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Dr. Bob is Robert Hsiung, MD,
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Posted by LouisianaSportsman on February 23, 2014, at 20:46:19
In reply to Re: 7 days on Brintellix » phidippus, posted by SLS on February 23, 2014, at 18:49:16
Scott, I'm surprised you didn't say anything on my thread.
Posted by SLS on February 23, 2014, at 21:06:28
In reply to Re: 7 days on Brintellix, posted by LouisianaSportsman on February 23, 2014, at 20:46:19
> Scott, I'm surprised you didn't say anything on my thread.
Oh. Sorry. I apologize. Can you direct me to it?
Please note my correction. Levomilnacipran (Fetzima) is not a 5-HT7 receptor antagonist.
Asenapine (Saphris) has been soporific for me. It has me sleeping for most of the day. I am taking only 5 mg/day. I plan to try splitting the tablets and take 2.5 mg b.i.d. So far, I have not experienced a worsening of depression the way I expected. If anything, it might be helping. My friend found Saphris to be energizing after her very first dose. Why can't I get so lucky? I am trying not to get too encouraged at this point.
I hope you find Psycho-Babble to be helpful. Again, I apologize for not posting along your thread. Either I didn't see it or didn't have the energy to respond to it when I first saw it.
- Scott
Posted by Phillipa on February 23, 2014, at 21:20:23
In reply to 7 days on Brintellix, posted by phidippus on February 23, 2014, at 18:18:33
Eric first person I've seen to go on this med. Good luck. Phillipa
Posted by johnLA on February 24, 2014, at 1:31:48
In reply to 7 days on Brintellix, posted by phidippus on February 23, 2014, at 18:18:33
any side-effects yet eric?
and, welcome back!
john
Posted by Lamdage22 on February 24, 2014, at 6:27:17
In reply to Re: 7 days on Brintellix » LouisianaSportsman, posted by SLS on February 23, 2014, at 21:06:28
How is it going with Brintellix?
I am considering this. I am attracted by the lack of sexual SEs and the novel modes of action. Finally there is a new non "me too" drug.
I will ask my pdoc on Wednesday.
Posted by phidippus on February 24, 2014, at 17:00:57
In reply to Re: 7 days on Brintellix, posted by Lamdage22 on February 24, 2014, at 6:27:17
I'm surprised at how good I feel only after a week on Brintellix. Some of its modes of action must work quicker than others.
Eric
Posted by phidippus on February 24, 2014, at 18:03:27
In reply to Re: 7 days on Brintellix » phidippus, posted by johnLA on February 24, 2014, at 1:31:48
no side effects yet!
Eric
Posted by phidippus on February 24, 2014, at 18:21:02
In reply to Re: 7 days on Brintellix » phidippus, posted by SLS on February 23, 2014, at 18:49:16
What cascade of events follows the antagonism of the 5ht7 receptor and what neuropsychiatric effects does it have?
Eric
Posted by SLS on February 25, 2014, at 5:59:21
In reply to Re: 7 days on Brintellix » SLS, posted by phidippus on February 24, 2014, at 18:21:02
Hi Eric.
> What cascade of events follows the antagonism of the 5ht7 receptor and what neuropsychiatric effects does it have?
>
> EricI apologize for the delay.
5-HT7 antagonism (heteroreceptor) > 5-HT release inhibition (5-HT1a mediated) > dopamine efflux (PFC, hippocampus, nucleus accumbens).
You are going to find this WAY cool:
http://www.ncbi.nlm.nih.gov/pubmed/22415605
I REALLY hope Brintellix works. I am hopeful for you.
- Scott
Posted by jono_in_adelaide on February 25, 2014, at 18:53:20
In reply to Re: 7 days on Brintellix » phidippus, posted by SLS on February 25, 2014, at 5:59:21
Scott
would you be willing to try 1mg of risperidone at night in order to hit the 5HT7 receptor (start off with 0.5mg for 2 nights, then go to 1mg)
Posted by SLS on February 25, 2014, at 20:56:00
In reply to Re: 7 days on Brintellix - SLS, posted by jono_in_adelaide on February 25, 2014, at 18:53:20
> Scott
>
> would you be willing to try 1mg of risperidone at night in order to hit the 5HT7 receptor (start off with 0.5mg for 2 nights, then go to 1mg)
I'll ask my doctor about that. Thanks.I did try adding risperidone to Parnate about 13 years ago. However, my regime has changed substantially since then.
- Scott
Posted by phidippus on February 26, 2014, at 17:24:31
In reply to Re: 7 days on Brintellix » phidippus, posted by SLS on February 25, 2014, at 5:59:21
It also does all this:
Serotonin transporter (SERT) blocker (i.e. serotonin reuptake inhibitor (SRI)) Ki (binding affinity) = 1.6 nM, IC50 = 5.4 nM
Norepinephrine transporter (NET) blocker Ki = 113 nM
5-HT1A receptor high-efficacy partial agonist/near-full agonist Ki = 15 nM, IA = 80%
5-HT1B receptor partial agonist Ki = 33 nM
5-HT1D receptor antagonist Ki = 54 nM
5-HT3A receptor antagonist Ki = 3.7 nM
5-HT7 receptor antagonist Ki = 19 nMI'm hitting day 12 on it - 3rd day at the 20 mg dose and I feel nifty. Its like my brain is opening up.
Eric
Posted by tommy12003 on February 26, 2014, at 17:50:16
In reply to Re: 7 days on Brintellix - SLS » jono_in_adelaide, posted by SLS on February 25, 2014, at 20:56:00
any sexual dysfunction?
Posted by Lamdage22 on February 27, 2014, at 11:58:10
In reply to Re: 7 days on Brintellix - SLS, posted by tommy12003 on February 26, 2014, at 17:50:16
Good stuff!
I wish this was on germanys market.
My doctor said that lundbeck was quick with approvals in germany.
And i also ask: Anorgasmia?
Posted by phidippus on February 27, 2014, at 14:34:36
In reply to Re: 7 days on Brintellix - SLS, posted by Lamdage22 on February 27, 2014, at 11:58:10
I came buckets last night!
Eric
Posted by SLS on February 27, 2014, at 15:12:09
In reply to Re: 7 days on Brintellix » SLS, posted by phidippus on February 26, 2014, at 17:24:31
> I'm hitting day 12 on it - 3rd day at the 20 mg dose and I feel nifty. Its like my brain is opening up.
"Nifty" sounds good. Can you expand on this description?
Thanks.
I hope you are able to keep a diary of sorts along this thread.
I am very excited about Brintellix, despite some negative reports (hearsay). I am particularly interested in its ability to block 5-HT7 receptors, although 5-HT1a partial agonism is important to me, too. I would not expect that it would make me feel worse. Unfortunately, I would have to discontinue Parnate in order to take Brintellix. It would take a minimum of 3 weeks before I would be able to start it. Were it not for its SRI property, I could simply add it right now.
What would be really cool is if I could discontinue Abilify if the addition of Brintellix were to work for me. In addition to being a D2/D3 partial agonist, Abilify is a 5-HT7 antagonist and a 5-HT1a partial agonist. So, if the dopaminergic properties of Abilify are not contributing to the improvement it gives me, I might be able to jettison it and lose the 60 pounds it put on me.
- Scott
Posted by phidippus on February 27, 2014, at 16:20:47
In reply to Re: 7 days on Brintellix » phidippus, posted by SLS on February 27, 2014, at 15:12:09
4th day 20 mgs.
I feel nifty.
This means Brintellix's anxiolytic properties are in full force. I'm taking this for OCD and am not too concerned about what its doing for my mood, although I have to say I've been pretty perky.
One interesting thing I notice is that my mind seems more 'open' as I am finding a lot more things to think about and I am enjoying thinking more. Thoughts are less heavy and I don't seem to be wading through a heap of negative ideations.
I've not experienced much in the way of side effects except for some stomach discontent.
Eric
ps. this drug starts working remarkably fast.
Posted by Phillipa on February 27, 2014, at 20:28:58
In reply to Re: 7 days on Brintellix » SLS, posted by phidippus on February 27, 2014, at 16:20:47
Eric since we both have some form of OCD please keep me updated. Phillipa
Posted by Lamdage22 on March 2, 2014, at 10:35:10
In reply to Re: 7 days on Brintellix » phidippus, posted by Phillipa on February 27, 2014, at 20:28:58
Idiscontinued Effexor due to anorgasmia.. when i reduced from 150 to 75, i got suicidal thoughts the first day. Now i reduced to 0 for the first day and i am suicidal again.
This Brintellix is not yet on the german market. I will try to push my doc to prescribe anyway.
Alternative would be Nortryptiline... isnt that purely noradrenergic? How is this supposed to help-
Help!
Posted by phidippus on March 2, 2014, at 18:20:11
In reply to Re: 7 days on Brintellix, posted by Lamdage22 on March 2, 2014, at 10:35:10
What antidepressants have you tried?
Eric
Posted by SLS on March 2, 2014, at 20:16:13
In reply to Re: 7 days on Brintellix, posted by Lamdage22 on March 2, 2014, at 10:35:10
Sorry for the little aside...
What are you taking metformin for, and what are the results?
Thanks.
- Scott
Posted by Lamdage22 on March 3, 2014, at 0:59:14
In reply to Re: 7 days on Brintellix » Lamdage22, posted by SLS on March 2, 2014, at 20:16:13
I tried Valdoxan, Remeron, Sertraline, Paroxetine, Cymbalta, Effexor.
My doctor suggested Nortryptiline, i want to try Brintellix.
Posted by doxogenic boy on March 7, 2014, at 16:27:59
In reply to Re: 7 days on Brintellix, posted by Lamdage22 on March 3, 2014, at 0:59:14
> I tried Valdoxan, Remeron, Sertraline, Paroxetine, Cymbalta, Effexor.
> My doctor suggested Nortryptiline, i want to try Brintellix.Have you tried Tianeurax? It is generic tianeptine manufactured in Germany.
Here is some information from the manufacturer:
http://www.neuraxpharm.de/html-de/erkrankungen-praeparate-detailansicht.php?name=Tianeuraxhttp://www.neuraxpharm.de/download-pil.php?pfad=GI_Tianeurax_12_5_mg_-_368_2.pdf
I have used it for 172 days, and for me it has been just as good as Stablon, which I used before.
There is a case showing that tianeptine can work together with an SSRI.I have quoted from it in this post:
http://www.dr-bob.org/babble/20090826/msgs/914964.htmlI have used high-dose tianeptine in combination with among others escitalopram 40 mg since October 2009 (see my signature), and it still works very well - no tolerance build-up.
- doxogenic
Posted by Lamdage22 on March 8, 2014, at 3:26:47
In reply to Re: 7 days on Brintellix » Lamdage22, posted by doxogenic boy on March 7, 2014, at 16:27:59
I will ask my doctor about it.
Do you have proof that Tianeurax can be taken with Ssri type drugs? I can show this to my doctor.
Posted by doxogenic boy on March 8, 2014, at 5:35:17
In reply to Re: 7 days on Brintellix, posted by Lamdage22 on March 8, 2014, at 3:26:47
> I will ask my doctor about it.
I would like to hear how it goes if you start taking Tianeurax. I hope this med can help you. It is important to start with an SSRI, SNRI or TCA first, and then add Tianeurax (tianeptine). If you start with Tianeurax and then add an SSRI or other serotonergic drug, it may worsen the depression:
http://informahealthcare.com/doi/abs/10.1080/13651500410005685-1
> Do you have proof that Tianeurax can be taken with Ssri type drugs? I can show this to my doctor.
I have my own experience, that it worked and still works in combination with SSRI + TCA (se my signature) against my severe treatment resistant depression and this case of TRD from the journal Psychiatrische Praxis - a combination of Gladem (sertraline), Saroten (amitriptyline), Neurotop (carbamazepine) and tianeptine:
Kasuistik Psychiatr Prax 2003; 221-222
DOI: 10.1055/s-2003-39488Therapieresistente endogene Depression: Symptombesserung nach Kombinationstherapie mit Antidepressiva und Tianeptin (Stablon)
Therapy Resistant Major Depression: Improvement of Symptomatology After Combining Antidepressants with Tianeptine (Stablon)
Helmut Niederhofer1
1 Univ.-Klinik für Psychiatrie, Abt. für Kinder- und Jugendpsychiatrie, InnsbruckZusammenfassung
Hintergrund: Für die Depressionsbehandlung stehen derzeit immer mehr verschiedene Antidepressiva zur Verfügung. Dennoch wird in einzelnen Fällen eine Therapieresistenz beobachtet. Diese Patienten können unter anderem mit Neuroleptika behandelt werden. Auch Tianeptin (Stablon) kann in diesen Fällen eingesetzt werden. Methodik: Wir berichten über eine 32-jährige therapieresistentedepressive Frau, bei welcher eine Monotherapie mit verschiedenen Antidepressiva einschließlich Tianeptin (Stablon) ineffektiv war. Ergebnisse: Eine Kombination von Antidepressiva und Tianeptin (Stablon) war schließlich effektiv und verringerte den Hamilton-Depressions-Score signifikant. Diskussion: Eine Kombination von Antidepressiva und Tianeptin (Stablon) scheint eine effektive neue Therapieoption für schwere Depressionen zu sein.Abstract
Objectives: In common, depressive disorders are treated with various antidepressants, the number of which is enormously increasing. Nevertheless, in some cases therapy resistance is observed. In these cases, neuroleptics are used as an alternative. Recently, Tianeptin (Stablon) has also been used for the treatment of depressive disorders. Method: We report a 32-year old therapy resistantdepressive female. Monotherapy with antidepressants and Tianeptin (Stablon) was inefective. Results: Finally, a combination of antidepressants and Tianeptin (Stablon) was effective and lowered the HAMD-Score significantly. Discussion: A combination of antidepressants and Tianeptin (Stablon) seems to be an effective new Option for the treatment of therapy resistantmajor depressions.Bisher wurden Antidepressiva, Neuroleptika und Additiv-Mood-Stabilizer bei der Behandlung depressiver Störungen eingesetzt [1]. Neuerdings wird auch der Serotonin-Enhancer Tianeptin (Stablon) für diese Zwecke verwendet [2][3][4]. In der aktuellen Literatur finden sich aber nur wenige Hinweise auf Effekte von Kombinationen der oben erwähnten Substanzgruppen und Tianeptin (Stablon) [5][6][7]. Es soll eine junge Patientin beschrieben werden, bei welcher psychotherapeutische Unterstützungen, Antidepressiva und Neuroleptika alleine keine ausreichende Besserung brachten. Erst eine Kombination dieser drei Komponenten mit Tianeptin (Stablon) zeitigte einen zufrieden stellenden Erfolg.
Falldarstellung
Berichtet wird über eine 32-jährige allein stehende Frau, die seit acht Jahren an einer schweren agitierten Depression leidet. Die Antriebssteigerung in Verbindung mit der subjektiv erlebten Aufmerksamkeits- und Konzentrationsschwäche im Rahmen der depressiven Hemmung hat bereits eine suizidale Krise mit konsekutiv längerem stationären Aufenthalt in einer psychiatrischen Krankenanstalt bewirkt. Auch eine Arbeitsfähigkeit war nur im Rahmen einer unregelmäßig ausgeführten Teilzeitbeschäftigung gegeben. Bei der Patientin bestehen keine organischen Erkrankungen, der IQ beträgt 110. In der Familie der Patientin leidet niemand unter Depressionen.½ Jahr nach dem ersten Auftreten der depressiven Verstimmung im April 1996 wurde erstmals ein Psychiater konsultiert. Er verordnete nach einer umfassenden hirnorganischen Abklärung (EEG, CCT, SPECT waren ohne Befund) im September 1996 Paroxetin (Seroxat) in der Dosierung von 20 mg TD, nach 4 Wochen 40 mg TD. Gleichzeitig wurde eine psychotherapeutische Behandlung in die Wege geleitet, welche von der Patientin auch derzeit noch wahrgenommen wird.
Der drei Wochen nach der Dosissteigerung gemessene Paroxetinserumspiegel lag im therapeutischen Bereich. Wegen unzureichender Besserung der Symptomatik wurde vom selben Arzt als Mood-Stabilizer zusätzlich Carbamazepin (Neurotop) in der Dosierung von 2 × 300 mg verordnet. Der wiederum drei Wochen später gemessene Carbamazepinserumspiegel lag im therapeutischen Bereich, genauso wie der gleichzeitig abermals gemessene Paroxetinspiegel.
Nachdem sich die Symptomatik nach insgesamt acht Monaten unter dieser Therapie nicht zufrieden stellend gebessert hatte, wurde die Patientin im Rahmen der ersten suizidalen Krise im September 1997 vier Wochen lang in einem psychiatrischen Krankenhaus stationär behandelt. Während des Aufenthaltes wurden die Psychopharmaka auf Citalopram (Seropram) 40 mg am Morgen und 50 mg Amitryptilin (Saroten) am Abend umgestellt. Die Phasenprophylaxe wurde abgesetzt. Die wiederholt gemessenen Citalopram- und TCA-Serumspiegel lagen wiederum im Normbereich. Nachdem sich innerhalb zwei Monaten die Symptomatik wiederum nicht zufrieden stellend gebessert hatte, wurde im November 1997 von Seropram auf Anafranil umgestellt. Trotz nach zwei Wochen gemessener im therapeutischen Bereich gelegener Serumspiegel beider Substanzen blieb die Symptomatik unverändert. Nach abermaliger CCT- und EEG-Kontrolle (beide Befunde o. B.) erhielt die Patientin einen Monat später zusätzlich Flupenthixol (Fluanxol) zum Ausgle ich der Stimmungsschwankungen. Ein klassischer Mood-Stabilizer wie z. B. Carbamazepin, Valproinsäure oder Lithium wurde auf Wunsch der Patientin nicht verabreicht. Die gewünschte Verbesserung der Symptomatik blieb unter dieser Therapie abermals aus. Eine Umstellung von Anafranil auf Gladem im Januar 1998 brachte ebenfalls keinen Erfolg. Der vorgeschlagene Therapieversuch mit dem reversiblen MAO-B-Hemmer Moclobemid (Aurorix) wurde seitens der Patientin unter Verweis auf die Angst vor einer weiteren Symptomaggravation durch Weglassen der bisher eingenommenen Psychopharmaka (Gefahr von Interaktionen!) abgelehnt.
Im April 2000 wurde eine abermalige Umstellung von Gladem auf Anafranil - wiederum ohne durchschlagenden Erfolg - vorgenommen. Im September 2000 erfolgte auf Wunsch der Patientin die abermalige Rückumstellung auf Gladem unter Beibehaltung der übrigen Medikation. Lorazepam wurde als Bedarfsmedikation verabreicht. Der gemessene TCA-Serumspiegel lag im Normbereich. Im November 2000 schließlich wurde die Fluanxolmedikation abgesetzt und durch Carbamazepin (2 × 300 mg Neurotop) ersetzt. Sowohl der Carbamazepin- als auch der TCA-Serumspiegel lagen zwei Wochen später im Normbereich. Wiederum besserte sich die Symptomatik kaum.
Im Januar 2001 wurde der Patientin unter Beibehaltung der Gladem-, Saroten- und Neurotopmedikation 37,5 mg Tianeptin (Stablon)/die verabreicht. Vorerst tägliche Kontrollen wurden mit der Patientin vereinbart und auch eingehalten. Interaktionen der Medikamente konnten nicht beobachtet werden. Die zwei Wochen nach Beginn der Tianeptin(Stablon-)medikation abermals bestimmten Medikamentenserumspiegel blieben unverändert. Die Symptomatik besserte sich allerdings innerhalb einer Woche nach Medikationsbeginn signifikant; die Patientin kann wieder regelmäßig und mit Freude einer Teilzeitbeschäftigung nachgehen, erlebt sich selbst als psychisch deutlich stabilisiert und nimmt an zwei Freizeitgruppen teil. Die erfreuliche Remission der Symptomatik dauert bis zum gegenwärtigen Zeitpunkt an.
Diskussion
Neben Antidepressiva und atypischen Neuroleptika gewinnt Tianeptin (Stablon) zunehmend Bedeutung bei der Behandlung depressiver Störungen, insbesondere bei so genannten therapieresistentenFällen [2]. Es gibt aber auch Fälle, bei welchen diese Alternative nicht zielführend ist. Eine Kombination der Behandlungsstrategien mit besonderem Augenmerk auf Tianeptin (Stablon) ist in der aktuellen Literatur praktisch nicht beschrieben [5][6][7]. Die vorliegende Falldarstellung berichtet über die erfolgreiche Behandlung eines derartigen therapieresistentenFalles mit Antidepressiva und Tianeptin (Stablon). Der beschriebenen Patientin konnte nach jahrelanger vergeblich lege artis durchgeführter Therapie mit Antidepressiva durch eine Kombination mit Tianeptin (Stablon) entscheidend und nachhaltig geholfen werden.Literatur
1 Riederer P, Laux G, Pöldinger W. Neuropsychopharmaka. New York Springer 19922 Wagstaff AJ, Ormrod D, Spencer CM. Tianeptine: a review of its use in depressive disorders. CNS drugs 2001; 15: 231-259
Dieser Artikel in: PubMed3 Pacher P, Kohegyi E, Kecskemeti V, Furst S. Current trends in the development of new antidepressants. Curr Med Chem 2001; 8: 89-100
Dieser Artikel in: PubMed4 Szadoczky E, Furedi J. Efficacy and acceptability of tianeptine and sertraline in the acute treatment phase of depression. Encephale 2002; 28: 343-349
Dieser Artikel in: PubMed5 Dziedzicka-Wasylewska M, Rogoz Z, Skuza G, Dlaboga D, Maj J. Effect of repeated treatment with tianeptine and fluoxetine on central dopamine D(2)/D(3) receptors. Behav Pharmacol 2002; 13: 127-138
Dieser Artikel in: PubMed6 Waintraub L, Septien L, Azoulay P. Efficacy and safety of tianeptine in major depression: evidence from a month controlled clinical trial versus paroxetine. CNS drugs 2002; 16: 65-75
Dieser Artikel in: PubMed7 Ridout F, Hindmarch I. Effects of tianeptine and mianserin on car driving skills. Psychopharmacology 2001; 154: 356-361
Dieser Artikel in: PubMed | CrossRef
Dr. Helmut Niederhofer
Univ.-Klinik für Psychiatrie · Abt. für Kinder- und Jugendpsychiatrie
Anichstraße 35
5020 Innsbruck · Österreich
-----------------------------
This quote shows that tianeptine was the latest drug to be added to the combination, which I think is important:
"Im Januar 2001 wurde der Patientin unter Beibehaltung der Gladem-, Saroten- und Neurotopmedikation 37,5 mg Tianeptin (Stablon)/die verabreicht."I use nearly ten times as much Tianeurax (300 mg), but the normal dose is 25 - 50 mg. Tianeurax is a serotonin reuptake enhancer (SSRE), the opposite of SSRIs, but they still can work together. Maybe future brain research shows why.
Tianeptine is neuroprotective:
http://www.pnas.org/content/98/22/12796.full
Excerpt from the link above:"Conclusions
The present data show that stress-induced alterations in brain metabolism, hippocampal volume, and cell proliferation are counteracted by tianeptine treatment that started 7 days after the onset of psychosocial stress. Thus, these findings provide experimental evidence for recent theories that impairments of brain structural plasticity are important features of depressive illness and suggest that pharmacological treatments should be sought to reverse structural changes in brain."
http://en.wikipedia.org/wiki/Tianeptine
http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_enhancer- doxogenic
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