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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on April 9, 2010, at 12:56:04
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
Blueboy that is truly fastinating. I'm not bipolar remember last time took sudafed and was extremly anxious. I wonder why? Phillipa ps you practicing law now?
Posted by evenintherain on April 11, 2010, at 14:12:00
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
that's really interesting.
i have a friend who has bipolar (more mania than depression) and takes Pseudoephedrine for focus sometimes.
Do you just buy it from a regular drugstore? Do you think they will limit you/report you after a while (when i buy Pseudoephedrine in my state they keep it behind the counter and i need a photo i.d. They collect my contact info)?
Posted by bleauberry on April 12, 2010, at 17:50:12
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
Your report does not surprise me. I can relate. I felt the same kind of rapid improvement on Yohimbe, and then later on Milnacipran. The thing they both had in common...strong boost in norepinephrine. The norepinephrine thing alone can be misleading...why didn't TCAs work?...why not MAOIs?...why not stimulants?...I think the exact mechanism of the agent is just as important, if not more so, than what its end result is. For example, sudafed will immediately make more NE available at the synapse, but so will any NE drug. So why does one work and not the other? Obviously something more complicated going on that we don't understand. And why would not DLPA or tyrosine work, since they are making NE, but sudafed which is a direct replacement for NE does work? Ya know? Too complicated for mankind at this time in history.
I am a bit surprised the docs weren't more aware of the potency of NE in psychiatric disorders. The focus all seems to be on serotonin and secondarily dopamine. The so-called NE drugs like cymbalta and effexor are so misleading because they barely impact NE at all compared to what they do to serotonin.
Anyway, I'm real excited for you. You want to lose weight as well, which is an added bonus.
I would suspect the main problems going forward might be:
1. Keep an eye on blood pressure.
2. Might possibly need to take short drug holidays to prevent tolerance.
Posted by alchemy on April 15, 2010, at 19:19:47
In reply to Re: Pseudoephedrine (sudafed), posted by bleauberry on April 12, 2010, at 17:50:12
that is awesome. keep us posted.
Posted by Zzzz on August 20, 2010, at 12:54:34
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
> Hi all. I haven't posted in a long time. I've been miserable, suffering from depression, since I last posted.
>
> I have been diagnosed bipolar II and have a spectrum of other disorders such as social anxiety, agoraphobia, a touch of OCD. I have tried many dozens of drugs and was, as of two weeks ago, taking 4x50mg Zoloft, various amounts of Mirapex, and klonopin as needed.
>
> I got hay fever and took some Sudafed (2x30mg pseudoephedrine). The results were miraculous. My only side effects are insomnia, which is actually not as bad as it was on Mirapex at higher dosage; mild hypomania; and weight loss!
>
> My pdoc is actually a team in the Treatment-Resistant Depression department of Emory University. They were fascinated because the sudafed not only treated the chronic depression I have been experiencing, but radically lowered my agoraphobia and social anxiety!
>
> They also gave me an ADHD screening, which was positive, and we discussed the poorly-understood relationship between ADHD and bipolar disorder. Despite a very high IQ, I have had a checkered academic record. I did manage to graduate from an Ivy League college and a decent law school, but my grades were not very good and my LSAT (800) would have indicated a much more selective law school. I did have periodic good grades alternating with bad ones.
>
> The bottom line I wanted to share with you: My psychiatric team was fascinated at the phenomenon -- especially the reduction of anxiety -- and said that, as far as they were concerned, I could take pseudoephedrine for the rest of my life. Of course if I should develop high blood pressure (which is so far unaffected) or any sort of heart problems, or any dangerous degree of mania, we would have to re-evaluate. But from what I have read, pseudoephedrine is easier to tolerate than most stimulants prescribed for ADHD.
>
> I'm now tapering off the Zoloft, which was ineffective, and then will taper off the Mirapex if all is well. The idea being to see whether the effect was from the sudafed alone, or a combinatory effect with the sertraline. The Mirapex was effective but had a lot of side effects.
>
> I really hope this works out. I've put on a lot of weight, which is terrible for my heart and general health, partially due to the effects of various SSRI/MAOI/bipolar medications. The extra weight is pouring off and, even if there is some ill effect to my heart, I need to balance that against the ill effects of the obesity. I am also getting some significant exercise for the first time in over 10 years!
>
> One of my doctors, who is in research, might do a case study, since this is the first treatment in 45 years of bipolar misery that has really truly helped me. I am praying that it continues to be effective and doesn't have deleterious side effects that make me discontinue it.
>
> But anyway, I am taking 4x30mg pseudoephedrine daily (I weigh 255 pounds) with the blessing of a good psychiatric team, and so far it has been startlingly effective to treat on a wide range of mental problems, including Axis I diagnosis of bipolar II. I have been diagnosed bipolar II and have a spectrum of other disorders such as social anxiety, agoraphobia, a touch of OCD. I have tried many dozens of drugs and was, as of two weeks ago, taking 4x50mg Zoloft, various amounts of Mirapex, and klonopin as needed.
>
> I got hay fever and took some Sudafed (2x30mg pseudoephedrine). The results were miraculous. My only side effects are insomnia, which is actually not as bad as it was on Mirapex at higher dosage; mild hypomania; and weight loss!
>
> My pdoc is actually a team in the Treatment-Resistant Depression department of Emory University. They were fascinated because the sudafed not only treated the chronic depression I have been experiencing, but radically lowered my agoraphobia and social anxiety!
>
> They also gave me an ADHD screening, which was positive, and we discussed the poorly-understood relationship between ADHD and bipolar disorder. Despite a very high IQ, I have had a checkered academic record. I did manage to graduate from an Ivy League college and a decent law school, but my grades were not very good and my LSAT (800) would have indicated a much more selective law school. I did have periodic good grades alternating with bad ones.
>
> The bottom line I wanted to share with you: My psychiatric team was fascinated at the phenomenon -- especially the reduction of anxiety -- and said that, as far as they were concerned, I could take pseudoephedrine for the rest of my life. Of course if I should develop high blood pressure (which is so far unaffected) or any sort of heart problems, or any dangerous degree of mania, we would have to re-evaluate. But from what I have read, pseudoephedrine is easier to tolerate than most stimulants prescribed for ADHD.
>
> I'm now tapering off the Zoloft, which was ineffective, and then will taper off the Mirapex if all is well. The idea being to see whether the effect was from the sudafed alone, or a combinatory effect with the sertraline. The Mirapex was effective but had a lot of side effects.
>
> I really hope this works out. I've put on a lot of weight, which is terrible for my heart and general health, partially due to the effects of various SSRI/MAOI/bipolar medications. The extra weight is pouring off and, even if there is some ill effect to my heart, I need to balance that against the ill effects of the obesity. I am also getting some significant exercise for the first time in over 10 years!
>
> One of my doctors, who is in research, might do a case study, since this is the first treatment in 45 years of bipolar misery that has really truly helped me. I am praying that it continues to be effective and doesn't have deleterious side effects that make me discontinue it.
>
> But anyway, I am taking 4x30mg pseudoephedrine daily (I weigh 255 pounds) with the blessing of a good psychiatric team, and so far it has been startlingly effective to treat on a wide range of mental problems, including Axis I diagnosis of bipolar II.Hi, Hope the PSE is still working for you. Pseudoephedrine (PSE) is also used for narcolepsy which symptoms are caused by the loss of neurons in the hypothalamus that produce orexin. Hypothalamus deregulation of metabolic homeostasis can also be a symptom which is altered weight/calorie ratio. Very severe for some. PSE does correct this. However, normal metabolic people do not lose weight with the medication. I have been taking PSE daily for over 15 years. The only side effect is slight blood pressure increase and an adverse reaction to cheese. Cheese causes a delayed abrupt drop of blood pressure to 80/50. My thought on this is the effect on MAO inhibition which causes tyramine to be in excess and break down into octopamine which works as a false neurotransmitter.
I would like to see research in this area.
Posted by Zzzz on August 26, 2010, at 11:34:49
In reply to Re: Pseudoephedrine (sudafed) » blueboy, posted by Zzzz on August 20, 2010, at 12:54:34
This info is to give more ref to my previous post in part to pseudoephedrine and weight loss comments. . Pennington Biomedical Research Center, 1999 Jul7(4):370-8, Greenway F
Quote Pseudoephedrine was no different than placebo in inducing weight loss.
-----
Pseudoephedrine corrects a weight/calorie ratio imbalance only in specific cases. Pertaining to when the body stores food intake as fat while depriving other body energy nutrition needs. Weight gain is in excess of caloric intake.
Posted by Zzzz on August 27, 2010, at 2:19:41
In reply to Re: Pseudoephedrine (sudafed), posted by bleauberry on April 12, 2010, at 17:50:12
Steady state dose, daily use is not the same effect.No tolerance develops with PSE. Time release is better and urine ph can deplete or cause overdose in diets that cause strong acid or alkaline urine.
Other drugs may compete such as antihistamine may knock out the weight/calorie control. The weight loss could be studied in ataxin-3 narcolepsy syndrome mice with hypophagia and obesity. PSE is a NET substrate. It could be tested to see if it is direct and or indirect for norepinephrine by using dopamine beta hydroxylase knock out mice that can not produce norepinephrine. Ephedrine has been proven to be a direct acting drug in this manner.
Sometimes the effect of a drug is due to the balance or ratio of that chemical to the others. More is not always better. PSE may also have MAOI depending upon dose and other factors.
Low dose Beta Blockers will work with PSE. Always double check all the meds taken together at one time for interactions. PSE does not use liver CYP isoenzymes which is a relief.
Hope this helps answer a few questions. PSE also has an L-PSE which does not effect blood pressure. I have tried to suggest the market of the L-PSE but the company was not interested. It would also be good because it makes L-methamphetamine which has poor stimulant strength compared to the D-PSE which is the over counter we use now.
Posted by highhatsize on August 27, 2010, at 13:01:06
In reply to Re: Pseudoephedrine (sudafed) » bleauberry, posted by Zzzz on August 27, 2010, at 2:19:41
I have lifelong unipolar depression. Serendipitously, I discovered that an antihistamine (Benedryl/diphenhydramine) combined with my antidepressant (Lexapro) enabled me to remain in good cheer at a substantially reduced dose of Lexapro, (1/4 of a .25 mil tab as opposed to 1.0 mil.)
The SSRI family of anti-depressants grew out of research into antihistamines. I have since found that another OTC antihistamine (Chlor Trimeton, chlorpheniramine) has an even more pronounced anti-depressant effect and is available online for 1000 tabs/$4. Not that I intend to switch.
My current dosage of Lexapro and Benadryl has NO sexual side effects. I am now heterosexual RAMPANT! (Okay, maybe that's just heterosexual normal, but it feels like rampant by comparison.)
Posted by Zzzz on August 27, 2010, at 18:23:13
In reply to Re: Pseudoephedrine (sudafed), posted by highhatsize on August 27, 2010, at 13:01:06
You are having LIVER isoenzyme drug drug intereactions.
Cytochrome P450 interaction of CYP 2D6 CYP 3A4. Try web site psy.psychiatryonline.org
Antihistamine drug drug interactions By Armstrom and Cozza
Lexapro CYP2C19 CYP2D6 CYP3A4
Benadryl CYP2D6 80percent CYP3A4 10percent
Posted by highhatsize on August 30, 2010, at 20:47:08
In reply to Re: Pseudoephedrine (sudafed) » highhatsize, posted by Zzzz on August 27, 2010, at 18:23:13
Dear Zzzz,
I read the references that you posted but they didn't answer my paramount question. Is this drug regimen bad? Is there any reason for me to stop taking Lexapro w/ diphenhydramine even though I am having isoenzyme liver drug drug reactions?
Perhaps the answer is in the references but I am not a biochemist and I note that you said earlier that you were taking pseudophedrine for over fifteen years.
I am not concerned about any effect that it might have on my weight. I'm taking it strictly as an antidepressant.
Thanks.
- highhatsize
Posted by Zzzz on August 30, 2010, at 23:36:28
In reply to Re: Pseudoephedrine (sudafed) » Zzzz, posted by highhatsize on August 30, 2010, at 20:47:08
I am glad you read the post. Your pharmacy needs to know of the combination of drugs. Please check with them before you even add one more over-the-counter or prescription drug. They will tell you about the cytochrome P450 for the drug and if it will cross react.
Let me make up a story to explain better. If you were the only customer in a store and somebody yelled fire you could run right out the open exit with no trouble. If you were a customer and there was only standing room because the store was filled with people....Then someone yelled fire. That one exit is going to take a long time to run through.
The reason you get the same effect with a reduced dose is because the drugs that you are using must exit through the same pathway. They can not get out of your body as fast and stay at a higher dose longer.
The danger is if you are given another drug on top of those drugs that requires that same exit pathway. Then a toxic overdose may happen. Please, please check the drugs before adding anything else.
Doctors do sometimes select drugs on purpose that enhance the dosage of each other.However, extreme care needs to be taken before adding any drug, vit., herbs or even grapefruit juice. Some drugs cause more problems than others. Some antihistamines had to be taken off the market.
Hope this helps explain it better?
Posted by Zzzz on August 31, 2010, at 16:16:27
In reply to Re: Pseudoephedrine (sudafed) » highhatsize, posted by Zzzz on August 30, 2010, at 23:36:28
Dear Highhatsize,
Goggle the name of your medication along with CYP450 Websites will pop up that tell you what drugs will interact. Such a website may be Drugs.com.
Also, pseudoephedrine is a NET substrate not a antihistamine. It does not use the CYP450 isoenzyme system. It has minor interaction with MAO.
The reason I would never use Providgil which is Modafinil is that there are 1506 brand and generic drugs known to interact with it according to Drugs.com. Then providgil is combined with an antidepressant. Those drugs have multiple drug-drug interactions also. The older the person the more likely additional medication will be used such as blood pressure, diabetic meds and so forth. It can become a nightmare of trouble.
Posted by Gup on April 22, 2011, at 16:49:50
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
> I got hay fever and took some Sudafed (2x30mg pseudoephedrine). The results were miraculous. My only side effects are insomnia, which is actually not as bad as it was on Mirapex at higher dosage; mild hypomania; and weight loss!
I discovered a similar effect, and found this thread while trying to research just exactly what was going on. I have unipolar major depression, and discovered that 1x 120mg time-release Pseudoephedrine gave me a substantial boost in mood and focus, as well as reduction in anxiety (which I did not expect from a sympathomimetic such as pseudoephedrine).
I've tried skipping a few days at a time, and there is definitely a difference when I take it. While it is possible a placebo effect is in play, I have failed trials on many other anti-depressants, and the effect of the pseudoephedrine is pretty dramatic.
After playing around with dosage time a bit, I now take it at night just before bedtime (doesn't seem to disrupt my sleep, and it's possible I may be sleeping better, actually).
Thus far, I only have a few weeks of experience with PE. I'm not sure if the best tactic will be to occasionally skip doses (if it builds tolerance), or to take it daily (if it works best with consistent use, like many anti-depressants).
Blueboy, if you happen to see this post -- any chance you'd be willing to point me in the direction of the Emory researchers? I would be interested to know if they have any information on what may be going on (or to offer any information that could further their research).
Posted by creepy on April 26, 2011, at 13:49:42
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on April 22, 2011, at 16:49:50
Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
Posted by mtdewcmu on April 30, 2011, at 12:43:28
In reply to Re: Pseudoephedrine (sudafed), posted by creepy on April 26, 2011, at 13:49:42
> Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.
Posted by mtdewcmu on April 30, 2011, at 13:21:36
In reply to Pseudoephedrine (sudafed), posted by blueboy on April 9, 2010, at 9:52:55
> But anyway, I am taking 4x30mg pseudoephedrine daily (I weigh 255 pounds) with the blessing of a good psychiatric team, and so far it has been startlingly effective to treat on a wide range of mental problems, including Axis I diagnosis of bipolar II.
This is an old zombie-thread, but I would be curious to know if the benefits were sustained. It's not hard to believe that PSE would have an up-front benefit, but I would be surprised if it lasted. In college I noticed that it was somewhat easier to get my homework done if I took some pseudoephedrine. The benefit was not very robust.
Pseudoephedrine (PE) has an identical structure to methamphetamine with the addition of a hydroxyl group. The effect of the hydroxyl group is to make the molecule more hydrophilic, and therefore less of it can cross the blood-brain barrier. If you eliminate the hydroxyl by reduction, you get methamphetamine (MA). If you eliminate the hydroxyl by oxidation, you get methcathinone (MC), which is a potent CNS stimulant similar to MA. Again, the reason MC is a more potent CNS stimulant than PE is that MC is less hydrophilic due to less opportunity to form hydrogen bonds. To the extent that some small amount of PE crosses the blood-brain barrier and gets into the CNS, it probably has effects very similar to MA. The only thing preventing PE from being as potent a stimulant as MA is its relative inability to get into the CNS. So, when looking at psychoactive effects, it makes sense to think of pseudoephedrine as being a very weak methamphetamine, with dosages being limited by its tendency to cause peripheral stimulant effects that become dangerous well before the CNS effects become intense.
So, I don't think pseudoephedrine is something new to psychiatry. I think a propensity to respond to PE is probably an indicator that you would do well if given amphetamines. (Meth)amphetamine has a long-established place in psychiatry, and it is an all-around cleaner stimulant than pseudoephedrine, with a greater degree of headroom to play with dose.
Posted by desolationrower on April 30, 2011, at 18:28:08
In reply to Sudafed: A weak amphetamine, posted by mtdewcmu on April 30, 2011, at 13:21:36
yeah, thats about right.
The reason we use pseudoephedrine is because the thing we used ot use for congestion, amphetamine, has strong effects on the CNS so it got restricted. (and interestingly, ephedrine/cathionine was the orignial allergy medication, since they are in ephedra/khat. and people could eat plants a long time before they could synth drugs.) so back the the future, i guess.
-d/r
Posted by mtdewcmu on April 30, 2011, at 19:39:12
In reply to Re: Sudafed: A weak amphetamine, posted by desolationrower on April 30, 2011, at 18:28:08
It would be strange if you got a cold and were given Dexedrine or Adderall for it. I think switching to pseudoephedrine was progress, since most people don't want to feel that high just to unclog their noses.
One thing I have not figured out is why pseudoephedrine became the standard for congestion and not ephedrine. Is there a pharmacological reason?
Posted by Gup on May 2, 2011, at 15:32:11
In reply to Re: Pseudoephedrine (sudafed), posted by creepy on April 26, 2011, at 13:49:42
>Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
Will do. Also, any opinion on the related tricyclic Imipramine?
Posted by desolationrower on May 2, 2011, at 18:15:57
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on May 2, 2011, at 15:32:11
> >Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
>
> Will do. Also, any opinion on the related tricyclic Imipramine?its a dirtier drug
-d/r
Posted by Gup on May 3, 2011, at 18:24:47
In reply to Re: Pseudoephedrine (sudafed), posted by desolationrower on May 2, 2011, at 18:15:57
Ok, thanks for the update. Any opinion on Protriptyline as well? I see it's listed as causing more psychomotor stimulation than other TCAs.
Posted by desolationrower on May 3, 2011, at 21:09:51
In reply to Re: Pseudoephedrine (sudafed), posted by Gup on May 3, 2011, at 18:24:47
> Ok, thanks for the update. Any opinion on Protriptyline as well? I see it's listed as causing more psychomotor stimulation than other TCAs.
>
>Its hard to get information on it (nothing on the kidb, but TCA page on wiki does have values), but if i recall correctly it works similarly as other secondary amine tcas (i would geuess more stimulation is a combination of less sedation from the mach, antihist, sri, etc effects that tcas like imipramine or amytryptaline have, plus you can/need to push the nri harder to get full depression relief.) It is not one of the genotoxic TCAs (http://www.ncbi.nlm.nih.gov/pubmed/1902910), so i guess that might be a reason to choose it vs desipramine.
-d/r
Posted by deepreason on May 7, 2011, at 9:31:41
In reply to Re: Pseudoephedrine (sudafed) » creepy, posted by mtdewcmu on April 30, 2011, at 12:43:28
> > Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> > Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
>
> That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.My mother suffers from chronic sinus pain, back pain and allergies. Her doctor previously tried her on Amitryptaline but no luck.
As far as I can see Desipramine / Norpramin / Pertofane don't exist in the UK. I can't find them in the BNF (British national formulary) prescribing guide. Can anyone recommend what would be the next closest relation drug wise that might work on sinus pain, back pain and allergies?
Posted by mtdewcmu on May 7, 2011, at 10:02:42
In reply to Re: Pseudoephedrine (sudafed) » mtdewcmu, posted by deepreason on May 7, 2011, at 9:31:41
> > > Id look into desipramine. The NRI effects did wonders for my chronic sinus congestion. The antihistamine effects helped with allergies too.
> > > Not usually a strong antidepressant, but a good pain reliever with some added bonuses if you have allergies.
> >
> > That's an interesting way to use desipramine. Maybe it should be the new gold standard for chronic allergies.
>
> My mother suffers from chronic sinus pain, back pain and allergies. Her doctor previously tried her on Amitryptaline but no luck.
>
> As far as I can see Desipramine / Norpramin / Pertofane don't exist in the UK. I can't find them in the BNF (British national formulary) prescribing guide. Can anyone recommend what would be the next closest relation drug wise that might work on sinus pain, back pain and allergies?
>I haven't heard of doctors deliberately prescribing antidepressants for their side benefits on allergies and sinus problems. I have heard of doxepin seeing some use as an antihistamine, but that's it. For sinus problems, topical drugs are typically the most potent. Nasal steroids like Flonase (or equivalent generics) are worth a try, and oxymetazoline nose spray (Afrin) is a very strong decongestant. There is also NasalCrom, which is ok if she can't tolerate steroids, and Astelin and Patanase, which are antihistamines. If she has itchy eyes, I use Opticrom, which I actually have to order from the UK, or there are other effective eye drops by prescription.
As far as systemic drugs, as far as I know, there is nothing stronger than pseudoephedrine as a decongestant. For antihistamines, there are the non-drowsy ones, Zyrtec, Allegra, and Claritin, and if those fail, I think most doctors would recommend diphenhydramine (Benadryl) next if she can tolerate it. There are a bunch of prescription antihistamines, but I don't know that they work any better. I guess doxepin may make the list, as I think it's one of the most potent antihistamines known.
Has your mother seen an allergy specialist?
Posted by mtdewcmu on May 7, 2011, at 10:38:59
In reply to Re: Pseudoephedrine (sudafed) » mtdewcmu, posted by deepreason on May 7, 2011, at 9:31:41
Another drug that may have benefit in allergy treatment is montelukast (Singulair). It's not one that I've ever come across, but apparently it can be added to an antihistamine for extra help.
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