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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Lamdage22 on August 18, 2014, at 8:46:46
But how??
Sigma 1 antagonist?
What else could be the mechanism of action here?
I had akathisia so stopped.
Posted by LostBoyinNC45 on August 18, 2014, at 13:11:42
In reply to Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 18, 2014, at 8:46:46
LOL
How about serotonin reuptake??????
Sertaline IS FDA approved for reducing suicidal thinking and it is in the class of anti-depressants known as selective serotonin reputake inhibitors.
Funny post you posted.
Eric AKA "LostBoyinNC"
> But how??
>
> Sigma 1 antagonist?
>
> What else could be the mechanism of action here?
>
> I had akathisia so stopped.
Posted by SLS on August 18, 2014, at 15:00:34
In reply to Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 18, 2014, at 8:46:46
> I had akathisia so stopped.
How do you know that you had akathisia rather than anxiety?
If you have anxiety, the use of a benzodiazepine for a short time can act as a bridge to mitigate transient SSRI startup anxiety.
If you have SSRI-induced akathisia, you can use cyproheptadine or low-dose mirtazapine, perhaps in combination with propranolol.
You may have abandoned sertraline prematurely because you had not considered treating the side effects.
- Scott
Posted by Phillipa on August 18, 2014, at 16:23:06
In reply to Re: Sertraline immediately eliminated suicide thoughts » Lamdage22, posted by SLS on August 18, 2014, at 15:00:34
Scott how are you doing? Phillipa
Posted by SLS on August 18, 2014, at 22:14:37
In reply to Re: Sertraline immediately eliminated suicide thoughts » SLS, posted by Phillipa on August 18, 2014, at 16:23:06
> Scott how are you doing? Phillipa
:-)
Thanks for asking.
It has been a very difficult summer.
- Scott
Posted by Phillipa on August 18, 2014, at 23:05:38
In reply to Re: Sertraline immediately eliminated suicide thoughts » Phillipa, posted by SLS on August 18, 2014, at 22:14:37
I thought so. Have you made any decisions on what is next? I think you will beat it something just says you will. Phillipa
Posted by Lamdage22 on August 19, 2014, at 5:51:59
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by LostBoyinNC45 on August 18, 2014, at 13:11:42
> LOL
>
> How about serotonin reuptake??????
>
> Sertaline IS FDA approved for reducing suicidal thinking and it is in the class of anti-depressants known as selective serotonin reputake inhibitors.
>
> Funny post you posted.Why funny? None of the other SSRI type drugs had this effect which makes me doubt.
>"If you have SSRI-induced akathisia, you can use cyproheptadine or low-dose mirtazapine, perhaps in combination with propranolol.
>
>You may have abandoned sertraline prematurely because you had not considered treating the side effects."Cyproheptadine feels like crap. Mirtazapine gives me nightmares and weight gain and i did try propranolol. That doesn't lead to increased wellbeing either.
I don't think i abandoned sertraline prematurely. And i wonder what other effects of Sertraline may have caused me to feel better. Sigma 1 or BDNF?
Posted by SLS on August 19, 2014, at 7:48:11
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 5:51:59
> I don't think i abandoned sertraline prematurely. And i wonder what other effects of Sertraline may have caused me to feel better. Sigma 1 or BDNF?
I've read that the probability of someone responding to antidepressants is linked to the pretreatment blood level of BDNF. Higher BDNF levels indicate better response to SSRIs, even though they are not necessarily linked to initial severity of depression. I don't know if sertraline has a direct affect on BDNF production.
Have you tried fluvoxamine? It is the most potent of the SSRIs with respect to activity at the sigma-1 receptor. Fluvoxamine, but not sertraline, potentiated nerve-growth factor (NGF)-induced neurite outgrowth in PC12 cells.
- Scott
Posted by Lamdage22 on August 19, 2014, at 11:00:11
In reply to Re: Sertraline immediately eliminated suicide thoughts » Lamdage22, posted by SLS on August 19, 2014, at 7:48:11
> > I don't think i abandoned sertraline prematurely. And i wonder what other effects of Sertraline may have caused me to feel better. Sigma 1 or BDNF?
>
> I've read that the probability of someone responding to antidepressants is linked to the pretreatment blood level of BDNF. Higher BDNF levels indicate better response to SSRIs, even though they are not necessarily linked to initial severity of depression. I don't know if sertraline has a direct affect on BDNF production.
>
> Have you tried fluvoxamine? It is the most potent of the SSRIs with respect to activity at the sigma-1 receptor. Fluvoxamine, but not sertraline, potentiated nerve-growth factor (NGF)-induced neurite outgrowth in PC12 cells.
>
>
> - ScottNo i haven't. Sertraline is a sigma 1 antagonist though and Fluvoxamine an agonist.
I was doing better.. but im in trouble with my mother. She is seeking esoteric help, i am seeking chemical help.
Posted by Lamdage22 on August 19, 2014, at 11:05:15
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 11:00:11
Hmm, how is Fluvoxamine in regard to akathisia?
I think my doc back then said that the other SSRI are either qt- prolonging or cause akathisia.
IDK.
Im not well
Posted by SLS on August 19, 2014, at 13:24:56
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 11:00:11
> No i haven't. Sertraline is a sigma 1 antagonist though and Fluvoxamine an agonist.
I see. I wish I knew what it was about sertraline that caused you to respond so well to it.
Interesting study:
http://www.ncbi.nlm.nih.gov/pubmed/20492642
Regarding akathisia and fluvoxamine:
http://www.ncbi.nlm.nih.gov/pubmed/24474992
http://www.ncbi.nlm.nih.gov/pubmed/20205742
Perhaps sertraline is more apt to produce akathisia because it is an antagonist of sigma receptors.
Hang in there.
- Scott
Posted by ed_uk2010 on August 19, 2014, at 13:41:11
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 11:00:11
>I don't think i abandoned sertraline prematurely.
Did the restlessness happen even at low dose eg. 25mg or did you not try?
>Sertraline is a sigma 1 antagonist though and Fluvoxamine an agonist.
Both drugs are ligands at sigma-1 receptors, but as far as I know, the definition of what constitutes an antagonist vs an agonist at this class of receptors is very poorly understood as present. It may be that fluvoxamine is worth a try but you'd need to check for drug interactions with your other medication. What are you currently taking?
Posted by Lamdage22 on August 19, 2014, at 13:51:51
In reply to Re: Sertraline immediately eliminated suicide thoughts » Lamdage22, posted by ed_uk2010 on August 19, 2014, at 13:41:11
Thanks, guys.
> >I don't think i abandoned sertraline prematurely.
>
> Did the restlessness happen even at low dose eg. 25mg or did you not try?I think we even tried 12.5 because we wanted to preserve this effect. I can't say im suicidal right now. But still, in a way, Sertraline helped.
>
> >Sertraline is a sigma 1 antagonist though and Fluvoxamine an agonist.
>
> Both drugs are ligands at sigma-1 receptors, but as far as I know, the definition of what constitutes an antagonist vs an agonist at this class of receptors is very poorly understood as present. It may be that fluvoxamine is worth a try but you'd need to check for drug interactions with your other medication. What are you currently taking?Seorquel 800
Zyprexa 7.5
Metformin 1500
Venlafaxine 37.5Venlafaxine could be abandoned of course.
Posted by Lamdage22 on August 19, 2014, at 13:58:16
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 13:51:51
It doesn't sound rosy: http://www.drugs.com/interactions-check.php?drug_list=1128-0,1573-0,1979-2549,1744-1113
Posted by Lamdage22 on August 20, 2014, at 10:11:23
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 13:58:16
Ok, now i am suicidal again..
Posted by SLS on August 20, 2014, at 12:29:37
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 20, 2014, at 10:11:23
> Ok, now i am suicidal again..
Why?
Neurobiology?
Psychology?
Both?
I wish I could help.
Hang in there. It will pass.
- Scott
Posted by ed_uk2010 on August 20, 2014, at 14:01:18
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 19, 2014, at 13:51:51
>Seorquel 800
>Zyprexa 7.5
>Metformin 1500
>Venlafaxine 37.5
>
> Venlafaxine could be abandoned of course.Hi,
If you were to switch to fluvoxamine I'd suggest stopping venlafaxine anyway. Taking two SSRIs or SNRIs together is not normal practice.
It is theoretically possible to take fluvoxamine together with most interacting drugs but substantial dosage reductions will be needed.
Fluvoxamine's drug interactions are mainly due to the inhibition of two drug-metabolising liver enzymes. It leads to potent inhibition of CYP 1A2 and moderate inhibition of CYP 3A4. Olanzapine is metabolised by CYP 1A2. Quetiapine is metabolised by CYP3A4.
Evidence suggests that fluvoxamine more than doubles the blood levels of olanzapine. As a result, it is suggested to reduce the dose of olanzapine where appropriate and to consider monitoring the blood level of olanzapine. In your case, you might need to reduce olanzapine to 5mg initially. I'm not sure how your pdoc would feel about this but you can ask for nothing.
http://www.ncbi.nlm.nih.gov/pubmed/12352274
http://www.ncbi.nlm.nih.gov/pubmed/11477325
The magnitude of effect of fluvoxamine on quetiapine levels is less clear. Very potent CYP 3A4 inhibitors such as the antifungal ketoconazole can increase quetiapine levels very dramatically, requiring quetiapine to be reduced to as little as one sixth of the original dose. Fluvoxamine is not such as potent inhibitor, however. It is likely that fluvoxamine would require the quetiapine dose to be reduce to approximately half or one third of the original dose, based on evidence that fluvoxamine increases quetiapine levels by an average of 159%. In your case, this would probably mean reducing quetiapine to about 300mg per day, adjusted according to response.http://www.ncbi.nlm.nih.gov/pubmed/11477325
Metformin does not interact with fluvoxamine.
Hope this is of some help.
Posted by Lamdage22 on August 21, 2014, at 0:18:38
In reply to Re: Sertraline immediately eliminated suicide thoughts » Lamdage22, posted by SLS on August 20, 2014, at 12:29:37
> > Ok, now i am suicidal again..
>
> Why?
>
> Neurobiology?
>
> Psychology?
>
> Both?
>
> I wish I could help.
>
> Hang in there. It will pass.
>
>
> - ScottThanks, Scott. IDK why. My guess would be neurobiology.
Posted by Lamdage22 on August 21, 2014, at 0:22:47
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 21, 2014, at 0:18:38
I really don't know WHAT to do. I was gonna try Brintellix next, but guess what, in Germany it won't be available until early 2015. Thats one and a half years later than US.
Posted by SLS on August 21, 2014, at 9:02:52
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 21, 2014, at 0:22:47
> I really don't know WHAT to do. I was gonna try Brintellix next, but guess what, in Germany it won't be available until early 2015. Thats one and a half years later than US.
Perhaps raising the dosage of lithium would help. You may have to go to a minimum of 600 mg/day to benefit from its anti-suicide effects. Zyprexa is sometimes good for suicidal states, but I would think that 10 mg/day would be enough. Perhaps you need more.
"At blood levels of 0.31.3 mg/mL (median dose: 0.5 mg/mL), lithium carbonate has produced a sustained remission in suicidal thinking beginning ~48 hours after the first dose"
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1439
- Scott
Posted by Lamdage22 on August 21, 2014, at 12:02:45
In reply to Re: Sertraline immediately eliminated suicide thoughts » Lamdage22, posted by SLS on August 21, 2014, at 9:02:52
Hey Scott,
im at 7.5 Zyprexa and 800mg Seroquel. And i take 360 mg of Lithium Orotate.
The anti suicidal effect did not get stronger by increasing the Lithium orotate dosage. And i DO have one from the LO.
I want to reduce those APs as far as possible to avoid side effects. Then i wanna try Brintellix in 2015 and hopefully i will respond to Glyx-13 and hopefully they find it beneficial for Schizophrenia.
I have schizophrenia and depression.
Posted by Lamdage22 on August 21, 2014, at 12:03:26
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 21, 2014, at 12:02:45
Reduce it in super slow-motion
Posted by Lamdage22 on August 22, 2014, at 3:18:58
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 21, 2014, at 12:03:26
Are there any other meds that are FDA approved for suicide thoughts? Besides Lithium and Sertraline?
Posted by SLS on August 22, 2014, at 7:42:53
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 21, 2014, at 12:02:45
Lithium orotate may not have any therapeutic value. I would use a lithium preparation that is proven to work with a well-established therapeutic dosage range. Suicide is too dangerous to experiment with an "alternative" treatment.
What are your reasons for choosing lithium orotate?
- Scott
Posted by SLS on August 22, 2014, at 7:44:19
In reply to Re: Sertraline immediately eliminated suicide thoughts, posted by Lamdage22 on August 22, 2014, at 3:18:58
> Are there any other meds that are FDA approved for suicide thoughts? Besides Lithium and Sertraline?
Clozapine (Clozaril).
- Scott
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