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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Lamdage22 on August 25, 2012, at 13:44:00
Latuda and low dose amisulpride?
Diagnoses i have gotten: Schizoaffective disorder, bipolar disorder, schizophrenia, depression, PTSD, social anxiety.
The predominant problems are depression and social anxiety, however, as you can see doctors have given me other diagnoses, too wether warranted or not. It does seem to be the case that i can go psychotic under certain circumstances, however not a classical case of schizophrenia. Its a very complex and difficult to treat thing. Low drive, weak desire to socialize, social anxiety but at the same time a vulnerability to going psychotic.
Anyhow, would these be worth a shot? Would they help social phobia and depression without cognitive side effects?
Im kinda desperate.
Thanks,
Lamdage
Posted by Lamdage22 on August 25, 2012, at 13:56:28
In reply to Latuda/Amisulpride combination?, posted by Lamdage22 on August 25, 2012, at 13:44:00
Some out of the box thinking, please!
Please notice that this is not your everyday mental illness. The social phobia is definite and so is the depression.. those are THE biggest problems i have.
the rest of the diagnoses is not so definite, but there is a reason doctors have voiced these. Special circumstances, both life events AND medication.Please help me get back on my feet feelin good!
Thanks in advance,
Lamdage
Posted by Lamdage22 on August 25, 2012, at 14:04:19
In reply to Re: Latuda/Amisulpride combination?, posted by Lamdage22 on August 25, 2012, at 13:56:28
Latuda and Stablon??
You know where im going. Out of the box problem, out of the box solution.
Is stablon something thats unlikely to destabilize me, drive me psychotic?
I need to get out of this depression and social phobia hole.
Posted by SLS on August 25, 2012, at 17:01:54
In reply to Re: Latuda/Stablon?, posted by Lamdage22 on August 25, 2012, at 14:04:19
What do your psychotic episodes look like?
Which drugs trigger these episodes?
How do you react to Lamictal?
How do you react to lithium?
How do you react to Abilify?
How do you react to Seroquel?
How do you react to Klonopin?
- Scott
Posted by bleauberry on August 25, 2012, at 20:22:44
In reply to Latuda/Amisulpride combination?, posted by Lamdage22 on August 25, 2012, at 13:44:00
I don't know about latuda. I have been on amisulpride multiple times. I think it alone stands a good shot at being helpful to you. Low dose, such as 25mg. For more of an antipsychotic effect, use 100mg or higher, though I've seen it also being that way as low as 50mg. I've also tried as low as 12.5mg, but that was not enough.
The antidepressant potential of it can happen quickly, sometimes the first day, and then fade away for a while to return in a few weeks with a good overall effect. I had more drive, greatly lessened fears of all kinds, mood stabilization, overall calmness but stimulated somewhat at the same time. Mileage varies, but I happen to think amisulpride would be a good choice.
Posted by Phillipa on August 25, 2012, at 20:39:50
In reply to Re: Latuda/Stablon?, posted by Lamdage22 on August 25, 2012, at 14:04:19
Lamadge in the USA now or Germany? Different meds different countries as sure you know. Phillipa
Posted by Lamdage22 on August 26, 2012, at 3:00:09
In reply to Re: Latuda/Amisulpride combination?, posted by bleauberry on August 25, 2012, at 20:22:44
What do your psychotic episodes look like?
-->Well, im not even sure if they are truly psychotic or not. They consist primarily of paranoia.. and its very hard for me to tell wether i have heard voices that didnt exist or not. My most recent experience was that everything is about me in a way and that people have their focus on me. And i think to some extent they really did since i have had an interaction with the police. Might have aroused some attention. Then again, the belief that internal thoughts influence external outcomes can be interpreted as spiritual.
Which drugs trigger these episodes?
-->The first time it happened was for like 3-4 days and i was on nardil 60mg at the time. The second time it was again only for a couple days on Wellbutrin 300 and effexor 375 plus 5htp and other supplements. After that i havent had an episode for almost a year and during that time i was on nardil 90mg, wellbutrin 150mg, SamE, 5htp, modafinil, and a little bit of enada nadh. No psychotic symptoms. I thought i had my problems solved, as you can imagine with this combination i wasnt very depressed. Then this year i came off of everything and was on nardil only. Then i had two stressful life events at once and the stress of going back and forth between USA and Germany. While on nardil 90mg and even on nardil+risperdal (risperdal is useless to me) i have had paranoia and this "everything is about me feeling" and potentially some voices that werent there. Most of them were there, meaning they stem from people, but still disturbed me.
How do you react to Lamictal?
-->I currently take it.. I would say it helps against my depression, but also gives me cognitive dulling so im not sure if that will be part of my "get through college" stack or not. Its not bad IF i could get rid of the cognitive side effects. I want have a cognitive BOOST if possible.
How do you react to lithium?
-->Lithium i havent taken for any long period of time because it gave me heart palpitations once and it makes me eat more. I have candida and having carb cravings doesnt help with that. I would say it does help some though. I certainly will have Lithium Orotate in my "college stack"
How do you react to Abilify?
-->Again, i havent taken it for a long enough period of time. With this one i fear cognitive side effects and the weight gain. I have candida.
How do you react to Seroquel?
--> Seroquel helped some to stabilize me while i was on effexor. The weight gain was less pronounced than zyprexa, but still a problem since i have the candida problem. Again im worried about cognitive side effects.
Zyprexa crushes any paranoia in a matter of one or two days. I will definitely have this in the bag as a last resort med.How do you react to Klonopin?
-->I havent taken Klonopin, but Xanax and lorazepam. They really work against Social Anxiety, but again im worried about cognitive impairments. I will have a benzo in the bag though for presentations at college.
--------------------------------------------------------
Lamadge in the USA now or Germany? Different meds different countries as sure you know. Phillipa
--> Hello Phillipa, i currently am in Germany, but the college im attending is in the US. Classes start in January.
I eventually could order the Latuda though. There aint no med that cant be ordered and i have a doctor here that isnt opposed to ordering exotic meds that much.--------------------------------------------------------
I don't know about latuda. I have been on amisulpride multiple times. I think it alone stands a good shot at being helpful to you. Low dose, such as 25mg. For more of an antipsychotic effect, use 100mg or higher, though I've seen it also being that way as low as 50mg. I've also tried as low as 12.5mg, but that was not enough.
The antidepressant potential of it can happen quickly, sometimes the first day, and then fade away for a while to return in a few weeks with a good overall effect. I had more drive, greatly lessened fears of all kinds, mood stabilization, overall calmness but stimulated somewhat at the same time. Mileage varies, but I happen to think amisulpride would be a good choice.-->Ok thanks. What about cognitive side effects? Did you have any?
Does amisulpride at low doses have a mood stabilizing and antipsychotic effect at all?
Thanks for helping me out.
Posted by Lamdage22 on August 26, 2012, at 6:40:31
In reply to Re: Latuda/Amisulpride combination?, posted by Lamdage22 on August 26, 2012, at 3:00:09
enough said.
Posted by jono_in_adelaide on August 26, 2012, at 21:59:26
In reply to God i wish i could be back on nardil, posted by Lamdage22 on August 26, 2012, at 6:40:31
Could you take Nardil and an atypical antipsychotic such as Geodon?
Posted by Lamdage22 on August 27, 2012, at 9:25:17
In reply to Re: God i wish i could be back on nardil, posted by jono_in_adelaide on August 26, 2012, at 21:59:26
The geodon would have to be ordered from another country (im currently in Germany) but yes i could do that.
Nardil 75mg and Geodon, how many mgs would you recommend?
Also, could i add stablon 3 times a day in half dosage?
Is it legal in the US if a doc prescribes it?
I dont give a damn to use grey market in Germany, but in the US i should care because of immigration matters. I could ask my lawyer though if being caught with Stablon would bar my immigration.
Thanks,Lamdage
Posted by Lamdage22 on August 27, 2012, at 10:49:58
In reply to Re: God i wish i could be back on nardil, posted by Lamdage22 on August 27, 2012, at 9:25:17
Do you think Latuda may be enough to prevent psychotic symptoms with the Nardil?
Thanks
Posted by Lamdage22 on August 27, 2012, at 11:15:29
In reply to How effective is latuda against psychosis?, posted by Lamdage22 on August 27, 2012, at 10:49:58
I would like to take Nardil 75mg, Latuda 80mg and Stablon 19mg..
With as needed Zyprexa if psychotic symptoms surface.
Opinions?
Posted by Lamdage22 on August 28, 2012, at 2:48:27
In reply to Nardil/Latuda/low dose Stablon?, posted by Lamdage22 on August 27, 2012, at 11:15:29
Posted by SLS on August 28, 2012, at 19:24:07
In reply to Anyone? (nm), posted by Lamdage22 on August 28, 2012, at 2:48:27
I wouldn't advise combining Geodon with Nardil. There is a theoretical risk of serotonin toxicity (serotonin syndrome). Latuda would be a better choice.
What happens when you take Nardil alone?
- Scott
Posted by jono_in_adelaide on August 29, 2012, at 1:32:01
In reply to Re: Anyone? » Lamdage22, posted by SLS on August 28, 2012, at 19:24:07
The risk of seretonin toxicity would be remote to say the least, especialy given that the atypicals all block the 5HT2 receptor, but, having said that, I only used geodon as an example, any atypical would do, depends which one suits you best realy
Posted by SLS on August 29, 2012, at 3:54:01
In reply to Re: Anyone?, posted by jono_in_adelaide on August 29, 2012, at 1:32:01
Geodon = ziprasidone
Latuda = lurasidoneThe bottom line is that you might be right that ziprasidone can be safely combined with a MAOI. I have never done it nor have I seen it done. Apparently, there are a few case reports listed on Medline/Pubmed.
------------------------------------------------
> The risk of seretonin toxicity would be remote to say the least,
I wouldn't use the word remote, but it may not be as frequent as I thought it was. I still wouldn't do this to my self, though. Latuda would be a better choice if one would like to have 5-HT7 receptor antagonism in a drug that is a Geodon analog. Latuda does not inhibit the reuptake of serotonin.
> especialy given that the atypicals all block the 5HT2 receptor,
What about Ziprasidone and 5-HT1a receptor agonism?
---------------------------------------Ziprasidone not an option for serotonin syndrome
A recent article concerning serotonin syndrome1 contained an inaccuracy that might result in clinicians attempting a misguided, if not fatal, treatment option. While correctly noting the presumed role of 5-HT1A receptor activation in the pathophysiology of the syndrome, the authors twice surmise that ziprasidone, an atypical antipsychotic, might warrant study as a therapeutic option because of its potent blockade of 5-HT1A receptors. The reference that the authors use as the pharmacologic basis for this assertion does acknowledge the potent binding of ziprasidone at the 5-HT1A receptor;2 however, the high affinity of the drug for this receptor is as an agonist, not as an antagonist.3,4 Other effects of ziprasidone on the serotonergic system include potent antagonism of 5-HT1D, 5-HT2A and 5-HT2C receptors, as well as moderate inhibition of serotonin reuptake.3,4 The net result of ziprasidone on serotonergic neurotransmission makes it an inappropriate candidate for treating serotonin syndrome. Aside from the overt problem of directly stimulating 5- HT1A receptors, there is also the more subtle, yet still concerning, matter of indirectly stimulating these same receptors via antagonism of 5-HT2A receptors and inhibition of serotonin reuptake. In fact, there have been reported cases of serotonin syndrome precipitated by the use of other atypical antipsychotics, which are also 5-HT2A receptor antagonists, in combination with serotonergic drugs.5 Thus, the use of ziprasidone for treatment of serotonin syndrome seems ill-advised and could prolong or worsen the patients symptoms. In cases in which the clinician seeks treatment with serotonin antagonists, purported options include methysergide, cyproheptadine and propranolol.6 Marshall E. Cates Associate Professor of Pharmacy Practice Samford University McWhorter School of Pharmacy Tuscaloosa, Ala.
--------------------------------------------------------
> but, having said that, I only used geodon as an example, any atypical would do, depends which one suits you best realy
Ho do you know this? Is this conjecture or based upon the lack of reported incidents? Geodon is a weak 5-HT reuptake inhibitor, but I wouldn't want to take a guess at the risks. I have had two incidents of serotonin toxicity when combining a MAOI with a serotonin reuptake inhibitors. I tend to err on the side of caution when it comes to serotonin toxicity (syndrome).---------------------------------------
I wish I could find the full articles of these:
http://www.ncbi.nlm.nih.gov/pubmed?term=ziprasidone%20%22serotonin%20syndrome%22
---------------------------------------
Although Dr. Stahl has tried this combination without sequalae, he offers this comment."In fact, you can give any atypical antipsychotic with phenelzine or any MAOIs although I would be a bit hesitant only with ziprasidone. It is a very weak reuptake inhibitor of 5HT, so it is mostly theoretical, but probably that is the only one maybe not to combine with an MAOI"
Stephen M. Stahl, MD, PhD
Adjunct Professor, Department of Psychiatry,
University of California, San Diego School of Medicine
Honorary Visiting Senior Fellow, University of Cambridge, UK---------------------------------------
--------------------------------------
CMAJ. 2003 November 25; 169(11): 11471148.
PMCID: PMC264947
Ziprasidone not an option for serotonin syndrome
Marshall E. Cates
Author information ► Copyright and License information ►A recent article concerning serotonin syndrome1 contained an inaccuracy that might result in clinicians attempting a misguided, if not fatal, treatment option. While correctly noting the presumed role of 5-HT1A receptor activation in the pathophysiology of the syndrome, the authors twice surmise that ziprasidone, an atypical antipsychotic, might warrant study as a therapeutic option because of its potent blockade of 5-HT1A receptors.
The reference that the authors use as the pharmacologic basis for this assertion does acknowledge the potent binding of ziprasidone at the 5-HT1A receptor;2 however, the high affinity of the drug for this receptor is as an agonist, not as an antagonist.3,4 Other effects of ziprasidone on the serotonergic system include potent antagonism of 5-HT1D, 5-HT2A and 5-HT2C receptors, as well as moderate inhibition of serotonin reuptake.3,4
The net result of ziprasidone on serotonergic neurotransmission makes it an inappropriate candidate for treating serotonin syndrome. Aside from the overt problem of directly stimulating 5-HT1A receptors, there is also the more subtle, yet still concerning, matter of indirectly stimulating these same receptors via antagonism of 5-HT2A receptors and inhibition of serotonin reuptake. In fact, there have been reported cases of serotonin syndrome precipitated by the use of other atypical antipsychotics, which are also 5-HT2A receptor antagonists, in combination with serotonergic drugs.5
Thus, the use of ziprasidone for treatment of serotonin syndrome seems ill-advised and could prolong or worsen the patient's symptoms. In cases in which the clinician seeks treatment with serotonin antagonists, purported options include methysergide, cyproheptadine and propranolol.6
Marshall E. Cates Associate Professor of Pharmacy Practice Samford University McWhorter School of Pharmacy Tuscaloosa, Ala.
-----------------------------------------------------
"Dangerous serotonin syndrome can occur with combinations of ziprasidone and monoamine oxidase (MAO) inhibitors."
Clinical Medicine Insights: Therapeutics 2012:4 18
----------------------------------------------------
It just frightens me, that's all. Perhaps my fears are unfounded, but I don't want to be the guinea pig to test this combination.
- Scott
Posted by Lamdage22 on August 31, 2012, at 9:19:43
In reply to Re: Anyone? » Lamdage22, posted by SLS on August 28, 2012, at 19:24:07
Hello Scott,
it helps a fair deal with depression and social anxiety. Yet under stressful times it can make me more prone to paranoia/psychotic features. (doesnt have to though).
> I wouldn't advise combining Geodon with Nardil. There is a theoretical risk of serotonin toxicity (serotonin syndrome). Latuda would be a better choice.
>
> What happens when you take Nardil alone?
>
>
> - Scott
Posted by phidippus on August 31, 2012, at 19:54:24
In reply to Latuda/Amisulpride combination?, posted by Lamdage22 on August 25, 2012, at 13:44:00
Amisulpride at low doses increases dopamine, which would work against the Latuda.
I'm going to say you are psychotically depressed, because you detail depresssive symptoms and psychosis.
I would then recommend an antidepressant and an antipsychotic as treatment. Latuda would work just fine as your antipsychotic. Now just pick an antidepressant-their are many to choose.
For that social phobia, I would recommend Xanax or Valium, then augment it with Topomax, which hass studies backing it as a treatment for social anxiety.
Eric
Posted by Lamdage22 on September 1, 2012, at 15:32:52
In reply to Re: Latuda/Amisulpride combination? » Lamdage22, posted by phidippus on August 31, 2012, at 19:54:24
Thats an interesting point you make. Psychotic depression.. one Pdoc told me that might be what i have.
What about Mifepristone then?? Should i go get my cortisol levels checked?
> Amisulpride at low doses increases dopamine, which would work against the Latuda.
>
> I'm going to say you are psychotically depressed, because you detail depresssive symptoms and psychosis.
>
> I would then recommend an antidepressant and an antipsychotic as treatment. Latuda would work just fine as your antipsychotic. Now just pick an antidepressant-their are many to choose.
>
> For that social phobia, I would recommend Xanax or Valium, then augment it with Topomax, which hass studies backing it as a treatment for social anxiety.
>
> Eric
Posted by phidippus on September 1, 2012, at 16:12:10
In reply to Mifepristone?, posted by Lamdage22 on September 1, 2012, at 15:32:52
Mifepristone is a cortisol blocker and in cases of psychotic depression, is used to control psychotic symptoms. It does not treat the depression, so you would still need an AD onboard.
It wouldn't hurt to have your cortisol levels checked.
I was part of Stanford's clinical trials for Mifepristone. That was fun.
Eric
Posted by Lamdage22 on September 2, 2012, at 5:54:56
In reply to Re: Mifepristone? » Lamdage22, posted by phidippus on September 1, 2012, at 16:12:10
Interesting..
> Mifepristone is a cortisol blocker and in cases of psychotic depression, is used to control psychotic symptoms. It does not treat the depression, so you would still need an AD onboard.
>
> It wouldn't hurt to have your cortisol levels checked.
>
> I was part of Stanford's clinical trials for Mifepristone. That was fun.
>
> Eric
Posted by SLS on September 2, 2012, at 6:45:40
In reply to Re: Mifepristone?, posted by Lamdage22 on September 2, 2012, at 5:54:56
> Interesting..
I tried mifepristone after conferring with Alan Schatzberg and his colleague in Britain, I was informed that the drug treatment only helped with the psychotic component of psychotic depression. I do not have psychotic depression. However, there were some reports of it helping with non-psychotic depression, too. I decided to try it anyway. It involved a long process of getting my treatment approved by the FDA as an open trial. I'm sure you know the protocol is to take mifepristone for eight consecutive days, and then discontinue it. I received no benefit. However, I felt "washed-out" afterwards. I didn't like the feeling. Mifepristone really shouldn't be taken for longer than a week or so. It causes the adrenal glands to secrete large amounts of cortisol because the negative-feedback loop is interrupted by the blockade of cortisol receptors in the hypothalamus. If anything is going to exhaust the adrenals, it would be a mifepristone.
- Scott>
> > Mifepristone is a cortisol blocker and in cases of psychotic depression, is used to control psychotic symptoms. It does not treat the depression, so you would still need an AD onboard.
> >
> > It wouldn't hurt to have your cortisol levels checked.
> >
> > I was part of Stanford's clinical trials for Mifepristone. That was fun.
> >
> > Eric
>
>
>
>
This is the end of the thread.
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