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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by joe f on October 9, 2014, at 14:41:03
still no viibryd experiences?
Posted by Phillipa on October 9, 2014, at 16:22:04
In reply to viibryd, posted by joe f on October 9, 2014, at 14:41:03
None that I've seen. Phillipa
Posted by oceansun on October 9, 2014, at 21:03:24
In reply to viibryd, posted by joe f on October 9, 2014, at 14:41:03
I was just prescribed Viibryd (what an awkward name) today! My pdoc said it tends not to be numbing like other SSRIs can be (I got emotionally numb on Zoloft and Prozac). Did your doctor tell you to take it in the morning or night? I forgot to ask. Apparently it can work more quickly than the other SSRIs -- we'll see. Kind of afraid of the potential diarrhea side effect, but if you take it with food it's supposed to lessen gastro side effects.
Mechanism of Action: I take low-dose propranolol for anxiety, which I read is a 5HT1a antagonist -- will it counteract the 5HT1a agonist effects of Viibryd? Should I stop taking the propranolol while I see if Viibryd does anything? Didn't know this until now so didn't ask pdoc about it...
Posted by oceansun on October 10, 2014, at 9:39:26
In reply to Re: viibryd -- and SLS, are you out there? :), posted by oceansun on October 9, 2014, at 21:03:24
Nevermind -- I took my first dose last night and the gastro effects are so bad I'm not taking it again. On to the next drug...
> I was just prescribed Viibryd (what an awkward name) today! My pdoc said it tends not to be numbing like other SSRIs can be (I got emotionally numb on Zoloft and Prozac). Did your doctor tell you to take it in the morning or night? I forgot to ask. Apparently it can work more quickly than the other SSRIs -- we'll see. Kind of afraid of the potential diarrhea side effect, but if you take it with food it's supposed to lessen gastro side effects.
>
> Mechanism of Action: I take low-dose propranolol for anxiety, which I read is a 5HT1a antagonist -- will it counteract the 5HT1a agonist effects of Viibryd? Should I stop taking the propranolol while I see if Viibryd does anything? Didn't know this until now so didn't ask pdoc about it...
Posted by SLS on October 10, 2014, at 12:16:33
In reply to Re: viibryd -- and SLS, are you out there? :), posted by oceansun on October 10, 2014, at 9:39:26
> Nevermind -- I took my first dose last night and the gastro effects are so bad I'm not taking it again. On to the next drug...
It is possible that the G.I. side effects would have disappeared quickly. I don't know if there is any way to know this in advance. People often experience nausea as a startup side effect of SRI antidepressants - particularly SNRIs. This can last for as little as a half a day, but can linger for a week or more. Vilazodone (Viibryd) is a rather potent SRI. It is 30 times stronger than fluoxetine (Prozac). Perhaps this renders vilazodone more apt to produce startup nausea.
Vortioxetine (Brintellix) is an interesting drug that is similar to vilazodone in some ways. However, it adds serotonin 5-HT7 receptor antagonism. This receptor is currently being investigated for its activity in the etiology and treatment of depression. There may be an interplay between 5-HT7 and 5-HT1a receptors that is important in the ability of vortioxetine to produces an antidepressant effect and improvements in cognition.
- Scott---------------------------------------------
From Medscape:
http://www.medscape.com/viewarticle/811959_2
Vortioxetine (Brintellix)
Mechanisms of Action
Vortioxetine is considered a new multimodal antidepressant. It has demonstrated antagonistic properties at 5-HT3A and 5-HT7 receptors, partial agonistic properties at 5-HT1B receptors, agonistic properties at 5-HT1A receptors, and potent inhibition of the serotonin reuptake transporter.[6] Of note, preclinical data suggest that these multiple (and in combination) unique effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine[7] as well as glutamatergic transmission.[8]
Posted by joe f on October 10, 2014, at 13:34:23
In reply to Re: viibryd -- and SLS, are you out there? :) » oceansun, posted by SLS on October 10, 2014, at 12:16:33
how do you know its 30 times more potent than Prozac-a pretty bold statement--then that would send you through the roof with anxiety
Posted by oceansun on October 10, 2014, at 15:50:29
In reply to Re: viibryd -- and SLS, are you out there? :) » oceansun, posted by SLS on October 10, 2014, at 12:16:33
Thanks, Scott! Unfortunately I'm having the full array of GI effects -- not even 16 mg of Zofran is touching the nausea -- and since the bathroom is far away at work I had to take the day off :(. So it's not practical for me to continue with Viibryd...
I'll look into Brintellix...afraid of the nausea side effect from that one too... Reading through this board, I'm thinking of minocycline, just cause it has a different MOA from anything I've ever tried. How long does it take to have an effect?> > Nevermind -- I took my first dose last night and the gastro effects are so bad I'm not taking it again. On to the next drug...
>
> It is possible that the G.I. side effects would have disappeared quickly. I don't know if there is any way to know this in advance. People often experience nausea as a startup side effect of SRI antidepressants - particularly SNRIs. This can last for as little as a half a day, but can linger for a week or more. Vilazodone (Viibryd) is a rather potent SRI. It is 30 times stronger than fluoxetine (Prozac). Perhaps this renders vilazodone more apt to produce startup nausea.
>
> Vortioxetine (Brintellix) is an interesting drug that is similar to vilazodone in some ways. However, it adds serotonin 5-HT7 receptor antagonism. This receptor is currently being investigated for its activity in the etiology and treatment of depression. There may be an interplay between 5-HT7 and 5-HT1a receptors that is important in the ability of vortioxetine to produces an antidepressant effect and improvements in cognition.
>
>
> - Scott
>
> ---------------------------------------------
>
> From Medscape:
>
> http://www.medscape.com/viewarticle/811959_2
>
> Vortioxetine (Brintellix)
>
> Mechanisms of Action
>
> Vortioxetine is considered a new multimodal antidepressant. It has demonstrated antagonistic properties at 5-HT3A and 5-HT7 receptors, partial agonistic properties at 5-HT1B receptors, agonistic properties at 5-HT1A receptors, and potent inhibition of the serotonin reuptake transporter.[6] Of note, preclinical data suggest that these multiple (and in combination) unique effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine[7] as well as glutamatergic transmission.[8]
>
>
>
Posted by SLS on October 10, 2014, at 18:26:25
In reply to Re: viibryd -- and SLS, are you out there? :), posted by joe f on October 10, 2014, at 13:34:23
> how do you know its 30 times more potent than Prozac-a pretty bold statement--then that would send you through the roof with anxiety
Hi Joe.
Here are a few things that I was able to find regarding vilazodone (Viibryd):
- Scott-----------------------------------------------
"In the rat cerebral cortex vilazodone inhibited serotonin reuptake 30 times more than fluoxetine"
-----------------------------------------------
"Although vilazodones selectivity for serotonin reuptake inhibition relative to norepinephrine or dopamine reuptake inhibition is comparable to that of the SSRI fluoxetine, its potency for serotonin reuptake inhibition is 30-fold greater."
-----------------------------------------------
"Results: Vilazodone inhibited serotonin reuptake into rat brain synaptosomes with an IC50 of 0.2 nM, which was 30-fold more potent than that of fluoxetine (IC50=6 nM)."
http://www.sec.gov/Archives/edgar/data/716646/000095012310052757/b81084exv99w6.htm
Refer to:
Kehne JH, Bartoszyk GD, Greiner HE, et al. In vitro characterization of vilazodone as a dual-acting serotonin reuptake receptor and 5-HT1A receptor partial agonist. Poster presented at: 65th Annual Meeting of the Society of Biological Psychiatry Meeting; May 2010; New Orleans, LA.
-----------------------------------------------
Posted by joe f on October 11, 2014, at 11:20:08
In reply to Re: viibryd -- and SLS, are you out there? :) » joe f, posted by SLS on October 10, 2014, at 18:26:25
could that be why I felt so irritable on it and could barely breath
Posted by SLS on October 11, 2014, at 17:51:17
In reply to Re: viibryd -- and SLS, are you out there? :), posted by joe f on October 11, 2014, at 11:20:08
> could that be why I felt so irritable on it and could barely breath
I really don't know. Have you ever shown signs of this with other antidepressants?
Behavioral side effects experienced by adolescents and young adults are different from those of older adults, and can include agitation and irritability. The breathing thing is worrisome. It can be a symptom of an allergic reaction. However, people describe the same symptom for panic attacks. Other possibilities include the development of akathisia, serotonin syndrome, or a switch into mania.
- Scott
Posted by Phillipa on October 11, 2014, at 20:53:44
In reply to Re: viibryd -- and SLS, are you out there? :), posted by joe f on October 11, 2014, at 11:20:08
Joe don't you have some medical problems also? Phillipa
Posted by LouisianaSportsman on October 11, 2014, at 21:37:03
In reply to Re: viibryd -- and SLS, are you out there? :) » SLS, posted by oceansun on October 10, 2014, at 15:50:29
> Thanks, Scott! Unfortunately I'm having the full array of GI effects -- not even 16 mg of Zofran is touching the nausea -- and since the bathroom is far away at work I had to take the day off :(. So it's not practical for me to continue with Viibryd...
> I'll look into Brintellix...afraid of the nausea side effect from that one too... Reading through this board, I'm thinking of minocycline, just cause it has a different MOA from anything I've ever tried. How long does it take to have an effect?
>
> > > Nevermind -- I took my first dose last night and the gastro effects are so bad I'm not taking it again. On to the next drug...
> >
> > It is possible that the G.I. side effects would have disappeared quickly. I don't know if there is any way to know this in advance. People often experience nausea as a startup side effect of SRI antidepressants - particularly SNRIs. This can last for as little as a half a day, but can linger for a week or more. Vilazodone (Viibryd) is a rather potent SRI. It is 30 times stronger than fluoxetine (Prozac). Perhaps this renders vilazodone more apt to produce startup nausea.
> >
> > Vortioxetine (Brintellix) is an interesting drug that is similar to vilazodone in some ways. However, it adds serotonin 5-HT7 receptor antagonism. This receptor is currently being investigated for its activity in the etiology and treatment of depression. There may be an interplay between 5-HT7 and 5-HT1a receptors that is important in the ability of vortioxetine to produces an antidepressant effect and improvements in cognition.
> >
> >
> > - Scott
> >
> > ---------------------------------------------
> >
> > From Medscape:
> >
> > http://www.medscape.com/viewarticle/811959_2
> >
> > Vortioxetine (Brintellix)
> >
> > Mechanisms of Action
> >
> > Vortioxetine is considered a new multimodal antidepressant. It has demonstrated antagonistic properties at 5-HT3A and 5-HT7 receptors, partial agonistic properties at 5-HT1B receptors, agonistic properties at 5-HT1A receptors, and potent inhibition of the serotonin reuptake transporter.[6] Of note, preclinical data suggest that these multiple (and in combination) unique effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine[7] as well as glutamatergic transmission.[8]
> >
> >
> >
>
>If you suffered GI effects on vilazodone, Id caution a trial of vortioxetine [Brintellix]. Vortioxetine is purported to have stronger GI effects; also, it seems prone to initiate hypomania. (Caution for those with bipolar depression and those on concomitant bupropion therapy since bupropion increases mean plasma concentration of vortioxetine due to a metabolic interaction with a liver enzyme.)
I would go an alternative route due to your failure with vilazodone.
Minocycline has strong evidence for the treatment of schizophrenia, and it has neuroprotective properties that may make it efficacious for the off-label treatment of other psychiatric disorders. I would not advise minocycline therapy due to the presence of other medications that present more clinical evidence for psychiatric treatment. Id consider it a last resort.
What medication are you taking presently and what medication have you failed? What psychiatric symptomlogy do you present right now that you necessitates medication?
Posted by oceansun on October 11, 2014, at 22:30:05
In reply to Re: viibryd -- and SLS, are you out there? :), posted by LouisianaSportsman on October 11, 2014, at 21:37:03
> > Thanks, Scott! Unfortunately I'm having the full array of GI effects -- not even 16 mg of Zofran is touching the nausea -- and since the bathroom is far away at work I had to take the day off :(. So it's not practical for me to continue with Viibryd...
> > I'll look into Brintellix...afraid of the nausea side effect from that one too... Reading through this board, I'm thinking of minocycline, just cause it has a different MOA from anything I've ever tried. How long does it take to have an effect?
> >
> > > > Nevermind -- I took my first dose last night and the gastro effects are so bad I'm not taking it again. On to the next drug...
> > >
> > > It is possible that the G.I. side effects would have disappeared quickly. I don't know if there is any way to know this in advance. People often experience nausea as a startup side effect of SRI antidepressants - particularly SNRIs. This can last for as little as a half a day, but can linger for a week or more. Vilazodone (Viibryd) is a rather potent SRI. It is 30 times stronger than fluoxetine (Prozac). Perhaps this renders vilazodone more apt to produce startup nausea.
> > >
> > > Vortioxetine (Brintellix) is an interesting drug that is similar to vilazodone in some ways. However, it adds serotonin 5-HT7 receptor antagonism. This receptor is currently being investigated for its activity in the etiology and treatment of depression. There may be an interplay between 5-HT7 and 5-HT1a receptors that is important in the ability of vortioxetine to produces an antidepressant effect and improvements in cognition.
> > >
> > >
> > > - Scott
> > >
> > > ---------------------------------------------
> > >
> > > From Medscape:
> > >
> > > http://www.medscape.com/viewarticle/811959_2
> > >
> > > Vortioxetine (Brintellix)
> > >
> > > Mechanisms of Action
> > >
> > > Vortioxetine is considered a new multimodal antidepressant. It has demonstrated antagonistic properties at 5-HT3A and 5-HT7 receptors, partial agonistic properties at 5-HT1B receptors, agonistic properties at 5-HT1A receptors, and potent inhibition of the serotonin reuptake transporter.[6] Of note, preclinical data suggest that these multiple (and in combination) unique effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine[7] as well as glutamatergic transmission.[8]
> > >
> > >
> > >
> >
> >
>
> If you suffered GI effects on vilazodone, Id caution a trial of vortioxetine [Brintellix]. Vortioxetine is purported to have stronger GI effects; also, it seems prone to initiate hypomania. (Caution for those with bipolar depression and those on concomitant bupropion therapy since bupropion increases mean plasma concentration of vortioxetine due to a metabolic interaction with a liver enzyme.)
>
> I would go an alternative route due to your failure with vilazodone.
>
> Minocycline has strong evidence for the treatment of schizophrenia, and it has neuroprotective properties that may make it efficacious for the off-label treatment of other psychiatric disorders. I would not advise minocycline therapy due to the presence of other medications that present more clinical evidence for psychiatric treatment. Id consider it a last resort.
>
> What medication are you taking presently and what medication have you failed? What psychiatric symptomlogy do you present right now that you necessitates medication?Hmm...I certainly don't want more GI effects! I take Wellbutrin, Lamictal (now raising from 400 mg to 600 mg), and I was taking Abilify but just stopped due to EPS. I have depression and anxiety. I'm currently depressed and am concerned about worsening anxiety/depression while the Abilify works its way out of my system. I've tried most classes of psych meds; too long to list. My pdoc thought of an SSRI as a prophylactic, but they didn't have a great effect and made me emotionally numb, so I'm not particularly a great fan. Not familiar with the relatively new ones, though.
I looked up minocycline and saw that it can discolor teeth with long-term use, so that's a no-go. Do you have any suggestions? Nervous that just raising Lamictal won't be enough.
Posted by LouisianaSportsman on October 11, 2014, at 22:44:18
In reply to Re: viibryd -- and SLS, are you out there? :), posted by oceansun on October 11, 2014, at 22:30:05
Pregabalin (Lyrica) may be the best mood brightener you could take right now, consider its cousin, gabapentin (Neurontin) as well-- at effective dosages. This will be a good anxiolytic to get you through the aripiprazole WD and stabilizes mood as well, in my case.
Riluzole may be good to augment to your Lamictal.
It possesses both glutamatergic modulating, antiepileptic, and neuroprotective properties, all of which make it a promising candidate for the treatment of mood and anxiety disorders. Clinical use and clinical investigations support riluzoles antidepressant and anxiety properties. These reports comprise either case series or open-label studies in patients with treatment-resistant conditions, especially bipolar depression and generalized anxiety disorders. The anti-anxiety effects of riluzole have been postulated to be the result of postsynaptic GABA-A receptor function potentiation in hippocampal neurons.
Matthew and colleagues (2008) found, in an eight-week open-label study, that riluzole 100 mg/day was effective in treating anxiety symptoms in patients with GAD. In this study, 80% of completers responded to riluzole, and 53% met remission criteria at eight weeks. One unique aspect of riluzole is that it does not require dose titration and the suggested initial dosage of 100mg. is indicated as effective in all-day anxiety treatment
it is very similar to Lamictal. Its neuroprotective, due to glutamate/NMDA-receptor antagonism, and it also increases the action of GABA through several mechanisms, making it perhaps an ideal candidate for some people with anxiety disorders. It has also treated depression.
Studies:
Riluzole in the treatment of mood and anxiety disorders.
CONCLUSIONS: Riluzole may hold promise for the treatment of several psychiatric conditions, possibly through its ability to modulate pathologically dysregulated glutamate levels, and merits further investigation.
Preliminary evidence of riluzole efficacy in antidepressant-treated patients with residual depressive symptoms.
CONCLUSIONS: These data suggest that riluzole augmentation produces antidepressant and anxiolytic effects in patients with treatment-resistant depression.
An open-label trial of riluzole in patients with treatment-resistant major depression.
CONCLUSIONS: Although preliminary, these results indicate that riluzole may have antidepressant properties in some patients.
Posted by joe f on October 11, 2014, at 23:08:21
In reply to Re: viibryd -- and SLS, are you out there? :), posted by LouisianaSportsman on October 11, 2014, at 22:44:18
yes phillipa I have diabetes and stents
Posted by SLS on October 12, 2014, at 9:45:10
In reply to Re: viibryd -- and SLS, are you out there? :), posted by LouisianaSportsman on October 11, 2014, at 21:37:03
> If you suffered GI effects on vilazodone, Id caution a trial of vortioxetine [Brintellix]. Vortioxetine is purported to have stronger GI effects; also, it seems prone to initiate hypomania. (Caution for those with bipolar depression and those on concomitant bupropion therapy since bupropion increases mean plasma concentration of vortioxetine due to a metabolic interaction with a liver enzyme.)
>
> I would go an alternative route due to your failure with vilazodone.
>
> Minocycline has strong evidence for the treatment of schizophrenia, and it has neuroprotective properties that may make it efficacious for the off-label treatment of other psychiatric disorders.I responded pretty well to the addition of minocycline to my treatment regime. It gave me more mental energy and reduced cognitive impairments. From what I understand, it works better with antiglutamatergic drugs like lamotrigine (Lamictal) and N-acetylcysteine (NAC). I stopped taking it after two years because I developed a darkening of the skin on my feet and shins. There are some reports indicting that adding 1000 - 2000mg/day of vitamin C (ascorbic acid) helps to prevent hyperpigmentation. I wish I had known that in advance. Unfortunately, I haven't seen anything that would lead me to believe that vitamin C would increase the rate of fading of the discolorations once you have them. They usually fade once minocycline is discontinued, but it can take a year for them to disappear.
Where can I find information regarding the rate of mania as a treatment-emergent event with vortioxetine?
- Scott
Posted by LouisianaSportsman on October 12, 2014, at 13:29:09
In reply to Re: viibryd -- and SLS, are you out there? :) » LouisianaSportsman, posted by SLS on October 12, 2014, at 9:45:10
>
> Where can I find information regarding the rate of mania as a treatment-emergent event with vortioxetine?
>
>
> - Scott
>Any serotonergic drug carries the risk of hypomanic episodes. Based on subjective experience reports on drugs.com, my experience, here, crazymeds-- it seems to cause hypomania more frequently than other medications with SRI properties. Just something I've picked up on. I'd be hesitant to have vortioxetine monotherapy for a patient with bipolar depression. It's really not the "blockbuster" medication. I'm in love with its MOA, however. It worked better than sertraline for me, but only slightly. Definitely more activating, IMO. Definitely contributes more treatment-emergent side effects than most SSRIs based on experience reports. Subjectively.
Posted by Phil on October 14, 2014, at 19:41:22
In reply to Re: viibryd -- and SLS, are you out there? :), posted by LouisianaSportsman on October 12, 2014, at 13:29:09
Just a comment on nausea. When I developed two problems in my gut, I went through weeks of nausea. Every 5 - 10 seconds I gagged like I was going to throw up but never did. This was constant.
I can handle mental illness for the rest of my life, but I prayed for death when that nausea hit. Straight up..god, kill me. Nasty. There was no comfortable position in bed. No relief. Hope things get better for you.
This is the end of the thread.
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