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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by SLS on June 14, 2015, at 11:40:31
Hi.
In animal studies, blocking serotonin 5-HT7 receptors can produce or enhance an antidepressant effect when combined with other antidepressants, even when those antidepressants are given at subtherapeutic dosages. Viibryd (vilazodone) and Brintellix (vortioxitine) might be worth continuing, even when they don't produce a remission monotherapeutically. If these drugs are well-tolerated, one can leave them in place and add other drugs from various classes. This is nothing more than conjecture based upon some very recent data.
Other drugs that block 5-HT7 receptors are Abilify and Latuda, two antipsychotics. There is no question that Abilify has the ability of enhancing the antidepressant effects of other drugs. Latuda, despite being touted as a monotherapeutic agent to treat bipolar depression, has yet to prove itself in post-marketing, in my opinion. Risperidone is another antipsychotic with 5-HT7 antagonist properties. Before Abilify came along, some doctors found risperidone to be helpful as an adjunct when treating refractory depression.
It might be fruitful to consider Viibryd and Brintellix as being adjuncts or augmenters rather than primary antidepressant agents. I imagine that there are some people who respond well to these two drugs, but the drugs don't seem very robust.
It might be interesting to combine one of these drugs, both of which are potent serotonin reuptake inhibitors, with a tricyclic norepinephrine reuptake inhibitor. I am partial to nortriptyline or desipramine because they do not inhibit serotonin reuptake and have milder side effects. With nortriptyline, you also get some 5-HT2a antagonism. Of course, the 5-HT1a partial agonism of Brintellix and Viibryd might be important in an admixture of properties that yield improvements in depression and anxiety.
- Scott
Posted by Phil on June 14, 2015, at 13:25:54
In reply to Viibryd and Brintellix might be better as adjuncts, posted by SLS on June 14, 2015, at 11:40:31
Scott, what's your diagnosis? I missed that somewhere along the way.
Posted by SLS on June 14, 2015, at 17:45:51
In reply to Re: Viibryd and Brintellix might be better as adjuncts » SLS, posted by Phil on June 14, 2015, at 13:25:54
> Scott, what's your diagnosis? I missed that somewhere along the way.
Chronic bipolar depression with a few medication-induced severe manic epidodes. The severity of the manias place me in the bipolar 1 classification.
- Scott
Posted by joe f on June 15, 2015, at 6:45:45
In reply to Re: Viibryd and Brintellix might be better as adjuncts » Phil, posted by SLS on June 14, 2015, at 17:45:51
very few posts ever about viibryd
Posted by SLS on June 15, 2015, at 11:50:06
In reply to Re: Viibryd and Brintellix might be better as adjuncts, posted by joe f on June 15, 2015, at 6:45:45
> very few posts ever about viibryd
I'm not sure why that is. I guess doctors are not very impressed with it. Viibryd produced a mild improvement for me that lasted for about a week. I don't think the drug is completely inert.
For Viibryd and Brintellix:
1. Is the dosage used high enough?
2. Is the time allowed for treatment long enough?
3. Is it better used as an adjunct to other drugs?I don't know.
It should be noted that as a multimodal antidepressant, Brintellix is a full agonist at 5-HT1a receptors rather than a partial agonist. Partial agonist drugs include Buspar, Geodon, Latuda, Abilify, and Viibryd. My initial thought is that partial agonism might be better than full agonism when treating depression, as it might act like a serotonin system stabilizer. This would be analogous to Abilify, a dopamine D2/3 receptor partial agonist that acts as a dopamine system stabilizer. Full agonism at dopamine receptors are not generally as helpful for depression as is Abilify.
- Scott
Posted by porkpiehat on July 5, 2015, at 20:12:39
In reply to Re: Viibryd and Brintellix might be better as adjuncts » joe f, posted by SLS on June 15, 2015, at 11:50:06
I was just going to start my own thread on this!
Neither Viibryd nor Brintellix worked for me as monotherapy. Brintellix at least helped me cognitively. So now that I'm back in school, I need help and I added 5mgs of Brintellix 5 days ago at night. My existing mix is 5-10mgs celexa and 150mgs Lamictal.
The first couple of days I could study and work through word problems better, follow complicated reasoning, etc. Now I'm actually starting to feel out of it and irritable, but that doesn't happen until I take my morning meds (celexa and lamictal). Not sure if I should though add an extra 5mgs.
I have a love-hate relationship for 5ht1a agonists. Something in me or my meds has significant cognitive defecits, especially in reading and quantitative reasoning. Buspar made a BIG dent in this for me. However it makes me incredibly irritable after a week or so and ultimately worsens my depression. The others make me less irritable but feel very detached, especially from other people.
Probably some variant of bipolar is involved based on what I am reading. But knowing that doesn't really help.
Posted by phidippus on July 14, 2015, at 20:13:29
In reply to Viibryd and Brintellix might be better as adjuncts, posted by SLS on June 14, 2015, at 11:40:31
>the 5-HT1a partial agonism of Brintellix and Viibryd
Brintellix is a full 5ht1a agonist
Eric
Posted by SLS on July 14, 2015, at 20:51:01
In reply to Re: Viibryd and Brintellix might be better as adjuncts, posted by phidippus on July 14, 2015, at 20:13:29
> >the 5-HT1a partial agonism of Brintellix and Viibryd
>
> Brintellix is a full 5ht1a agonist
>
> EricYes. Good catch.
:-)
How would you compare the two drugs?
- Scott
Posted by porkpiehat on July 20, 2015, at 11:34:58
In reply to Re: Viibryd and Brintellix might be better as adjuncts » phidippus, posted by SLS on July 14, 2015, at 20:51:01
BTW I ended my trial w/Brintellix as an add-on if anyone was interested. It was reacting with Celexa or Lamictal and creating bad brain fog and other problems. Bummer because for a week I slept better, thought better, and worried less.
Posted by SLS on July 20, 2015, at 12:32:25
In reply to Re: Viibryd and Brintellix might be better as adjuncts, posted by porkpiehat on July 20, 2015, at 11:34:58
> BTW I ended my trial w/Brintellix as an add-on if anyone was interested. It was reacting with Celexa or Lamictal and creating bad brain fog and other problems. Bummer because for a week I slept better, thought better, and worried less.
Ouch.
Sorry to hear that.
- Scott
Posted by porkpiehat on July 24, 2015, at 7:32:36
In reply to Re: Viibryd and Brintellix might be better as adjuncts » porkpiehat, posted by SLS on July 20, 2015, at 12:32:25
Has anyone else tried using either of these as an augmentor? If so, with what?
My doctor didn't think only five mgs each of celexa and brintellix would have a bad reaction but at this point she's just along for the ride.
There are so many benefits but it just isn't good for a monotherapy for me.
This is the end of the thread.
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