Psycho-Babble Medication Thread 1019496

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Re: Memantine for Depression - How long to wait? » SLS

Posted by g_g_g_unit on June 12, 2012, at 8:58:57

In reply to Memantine for Depression - How long to wait?, posted by SLS on June 9, 2012, at 0:46:21

I don't know, but I do know it takes at least a week to achieve a stable blood level. Plus, most people titrate up from 5mg, so you might need to hold out longer for unpleasant sfx. (dissociation etc.) to pass.

How's it going so far?

 

Re: Memantine for Depression - How long to wait? » g_g_g_unit

Posted by SLS on June 12, 2012, at 14:12:02

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by g_g_g_unit on June 12, 2012, at 8:58:57

> I don't know, but I do know it takes at least a week to achieve a stable blood level. Plus, most people titrate up from 5mg, so you might need to hold out longer for unpleasant sfx. (dissociation etc.) to pass.

That is incredibly useful information. Thank you.

> How's it going so far?

Well, because of cognitive side effects, I had to discontinue the memantine so that I could re-titrate the prazosin. I was taking too much. My head has cleared for having lowered the dosage to 6 mg. I will wait another week or so before restarting the memantine so as to give me enough time to establish the optimum dosage of prazosin. As per your advice, I will start the memantine at a lower dosage.

I do hope that you are feeling better. It can be an extremely frustrating and often demoralizing odyssey to search for effective treatments. I hope you find one soon.

Thanks again.

:-)


- Scott

 

Re: Memantine for Depression - How long to wait? » SLS

Posted by g_g_g_unit on June 13, 2012, at 4:43:46

In reply to Re: Memantine for Depression - How long to wait? » g_g_g_unit, posted by SLS on June 12, 2012, at 14:12:02

> > I don't know, but I do know it takes at least a week to achieve a stable blood level. Plus, most people titrate up from 5mg, so you might need to hold out longer for unpleasant sfx. (dissociation etc.) to pass.
>
> That is incredibly useful information. Thank you.
>

Don't sweat it.

> > How's it going so far?
>
> Well, because of cognitive side effects, I had to discontinue the memantine so that I could re-titrate the prazosin. I was taking too much. My head has cleared for having lowered the dosage to 6 mg. I will wait another week or so before restarting the memantine so as to give me enough time to establish the optimum dosage of prazosin. As per your advice, I will start the memantine at a lower dosage.

Yeah, are you taking Memantine without your doctor's guidance? I think the typical schedule for Alzheimer's is 5mg week 1, then 10mg week 2, then 10mg + 5mg week 3, then 10mg + 10mg week 4.

Did you plan on taking the 20mg all at once? Because I also understand that in order to keep blood levels stable (and hence, reap optimum benefits), you should be quite strict about dosing 10mg + 10mg exactly 12 hours apart.
>


 

Re: Memantine for Depression - How long to wait? » g_g_g_unit

Posted by SLS on June 13, 2012, at 5:57:14

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by g_g_g_unit on June 13, 2012, at 4:43:46

> Yeah, are you taking Memantine without your doctor's guidance?

I guess you could say that. He knows that I will be taking memantine, but we didn't go over a titration schedule this time. I had taken it once before, and it helped a bit. However, I believe I used a starter pack to initiate treatment.

> I think the typical schedule for Alzheimer's is 5mg week 1, then 10mg week 2, then 10mg + 5mg week 3, then 10mg + 10mg week 4.

Okee dokee...

:-)

> Did you plan on taking the 20mg all at once? Because I also understand that in order to keep blood levels stable (and hence, reap optimum benefits), you should be quite strict about dosing 10mg + 10mg exactly 12 hours apart.

Okee dokee...

:-)

I will probably start memantine treatment next week. I am trying to accelerate my rate of recovery. It is too slow for my tastes. If that does not work, I am to try Topamax again at 100 mg, a drug that also helped me to some degree. I will titrate Topamax more slowly than the starter pack provides for. I start at 25 mg/day and move up by 25 mg every week. Following this schedule in the past has obviated any cognitive or memory impairments. If that doesn't work, I will then pursue ketamine and rTMS. If I cannot trigger a more rapid antidepressant response using any of these treatments, then I will simply sit back and settle for the snail's pace of improvement that I currently enjoy. Perhaps that is the most I can expect in my case, regardless of treatment. I am, of course, grateful for what I do have.

Thanks again.


- Scott

 

Re: Memantine for Depression - How long to wait? » SLS

Posted by phidippus on June 19, 2012, at 17:30:49

In reply to Memantine for Depression - How long to wait?, posted by SLS on June 9, 2012, at 0:46:21

I've experienced positive effects within a week.

Eric

 

Re: Memantine for Depression - How long to wait? » phidippus

Posted by SLS on June 19, 2012, at 20:06:03

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by phidippus on June 19, 2012, at 17:30:49

> I've experienced positive effects within a week.
>
> Eric

Thanks, Eric.

What dosage did you start at?


- Scott

 

Re: Memantine for Depression - How long to wait?

Posted by SLS on June 21, 2012, at 10:07:54

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by phidippus on June 19, 2012, at 17:30:49

I was disappointed to see this:

http://www.ncbi.nlm.nih.gov/pubmed/22329473


- Scott

-----------------------------------------

Bipolar Disord. 2012 Feb;14(1):64-70. doi: 10.1111/j.1399-5618.2011.00971.x.
Early antidepressant effect of memantine during augmentation of lamotrigine inadequate response in bipolar depression: a double-blind, randomized, placebo-controlled trial.
Anand A, Gunn AD, Barkay G, Karne HS, Nurnberger JI, Mathew SJ, Ghosh S.
Source

Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA. aanand@iupui.edu
Abstract
BACKGROUND:

Recent studies indicate that modulation of glutamate neurotransmission is associated with antidepressant response. Lamotrigine, an anticonvulsant which decreases presynaptic glutamate release, has been shown to be effective in the depressive phase of bipolar disorder (BD-D); however, only 40-50% of patients have a full response. This pilot study investigated whether memantine, a low-affinity N-methyl-D-aspartate (NMDA) receptor antagonist approved for Alzheimer's disease, can augment the effects of lamotrigine.
METHODS:

BD-D outpatients in a major depressive episode on a stable dose of lamotrigine (100 mg or more) were randomized to either memantine (starting dose of 5 mg increased up to 20 mg over four weeks, then 20 mg stable dose from four to eight weeks) or matching pill placebo for eight weeks. Patients were rated on the 17-item Hamilton Depression Rating Scale (HDRS) and other behavioral measures weekly.
RESULTS:

The eight-week repeated-measures mixed-effect model for HDRS was not significant for memantine (n = 14) versus placebo (n = 15). Exploratory mixed-effect analyses for the first four weeks, while the memantine dose was being titrated up every week, revealed a significant decrease in HDRS scores from baseline (p = 0.007).
CONCLUSION:

This proof-of-concept study failed to show a statistically significant benefit of memantine augmentation of lamotrigine for patients with BD-D over eight weeks. However, memantine had an antidepressant effect early on in the treatment while its dose was being titrated up. Larger placebo-controlled studies are needed to ascertain optimal timing and dosing for memantine augmentation of lamotrigine in BD-D.

© 2012 John Wiley and Sons A/S.

PMID:
22329473
[PubMed - indexed for MEDLINE]

 

Re: Memantine for Depression - How long to wait?

Posted by sk85 on June 23, 2012, at 4:21:06

In reply to Re: Memantine for Depression - How long to wait?, posted by SLS on June 21, 2012, at 10:07:54

I didn't find memantine very helpful for depression, but then again my issue is mostly related to unipolar depression and most antidepressant effective for bipolar make me more "down" than "up". And I really hate memantine's effect on dopamine D2 receptor.

-Ikaros

 

Re: Memantine for Depression - How long to wait? » sk85

Posted by SLS on June 23, 2012, at 5:41:49

In reply to Re: Memantine for Depression - How long to wait?, posted by sk85 on June 23, 2012, at 4:21:06

> I didn't find memantine very helpful for depression, but then again my issue is mostly related to unipolar depression and most antidepressant effective for bipolar make me more "down" than "up". And I really hate memantine's effect on dopamine D2 receptor.
>
> -Ikaros


Thanks for the feedback.

How are you doing currently? What treatments have you had the most success with?


- Scott

 

Re: Memantine for Depression - How long to wait? » sk85

Posted by g_g_g_unit on June 23, 2012, at 7:19:37

In reply to Re: Memantine for Depression - How long to wait?, posted by sk85 on June 23, 2012, at 4:21:06

>And I really hate memantine's effect on dopamine D2 receptor.
>

What can you specifically attribute to its effect on the D2 receptor?

 

Re: Memantine for Depression - How long to wait?

Posted by sk85 on June 23, 2012, at 11:38:25

In reply to Re: Memantine for Depression - How long to wait? » sk85, posted by SLS on June 23, 2012, at 5:41:49

I'm doing OK at the moment. Because I have EPS (dystonia) from the SSRIs my medication choice is very limited. I'm taking imipramine at the moment which doesn't aggravate any of my EPS symptoms, but adding in clomipramine would definately improve it, as it worked wonders in the past, but eventually quit it because of other side-effects. I'm devising a plan to get back on it to find the optimal balance between benefit and side-effects.
The most success in regard to mood I've had with, again, clomipramine, but not in the lower dosage range however. And I remeber feeling very good on Effexor just before it also started triggering dystonia.
I'm not advocating illegal treatments here, but as I can notice ketamine is getting a lot of praise here, have you ever considered experimenting with psilocybin. I've heard it having a very good after-effects in regard to bipolar depression. My own experience with it is mixed however. I tried it because there are number of anecdotal reports on Pubmed that it significantly alleviates OCD, which it did mostly, but it also had a bit uncomfortable mood flattening effect afterwards which I found not so great, but I would imagine it would actually work out really well for someone with bipolar issues, especially regarding (hypo)manic states. Any psilocybin use should be done in a safe and peaceful environment. It also a has studies backing up its antidepressant properties, but it is certainly a controversial and complicated substance to work around.

-Ikaros

 

Re: Memantine for Depression - How long to wait?

Posted by sk85 on June 23, 2012, at 17:18:46

In reply to Re: Memantine for Depression - How long to wait? » sk85, posted by g_g_g_unit on June 23, 2012, at 7:19:37

> >And I really hate memantine's effect on dopamine D2 receptor.
> >
>
> What can you specifically attribute to its effect on the D2 receptor?
>

Aggravation and triggering of movement disorders. Also, for some people like me D2 agonism seems to be prodepressant rather than antidepressant. But yes there are apparently others that find it antidepressant.

 

Re: Memantine for Depression - How long to wait? » g_g_g_unit

Posted by phidippus on June 25, 2012, at 16:28:14

In reply to Re: Memantine for Depression - How long to wait? » sk85, posted by g_g_g_unit on June 23, 2012, at 7:19:37

Its a D2 Agonist.

Eric

 

Re: Memantine for Depression - How long to wait? » SLS

Posted by phidippus on June 25, 2012, at 16:33:39

In reply to Re: Memantine for Depression - How long to wait?, posted by SLS on June 21, 2012, at 10:07:54

I'm telling you Scott, try Buprenorphine. It works extremely well for depression.

Eric

 

Re: Memantine for Depression - How long to wait? » SLS

Posted by phidippus on June 25, 2012, at 16:41:31

In reply to Re: Memantine for Depression - How long to wait? » phidippus, posted by SLS on June 19, 2012, at 20:06:03

Started at 20 mg (10 in the morning, ten at night) Eventually tapered up to 40 mg (20 twice a day). Is this your first time on it?

Eric

 

my exp is waiting is only relevant to s/e's » SLS

Posted by iforgotmypassword on June 26, 2012, at 1:20:30

In reply to Re: Memantine for Depression - How long to wait? » sk85, posted by SLS on June 23, 2012, at 5:41:49

we may not be after the same mechanism tho. but, given the mention of parnate i think i saw before... it would work well with it and it's metabolites i think, and having mao-b smushed might help allay some worry about the oxidative potential of DA.

an odd thing is my experience is that lamotrigine helps fight side effect with memantine increases. i think this is because memantine redirects glutamate to other receptors (AMPA, kainate..).

 

Re: my exp is waiting is only relevant to s/e's » iforgotmypassword

Posted by SLS on June 26, 2012, at 5:42:28

In reply to my exp is waiting is only relevant to s/e's » SLS, posted by iforgotmypassword on June 26, 2012, at 1:20:30

> we may not be after the same mechanism tho. but, given the mention of parnate i think i saw before... it would work well with it and it's metabolites i think, and having mao-b smushed might help allay some worry about the oxidative potential of DA.

> an odd thing is my experience is that lamotrigine helps fight side effect with memantine increases. i think this is because memantine redirects glutamate to other receptors (AMPA, kainate..).

Wow. You really know your stuff. There is a secondary effect of memantine on AMPA and kainate receptors via NMDA receptors, but it is complex, and I don't understand it.

When I began memantine treatment at 20 mg, I immediately developed cognitive blunting. My doctor asked that I try Topamax instead at this juncture. If Topamax does not yield results, I might retry memantine, but starting at 5 mg.

Thanks for your input.


- Scott

 

Re: Memantine for Depression - How long to wait? » phidippus

Posted by SLS on June 26, 2012, at 5:51:26

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by phidippus on June 25, 2012, at 16:33:39

> I'm telling you Scott, try Buprenorphine. It works extremely well for depression.

I have brought up the subject of my trying buprenorphine with my doctor twice in the past. He seems unwilling to prescribe it. Perhaps I can get some feedback from one of the Harvard / Massachusetts General doctors.

What kind of dosage range are we talking about?

Thanks.


- Scott

 

Re: Memantine for Depression - How long to wait? » phidippus

Posted by SLS on June 26, 2012, at 6:04:21

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by phidippus on June 25, 2012, at 16:41:31

> Started at 20 mg (10 in the morning, ten at night) Eventually tapered up to 40 mg (20 twice a day). Is this your first time on it?

I tried memantine several years ago. I thought it might have helped a bit. I was taking Parnate at the time, but not prazosin or nortriptyline. I titrated the dosage using the manufacturer's starter-pack to a dosage of 20 mg. I tolerated this very well. Unfortunately, I began to feel worse at some point. I discontinued memantine, thinking that it was the culprit. Actually, the culprit was the generic lamotrigine (Lamictal) that I was switched to. Once I restarted the name-brand Lamictal, I regained the therapeutic effect, but elected not to retry memantine. I don't remember why.

Thanks for your support, Eric.


- Scott

 

Re: my exp is waiting is only relevant to s/e's » iforgotmypassword

Posted by g_g_g_unit on June 28, 2012, at 8:14:20

In reply to my exp is waiting is only relevant to s/e's » SLS, posted by iforgotmypassword on June 26, 2012, at 1:20:30

> we may not be after the same mechanism tho. but, given the mention of parnate i think i saw before... it would work well with it and it's metabolites i think, and having mao-b smushed might help allay some worry about the oxidative potential of DA.
>
it was me who wanted to add it Parnate. if my sleep ever settles, I probably will.

how do you sleep on Memantine?

 

Re: D2 (D3) agonists' capacity to flatten affect

Posted by psychobot5000 on June 28, 2012, at 13:09:49

In reply to Re: Memantine for Depression - How long to wait?, posted by sk85 on June 23, 2012, at 17:18:46

> > >And I really hate memantine's effect on dopamine D2 receptor.
> > >
> >
> > What can you specifically attribute to its effect on the D2 receptor?
> >
>
> Aggravation and triggering of movement disorders. Also, for some people like me D2 agonism seems to be prodepressant rather than antidepressant. But yes there are apparently others that find it antidepressant.

There's some research that shows that D2/D3 agonists (and it's probably D3 that's most important in mood) preferentially tend to occupy D3 presynaptic autoreceptors that reduce synaptic dopamine in the area, causing a perverse reduction in D3 signalling that causes a flattening of affect.

My experience with D2 and D3 agonists (i.e. ropinirole and pramipexole) has born this out, i.e. a single small dose produced marked reductions in affect until the drug was out of my system. I am unsure whether there might be a dosing regimen of agents with D3 (a 'D2-like' receptor) that might prevent or supercede this phenomenon, i.e. perhaps with higher doses.

 

Re: D2 (D3) agonists' capacity to flatten affect » psychobot5000

Posted by SLS on June 28, 2012, at 14:07:16

In reply to Re: D2 (D3) agonists' capacity to flatten affect, posted by psychobot5000 on June 28, 2012, at 13:09:49

> I am unsure whether there might be a dosing regimen of agents with D3 (a 'D2-like' receptor) that might prevent or supercede this phenomenon, i.e. perhaps with higher doses.

Very possibly. The dosage-response curve of apomorphine, comprising sedation followed by hyperlocomotion, is an example of this.

Aripiprazole and cariprazine are partial D2/D3 agonists that seem not to have a pervasive effect of the flattening of mood at low dosages. Infrequently, these drugs can blunt cognition and affect at high dosages.


- Scott

 

Re: D2 (D3) agonists' capacity to flatten affect » SLS

Posted by psychobot5000 on June 28, 2012, at 18:46:48

In reply to Re: D2 (D3) agonists' capacity to flatten affect » psychobot5000, posted by SLS on June 28, 2012, at 14:07:16

> > I am unsure whether there might be a dosing regimen of agents with D3 (a 'D2-like' receptor) that might prevent or supercede this phenomenon, i.e. perhaps with higher doses.
>
> Very possibly. The dosage-response curve of apomorphine, comprising sedation followed by hyperlocomotion, is an example of this.
>
> Aripiprazole and cariprazine are partial D2/D3 agonists that seem not to have a pervasive effect of the flattening of mood at low dosages. Infrequently, these drugs can blunt cognition and affect at high dosages.
>
>
> - Scott

Hmm. This is useful--though aripiprazole unfortunately blunted my cognition in a big way even on a small dose. ...I've heard of that effect wearing off, though.

Do you know of any links/papers that might support these ideas, Scott, i.e. something I could take to my doc to show there's good reason to do a trial?
-PB

 

Re: Memantine for Depression - How long to wait? » SLS

Posted by phidippus on July 6, 2012, at 14:39:46

In reply to Re: Memantine for Depression - How long to wait? » phidippus, posted by SLS on June 26, 2012, at 5:51:26

I take up to 8 mg sublingual tablet.

Erric

 

Re: Memantine for Depression - How long to wait?

Posted by psychobot5000 on July 6, 2012, at 18:49:46

In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by phidippus on July 6, 2012, at 14:39:46

> I take up to 8 mg sublingual tablet.
>
> Erric

I've also been on buprenorphine for TRD. I dosed at 2mg sublingually, and hated it. There was a transient increase in mood (i.e. for about 8 hours), but that dissipated, and I paid back that mood benefit during the couple of days when the medication was leaving my bloodstream. I found the medication slightly stupifying.


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