![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 23 to 47 of 47. Go back in thread:
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
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?
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.
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
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.
>
>
> - ScottHmm. 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
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
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.
>
> ErricI'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.
Posted by novelagent on July 10, 2012, at 8:55:02
In reply to Re: Memantine for Depression - How long to wait?, posted by psychobot5000 on July 6, 2012, at 18:49:46
Aricept has actual evidence of elevating mood without it just being a placebo effect-- I don't understand why a drug that doesn't work gets all the attention, and Aricept, a perfectly fine drug that actually works, is ignored.
I've tried memantine at 40mg, and it does nothing-- I wasn't taking it for mood, just for cognition, but it didn't even increase my Lumosity.com scores. And even DHEA would consistently do that. Aricept works, try that.
Posted by SLS on July 10, 2012, at 11:15:29
In reply to Re: Memantine for Depression - How long to wait?, posted by novelagent on July 10, 2012, at 8:55:02
> Aricept has actual evidence of elevating mood without it just being a placebo effect-- I don't understand why a drug that doesn't work gets all the attention, and Aricept, a perfectly fine drug that actually works, is ignored.
>
> I've tried memantine at 40mg, and it does nothing-- I wasn't taking it for mood, just for cognition, but it didn't even increase my Lumosity.com scores. And even DHEA would consistently do that. Aricept works, try that.I already tried Aricept. If it worked for everyone, you would never have heard of me.
- Scott
Posted by novelagent on July 10, 2012, at 23:48:43
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by SLS on July 10, 2012, at 11:15:29
> > Aricept has actual evidence of elevating mood without it just being a placebo effect-- I don't understand why a drug that doesn't work gets all the attention, and Aricept, a perfectly fine drug that actually works, is ignored.
> >
> > I've tried memantine at 40mg, and it does nothing-- I wasn't taking it for mood, just for cognition, but it didn't even increase my Lumosity.com scores. And even DHEA would consistently do that. Aricept works, try that.
>
> I already tried Aricept. If it worked for everyone, you would never have heard of me.
>
>
> - ScottScott,
sorry to hear it didn't work out. For me, Aricept didn't kick in for 3 months-- how long did you try it for? Was it with a stimulant?
Posted by SLS on July 11, 2012, at 6:47:14
In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by novelagent on July 10, 2012, at 23:48:43
> > > Aricept has actual evidence of elevating mood without it just being a placebo effect-- I don't understand why a drug that doesn't work gets all the attention, and Aricept, a perfectly fine drug that actually works, is ignored.
> > >
> > > I've tried memantine at 40mg, and it does nothing-- I wasn't taking it for mood, just for cognition, but it didn't even increase my Lumosity.com scores. And even DHEA would consistently do that. Aricept works, try that.
> >
> > I already tried Aricept. If it worked for everyone, you would never have heard of me.
> >
> >
> > - Scott
>
> Scott,
>
> sorry to hear it didn't work out. For me, Aricept didn't kick in for 3 months-- how long did you try it for? Was it with a stimulant?I am sure that I did not take Aricept for as long as three months. I'll have to ask my doctor about his current thoughts on Aricept. I know of only one person who was on Aricept for many months, and it didn't help her depression, even though she believed it helped improve her cognition briefly at first. I don't know what dosages either of us took. She might have been taking Ritalin at the time. I was not taking any type of psychostimulant except caffeine.
Thanks for your taking an interest in my case.
- Scott
Posted by novelagent on July 11, 2012, at 17:56:45
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by SLS on July 11, 2012, at 6:47:14
Scott,I take it you were only on the starting dose of 5mg then-- Aricept is dosed at 5mg for 3 months before it's raised to 10mg.
The way acetylcholine works, Aricept won't work for months, because it basically slowly builds up stores of Ach. before anything happens... I'm over-simplifying, but basically, yeah.
Also, CDP Choline alone probably won't do anything for mood, but you should note a study of schizophrenics who took galantamine (Reminyl) and 2 grams of CDP Choline/day found great benefit to their cognitive functioning. So this would likely be replicable with Aricept + CDP Choline (aka citicoline).
I feel for you. If it wasn't for this board, I would have never gotten the idea (it was someone else's) of taking selegiline and DLPA combined. This combination brought me out of a year's deep depression in a single day (and there's a theoretical basis for why the combo works so quickly). Although I'm guessing you've tried that... you seem to have tried many things. This was before Emsam came out... it was 2004.
Anyhow, hang in there, it gets better. Something will stick-- before I tried selegeline, I even tried antipsychotisc+SSRI combos. The trick, though, is to keep busy. I'm just working 2 days/week, so I signed up with a group to work the other 5 days. I was afraid I'd get depressed again if I had too much free time.
I think it would be a disorder if someone _didn't_ get depressed if they stared at a wall everyday, which is what a lot of mentally ill people do, sadly, watching tv, etc.
No one ever has a recovery story that starts with, "I took meds while sitting on my *ss, and the meds were so powerful, I got better anyhow." I didn't want to be like that, and it's nice to go to bed everyday knowing I did something meaningful.
Of course, depression means one has less energy. But as a CBT packet explained to me when I was depressed, activity while one is depressed is energizing, and energy begets more energy. So... if you are worried about doing too much, just think of how little energy you feel when you don't do anything at all, and see activity as a counter to that. Of course, you may very well be super busy already. =)
> > > > Aricept has actual evidence of elevating mood without it just being a placebo effect-- I don't understand why a drug that doesn't work gets all the attention, and Aricept, a perfectly fine drug that actually works, is ignored.
> > > >
> > > > I've tried memantine at 40mg, and it does nothing-- I wasn't taking it for mood, just for cognition, but it didn't even increase my Lumosity.com scores. And even DHEA would consistently do that. Aricept works, try that.
> > >
> > > I already tried Aricept. If it worked for everyone, you would never have heard of me.
> > >
> > >
> > > - Scott
> >
> > Scott,
> >
> > sorry to hear it didn't work out. For me, Aricept didn't kick in for 3 months-- how long did you try it for? Was it with a stimulant?
>
> I am sure that I did not take Aricept for as long as three months. I'll have to ask my doctor about his current thoughts on Aricept. I know of only one person who was on Aricept for many months, and it didn't help her depression, even though she believed it helped improve her cognition briefly at first. I don't know what dosages either of us took. She might have been taking Ritalin at the time. I was not taking any type of psychostimulant except caffeine.
>
> Thanks for your taking an interest in my case.
>
>
> - Scott
>
>
Posted by phidippus on July 11, 2012, at 18:13:29
In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by novelagent on July 11, 2012, at 17:56:45
Memantine is going to enhance mood through two primary mechanisms of action: NMDA antagonism and through D2 agonism. I was on and off it for 3 months or so and found great benefit. I found a 40 mg dose was really optimal.
Eric
Posted by phidippus on July 11, 2012, at 18:28:50
In reply to Re: Memantine for Depression - How long to wait?, posted by psychobot5000 on July 6, 2012, at 18:49:46
I find the drug somewhat inconsistent, but at 8 mg it really undermines my depression. I found the stupifying effects went away after about a week of dosing.
Eric
Posted by psychobot5000 on July 11, 2012, at 18:55:27
In reply to Re: Memantine for Depression - How long to wait? » psychobot5000, posted by phidippus on July 11, 2012, at 18:28:50
> I find the drug somewhat inconsistent, but at 8 mg it really undermines my depression. I found the stupifying effects went away after about a week of dosing.
>
> EricThese are good things to know--memantine is a somewhat paradoxical medication, though, with its several mechanisms of action. Probably for this patient, though not others, it won't be useful. From what I've seen elsewhere, I don't seem to do well with D2 agonism. Memantine gave me the same sort of blunting of positive affect. I think that would probably interfere, for me, with any positive effects it might otherwise have.
Posted by SLS on July 11, 2012, at 22:28:55
In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by novelagent on July 11, 2012, at 17:56:45
That's great advice. Thanks.
- Scott
Posted by novelagent on July 12, 2012, at 15:12:24
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by SLS on July 11, 2012, at 22:28:55
> That's great advice. Thanks.
>
>
> - Scotthmm. I hope it didn't sound judgmental? I was just trying to say what worked for me more so than give advice, I dunno. I hope things go well for you.
Posted by SLS on July 12, 2012, at 17:42:05
In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by novelagent on July 12, 2012, at 15:12:24
> > That's great advice. Thanks.
> >
> >
> > - Scott
>
> hmm. I hope it didn't sound judgmental? I was just trying to say what worked for me more so than give advice, I dunno. I hope things go well for you.Thanks.
I was not being sarcastic. Although I may not agree with every word posted on the board, I am clever enough to extract the gems of wisdom that people like you come up with. I was referring to your comments about depression, energy, and CBT.
- Scott
Posted by uncouth on July 13, 2012, at 14:31:40
In reply to Re: Memantine for Depression - How long to wait? » SLS, posted by novelagent on July 12, 2012, at 15:12:24
Oh Scott I'm so sorry I've missed this thread over the past month because I've been experimenting with memantine (high dose) over the past three months myself, and have had actually pretty great results! I'm also BP2, and have had very terrible depressions in the past, though not as bad as yours, and I am more functional now (just started a job 2.5 months ago, though its still touch and go).
Please update me on your memantine experience. Interestingly, i'm also toying around with topamax as an adjunct to saphris to prevent weight gain (low dose). But back to to the memantine...here is my advice--- DO NOT GIVE UP ON MEMANTINE. I don't care how you feel on it. I don't care if you feel high as a kite. DO NOT GIVE UP ON IT. Are you still taking it? What dose? Are you taking the name brand or generic? There are differences. And I will echo what other people have said, you need to take it at the same time each day, 12 hours apart, and you also need to increase the dose SLOWLY, potentailly even more slowly than recommended....i messed around with my dosage way too much and suffered for it.
For me, I actually welcomed the dissassosicative and brainfoggish symptoms a bit...i was so wound up and was suffering from OCD-ish symptoms alongside the morbid depressive/hypomania/instability/hypersexuality (typical bipolar you know the drill) and dealing with severe insomnia becuase of sleep apnea, and starting a new job, that i was actually OK to be "checked out" for a few weeks while I was escalating the dose. Every time you increase the dose of memantine, you get to that dissassociative state again. I don't know if it's from the NMDA antagonism, or the nAchR antagonism, or a combination of both, but whatever it is, it's legit, and it's STRONG, and it can knock you out, and it can legitimately make you think that this drug is worthless and not for you and screw it. But DO NOT GIVE UP ON YOU. If you have to, back off the dose, slightly. If you have to, increase the dose by 2.5mg/week...but don't give up on it.
And don't stop escalating...you have not given the drug a full challenge until you have hit 60mg/day...i'm serious. Maybe you have to stay at each dose for 2 weeks, i don't know, maybe you have to endure some brain fog...i don't know...if it really gets intolerable, then just back off a little bit....you're the best judge...just remember it has a long half life, so it builds up, and the effects of your dosing will still be in you 2-3 days later, so take that into account when making dosage adjustments....take it from me...i've been kinda a basket case becuase i've tried to change things too quickly.
Oh and i'd recommend just sticking with the name brand namenda, if you can. The generic i ordered from overseas pharmacies feels less powerful.
Please let me knwo if you have any other questions.
It's working for me, in some dimensions, very dramatically, in other ways, less so, but my life is changing. THere are still ups and downs, fits and starts. My sleep apnea is still bad. Maybe i'm still a little to dissassociated for my own good....but i'm functional. In control of my impulses so much more. My cognition has improved. I don't feel depressive pain. I'm optimistic at times, even.
I'm at 50mg right now. may go up to 60mg.
Tell me what you think of it so far?
Posted by SLS on July 13, 2012, at 14:58:50
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by uncouth on July 13, 2012, at 14:31:40
Hi Uncouth.
I didn't stay with memantine for very long. I thought it was interfering with my cognitive processes. I was wrong. It turns out that I was taking too much prazosin.
> Tell me what you think of it so far?
I think your observations are very important, and I am leaning towards retrying memantine based upon your results and recommendations.
Thank you.
- Scott
Posted by g_g_g_unit on July 16, 2012, at 8:15:49
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by phidippus on July 11, 2012, at 18:13:29
I take it most posters here added Memantine to a pre-existing stimulant regime, therefore noticing no change in their 'tolerance' or the subjective effects of the stimulant?
Posted by ceebee on July 18, 2012, at 14:15:32
In reply to Re: Memantine for Depression - How long to wait? » novelagent, posted by uncouth on July 13, 2012, at 14:31:40
> Oh Scott I'm so sorry I've missed this thread over the past month because I've been experimenting with memantine (high dose) over the past three months myself, and have had actually pretty great results! I'm also BP2, and have had very terrible depressions in the past, though not as bad as yours, and I am more functional now (just started a job 2.5 months ago, though its still touch and go).
>
> Please update me on your memantine experience. Interestingly, i'm also toying around with topamax as an adjunct to saphris to prevent weight gain (low dose). But back to to the memantine...here is my advice--- DO NOT GIVE UP ON MEMANTINE. I don't care how you feel on it. I don't care if you feel high as a kite. DO NOT GIVE UP ON IT. Are you still taking it? What dose? Are you taking the name brand or generic? There are differences. And I will echo what other people have said, you need to take it at the same time each day, 12 hours apart, and you also need to increase the dose SLOWLY, potentailly even more slowly than recommended....i messed around with my dosage way too much and suffered for it.
>
> For me, I actually welcomed the dissassosicative and brainfoggish symptoms a bit...i was so wound up and was suffering from OCD-ish symptoms alongside the morbid depressive/hypomania/instability/hypersexuality (typical bipolar you know the drill) and dealing with severe insomnia becuase of sleep apnea, and starting a new job, that i was actually OK to be "checked out" for a few weeks while I was escalating the dose. Every time you increase the dose of memantine, you get to that dissassociative state again. I don't know if it's from the NMDA antagonism, or the nAchR antagonism, or a combination of both, but whatever it is, it's legit, and it's STRONG, and it can knock you out, and it can legitimately make you think that this drug is worthless and not for you and screw it. But DO NOT GIVE UP ON YOU. If you have to, back off the dose, slightly. If you have to, increase the dose by 2.5mg/week...but don't give up on it.
>
> And don't stop escalating...you have not given the drug a full challenge until you have hit 60mg/day...i'm serious. Maybe you have to stay at each dose for 2 weeks, i don't know, maybe you have to endure some brain fog...i don't know...if it really gets intolerable, then just back off a little bit....you're the best judge...just remember it has a long half life, so it builds up, and the effects of your dosing will still be in you 2-3 days later, so take that into account when making dosage adjustments....take it from me...i've been kinda a basket case becuase i've tried to change things too quickly.
>
> Oh and i'd recommend just sticking with the name brand namenda, if you can. The generic i ordered from overseas pharmacies feels less powerful.
>
> Please let me knwo if you have any other questions.
>
> It's working for me, in some dimensions, very dramatically, in other ways, less so, but my life is changing. THere are still ups and downs, fits and starts. My sleep apnea is still bad. Maybe i'm still a little to dissassociated for my own good....but i'm functional. In control of my impulses so much more. My cognition has improved. I don't feel depressive pain. I'm optimistic at times, even.
>
> I'm at 50mg right now. may go up to 60mg.
>
> Tell me what you think of it so far?I'm taking Namenda for very severe OCD and Panic Disorder. I went to 20mg and it caused increased anxiety (held there for 16 days). Now I am back down to 15mg. 10mg in the morning, 5mg at night. Also take Toprol XL and Adderall XR. Do you think I gave 20mg a fair shot? I feel like I am benefiting from it somewhat.
Posted by uncouth on July 25, 2012, at 9:03:51
In reply to Re: Memantine for Depression - How long to wait? » uncouth, posted by SLS on July 13, 2012, at 14:58:50
Scott, what did you decide?
For me, namenda seems to be so impactful that I notice the difference even when i go on to a generic version.....maybe i have junk, but last 10 days i've been out of my name brand becuase insurance only pays for 60 a month of the 10mg which only lasts <15 days, so i have to for the rest of the month use generic i buy overseas, at 50mg dose, whoosh totally different...and condition signfiicantly worsened...namenda NAME BRAND was stabilizing me, even when trying to do dose adjustments, the memantine from overseas i dont think was even nearly half as powerful....it may even be total bunk, i don't know.Anyway, did you try namenda again at significant dose? Titrate upward, and only use name brand!
Posted by SLS on July 25, 2012, at 10:14:28
In reply to Re: Memantine for Depression - How long to wait?, posted by uncouth on July 25, 2012, at 9:03:51
> Scott, what did you decide?
> For me, namenda seems to be so impactful that I notice the difference even when i go on to a generic version.....maybe i have junk, but last 10 days i've been out of my name brand becuase insurance only pays for 60 a month of the 10mg which only lasts <15 days, so i have to for the rest of the month use generic i buy overseas, at 50mg dose, whoosh totally different...and condition signfiicantly worsened...namenda NAME BRAND was stabilizing me, even when trying to do dose adjustments, the memantine from overseas i dont think was even nearly half as powerful....it may even be total bunk, i don't know.
>
> Anyway, did you try namenda again at significant dose? Titrate upward, and only use name brand!
Thanks for the tips!I'm sorry you have had such bad luck with the generic memantine. I have just discontinued my trial of Topamax. I'm going to let things settle down a bit and then consider moving on to memantine.
Thanks for the words of encouragement.
- Scott
Posted by AlexCanada on August 30, 2012, at 18:02:15
In reply to Re: Memantine for Depression - How long to wait?, posted by sk85 on June 23, 2012, at 4:21:06
I might b trying memantine very soon. I have doc apt tomorrow.
I have melancholic depression, low energy, poor interest, poor cognition, inability to enjoy things, poor level of emotion.
Can you elaborate on the dopamine d2 effect?
ritalin btw has helped me a lot but it has developed much tolerance.
> 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
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.