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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Lamdage22 on November 16, 2013, at 5:14:59
Hello,
i need some help with my Schizo-Affective disorder.
i am currently in hospital and am on a regimen as follows:
700mg Serouqel
15mg Zyprexa
600mg N-acetylcysteine
750mg Metformin
250mg Lithium Orotate
2g Sarcosine
The lithium did curb my suicidal thoughts. Might it do even more so if i increase the dose? A doctor asked if we could do that.N-acetylcysteine harbored a great improvement for me when i took 1800 mg. I will certainly do that in the future again. Or even take 2400mg.
Metformin doesnt help alot with the weight gain i have. Is the dosage too low?
The doctor wants to try cymbalta after Effexor didnt show much improvement and after Zoloft showed improvement but made me restless.
Does anybody understand this whole glutamate business? I remember when i took Lamictal, i had no psychosis. And i remember N-acetylcysteine help me. Both are Glutamate/Nmda antagonists.But now i read that nmda agonists help Schizophrenia!? That doesnt make sense to me.
What is true? It is said that schizophrenia comes with glutamate hyperfunction, but glutamate is a nmda agonist and they are supposed to help against schizophrenia.
Also id like to know more about minocycline.
Can i combine nmda antagonists and agonists? Or is this b*llsh*t?
I know the brain is alot more complicated. But does someone know whats going on here?Advice greatly appreciated on ANYTHING i can do against negative symptoms, cognitive and depression WITHOUT triggering psychosis.
PLease Help
Posted by Christ_empowered on November 16, 2013, at 7:21:23
In reply to Help for Schizo-Affective please., posted by Lamdage22 on November 16, 2013, at 5:14:59
Maybe switch out the zyprexa for 15-30 Abilify, plus lamictal? Just a random thought...clearly, I'm not a doctor.
Posted by Lamdage22 on November 16, 2013, at 11:45:37
In reply to Help for Schizo-Affective please., posted by Lamdage22 on November 16, 2013, at 5:14:59
Scott,
how is it that sarcosine and glycine are good for schizophrenia as agonists and at the same time minocycline and lamictal are good as antagonists.
Also, can i do anything about NAC causing kidneystones. Its a real wonderdrug for me. If NAC and Lamictal helps, what others could help.
@christ:
i am considering Lamictal. Low dosage.
Abilify: cant tolerate it.
Posted by phidippus on November 16, 2013, at 14:15:48
In reply to Help for Schizo-Affective please., posted by Lamdage22 on November 16, 2013, at 5:14:59
Over the past few years, attention has been focused on the glutamatergic system involving agents that block N-methyl-d-aspartate or NMDA. Glutamic acid is the major excitatory neurotransmitter in the brain involving 40% of all synapses. Two street drugs, PCP (angel dust) and ketamine (the date rape drug) are known to cause behavior that closely resembles that of schizophrenia. These drugs block the N MDA receptors. In fact, the psychosis induced by both PCP and ketamine very closely resemble schizophrenia because they not only produce positive symptoms but also the negative symptoms and cognitive deficits that are so resistant to treatment in schizophrenia.
Post mortem evaluations of the brains of people with schizophrenia have shown that they have fewer NMDA receptors than people who do not have the disease. Both glycine and d-serine (NMDA agonists) have been found to be decreased in both the blood and cerebrospinal fluid of people with schizophrenia compared to controls. This has all led to the hypothesis that people with schizophrenia have too little NMDA and that is one cause of some of the symptoms of the disease particularly the negative symptoms and the cognitive deficits.
This knowledge has lead to a number of investigations evaluating the effect of various agents that will increase the amount of NMDA in the brains of those with schizophrenia
Eric
Posted by Lamdage22 on November 17, 2013, at 9:21:02
In reply to Re: Help for Schizo-Affective please. » Lamdage22, posted by phidippus on November 16, 2013, at 14:15:48
Almost immediate improvement. No 6 month.
I hope this good response will last.
Posted by Lamdage22 on November 17, 2013, at 9:38:09
In reply to Re: Help for Schizo-Affective please. » Lamdage22, posted by phidippus on November 16, 2013, at 14:15:48
Yes, but on one website i found that Lamictal and Gabapentin (nmda antagonists) are good against schizophrenia and that Glutamate (a Nmda agonist) is BAD for schizophrenia. It doesnt seem to be THAT easy.
I will see where NAC takes me. The response is very strong on day number 2! WOW
> Over the past few years, attention has been focused on the glutamatergic system involving agents that block N-methyl-d-aspartate or NMDA. Glutamic acid is the major excitatory neurotransmitter in the brain involving 40% of all synapses. Two street drugs, PCP (angel dust) and ketamine (the date rape drug) are known to cause behavior that closely resembles that of schizophrenia. These drugs block the N MDA receptors. In fact, the psychosis induced by both PCP and ketamine very closely resemble schizophrenia because they not only produce positive symptoms but also the negative symptoms and cognitive deficits that are so resistant to treatment in schizophrenia.
>
> Post mortem evaluations of the brains of people with schizophrenia have shown that they have fewer NMDA receptors than people who do not have the disease. Both glycine and d-serine (NMDA agonists) have been found to be decreased in both the blood and cerebrospinal fluid of people with schizophrenia compared to controls. This has all led to the hypothesis that people with schizophrenia have too little NMDA and that is one cause of some of the symptoms of the disease particularly the negative symptoms and the cognitive deficits.
>
> This knowledge has lead to a number of investigations evaluating the effect of various agents that will increase the amount of NMDA in the brains of those with schizophrenia
>
> Eric
Posted by SLS on November 17, 2013, at 10:08:01
In reply to Scott, can you enlighten me? (Nmda), posted by Lamdage22 on November 16, 2013, at 11:45:37
> Scott,
>
> how is it that sarcosine and glycine are good for schizophrenia as agonists and at the same time minocycline and lamictal are good as antagonists.I am not educated enough to answer your question.
When glycine bonds to its sub-receptor of the NMDA receptor, it acts to reduce excess glutamateric activity. Minocycline and Lamictal reduce excess glutamatergic activity as well, albeit through different mechanisms.
Sorry I couldn't help you with the sarcosine.
- Scott
Posted by Lamdage22 on November 17, 2013, at 10:53:50
In reply to Re: Scott, can you enlighten me? (Nmda) » Lamdage22, posted by SLS on November 17, 2013, at 10:08:01
> > Scott,
> >
> > how is it that sarcosine and glycine are good for schizophrenia as agonists and at the same time minocycline and lamictal are good as antagonists.
>
> I am not educated enough to answer your question.
>
> When glycine bonds to its sub-receptor of the NMDA receptor, it acts to reduce excess glutamateric activity. Minocycline and Lamictal reduce excess glutamatergic activity as well, albeit through different mechanisms.
>
> Sorry I couldn't help you with the sarcosine.
>
>
>
> - ScottHi Scott,
sarcosine is basically a "glycine reuptake inhibitor". It is making me a little nervous and akathisia like. I will probably change and try glycine instead. I suspect this reuptake inhibitor business gives me akathisia in general.
Scott, i am responding to Acetylcysteine big time. Also i reacted to lamictal in a way that i didnt need antipsychotics anymore.
Does this mean that i may be cured afterall?
Id really appreciate some guidance/thoughts.
Posted by SLS on November 17, 2013, at 11:36:17
In reply to Re: Scott, can you enlighten me? (Nmda), posted by Lamdage22 on November 17, 2013, at 10:53:50
> > > Scott,
> > >
> > > how is it that sarcosine and glycine are good for schizophrenia as agonists and at the same time minocycline and lamictal are good as antagonists.
> >
> > I am not educated enough to answer your question.
> >
> > When glycine bonds to its sub-receptor of the NMDA receptor, it acts to reduce excess glutamateric activity. Minocycline and Lamictal reduce excess glutamatergic activity as well, albeit through different mechanisms.
> >
> > Sorry I couldn't help you with the sarcosine.
> >
> >
> >
> > - Scott
>
> Hi Scott,
>
> sarcosine is basically a "glycine reuptake inhibitor". It is making me a little nervous and akathisia like. I will probably change and try glycine instead. I suspect this reuptake inhibitor business gives me akathisia in general.
>
> Scott, i am responding to Acetylcysteine big time. Also i reacted to lamictal in a way that i didnt need antipsychotics anymore.
>
> Does this mean that i may be cured afterall?Perhaps you have managed to "squelch" noisy glutamatergic neuronal circuits by using drugs like:
1. NAC
2. Lamictal
3. MinocyclineI would not play with a direct-acting NMDA channel blocker like memantine or ketamine. I would stay away from sarcosine if it does what you describe pharmacologically.
I'll give this more thought. If I come up with anything, I will post.
I am excited to hear that your response to NAC was so rapid. With affective disorders, it can take as long as 6 months to take effect. Let's hope it "sticks".
- Scott
Posted by Lamdage22 on November 17, 2013, at 12:23:15
In reply to Re: Scott, can you enlighten me? (Nmda) » Lamdage22, posted by SLS on November 17, 2013, at 11:36:17
Ok, why stay away from it?
What about Glycine?
Thanks, Scott! You are always welcome to post in my threads.
Posted by SLS on November 18, 2013, at 17:15:31
In reply to Re: Scott, can you enlighten me? (Nmda), posted by Lamdage22 on November 17, 2013, at 12:23:15
> Ok, why stay away from it?
I think memantine and ketamine can promote a worsening of postitive symptoms in schizophrenia.
> What about Glycine?
Glycine has been used in the treatment of schizophrenia experimentally. It seems to improve negative symptoms, but not by very much. Glycine seems harmless enough, though. It might be worth a try in combination with one or more of the antiglutamatergic drugs that I mentioned in my previous post.
- Scott
Posted by Lamdage22 on November 19, 2013, at 4:08:17
In reply to Re: Scott, can you enlighten me? (Nmda) » Lamdage22, posted by SLS on November 17, 2013, at 11:36:17
I read that it releases glutamate into extracellular space.
Posted by SLS on November 19, 2013, at 7:05:39
In reply to Are you sure NAC is anti-glutamate?, posted by Lamdage22 on November 19, 2013, at 4:08:17
> I read that it releases glutamate into extracellular space.
NAC is being used as a glutamatergic modulator at Harvard / Massachusetts General to treat stubborn cases of depression and bipolar disorder.
I am guessing that you saw this article. Here, the excess *extrasynaptic* glutamate acts on glutamate *autoreceptors* along the neuron that, when stimulated, inhibit the release of *intrasynaptic* glutamate. Stimulating autoreceptors usually inhibits synthesis and release of neurotransmitters.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/
- Scott-------------------------------------------------------
N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action
Glutamate
In addition to the effects on oxidative balance, alterations in cysteine levels have also been shown to modulate neuro-transmitter pathways, including glutamate and dopamine (DA; Fig. 1).23,24 Cysteine assists in the regulation of neuronal intra- and extracellular exchange of glutamate through the cystineglutamate antiporter. Whereas this antiporter is ubiquitous throughout all cell types, in the brain it is preferentially located on glial cells.25 The dimer, cystine, is taken up by astrocytes and exchanged for glutamate, which is released into the extracellular space.
...* This free glutamate appears to stimulate inhibitory metabotropic glutamate receptors on glutamatergic nerve terminals and thereby reduce the synaptic release of glutamate. *...
Given that relation, the amount of cysteine in the system as well as the feedback via GSH production by neurons may directly regulate the amount of glutamate present in the extracellular space. Furthermore, GSH itself has been shown to potentiate brain N-methyl-d-aspartate receptor response to glutamate in rats.27,28 Changes in the levels of neuronal GSH may not only alter available glutamate levels, but also have direct consequences on glutamatergic function.
-----------------------------------------------------
Posted by Lamdage22 on November 19, 2013, at 8:17:39
In reply to Re: Are you sure NAC is anti-glutamate? » Lamdage22, posted by SLS on November 19, 2013, at 7:05:39
Ok,
the initial effect wore off unfortunately.
Posted by Lamdage22 on November 20, 2013, at 3:46:44
In reply to Re: Are you sure NAC is anti-glutamate?, posted by Lamdage22 on November 19, 2013, at 8:17:39
Posted by Lamdage22 on November 20, 2013, at 9:13:43
In reply to Help for Schizo-Affective please., posted by Lamdage22 on November 16, 2013, at 5:14:59
I dont know what to do. The next medications to try are cymbalta and aurorix in that order.
Also i will be put on Lamictal and 500mg Lithium Orotate perhaps. I just want to go back out into society.
Suicidality sucks.
Posted by SLS on November 22, 2013, at 17:01:21
In reply to Now im worse on NAC, posted by Lamdage22 on November 20, 2013, at 9:13:43
> I just want to go back out into society.
I know. You deserve to.
> Suicidality sucks.Hang in there. It is likely that your suicidal state will dissipate shortly. I know it's a gamble of sorts, but I'm betting that you will feel significantly better, and that you would have sacrificed a good life were you to end it too soon.
I hope you feel that people on Psycho-Babble are supportive.
I find that good old-fashioned lithium carbonate 450 mg/day does the trick for depression as an augmenter when combined with Parnate. If lithium oratate is not at all helpful, I would encourage you to explore pharmaceutical lithium before declaring lithium useless.
Good luck
- Scott
Posted by Lamdage22 on November 23, 2013, at 12:02:21
In reply to Re: Now im worse on NAC, posted by SLS on November 22, 2013, at 17:01:21
Scott, supplemental lithium is helpful!
It keeps me out of the locked ward. I think about increasing orotate to 500. Currently 250.
Posted by SLS on November 23, 2013, at 15:59:53
In reply to Re: Now im worse on NAC, posted by Lamdage22 on November 23, 2013, at 12:02:21
> Scott, supplemental lithium is helpful!
>
> It keeps me out of the locked ward. I think about increasing orotate to 500. Currently 250.Good to know. Thanks. A friend of mine implores me to take lithium oratate. He explained the reasons why it was less toxic to the body than lithium carbonate.
Right now, I am reluctant to make any changes in my lithium treatment. I am improving rapidly (for now). I will definitely do more research on oratate.
Thanks again.
- Scott
Posted by Lamdage22 on November 24, 2013, at 5:07:05
In reply to Re: Now im worse on NAC » Lamdage22, posted by SLS on November 23, 2013, at 15:59:53
The studies made on lithium in drinking water found it helps reduce violent crime and suicide. Low doses probably.
I wonder if i can get a better response with more than 2 pills.
I will definitely do more research on oratate.
>
> Thanks again.
>
>
> - Scott
>
>
Posted by Lamdage22 on November 27, 2013, at 3:21:07
In reply to Help for Schizo-Affective please., posted by Lamdage22 on November 16, 2013, at 5:14:59
Its day 2 of Cymbalta and my suicide thoughts seem to be gone. Mood is lifted.
Posted by SLS on November 27, 2013, at 8:44:57
In reply to Cymbalta seems to be working, posted by Lamdage22 on November 27, 2013, at 3:21:07
> Its day 2 of Cymbalta and my suicide thoughts seem to be gone. Mood is lifted.
Do NOT evaluate the therapeutic potential of Cymbalta during the first 3 weeks. Some people experience a brief "blip" improvement that begins during the first few days of treatment and lasts for less than a week. So if you should "relapse" over the next few days, there is still a great deal of hope that you will eventually be a responder to Cymbalta. Of course, it would be nice if your were to feel better and better without the disappearance of your current improvement.
I took Cymbalta briefly. I didn't like that it made me feel fatigued. It might be worth adding Wellbutrin to Cymbalta if low energy becomes a problem. Wellbutrin also makes a good adjunct to Effexor and Pristiq.
- Scott
Posted by Lamdage22 on November 27, 2013, at 11:28:47
In reply to Re: Cymbalta seems to be working » Lamdage22, posted by SLS on November 27, 2013, at 8:44:57
Im kinda desperate for something to work.
Posted by SLS on November 27, 2013, at 11:49:10
In reply to Re: Cymbalta seems to be working, posted by Lamdage22 on November 27, 2013, at 11:28:47
> Im kinda desperate for something to work.
I know.
Hang in there.
- Scott
This is the end of the thread.
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