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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by LouisianaSportsman on March 3, 2014, at 15:58:56
To follow-up my previous thread after today's visit, my PDOC and I decided to taper Effexor XR (venlafaxine) and replace it with Brintellix (vortioxetine).
Eric, to say that I didn't put a lot of weight on your assessment of Brintellix would be a lie; your guidance coupled with everything I've been reading has lead me to believe that this would be the best AD option going forward per my symptomatic indications.
Scott, your interest in vortioxetine has also really enthralled me; especially,intriguing to me was when I read that your expressed interest in giving up tranylcypromine just to try this 5-HT7 receptor antagonist.
Lamdage22, I know that you're in Germany, but you've expressed considerable, notable interest about vortioxetine on the board, so I will also keep you in the know.
To begin thetrial, I received 4 sample bottles of #7 10mg. tablets for this month. My PDOC advised, depending on toleration, that the dosage will increase to 20mg. next month. She advised that she had prescribed other patients Brintellix and had high expectations for the drug.
Perhaps, I should have quizzed her more, but from what I gathered, it seemed like she had two other patients taking it one geriatric man and one middle-aged woman; both of whom had main complaints of nausea which she postulated was due to vortioxetine's 5-HT3 receptor anatognism [drugs that target this receptor are antiemetics actually, e.g. Zofran, but such antagonism can lead to adverse emetic effects].
Neither of the two patients has had their dosage increased to 20mg. I do not know of duration, and she didn't note anything "blockbuster" about their trial progression. Furthermore, she told me outright that I was her "guinea pig", lol.
I took my first tablet ~3hours. ago and so far I feel nothing psychoactively or in terms of side effects. My stomach is currently "growling", but it was growling before I had administered vortioxetine; therefore, it is hard to judge if this is an effect or not. I will be sure to report more information at a later date.
Interesting to note, while 20mg. is the PI sheet's target dosage, 10mg. is at least somewhat effective in studies.
via PI sheet
"Study 1: 10mg. -5.7 overall from placebo; +0.2 placebo-subtracted difference from 20mg. therapy.
Study 2: 10mg. -4.9 overall from placebo; -0.8 difference from 20mg. therapy.
Study 5: 10mg. -2.2 overall from placebo; +1.4 difference from 20mg. therapy."
My current cocktail (also switched to extended-release topiramate today), for a reference, is as follows: Adderall IR (amphetamine salts) 60mg.; Aplenzin (bupropion hydrobromide) 522mg.; Brintellix (vortioxetine) 10mg.; Lamictal (lamotrigine) 200mg.; Latuda (lurasidone) 80mg.; Nuvigil (armodafinil) 250mg.; Neurontin (gabapentin) 1,200mg.; Trokendi XR (topiramate) 100mg.
I will let the board know of my Brintellix progression as I notice the difference! (if any difference at all, lol, *crossing my fingers*)
If anyone has any questions or concerns, please feel free to let me know; I would love to discuss it.
Thanks!
Posted by Phillipa on March 3, 2014, at 16:17:59
In reply to Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 3, 2014, at 15:58:56
Diagnosis have been reading same? So some docs have samples? Phillipa
Posted by LouisianaSportsman on March 3, 2014, at 16:37:43
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » LouisianaSportsman, posted by Phillipa on March 3, 2014, at 16:17:59
> Diagnosis have been reading same? So some docs have samples? Phillipa
Phillipa,
My doctor opened up her supply closet, and she seemed to have a good number of Brintellix sample boxes, but I couldn't get a good glimpse at the specific quantity. A Brintellix representative, like I was hoping, did come by her office is all I know.
She also gave me a prescription discount card to use at the pharmacy for when I do eventually get a Brintellix script from her.
As an aside, she's really chill with her samples. I have yet to receive a script for Latuda from her as she has been feeding me sample packs for maybe 4-5 months now. I imagine she will do this for awhile with the Brintellix, long as she can, but I don't expect the gravy train to last forever, lol.
In terms of diagnoses what gets the best of me and what I'm looking for vortioxetine to alleviate is the depressive side of my BP2 [I know it is not indicated for this.] lethargy, lack of motivation, etc. My "highs" are controlled to say the least. I know this sounds terrible and completely off base, but I'd almost welcome a manic boost, lol jk.
Effexor XR seemed to being doing nothing beyond placebo, so I definitely want to be taking an AD that is going to be efficacious for my situation.
Thank you for your ongoing concern, Phillipa!
Posted by SLS on March 3, 2014, at 16:50:35
In reply to Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 3, 2014, at 15:58:56
Good luck!
- Scott
Posted by LouisianaSportsman on March 3, 2014, at 19:18:48
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » LouisianaSportsman, posted by SLS on March 3, 2014, at 16:50:35
> Good luck!
>
>
> - ScottThanks!
Scott, are you on asenapine now?
I'll let you know if this Brintellix is worth the Parnate switch or not. I let you down on the lurasidone, so be weary of my advice, lol.
Posted by SLS on March 3, 2014, at 19:45:05
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 3, 2014, at 19:18:48
> > Good luck!
> >
> >
> > - Scott
> Thanks!
>
> Scott, are you on asenapine now?
>
> I'll let you know if this Brintellix is worth the Parnate switch or not.Thanks - big time.
> I let you down on the lurasidone, so be weary of my advice, lol.
Silly!
My reaction to asenapine was very similar to lurasidone. I felt better for a few days, and then began to deteriorate. I felt worse on it than off it. I attribute this to NE alpha-2a receptor antagonism. Both drugs do this. So do mirtazapine and idazoxan. All four of these drugs exacerbate my depression. I can't help but to conclude that NE alpha-2a antagonism is to blame. In the cases of lurasidone and asenapine, I think the 5-HT7 receptor blockade produced the initial improvement, only to be opposed later by the emergence of sufficient NE alpha-2 blockade to disrupt my mood. I think it was a matter of time dependence rather than dosage dependence.
I am very anxious to see how people do on Brintellix. Eric (Phiddipus) has chosen to describe his response to Brintellix using words that I like to hear.
- Scott
Posted by LouisianaSportsman on March 3, 2014, at 20:04:51
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » LouisianaSportsman, posted by SLS on March 3, 2014, at 19:45:05
> My reaction to asenapine was very similar to lurasidone. I felt better for a few days, and then began to deteriorate. I felt worse on it than off it. I attribute this to NE alpha-2a receptor antagonism. Both drugs do this. So do mirtazapine and idazoxan. All four of these drugs exacerbate my depression. I can't help but to conclude that NE alpha-2a antagonism is to blame. In the cases of lurasidone and asenapine, I think the 5-HT7 receptor blockade produced the initial improvement, only to be opposed later by the emergence of sufficient NE alpha-2 blockade to disrupt my mood. I think it was a matter of time dependence rather than dosage dependence.
>
> I am very anxious to see how people do on Brintellix. Eric (Phiddipus) has chosen to describe his response to Brintellix using words that I like to hear.
>
>
> - ScottSo you're hoping that the 5-HT7 boost without the malicious NE alpha-2a antagonism will be so b*d*ss enough to be an alternative to Parnate? I guess so if aripiprazole has been the most effective for you so far. How well do you do on run-of-the-mill SSRIs? I'm curious if it'll have a reuptake inhibition effect similar to that of a Cymbalta (duloxetine) SNRI type or your traditional SSRI, Prozac (fluoxetine) type. How well do you do on -xetine's?
If you do OK enough and the 5-HT7 antagonism is significant enough, it might overcome the activity of MAOI; thus it would be a wise switch.
Yeah, obvious Eric's input was in my subconscious when I brought this up at the PDOC today. I also liked his input, I am hoping for a similar result!
Posted by Phillipa on March 3, 2014, at 20:50:28
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 3, 2014, at 20:04:51
I asked diagnosis as Eric is OCD so wondering if good for this as also have the ruminating type. But also realize very expensive. But I am very interested in how it works for bipolar. Best of luck and keep Posting. Phillipa
Posted by LouisianaSportsman on March 8, 2014, at 8:01:42
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 3, 2014, at 20:04:51
> > My reaction to asenapine was very similar to lurasidone. I felt better for a few days, and then began to deteriorate. I felt worse on it than off it. I attribute this to NE alpha-2a receptor antagonism. Both drugs do this. So do mirtazapine and idazoxan. All four of these drugs exacerbate my depression. I can't help but to conclude that NE alpha-2a antagonism is to blame. In the cases of lurasidone and asenapine, I think the 5-HT7 receptor blockade produced the initial improvement, only to be opposed later by the emergence of sufficient NE alpha-2 blockade to disrupt my mood. I think it was a matter of time dependence rather than dosage dependence.
> >
> > I am very anxious to see how people do on Brintellix. Eric (Phiddipus) has chosen to describe his response to Brintellix using words that I like to hear.
> >
> >
> > - Scott
>
> So you're hoping that the 5-HT7 boost without the malicious NE alpha-2a antagonism will be so b*d*ss enough to be an alternative to Parnate? I guess so if aripiprazole has been the most effective for you so far. How well do you do on run-of-the-mill SSRIs? I'm curious if it'll have a reuptake inhibition effect similar to that of a Cymbalta (duloxetine) SNRI type or your traditional SSRI, Prozac (fluoxetine) type. How well do you do on -xetine's?
>
> If you do OK enough and the 5-HT7 antagonism is significant enough, it might overcome the activity of MAOI; thus it would be a wise switch.
>
> Yeah, obvious Eric's input was in my subconscious when I brought this up at the PDOC today. I also liked his input, I am hoping for a similar result!
>
>Today is now Day 6 of Brintellix therapy, and I must say that I think I like it quite well thus far. There is a poster that mentioned they felt anxiolytic results this early in medicating, I believe.
I feel that I may be experiencing an induced hypomanic response in other words, an antidepressant response for most persons. I cannot say if my swing to hypomania from my recent depressive episode is caused by vortioxetine. I am up early, and I actually want to do activities outside my window in the real world.
If you want to call this mania, thats fine. But, Id say my depression levels have been reduced with Brintellix.
I dont want to solely exist inside the phony, yet well-developed, inner reality in my head. I was discussing with my girlfriend whether or not she preferred the external world or the internal world inside her head (and the things associated with it). I told her that I would have to pick my internal world which comprises my dreamscape and creativity. She told me that this choice wasn't typical and that most people, especially those who are underprivileged, do not have the luxury to develop a luscious internal world because they have too many external obligations. This really made me realize that I should attempt to exteriorize myself more.
I do not have a divination that my mania will be bombastic. The feeling that I acquire from vortioxetine administration is subtle yet potent. I would describe my response compatibly to my initial response to the atypical antipsychotics Abilify (aripiprazole) and Latuda (lurasidone). I didnt experience any physical side effects from any of the pharmacons Im discoursing, but I did get agile mental effects in terms of altering the way I ruminate about life. You dream it, you live it.
Side effects, there are none to report. I cannot attribute any symptoms to vortioxetine.
Scott, I'm not sure if you really care about my input, but I would go for this if you're only getting 35% symptom relief with Parnate (I read that somewhere recently, might be a really old post of yours).
Sorry about the delay, there wasn't much interest.
Posted by SLS on March 8, 2014, at 9:57:16
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 8, 2014, at 8:01:42
> Scott, I'm not sure if you really care about my input, but I would go for this if you're only getting 35% symptom relief with Parnate (I read that somewhere recently, might be a really old post of yours).
>
> Sorry about the delay, there wasn't much interest.No worries. Thanks for considering me. You recall correctly that I am only 35% better. I am pretty close to deciding to try Brintellix. I'll probably wait a month or two for my system to settle after coming off of my trials of Latuda and Saphris.
What's you treatment plan should you become manic?
Good luck!
- Scott
Posted by LouisianaSportsman on March 8, 2014, at 20:22:26
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » LouisianaSportsman, posted by SLS on March 8, 2014, at 9:57:16
>
> What's you treatment plan should you become manic?
>
> Good luck!
>
>
> - ScottNo idea! I've been trying to use all this medication to get manic, if that makes sense; so, initiation seems to be easier than treatment.
If I were to truly go manic, textbook mania, I believe I would increase my dosage of Latuda and augment either lithium or valproic acid depending on which one my PDOC preferred. Both are classic, effective, and possibly underutilized. It seems that lamotrigine is in the spotlight for first-line treatment now.
What would you augment if you were me, Scott? You know my medications, or you can refer to them. The drugs I've failed in the past are: sertraline, atomoxetine, guanfacine, aripiprazole, methylphenidate, hydroxyzine, venlafaxine.
Yes, those are the only drugs I've failed. Those plus the drugs I take now (*I did not fail clonazepam and pregabalin) are the only psychiatric medications I've fooled with. I'm not a seasoned veteran like you are! Lol
I have a tendency to latch on to a medication and just continue to take it because it's "whatever". My philosophy is: if it's not causing any side effects and life got better during the trial, then it must be good stuff.
The only medications that I've ever "noticed" are Adderall, Concerta and Nuvigil for obvious reasons Effexor/Pristiq due to anorgasmia, Strattera (hydroxyzine too but doesn't really count) due to lethargy and Lyrica/Neurontin for anxiolytic effects.
I'm so resistant to side effects that I went an entire year without bupropion; however, one day, the PDOC and I, thought it may be a good idea for me to go back on it since I didn't have any side effects on it before. She decided to put me on 522mg. Aplenzin. I knew I needed it strong, and I wanted it to go ahead to be at an effective dosage fast (300mg. Wellbutrin XL: meh), and she understood that.
She said, "Well, I normally titrate, but you do have prior experience with the drug. You never complain about medication side effects. I'm confident that you can handle this, but you're the only patient that could. I'm concerned about seizure threshold, but you're on so many AEDs. This dosage is essentially what I'm intending to try, bupropion was used in studies when it first came out in much higher doses until they found out it caused seizures significantly."
I cannot distinguish the physical feeling of bupropion nor the physical feeling of aripiprazole even the first day I took both, etc. I just know my emotions. That's why I write those emotions down.
Well, I'm sure all of this information would be helpful for to you if you were to "play PDOC" for me, SLS! Any advice or input would be welcome.
Take care!
Posted by SLS on March 10, 2014, at 8:11:31
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22, posted by LouisianaSportsman on March 8, 2014, at 20:22:26
> >
> > What's you treatment plan should you become manic?
> >
> > Good luck!
> >
> >
> > - Scott
>
> No idea! I've been trying to use all this medication to get manic, if that makes sense; so, initiation seems to be easier than treatment.This is not such a bad thing if your mania manifests as hypomania and not a psychotic mania. My doctors have thought the same thing. If they could bring on hypomania, they could easily stabilize me with either valproate or an antipsychotic. Just budging my system at all is a feat.
I wish you luck. Get well soon - like tomorrow!
:-)
- Scott
Posted by jrbecker76 on May 9, 2014, at 9:48:36
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » LouisianaSportsman, posted by SLS on March 3, 2014, at 19:45:05
> > > Good luck!
> > >
> > >
> > > - Scott
>
>
> > Thanks!
> >
> > Scott, are you on asenapine now?
> >
> > I'll let you know if this Brintellix is worth the Parnate switch or not.
>
> Thanks - big time.
>
> > I let you down on the lurasidone, so be weary of my advice, lol.
>
> Silly!
>
> My reaction to asenapine was very similar to lurasidone. I felt better for a few days, and then began to deteriorate. I felt worse on it than off it. I attribute this to NE alpha-2a receptor antagonism. Both drugs do this. So do mirtazapine and idazoxan. All four of these drugs exacerbate my depression. I can't help but to conclude that NE alpha-2a antagonism is to blame. In the cases of lurasidone and asenapine, I think the 5-HT7 receptor blockade produced the initial improvement, only to be opposed later by the emergence of sufficient NE alpha-2 blockade to disrupt my mood. I think it was a matter of time dependence rather than dosage dependence.
>
> I am very anxious to see how people do on Brintellix. Eric (Phiddipus) has chosen to describe his response to Brintellix using words that I like to hear.
>
>
> - Scott
Hi Scott,Just curious when you had the opportunity to try Idazoxan. Was it in a clinical trial?
I've come to the conclusion that alpha-2 NE activity might also be counterproductive for me. Just my hunch given certain reactions (i.e., irritability, agitation) I've had to drugs that hit that profile (e.g., Mirtazapine, Seroquel). I've wanted to do a trial with Yohimbine just to confirm it, but I think this would be confounded by the fact that Yohimbine has affinity for 5-HT1b as well which would also probably contribute to its deleterious effects.
JB
Posted by SLS on May 9, 2014, at 14:19:08
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » SLS, posted by jrbecker76 on May 9, 2014, at 9:48:36
Hi JRB.
> Hi Scott,
>
> Just curious when you had the opportunity to try Idazoxan. Was it in a clinical trial?1992 at the National Institutes of Health - NIMH. It made my depression significantly worse. This is also true of Remeron, Latuda, and Saphris. Latuda was worse than Saphris.
I really went to the NIMH so that I could be treated with clorgyline (irreversible specific MAO-A inhibitor). I hadn't anticipated 12 weeks of idazoxan hell in order to try it.
> I've come to the conclusion that alpha-2 NE activity might also be counterproductive for me. Just my hunch given certain reactions (i.e., irritability, agitation) I've had to drugs that hit that profile (e.g., Mirtazapine, Seroquel). I've wanted to do a trial with Yohimbine just to confirm it, but I think this would be confounded by the fact that Yohimbine has affinity for 5-HT1b as well which would also probably contribute to its deleterious effects.I didn't know that Seroquel or any of its metabolites were NE alpha-2 antagonists. Science discovers new properties of old drugs all of the time.
- Scott
Posted by jrbecker76 on May 10, 2014, at 10:42:43
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » jrbecker76, posted by SLS on May 9, 2014, at 14:19:08
> Hi JRB.
>
> > Hi Scott,
> >
> > Just curious when you had the opportunity to try Idazoxan. Was it in a clinical trial?
>
> 1992 at the National Institutes of Health - NIMH. It made my depression significantly worse. This is also true of Remeron, Latuda, and Saphris. Latuda was worse than Saphris.
>
> I really went to the NIMH so that I could be treated with clorgyline (irreversible specific MAO-A inhibitor). I hadn't anticipated 12 weeks of idazoxan hell in order to try it.
>
> > I've come to the conclusion that alpha-2 NE activity might also be counterproductive for me. Just my hunch given certain reactions (i.e., irritability, agitation) I've had to drugs that hit that profile (e.g., Mirtazapine, Seroquel). I've wanted to do a trial with Yohimbine just to confirm it, but I think this would be confounded by the fact that Yohimbine has affinity for 5-HT1b as well which would also probably contribute to its deleterious effects.
>
> I didn't know that Seroquel or any of its metabolites were NE alpha-2 antagonists. Science discovers new properties of old drugs all of the time.
>
>
> - ScottInteresting. Yes, in regards to Seroquel, my theory is that the metabolite's binding affinity with alpha-2 in combination with extremely potent NE reuptake inhibition might lead to my adverse reaction to it.
In regards to NE reuptake, I know we also share caution that front as well. I fare very poorly on Reboxetine (most do of course) as well as Milnacipran. I do, however, fare well on lower doses of Effexor and Cymbalta, the former of which I take currently.
JB
Posted by ed_uk2010 on May 11, 2014, at 14:02:37
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » jrbecker76, posted by SLS on May 9, 2014, at 14:19:08
I didn't know that Seroquel or any of its metabolites were NE alpha-2 antagonists.
How do you respond to Seroquel Scott?
Posted by SLS on May 11, 2014, at 20:08:07
In reply to Re: Brintellix Trial 10mg. @Eric, Scott, Lamdage22 » SLS, posted by ed_uk2010 on May 11, 2014, at 14:02:37
> I didn't know that Seroquel or any of its metabolites were NE alpha-2 antagonists.
>
> How do you respond to Seroquel Scott?It was not pleasant. I remember that it made me feel irritable. I stopped taking it within a week of starting it.
- Scott
This is the end of the thread.
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