![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Rockel By on March 10, 2014, at 13:58:54
What is the deal with serenics for aggression. Have any of these proven to be good for aggression or are they failures? Where is the true info? I have repeated destructive episodes of rage and mixed depression related irritability and agitation. I wondered if these would be any good for such in the future. Out of curiosity Are they uncontrolled substances and easy to buy? What about dosing information?
What are other non-antipsychotic drugs useful for severe depression and such rage?
Posted by phidippus on March 10, 2014, at 14:58:45
In reply to Serenics, posted by Rockel By on March 10, 2014, at 13:58:54
Lithium is widely prescribed to control rage.
Eric
Posted by Rockel By on March 11, 2014, at 6:00:44
In reply to Serenics, posted by Rockel By on March 10, 2014, at 13:58:54
I'll keep that in mind. I want to avoid lithium and depakote because of possible renal damage with lithium (which is gradual but irreversible) and hepatoxicity in valproate. How well does oxcarbazepine work for severe agitation and intense anger. Worth a try? I can't risk getting another episode and need something that's very likely to work and not just hit or miss.
Anyway, out of interest, I'd like info on serenics like eltoprazine and others. All I know is they are specific antiaggressives and work in animal models. I want to know if they work in humans.
Posted by SLS on March 11, 2014, at 8:32:15
In reply to Re: Serenics, posted by Rockel By on March 11, 2014, at 6:00:44
Are we talking about hypomania?
Tegretol (carbamazepine) and Trileptal (oxcarbazepine) do work for aggression and impulse control. I have seen both of these drugs work in other people.
Each drug has its liabilities. Agranulocytosis and hyponatremia occur infrequently with Tegretol and Trileptal, respectively.
Tegretol: Periodic blood tests to screen for agranulocytosis.
Trileptal: Periodic blood tests to screen for hyponatremia.Trileptal would be my choice. I was not at all sedated when I tried it. If sedation is desirable, Tegretol might make a better choice. These drugs probably work by stabilizing the temporal lobes.
Not very long after Zoloft was approved for use in the USA, doctors were using it to treat aggression. It seemed to work for some people. Tegretol + Zoloft was used sometimes. Unfortunately, in some people, Zoloft can produce akathisia and anxiety. The anxiety is likely to dissipate with time and can be controlled temporariliy with a benzodiazepine or doxepin. Akathisia is a profoundly intense reaction that is difficult to treat, although I have heard of the successful use of propranolol and benztropine (Cogentin).
As mentioned by Phidippus, lithium can be pacifying. I experience this with dosages above 450 mg/day. Unless you are bipolar, I would not make this my first choice, simply because it can be toxic on thyroid and kidneys at higher dosages.
- Scott
-----------------------------------------------J Clin Psychopharmacol. 2005 Dec;25(6):575-9.
Oxcarbazepine in patients with impulsive aggression: a double-blind, placebo-controlled trial.
Mattes JA.
Author information
Abstract
OBJECTIVE:Impulsive aggression is a common clinically significant symptom, but there are few controlled studies evaluating drug treatment. This study evaluated oxcarbazepine in patients with impulsive aggression and whether diagnosis or other baseline characteristics predict response.
METHOD:Eligible outpatients had clinically significant impulsive aggression, without other psychiatric symptoms clearly requiring treatment. Patients were randomized to oxcarbazepine or placebo, double-blind, for 10 weeks, at a variable dose increasing to 1200 mg/d if tolerated and to 2400 mg/d if aggression persisted. Primary outcome measures were (1) change in a Global Overt Aggression rating derived from the Overt Aggression Scale-Modified and (2) patient-rated global improvement.
RESULTS:Of 48 patients, 24 per group, 9 dropped out due to adverse events, but 45 completed at least 4 weeks on double-blind medication. Analyses showed consistent evidence of benefit from oxcarbazepine, compared with placebo, on both primary efficacy measures and most secondary measures. There were no significant interactions between diagnosis or other baseline characteristics and differential response to oxcarbazepine or placebo.
CONCLUSION:Oxcarbazepine appears to benefit adults with clinically significant impulsive aggression.
-----------------------------------------------
Posted by phidippus on March 11, 2014, at 11:04:47
In reply to Re: Serenics » Rockel By, posted by SLS on March 11, 2014, at 8:32:15
>Not very long after Zoloft was approved for use in the USA, doctors were using it to treat aggression.
Prozac is a popular choice amongst prison psychiatrists-my late brother-in-law was on Prozac (he had been in prison for attempted murder).
I have been on Lithium (1200 mg) for 11 years and have never had any kidney problems, but do have lithium induced hypothyroidism which is easily treated with levothyroxine.
Eric
Posted by Rockel By on March 11, 2014, at 17:30:28
In reply to Re: Serenics » Rockel By, posted by SLS on March 11, 2014, at 8:32:15
> Are we talking about hypomania?
>Possibly. I get severe depression with extremely severe irritability and a frenzied sort of anger, where I was so depressed and angry that I even crushed up my food and banged it on to the plate because I felt I had no place to go and no one to love me and because I was given drugs without my consent or permission, (this is unrealistic because I'm a danger when I'm unmedicated). I get such intense anger that I frantically walk around the house looking to destroy something in my anger, and I shatter glasses and other objects, because I have unrealistic mood in my head, I have everything I need and am lacking nothing, but I get crushing feelings on being unloved and a mix of depression and severe anger at perceived insults and deep hurt when people do anything like go out with their friends. I don't have friends or a social life and I'm hurt because I feel that they don't care about me enough to stay with me or pay me attention and give me their love exclusively.
I'm hurt because when I do try to love others, I'm rejected and destroyed by their unacceptence, like priests at church who tell me I can't convert to the Christian faith and receive the holy bread because I have a 'psychological problem' as if God rejects people who are ill.
I get obsessive thoughts about people, like a young girl I saw at church and who is very 'beautiful' but I have morbidly jealous thoughts and black and white thinking because they can't live up to my expectations. I imagine their love for other people. As normal people love each other but I can't accept that. I can't accept people's 'healthy sexuality', the world's concupiscence, young men and women's curiosity for each other and the drawing of their eyes to each other. Nor the fact that anyone I'm with would even look at another man or have thought even a curious thought about anyone. It is not their fault that they do not keep their eyes downwards or thoughts dejected, but my fault that I can't accept what nature God has made.
So I punish myself, sometimes physically when I'm severely depressed. I tell myself that since my family whom I love hasn't received the eucharist either, I won't too, because I love them and will only receive from Christ's own hands when he comes. So I thought that I won't convert either although I did talk to a priest just to see if they would at least accept me as a part of their community, but the priests tell me I don't have a 'Christian disposition' and I better go to a fringe Protestant church instead.
And then I have severely depressed thoughts because I can't live a life everyone else can, because sometimes people love their friends, love the world more than they love me, so I do not want to go to heaven either, because God, even though he gave his life for me, has made a nature for men that I can't accept.
But these thoughts are fairly recent compared to my condition during teen years (I'm 22 now). My father is an abusive person (I do love him because I see the father who did love me when I was a kid) but he wars with my mother and rejects her, and despises her. He would abuse his children too. And so for some time, I lived alone in our other apartment in the building. I sometimes got so angry that for days I would refuse to eat at all, until I got a severe headache and couldn't stand it any longer. I do not know why my mind gets like that.
Right now, I have everything. My mother gives me everything, I'm not asked to work. I can do whatever I want at home, but why this severe anger comes to me, I don't know. Once I was so full of severe irritability and rage, I banged and destroyed furniture for many many hours. Mostly, after a couple hours, I stop, being exhausted with my mind hurting and all and strained and tired out, headachey. This rage got more severe since 6 years ago though I've had depressive-like symptoms since 12 years of age.
I've always concluded that I have a mood disorder with mixed, agitated depression because that's what it seems like to me, but to be honest, my doctor thinks I might have psychotic prodrome. Though I'm not convinced since I've had no active schizo symptoms, even the mild ones, like seeing a shadow near you or recognizing a sound in a whisp of coming wind that happens in some prodromes, neither the classic schizo sx, auditory symptoms.
As for hypomania, I do think it's agitated mixed state, but I don't have some symptoms like racing thoughts, if I do, then it's mild. Mostly my head feels compressed and achey and hurts me to look at anything and even observe anything around me. Someone, not a professional, said that my rage sits in the temporal lobes, I'm not sure what they meant.
My EEG is normal. Sometimes I get extreme states of fear, it passes away. For example, when I was in the dark going to the bathroom and my mother calls out to me for some reason, I got extreme fear and panic, but it passed away after some moments. When my symptoms are great, I tend not to sleep much, some days not at all, even though I'm greatly fatigued and tired. If I do sleep, my timing sets so I sleep in the morning instead. A lot of the time I keep my lights open, because I'm scared of the dark, and scared of sleeping ,because losing consciousness and the thought of going into a state of sleep scares me. Anyway, I do stuff on the internet obsessively, whether reading something or researching something like an alternative to the antipsychotics a drug class made in hell that always gives me stifling side effects.
Well, I think the extreme states of agitation is mixed depression/mixed states. But I don't know. I've taken lamitrigine and valproate, but I had severe episodes of weeping for hours and hours and a depressed mood constantly like I get when in a deep stage of depression. I don't think they worked for me. But there must be something that works for me. I hope.
Posted by phidippus on March 12, 2014, at 16:35:28
In reply to Re: Serenics, posted by Rockel By on March 11, 2014, at 17:30:28
It seems you have borderline personality disorder.
Do you have a therapist?
Eric
Posted by SLS on March 12, 2014, at 16:48:40
In reply to Re: Serenics » Rockel By, posted by phidippus on March 12, 2014, at 16:35:28
> It seems you have borderline personality disorder.
Good call.
- Scott
Posted by Rockel By on March 13, 2014, at 4:09:14
In reply to Re: Serenics » phidippus, posted by SLS on March 12, 2014, at 16:48:40
I've never considered borderline, I'll look into it. However, I was searching for information on rages, and did come across some information on the internet about 'limbic rage'.
I would like to say, that in my rages, though I usually destroy glass objects and other property and destroy furniture, I've also once violently attacked my mother (a few years ago), hitting her many times, because of something that happened that I did not like. I was in a deep stage of illness then, with severe depression and anger.
When I'm in a rage, I realize what's going on, but I cannot control it.
Anyway, I read that there are a form of seizures (not actually seizures) that are called, 'emotional seizures' or 'rage seizures', called seizures because it emanates because of abnormal electrical activity from the same limbic system that causes actual seizures, and is uncontrolled because of defects in the amygdala and prefrontal cortex's ability to modulate it. So one site says, that recently rage disorders have been come to be seen as neuropsychiatric problems, that doesn't always come from injuries or developmental problems, but also because of genetic manifestations that can run in families also. It causes chronic irritability and rage and aggression against others or property or self. I know mine is always chronic because when I'm un-medicated, I'm chronically extremely in a state of hyper-irritability and anger impulses all the freaking time.
"Why is the Limbic System Important for Neuropsychiatric Disorders?
Since this is our emotion brain, it is vulnerable to disorders in brain chemistry and in brain electrical activity. Some disorders run in families and are genetic in origin, while others are acquired by developmental brain damage (e.g.; drugs or alcohol used during pregnancy, or a difficult birth). A disorder in the emotion brain can produce emotions that are out-of-control. Extreme acts of violence, suicidal behavior, agitation, and mood swings can be due to disorders of this brain system."
BRAIN DISORDER INDICATORS:
Repetitive rage behavior (Pathological Aggression) with no provocation or gain
Impulsivity with impulsive aggression
Chronic irritability
Poor planning skills (runaway with no plan, no money, nowhere to go)
Short attention span & poor memoryIt goes on to list stuff like injuries and structural abnormalities also, which I don't have.
Anyway, some places online also say that since the emotional part of brain which is the limbic system, is located deep inside the brain, disorders of it don't always show up in an EEG and a qEEG is required which is an EEG with types of auditory and visual stimulation.
Do you think my rages could have anything to do with this "Limbic Rage"?
Also, one thing I forgot to mention, though I have had emotional problems since early age, when the disease worsened and I started getting severe rages and all, the school I was at also had bullies of a very sick type, and I became very self-conscious in social settings, and whether because of that, or because of some other reason, I found that I was so conscious that I was unable to speak properly, as if the words I said weren't pronounced properly or enunciated properly, but I had to repeat myself twice to others, and maybe because I became very conscious or maybe some other reason, I found that I was unable to soak in what other people said to me, it was like so much activity was going on in the classroom that I couldn't understand what others said to me in conversation. All that went away, after I was medicated (risperidone 3 mg for the rages) and my family made it a point to have me converse much. Anyway, just putting that in.
Posted by phidippus on March 13, 2014, at 5:44:56
In reply to Re: Serenics, posted by Rockel By on March 13, 2014, at 4:09:14
>I was searching for information on rages, and did come across some information on the internet about 'limbic rage'.
This is also known as intermittent explosive disorder and is treated with Lithium and or antidepressants such as Prozac. Anger management classes are also par for the course.
> Anyway, I read that there are a form of seizures (not actually seizures) that are called, 'emotional seizures' or 'rage seizures'
If your worried about seizures, visit a neurologist and explain your symptoms.
>I found that I was unable to soak in what other people said to meThis is a dissociative symptom due to anxiety.
What effect does marijuanahave on you?
Eric
Posted by SLS on March 13, 2014, at 7:06:23
In reply to Re: Serenics » Rockel By, posted by phidippus on March 13, 2014, at 5:44:56
Trileptal and Tegretol can really produce improvements in impulse and anger control. I have seen Tegretol work well for anger/aggression. I have also seen Trileptal work for borderline personality disorder.
Is the 5-HT2c antagonism produced by Prozac important here?
- Scott
Posted by Rockel By on March 13, 2014, at 7:10:33
In reply to Re: Serenics » Rockel By, posted by phidippus on March 13, 2014, at 5:44:56
> What effect does marijuanahave on you?
>
> EricNot willing to try it. .
Posted by phidippus on March 13, 2014, at 8:57:02
In reply to Re: Serenics » phidippus, posted by SLS on March 13, 2014, at 7:06:23
5ht2c antagonism can indeed reduce aggressive behaviors.
Eric
Posted by Rockel By on March 14, 2014, at 3:44:19
In reply to Re: Serenics » SLS, posted by phidippus on March 13, 2014, at 8:57:02
> 5ht2c antagonism can indeed reduce aggressive behaviors.
>
> EricI don't understand science, but Wikipedia says something about 5-ht2c receptors downregulating quickly with antagonists, which I take to mean, that antidepressants which are antagonists lose their effectiveness. Is that right? And so I need inverse agonists. Are there any good inverse agonists with an excellent safety profile, no bad effects on major organs? They all seem to be APs, AAPs and tricyclics. I'd rather not take those.
Posted by Rockel By on March 14, 2014, at 3:55:43
In reply to Re: Serenics » phidippus, posted by Rockel By on March 14, 2014, at 3:44:19
I have decided to go to a neuropsych to consult about 'limbic rage' and 'emotional seizures'. I'll report back if anything happens.
Posted by SLS on March 14, 2014, at 7:05:02
In reply to Re: Serenics, posted by Rockel By on March 14, 2014, at 3:55:43
> I have decided to go to a neuropsych to consult about 'limbic rage' and 'emotional seizures'. I'll report back if anything happens.
I would be interested to know what happens.
Good luck.
- Scott
Posted by phidippus on March 14, 2014, at 18:15:43
In reply to Re: Serenics, posted by Rockel By on March 14, 2014, at 3:55:43
Please see a psychologist about borderline personality disorder.
Eric
Posted by phidippus on March 14, 2014, at 18:21:26
In reply to Re: Serenics » phidippus, posted by Rockel By on March 14, 2014, at 3:44:19
>antidepressants which are antagonists lose their effectiveness
some antidepressants antagonize certain 5ht ligands, while blocking the reuptake of seratonin or other transmitters such as norepenephrine or dopamine. Most antidepressants do not lose their efficacy over time.
You need a mood stabilizer or an antidepressant.
Eric
Posted by Rockel By on March 17, 2014, at 9:20:01
In reply to Re: Serenics » Rockel By, posted by phidippus on March 14, 2014, at 18:21:26
I've not yet consulted a neuro-psych doctor, but have started Eslicarbazepine Acetate @ 800mg per day. I took my first dose yesterday. Do you think it is likely to help? It made me extremely sleepy and I slept for a long time yesterday.
Also, I noticed when I did take Escitalopram 10mg before that it tends to reduce irritation, but when I reduced the Risperidone 3mg I was taking with it, I had agitation - escalating anger, the urge to shout at people near us for making noises, wanting to attack people, wanting to take out my aggression by playing loud music the whole nights and not letting them sleep. If that had gone on, I would soon be destroying things and damaging stuff again in agitation for sure, so we quickly raised the risperidone dose again, but raising the dose messed up my head for some reason, and I stopped sleeping much for many days again as I would when ill, started being awake at night, extremely depressed with lots of weeping. It was as if it stopped working.
I'm not sure though if Eslicarbazepine will help with depression and thinking about adding an antidepressant again if I need it, but worried about the escalating dangerous anger issue.
Also, doctor did not order any blood test for eslicarbazepine. Is that wise? I have liver, renal, and blood tests, but those were taken a year and a half back. I'm worried since I've already started the drug, I don't want to do the start stop thing. Is it okay if I get blood tests after a few doses? And any of the tests are actually necessary with this drug or I should stop worrying?
Posted by phidippus on March 17, 2014, at 13:17:16
In reply to Re: Serenics, posted by Rockel By on March 17, 2014, at 9:20:01
>have started Eslicarbazepine Acetate @ 800mg per day. I took my first dose yesterday. Do you think it is likely to help?
It could. Both Carpamazapine and Oxcarbazapine are reported to reduce agitation and Eslicarbazepine and Oxcarbazapine have the exact same mechanism of action.
I'd eventually go on to a larger dose if you can.
>about the escalating dangerous anger issue.
Continue taking the risperdal.
>Also, doctor did not order any blood test for eslicarbazepine. Is that wise?
The only blood test recommended for this drug is to check sodium levels.
Eric
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.