![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by SLS on September 22, 2012, at 7:10:07
I am still responding well to minocycline. Some days are better than others, but I don't expect a perfectly smooth response curve. The variability in mood is rather small, though.
I discontinued prazosin two weeks ago. It seemed like the logical thing to do. I did experience about three days of somewhat increased depression, but this resolved completely. Apparently, it was a withdrawal rebound. Perhaps minocycline operates upstream of those sites affected by prazosin. Who knows?
Although I am not yet experiencing the magic of full remission, I remain optimistic that I am heading in that direction. It is hard for me to gauge my state of illness sometimes. What I can say is that I am better than 25% improved but less than 50% improved. 50% is a big number.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
lithium 300 mg
Abilify 10 mg
minocycline 200 mg
- Scott
Posted by phillipa on September 22, 2012, at 9:47:13
In reply to Minocycline update., posted by SLS on September 22, 2012, at 7:10:07
Scott great. Maybe a way to guage the improvement is not by percentages but listing what you can now do that you were unable to do before. As you once wrote you were singing Karokee. Are you driving, going to stores, reading books, etc. In all seriously have you had ever the test for lymes? Even though it's all over the world yours is a typical spot. Phillipa
Posted by jono_in_adelaide on September 22, 2012, at 10:01:24
In reply to Re: Minocycline update. » SLS, posted by phillipa on September 22, 2012, at 9:47:13
Glad you're feeling benifit from it Scott.
Whats your diagnosis?
Posted by SLS on September 22, 2012, at 11:08:39
In reply to Re: Minocycline update., posted by jono_in_adelaide on September 22, 2012, at 10:01:24
> Glad you're feeling benifit from it Scott.
>
> Whats your diagnosis?Well, according to William Z. Potter (formally of the NIH), I am bipolar, even though the only times I have experienced mania has been in association with taking antidepressants. Without antidepressants, I never get manic. Otherwise, I have been chronically depressed for decades. That really sucks.
My bipolar really does look bipolar. It is sort of like a hybrid of atypical and melancholic. It looks atypical in many ways, but includes psychomotor retartdation, melancholy, intrusive thoughts, and is areactive.
It may be that minocycline is particularly effective when combined with other anti-glutamatergic or pro-dopaminergic drugs. For me, that would include Lamictal and Abilify, respectively.
- Scott
Posted by jono_in_adelaide on September 22, 2012, at 18:49:28
In reply to Re: Minocycline update. » jono_in_adelaide, posted by SLS on September 22, 2012, at 11:08:39
I seem to remember that the original protocol called for mnocycline and aspirin twice a day, have you decided to leave out the aspirin, or has that part of the treatment since been dropped more widely?
Posted by SLS on September 23, 2012, at 1:35:42
In reply to Re: Minocycline update., posted by jono_in_adelaide on September 22, 2012, at 18:49:28
> I seem to remember that the original protocol called for mnocycline and aspirin twice a day, have you decided to leave out the aspirin, or has that part of the treatment since been dropped more widely?
I know the study you are referring to. Of the current studies of minocycline, it is the only one that uses aspirin. It is interesting that they are focused on brain inflammation rather than some of the other actities that minocycline participates in. Because there are 4 arms to the study, they might very well find that the aspirin is unnecessary. If it turns out that aspirin makes minocycline work better, it would be an amazing finding. I just so happen to be taking aspirin 81 mg/day (81 mg q.d.) as a prophylactic against heart disease. The dosage being used in the study is 162 mg/day (81 mg b.i.d.)
http://clinicaltrials.gov/ct2/results?term=minocycline+AND+depression&Search=Search
- Scott
Posted by bleauberry on September 23, 2012, at 14:52:29
In reply to Minocycline update., posted by SLS on September 22, 2012, at 7:10:07
Cool update, thanks. Nice looking cocktail.
Posted by jono_in_adelaide on September 23, 2012, at 21:13:15
In reply to Re: Minocycline update., posted by bleauberry on September 23, 2012, at 14:52:29
Which symptoms do you feel that the minocycline is helping most Scott?
Posted by SLS on September 23, 2012, at 21:51:35
In reply to Re: Minocycline update., posted by jono_in_adelaide on September 23, 2012, at 21:13:15
> Which symptoms do you feel that the minocycline is helping most Scott?
It definitely helps with cognition and memory. My capacity to read has improved. I can concentrate better. I have more mental energy, although I am still looking for more motivation to initiate activities and socialize, although social anxiety is reduced. Anhedonia has improved somewhat. So has psychomotor retardation.
Obviously, I don't want to take more drugs than is necessary to achieve the goal of remission. I discontinued taking prazosin a few weeks ago hoping that I could avoid the cognitive issues at higher dosages and the decrease in libido that it causes. However, I have decided to reintroduce it in an effort to capture a broader and more robust antidepressant response. I also attempted to discontinue taking Abilify 10 mg/day. I began to deteriorate after being at 5 mg/day for three days, so I went back to my original dosage. Abilify is responsible for raising my triglycerides and increasing my body weight. The one drug that I could probably discontinue successfully is lithium. However, as I have noted in the past, I retain it in my treatment regime in the hopes that it will reduce my risk of contracting Alzheimers Dementia. I think it has subtle effects to reduce mood drift, but I am not sure this would continue to be a problem with the minocycline aboard.
If I do improve further with the addition of prazosin, I will ask my doctor to try doxazosin as a replacement for for it because it produces a much more consistant blood level. Prazosin has a half life of only 3 hours. Doxazosin has a half life of 22 hours.
I guess that's more information than you asked for.
- Scott
Posted by jono_in_adelaide on September 24, 2012, at 1:48:33
In reply to Re: Minocycline update. » jono_in_adelaide, posted by SLS on September 23, 2012, at 21:51:35
Its amazing when you feel that "swimming through a tank of mud" feeling start to recede isnt it - to begin to feel what its like to be normal again.
Thats the effect I have had from drugs that boost noradrenalin (nortriptyline, reboxetine, bupropion) every time i have slipped into melancholic depression. I have decided that after 3 times, i am going to take them for the rest of my life, along with an SSRI, and quite likely alprazolam (for GAP and panic)
They keep me (relatively) happy, functioning, in the workforce and a normal member of society, rather than that guy who never leaves the house, with an overgorwn lawn and 27 cats (hey, I even managed to have sex last week!)
So happy you're starting to feel it Scott, you're smart and you're a lovely guy, all the best!
Posted by phillipa on September 24, 2012, at 18:52:38
In reply to Re: Minocycline update. » jono_in_adelaide, posted by SLS on September 23, 2012, at 21:51:35
Scott why do you feel you could get Alzheimer's Dementia? Phillipa
Posted by SLS on September 24, 2012, at 20:27:21
In reply to Re: Minocycline update. » SLS, posted by phillipa on September 24, 2012, at 18:52:38
> Scott why do you feel you could get Alzheimer's Dementia? Phillipa
Current statistics indicate that people with severe depressive disorders are two to three times as likely to develop Alzheimer's Dementia as is seen in the general population.
http://alzheimers.about.com/od/whatisalzheimer1/f/depriskfactor.htm
- Scott
Posted by phillipa on September 24, 2012, at 21:04:01
In reply to Re: Minocycline update. » phillipa, posted by SLS on September 24, 2012, at 20:27:21
If you show no signs of it for now I wouldn't be that concerned. Any in family? Isn't there also a gene test for it? Phillipa
Posted by jono_in_adelaide on September 24, 2012, at 22:23:56
In reply to Re: Minocycline update. » SLS, posted by phillipa on September 24, 2012, at 21:04:01
"Current statistics indicate that people with severe depressive disorders are two to three times as likely to develop Alzheimer's Dementia as is seen in the general population"
I wish I hadnt read that!
Posted by SLS on September 25, 2012, at 9:33:14
In reply to Re: Minocycline update., posted by jono_in_adelaide on September 24, 2012, at 22:23:56
> "Current statistics indicate that people with severe depressive disorders are two to three times as likely to develop Alzheimer's Dementia as is seen in the general population"
>
> I wish I hadnt read that!I know.
The good thing is, there will soon be prophylactic treatments to help prevent the development of Alzheimers. For now, low-dose lithium makes sense for me to retain as a treatment to help with depression and to prevent Alzheimers.
http://www.ncbi.nlm.nih.gov/pubmed/18981345http://www.ncbi.nlm.nih.gov/pubmed/18760542
http://www.ncbi.nlm.nih.gov/pubmed/17401045
http://www.ncbi.nlm.nih.gov/pubmed/18322403
http://www.ncbi.nlm.nih.gov/pubmed/22746245
http://www.ncbi.nlm.nih.gov/pubmed/21525519
- Scott
Posted by SLS on September 25, 2012, at 10:07:52
In reply to Re: Minocycline update. » jono_in_adelaide, posted by SLS on September 25, 2012, at 9:33:14
Minocycline is also garnering some interest as a drug to help prevent Alzheimer's Dementia. It is its anti-inflammatory properties and the inhibition of apoptotic processes that might be responsible for modifying the Alzheimers disease process.
http://www.ncbi.nlm.nih.gov/pubmed/22472085
http://www.ncbi.nlm.nih.gov/pubmed/20173335
http://www.ncbi.nlm.nih.gov/pubmed/22584394
http://www.ncbi.nlm.nih.gov/pubmed/21602593
http://www.ncbi.nlm.nih.gov/pubmed/19001528
- Scott
Posted by uncouth on October 2, 2012, at 9:46:46
In reply to Re: Minocycline update., posted by SLS on September 25, 2012, at 10:07:52
Scott how is the minocycline going? How long did it take before you felt benefits, and at what dose? I am BP2 too and may ask my doctor about it today...i responded well to memantine at higher doses a few months ago esp for OCD-ish symptoms but my addictive drive has come back and my mood has declined since I stopped cymbalta, which cuased hypomania and weight gain. My primary antidepressant is bupropion which is helping but does not seem to be sufficient at 600mg. I am hoping to finally drop the antipsychotics and mood stabilizers, though. I am still having a terrible time with sleep insomnia and apnea.
Posted by SLS on October 2, 2012, at 12:07:30
In reply to Re: Minocycline update., posted by uncouth on October 2, 2012, at 9:46:46
> Scott how is the minocycline going?
I am still responding well to minocycline. However, I found that I still need prazosin at this point. I had discontinued it, and did not feel as well.
I am now attempting to replace prazosin (half-life = 3 hours) with its sister drug, doxazosin (half-life = 22 hours) in the hope that the timing of dosing won't be so critical and that my libido will not be so greatly reduced. So far, it seems that the doxazosin is inferior, if not inert. Still, I have not lost the improvement produced by minocycline.
> How long did it take before you felt benefits, and at what dose?I began to respond to minocycline by day 5 at a dosage of 100 mg/day. However, I respond better at 200 mg/day.
> I am BP2 too and may ask my doctor about it today...i responded well to memantine at higher doses a few months ago esp for OCD-ish symptoms but my addictive drive has come back and my mood has declined since I stopped cymbalta, which cuased hypomania and weight gain. My primary antidepressant is bupropion which is helping but does not seem to be sufficient at 600mg. I am hoping to finally drop the antipsychotics and mood stabilizers, though. I am still having a terrible time with sleep insomnia and apnea.
What are you currently taking?
Here are two studies you could show your doctor:
http://clinicaltrials.gov/ct2/show/NCT01514422
http://clinicaltrials.gov/ct2/show/NCT01403662
I understand your desire to rid yourself of drugs with side effects. I also understand your desire to take fewer drugs. I hope you can achieve these goals. However, if you find yourself in need of alternatives:
Right now, there is only one drug approved as monotherapy for bipolar depression - Seroquel. The next drug that might be approved for this indication is Latuda.
Have you tried combining Lamictal with Abilify? You might want to consider these two drugs if adding minocycline to bupropion is inadequate. You would want to continue the minocycline while exploring the utility of the combination treatment. You might want to add the Lamictal first and see how you do with it before adding Abilify.
- Scott
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.