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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by undopaminergic on August 16, 2023, at 4:45:14
Hi all,
With reference to an older thread I started about vortioxetine (Brintellix; Trintellix), which is found at: https://www.dr-bob.org/babble/20220917/msgs/1121240.html
Incidentally, SLS was very involved in that thread.In the thread referenced above, I documented several very promising initial reactions I had to vortioextine. After a while, the episodes of improvement (in mood and cognition) ostensibly petered out. It is possible they disappeared objectively, or that the improvements became "assimilated" into a new baseline, so that I just wouldn't notice them any longer.
Now I've started 15 mg/day (in the morning), and I've had *very* promising responses again. The most obvious reaction is improved mood, and this time it's not limited to short episodes. Then there is also improved motor function, and slight improvements of memory.
But perhaps the most remarkable development is an anti-anhedonic improvement, which I find remarkable because the only (other) drug I've had that has affected the anhedonia is pramipexole (Sifrol; Mirapex). I'm now (it seems) experiencing feelings of reward in response to completing tasks. These rewarding feelings are not as dramatic as with the pramipexole, but they seem to be much more frequent -- the tasks are often minor, such as completing a short meeting (which I'm not even emotionally invested in).
My apathy in terms of a subjective lack of energy is much ameliorated, but I'm still suffering from poverty of thought.
On the flip side, I'm also more responsive to negative experiences. I'm more affected by failures, disappointments, and/or deteriorations, such as a negative change in surroundings.
I've taken the 15 mg dose of vortioxetine for somewhat more than a week now. The reactions did not come directly in response to increases in the concentrations of the drug, which they would have if it were a (dopaminergic) stimulant. It's more like there is a gradual effect, such as perhaps an indirect increase in dopaminergic neurotransmission in reponse to the prolonged serotonergic actions of the drug.
-undopaminergic
Posted by SLS on August 16, 2023, at 8:44:11
In reply to Partial response to vortioxetine (Brintellix), posted by undopaminergic on August 16, 2023, at 4:45:14
Hi, UD.
I am extremely optimistic for you. I know that I have said this ad nauseam, and drove people away by my mania, but patience is crucial. An ultimately successful treatment often starts with a brief improvement during the first two weeks (often within 7 days), only to disappear. However, my doctors at the NIH told me that this is considered by them to be a "blip improvement", and predictive of eventual success.Unless you feel worse or have intolerable side-effects that don't mitigate over time, it is worth sticking with it - at least for 6 weeks. During this period of latency, use whatever you know that eases your symptoms palliatively, just as long as it won't interfere with the therapeutic actions of vortioxetine. That will necessitate guesswork that I think you are more qualified than me to evaluate.
Vortioxetine, as I'm sure you are aware, hits almost every serotonin receptor, some as an agonist and some as an antagonist. Initially, researchers were focused on 5-HT7 receptors. I don't know if the consensus on this has changed.
I don't know if you believe that prayer serves any purpose, but I prayed for you anyway.
The best of luck!
- Scott
> Hi all,
>
> With reference to an older thread I started about vortioxetine (Brintellix; Trintellix), which is found at: https://www.dr-bob.org/babble/20220917/msgs/1121240.html
> Incidentally, SLS was very involved in that thread.
>
> In the thread referenced above, I documented several very promising initial reactions I had to vortioextine. After a while, the episodes of improvement (in mood and cognition) ostensibly petered out. It is possible they disappeared objectively, or that the improvements became "assimilated" into a new baseline, so that I just wouldn't notice them any longer.
>
> Now I've started 15 mg/day (in the morning), and I've had *very* promising responses again. The most obvious reaction is improved mood, and this time it's not limited to short episodes. Then there is also improved motor function, and slight improvements of memory.
>
> But perhaps the most remarkable development is an anti-anhedonic improvement, which I find remarkable because the only (other) drug I've had that has affected the anhedonia is pramipexole (Sifrol; Mirapex). I'm now (it seems) experiencing feelings of reward in response to completing tasks. These rewarding feelings are not as dramatic as with the pramipexole, but they seem to be much more frequent -- the tasks are often minor, such as completing a short meeting (which I'm not even emotionally invested in).
>
> My apathy in terms of a subjective lack of energy is much ameliorated, but I'm still suffering from poverty of thought.
>
> On the flip side, I'm also more responsive to negative experiences. I'm more affected by failures, disappointments, and/or deteriorations, such as a negative change in surroundings.
>
> I've taken the 15 mg dose of vortioxetine for somewhat more than a week now. The reactions did not come directly in response to increases in the concentrations of the drug, which they would have if it were a (dopaminergic) stimulant. It's more like there is a gradual effect, such as perhaps an indirect increase in dopaminergic neurotransmission in reponse to the prolonged serotonergic actions of the drug.
>
> -undopaminergic
>
Posted by SLS on August 16, 2023, at 8:49:15
In reply to Partial response to vortioxetine (Brintellix), posted by undopaminergic on August 16, 2023, at 4:45:14
Hi, again.
I just went back and took a look at my first response to you along the thread you posted a link to. I might as well have just copy-and-pasted my old post to you. At least I'm consistent. <smile>
- Scott
Posted by undopaminergic on August 16, 2023, at 10:17:53
In reply to Partial response to vortioxetine (Brintellix), posted by undopaminergic on August 16, 2023, at 4:45:14
Correction:
I wrote: "I've taken the 15 mg dose of vortioxetine for somewhat more than a week now.".
Actually, I've taken it for more than 2½ weeks, which is enough to reach steady-state at the new dosage.
-undopaminergic
Posted by undopaminergic on August 16, 2023, at 10:37:36
In reply to Re: Partial response to vortioxetine (Brintellix) » undopaminergic, posted by SLS on August 16, 2023, at 8:44:11
> Hi, UD.
>Hi, SLS.
> An ultimately successful treatment often starts with a brief improvement during the first two weeks (often within 7 days), only to disappear. However, my doctors at the NIH told me that this is considered by them to be a "blip improvement", and predictive of eventual success.
>Yes. I had the blips early on, and they were transient. Now, months later, I'm responding more substantially. This second "batch" of reactions came soon after a dose increase, so with an earlier dose elevation I might well have responded much sooner.
> Unless you feel worse or have intolerable side-effects that don't mitigate over time, it is worth sticking with it - at least for 6 weeks.
>I've been on it since 9 Dec 2022, although I started at only 5 mg/day.
> Vortioxetine, as I'm sure you are aware, hits almost every serotonin receptor, some as an agonist and some as an antagonist. Initially, researchers were focused on 5-HT7 receptors. I don't know if the consensus on this has changed.
>The 5-HT7 receptor blockade, on its own, does not produce much of an effect. I know this because I tried lurasidone (Latuda).
I'm less certain about 5-HT3 blockade. I think it may have been involved in my early reactions to vortioxetine.
> I don't know if you believe that prayer serves any purpose, but I prayed for you anyway.
>Thank you.
> The best of luck!
>And thank you!
-undopaminergic
Posted by Jay2112 on August 28, 2023, at 22:13:14
In reply to Partial response to vortioxetine (Brintellix), posted by undopaminergic on August 16, 2023, at 4:45:14
Hi U/D,
Glad you are feeling a bit better. Could you not add a small, even tiny, dose of pramipexole? Did the pramipexole predispose you to a mania or psychosis? Otherwise, I think that would be a spot-on combination. I, too, found Brintellix to leave me with a similar set of feelings as you described, with that poverty of thought. Or, how about Ritalin? I believe you had said you had a positive response to that med.
Just keep at 'er. I believe with the number of meds that reach so many neurochemicals, and so many parts of the brain, mental health is reachable with persistence and creativity. I know...'mental health' means many different things to all of us. But...I think you get my drift.
p.s. Besides pramipexole and Ritalin, have you tried any other dopamine agonists?
Best,
Jay
> Hi all,
>
> With reference to an older thread I started about vortioxetine (Brintellix; Trintellix), which is found at: https://www.dr-bob.org/babble/20220917/msgs/1121240.html
> Incidentally, SLS was very involved in that thread.
>
> In the thread referenced above, I documented several very promising initial reactions I had to vortioextine. After a while, the episodes of improvement (in mood and cognition) ostensibly petered out. It is possible they disappeared objectively, or that the improvements became "assimilated" into a new baseline, so that I just wouldn't notice them any longer.
>
> Now I've started 15 mg/day (in the morning), and I've had *very* promising responses again. The most obvious reaction is improved mood, and this time it's not limited to short episodes. Then there is also improved motor function, and slight improvements of memory.
>
> But perhaps the most remarkable development is an anti-anhedonic improvement, which I find remarkable because the only (other) drug I've had that has affected the anhedonia is pramipexole (Sifrol; Mirapex). I'm now (it seems) experiencing feelings of reward in response to completing tasks. These rewarding feelings are not as dramatic as with the pramipexole, but they seem to be much more frequent -- the tasks are often minor, such as completing a short meeting (which I'm not even emotionally invested in).
>
> My apathy in terms of a subjective lack of energy is much ameliorated, but I'm still suffering from poverty of thought.
>
> On the flip side, I'm also more responsive to negative experiences. I'm more affected by failures, disappointments, and/or deteriorations, such as a negative change in surroundings.
>
> I've taken the 15 mg dose of vortioxetine for somewhat more than a week now. The reactions did not come directly in response to increases in the concentrations of the drug, which they would have if it were a (dopaminergic) stimulant. It's more like there is a gradual effect, such as perhaps an indirect increase in dopaminergic neurotransmission in reponse to the prolonged serotonergic actions of the drug.
>
> -undopaminergic
>
Posted by undopaminergic on August 29, 2023, at 3:33:03
In reply to Re: Partial response to vortioxetine (Brintellix) » undopaminergic, posted by Jay2112 on August 28, 2023, at 22:13:14
> Hi U/D,
>Hi Jay.
> Glad you are feeling a bit better. Could you not add a small, even tiny, dose of pramipexole? Did the pramipexole predispose you to a mania or psychosis? Otherwise, I think that would be a spot-on combination. I, too, found Brintellix to leave me with a similar set of feelings as you described, with that poverty of thought. Or, how about Ritalin? I believe you had said you had a positive response to that med.
>I used to respond well to dopamine reuptake inhibitors, including methylphenidate (Concerta; Ritalin). It helped with apathy, including the poverty of thought. At some point, I stopped experiencing the same benefits from these drugs. However, co-administration of high doses (like 500+ mg) of caffeine restored the effects.
If I had access to pramipexole and/or stimulants, I might well try adding them.
> p.s. Besides pramipexole and Ritalin, have you tried any other dopamine agonists?
>Cocaine-like: desoxypipradrol (2-diphenylmethylpiperidine, 2-DPMP) and ethylphenidate; amphetamine-like: phenylethylamine (PEA); precursors: phenylalanine, tyrosine, and L-dopa; MAOIs: selegiline. I've combined some of these, eg. selegiline + PEA.
This is the end of the thread.
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