impossible to treat, posted by sowhysosad on April 12, 2009, at 19:56:42
okay so i know like the name of every AD and AP and maoi ans tca and so on... lol
but i dont really know what they chemically doso by antagonist, you mean remeron does what?
..i mean how is it different from the other 'normal' ssri ADs?
Posted by Zana on April 13, 2009, at 11:38:25
In reply to Re: akathisia + depression is impossible to treat, posted by sowhysosad on April 12, 2009, at 19:56:42
I take mirtazipine for sleep but it doesn't seem to have any AD effect at all. What's the story with it? I have no idea what it is supposed to be doing other than knocking me out at night.
Zana
Posted by bleauberry on April 13, 2009, at 17:04:42
In reply to akathisia + depression is impossible to treat :[, posted by michael45 on April 12, 2009, at 11:05:09
For something really different, you could wait till the end of May and get Savella (Milnacipran). It is new in USA, but has a long track record in the rest of the world as a good one. It is a reuptake inhibitor, 2 parts norepinephrine to 1 part serotonin. I believe that ratio could prevent serotonin induced akathisia, as it would be balanced strongly from the other side. It is kind of like a tricyclic, except without the anticholinergic and other TCA side effects.
Posted by sowhysosad on April 13, 2009, at 18:27:55
In reply to Re: akathisia + depression is impossible to treat, posted by Zana on April 13, 2009, at 11:38:25
> I take mirtazipine for sleep but it doesn't seem to have any AD effect at all. What's the story with it? I have no idea what it is supposed to be doing other than knocking me out at night.
>
> ZanaIt's one of the most powerful antihistamines on the planet, which is why it makes you drowsy and hungry.
It also blocks alpha-2 receptors which would normally prevent the release of norepinephrine and serotonin, thus allowing more serotonin and norepinephrine to be released.
However, there's some debate over the validity of the claims regarding serotonin release:
http://www.psychotropical.com/9_st_mirt.shtml
Another, unrelated effect of mirtazapine is blocking certain serotonin receptors which are associated with anxiety. That might explain why some people find it a good add-on for SSRI's, which can increase anxiety by over-stimulating those receptors. Plus, the night-time sedation might counteract insomnia from SSRI's too.
Posted by sowhysosad on April 13, 2009, at 18:33:16
In reply to Re: akathisia + depression is impossible to treat » sowhysosad, posted by michael45 on April 12, 2009, at 22:28:55
> okay so i know like the name of every AD and AP and maoi ans tca and so on... lol
> but i dont really know what they chemically do
>
> so by antagonist, you mean remeron does what?
> ..i mean how is it different from the other 'normal' ssri ADs?The Remeron "blocks" the serotonin receptors that can cause anxiety and akathisia, so it might prevent them from getting "over-stimulated" by the serotonin boost from the SSRI/SNRI.
And the sedation might help a little too.
Posted by sowhysosad on April 13, 2009, at 18:47:05
In reply to Re: akathisia + depression is impossible to treat :[, posted by bleauberry on April 13, 2009, at 17:04:42
> For something really different, you could wait till the end of May and get Savella (Milnacipran). It is new in USA, but has a long track record in the rest of the world as a good one. It is a reuptake inhibitor, 2 parts norepinephrine to 1 part serotonin. I believe that ratio could prevent serotonin induced akathisia, as it would be balanced strongly from the other side. It is kind of like a tricyclic, except without the anticholinergic and other TCA side effects.
Its serotonin reuptake inhibition is much weaker than all the other SSRI's and SNRI's too so it should have a much gentler effect on the 5HT2A/C receptors, assuming that's where the akathisia is coming from.
Posted by Phillipa on April 13, 2009, at 19:15:15
In reply to Re: akathisia + depression is impossible to treat, posted by sowhysosad on April 13, 2009, at 18:47:05
You guys your knowledge is awesome but a lot of new posters. Is there a way to say in simple words what these meds are supposed to do. If so I think a lot of the others would be grateful. Love Phillipa
Posted by michael45 on April 13, 2009, at 21:37:39
In reply to Re: akathisia + depression is impossible to treat, posted by sowhysosad on April 13, 2009, at 18:33:16
ha okay thanks now thats its in lamens terms its much easier to understand:]
thankyou
Posted by michael45 on April 13, 2009, at 21:39:41
In reply to Re: akathisia + depression is impossible to treat :[, posted by bleauberry on April 13, 2009, at 17:04:42
hmm i have a random question to ask
..would a drug like nardil make akathisia worse on average?..i mean each person works differently.......but i here it relaxes you alot, but then gives you insomia too...so would that mean it would make akathisia worse?
just your opinion??
thanks
Posted by yxibow on April 13, 2009, at 23:25:12
In reply to akathisia + depression is impossible to treat :[, posted by michael45 on April 12, 2009, at 11:05:09
> ive figured it out every ssri/srni/and antipsychs and even some others all cause increased akathisia for me
>
> benzos + plus inderal barely take the edgee off akathisia but worsen depression
>
> its like a circle i cant get out of :[
>
> any powerful AD that can help treat both? or at least target depression w/o worsening tension from akathisia
>
> im so losttttttt and imma try this thing called neurontin in a few days, but dont know if will do anythingYou may be one of those people very sensitive to things that reduce dopamine (and SSRIs can downregulate dopamine, which is experimentally a wanted effect but not typically) -- I know I am sensitive to neuroleptics. Seroquel is about the only thing I can take.
Neurontin may help some people who are benzodiazepine naive (not regular takers)Have you ever tried Artane to see if it helps the akathisia and sorts out what exactly is going on, because that sounds like a rather enormous amount of medications to go through?
I'm not blaming you at all, but did you give them more than a week or two because sometimes this effect may go away for you.
Propranolol can also sometimes block some of it but too much for -some- people may cause depression (above or around 80mg give or take).
What about Lamictal which isn't technically an antidepressant but is considered to have antidepressant activity by psychiatrists ?-- Jay
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