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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by bulldog2 on April 9, 2008, at 5:25:50
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by SLS on April 9, 2008, at 4:04:41
I believe the NIH is running a test right using memantine as an augmentaion strategy for depression.
Posted by SLS on April 9, 2008, at 6:07:21
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by bulldog2 on April 9, 2008, at 5:25:50
> I believe the NIH is running a test right using memantine as an augmentaion strategy for depression.
I am unaware of this study. Perhaps you can find where you read about it.
The NIMH has recently completed an investigation into the monotherapeutic use of memantine in major depression. The conclusion was that it didn't work.
I tried memantine to augment a partial response to two antidepressants plus Lamictal. I did not feel any different after 4 weeks.
- Scott
Posted by bulldog2 on April 9, 2008, at 18:18:42
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bulldog2, posted by SLS on April 9, 2008, at 6:07:21
> > I believe the NIH is running a test right using memantine as an augmentaion strategy for depression.
>
> I am unaware of this study. Perhaps you can find where you read about it.
>
> The NIMH has recently completed an investigation into the monotherapeutic use of memantine in major depression. The conclusion was that it didn't work.
>
> I tried memantine to augment a partial response to two antidepressants plus Lamictal. I did not feel any different after 4 weeks.
>
>
> - ScottCouldn't find the thread will keep looking..It could have been an old study and has already been completed.
I remember years ago an andrewb used memantine to prevent addreall tolerance. He came back on the site a year or two ago to state he felt it was doing something positive for him.
Posted by bleauberry on April 9, 2008, at 20:32:54
In reply to Memantine May Prevent More Than Stimulant Tol, posted by bulldog2 on April 8, 2008, at 16:58:51
My doc just gave me a script for memantine. Scheduled to try it in about a week. Neither of us are really sure about memantine, except that we are open to trying new stuff. All the conventional stuff is a deadend road for me. Doc is concerned though that memantine might not do much unless it is working with something else. Except for an antibiotic and 5mg hydrocortisone, I'm not on anything else. But we will see first hand what memantine can do, if anything.
Posted by undopaminergic on April 10, 2008, at 6:51:00
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bulldog2, posted by SLS on April 9, 2008, at 6:07:21
Memantine at 20 mg works as well as escitalopram for depression:
http://www.ncbi.nlm.nih.gov/pubmed/18348597Memantine up to 40 mg is effective for depression:
http://www.ncbi.nlm.nih.gov/pubmed/17545748However, memantine up to 20 mg was no better than placebo:
http://www.ncbi.nlm.nih.gov/pubmed/16390905The truth is that it works in some cases, but not in others. For example, it worked a lot better than SSRIs for me, but that doesn't predict its effects on anyone else. It's just one of many options that may be worth trying.
Posted by bulldog2 on April 10, 2008, at 9:10:36
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 10, 2008, at 6:51:00
Currently only on deplin for depression and klonopin for anxiety. Dropped luvox. Really don't want to be on an ssri only because they eventually lower dopamine and that can cause amhedonia. Want to try memantine next time I see my doc. Have been on deplin about a week and have had some good days since starting it.
Posted by atmlady on April 10, 2008, at 22:44:58
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by bleauberry on April 9, 2008, at 20:32:54
Bleauberry - Are you on long term hydrocortisone therapy? If so, is it for adrenal fatigue? Just curious as I have been reading about adrenal fatigue, wondering if that is the cause of my crushing physical fatigue .....
Posted by Sigismund on April 11, 2008, at 1:44:37
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 10, 2008, at 6:51:00
What did Memantine feel like for you?
Excitotoxicity?
Does it have symptoms associated with it?
Do you know what they are?
Posted by bulldog2 on April 11, 2008, at 16:02:46
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bleauberry, posted by atmlady on April 10, 2008, at 22:44:58
> Bleauberry - Are you on long term hydrocortisone therapy? If so, is it for adrenal fatigue? Just curious as I have been reading about adrenal fatigue, wondering if that is the cause of my crushing physical fatigue .....
If you have adrenal fatigue ,Ixel because of Ne could make that worse. A drug such as memantine even if not effective as an ad could help with the fatigue...maybe stop ixel and run memantine and get the dose up to 20 mg and restart the ixel.
Posted by bleauberry on April 11, 2008, at 19:12:41
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bleauberry, posted by atmlady on April 10, 2008, at 22:44:58
Crushing fatigue. Yikes. You phrased that perfectly.I don't know where hydrocortisone is going. For now I am only sampling 2.5mg. If longterm, it would be for a year or less and at 20mg or less. Adrenal fatigue is the diagnosis based on physical symptoms, lab cortisol readings, and history.
Crushing fatigue can have several causes, but the top two as I see it are adrenal and thyroid issues, but usually both at the same time. Lab numbers are deceiving and not very useful. They are often harmful by appearing normal and keeping the patient from getting the treatment they need. Normal thyroid in the blood does not mean normal thyroid function. Long story. Hundreds if not thousands of people have had normal labs despite crushing symptoms, and improved dramatically with HC and T3.
Posted by bleauberry on April 11, 2008, at 19:23:47
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by bulldog2 on April 11, 2008, at 16:02:46
Thanks for the post bulldog2. Appreciate the input.
I am not on Ixel. Though it feels like it has good potential for me, way different than anything of the other noradrenergic meds, I cannot tolerate it for several reasons. Adrenal fatigue, as you said, is probably a central reason for the good response and the dramatic side effects.
After seeing the clinical evidence for Memantine on this thread, and your input, I am more enthused and hopeful to open up that prescription bottle sitting on the shelf. My doctor thinks it works to help other things work, and that it probably won't do much by itself. But those studies show that with a high enough dose it can work by itself. I'll have to email those studies to my doc. He's pretty cool and open minded, now that we have spent a year with disappointing trials and developing a doctor/patient relationship that I think in most cases does require time and failures.
> > Bleauberry - Are you on long term hydrocortisone therapy? If so, is it for adrenal fatigue? Just curious as I have been reading about adrenal fatigue, wondering if that is the cause of my crushing physical fatigue .....
>
> If you have adrenal fatigue ,Ixel because of Ne could make that worse. A drug such as memantine even if not effective as an ad could help with the fatigue...maybe stop ixel and run memantine and get the dose up to 20 mg and restart the ixel.
Posted by bleauberry on April 11, 2008, at 19:27:23
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bulldog2, posted by SLS on April 9, 2008, at 6:07:21
Do you recall what your dose was Scott? As you and I know, there is nothing that works all the time or for everyone. But according to the limited clinical evidence just starting to gather, memantine below 20mg is kind of useless. I guess if there is potential with it, it has to be in the 30mg to 40mg range.
> I tried memantine to augment a partial response to two antidepressants plus Lamictal. I did not feel any different after 4 weeks.
>
>
> - Scott
Posted by emme on April 11, 2008, at 22:29:47
In reply to Re: Memantine May Prevent More Than Stimulant Tol » SLS, posted by bleauberry on April 11, 2008, at 19:27:23
> Do you recall what your dose was Scott? As you and I know, there is nothing that works all the time or for everyone. But according to the limited clinical evidence just starting to gather, memantine below 20mg is kind of useless.
> I guess if there is potential with it, it has to be in the 30mg to 40mg range.
5 mg did a tremendous amount to help my depression. 10 mg was far too high for me to tolerate. The clinical evidence may point to higher doses, but I think it still makes sense to start low and titrate up for us slow metabolizers.
emme
Posted by Sigismund on April 12, 2008, at 1:30:54
In reply to Re: Memantine May Prevent More Than Stimulant Tol » bleauberry, posted by emme on April 11, 2008, at 22:29:47
Hey Emme
'Helping my depression' could mean a number of things.
Can you tell me how Memantine felt for you, what it helped with, and so on.
TIA
Posted by SLS on April 12, 2008, at 2:19:32
In reply to Re: Memantine May Prevent More Than Stimulant Tol » SLS, posted by bleauberry on April 11, 2008, at 19:27:23
Hi BB.
> Do you recall what your dose was Scott?
I tried going up to 40mg after awhile. I felt like I was drunk. I got scared and retreated back to 20mg. I was less patient with drugs at that time. Perhaps the cognitive effects would have dissipated had I waited longer.
Hope you are well.
- Scott
Posted by emme on April 12, 2008, at 8:28:26
In reply to Re: Memantine May Prevent More Than Stimulant Tol » emme, posted by Sigismund on April 12, 2008, at 1:30:54
> Hey Emme
> 'Helping my depression' could mean a number of things.
> Can you tell me how Memantine felt for you, what it helped with, and so on.
> TIAHi. It helped specifically with the depressed mood. You know - that sense of emotional agony and hopelessness. It definitely lessened it quite a lot. I don't recall it doing much to help the apathy. It did not worsen my anxiety.
I ultimately stopped it because I couldn't tolerate it at a therapeutic dose. I felt fatigued and unwell on it even at 5 mg. But that sort of extreme sensitivity is par for the course for me.
emme
Posted by undopaminergic on April 13, 2008, at 19:11:00
In reply to Re: Memantine May Prevent More Than Stimulant Tol » undopaminergic, posted by Sigismund on April 11, 2008, at 1:44:37
> What did Memantine feel like for you?
>It had a kind of stimulant effect that is hard to describe, but it has to do with motivation, incentive salience, anticipation, desire, and other such rather vague terms. Normally, at the emotional level, I experience little or no anticipation of reward (anticipatory anhedonia), and so nothing comes natural but requires conscious effort. With stimulants, I'm capable of more conscious effort, and I can be quite high-functing in many respects, but still nothing comes effortlessly, and I really don't do things just for fun (for example, I've stopped watching TV). Things don't *feel* interesting or important, although I may *know* that they are and consciously direct my efforts accordingly.
Those are some of the things affected by memantine. For example, it made me engage in spontaneous "meaningless" explorative behaviour without any particular reason. It imparted a sense of everything being possible and achievable, without much conscious effort, or in other words, motivational problems were nearly abolished. Generally speaking, life seemed a more pleasant experience and less of a chore than usual.
I'd say that in general, the effects were those that have traditionally been associated with mesolimbic dopamine (the nucleus accumbens, etc.), yet memantine was decidedly different from any dopaminergic agent I've tried. I suspect that NMDA-receptor activation somehow interferes with important aspects of dopaminergic signalling, and that memantine reduces that interference.
> Excitotoxicity?
> Does it have symptoms associated with it?
> Do you know what they are?Excitotoxicity is the overstimulation of neurons, which if sustained and intense results in irreversible damage. Widespread damage would probably result in death or long-lasting neurological deficits. It has been proposed that low-level excitotoxicity may be an underlying cause of conditions such as migraine, depression, ADHD, and probably others.
Posted by cumulative on April 14, 2008, at 0:21:56
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 13, 2008, at 19:11:00
Posted by cumulative on April 14, 2008, at 0:29:01
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 13, 2008, at 19:11:00
warning, pure theory ahead. :) apologies for the disorganization, again.
On the addforums, the poster trying memantine (I think it's temoigneur) mentioned that the only problematic side effect he was experiencing was a seeming drop in creativity.
This is interesting to me in the context of the mesolimbic dopamine system that we're looking at.
Given the effects you describe, albeit creativity being far more complex than all this, I would somewhat expect the opposite -- an improvement in, say, associative idea generation.
Sometimes an eventual "zombifying" effect from the psychostimulants is spoken of. Usually this occurs after the initial mood lift disappears. I have thought about exogenous stimulation of the frontal lobe possibly to some extent clamping down on mesolimbic dopamine function (apollonian-dionysian, eh?) -- hence the focus, but lack of spark and interest in life, and novel thinking, that may or may not appear.
Another mechanism might be the psychostimulants stimulating NMDA ---> desensitization of ventral tegmental dopamine.
So, what do you think, undopaminergic? What did memantine do for you in this respect, creativity?
Did you seem to suffer any cognitive impairment from the memantine? The "partial antagonism" that memantine provides may go a long way in avoiding such things.
Posted by Sigismund on April 14, 2008, at 3:17:34
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 13, 2008, at 19:11:00
Oh my goodness.
Thank you.
I'm very interested in the symptoms (for want of a better word) you describe.
Posted by Sigismund on April 14, 2008, at 3:39:07
In reply to Re: Memantine May Prevent More Than Stimulant Tol, posted by undopaminergic on April 13, 2008, at 19:11:00
I just about always wake in the middle of the night after 3 or 4 hours of sleep, and it feels like some stimulatory chemical is in my system.
Posted by SLS on April 17, 2008, at 9:37:30
In reply to Re: Memantine May Prevent More Than Stimulant Tol » SLS, posted by bleauberry on April 11, 2008, at 19:27:23
> Do you recall what your dose was Scott?
At first, 20mg. After a few weeks, I tried 40mg. I felt drunk on it after 1 day. I quit at that point. I was less patient then. Perhaps that effect would have disappeared after a few days.
40mg is being used for OCD with reported success.
- Scott
Posted by undopaminergic on May 1, 2008, at 2:31:08
In reply to Creativity? for undopaminergic and others, posted by cumulative on April 14, 2008, at 0:29:01
>
> Given the effects you describe, albeit creativity being far more complex than all this, I would somewhat expect the opposite -- an improvement in, say, associative idea generation.
>That is precisely what I experienced during one of several trials of amantadine (of which memantine is a dimethyl-derivative), to the point of an overwhelming hypomanic-like flight of ideas.
>
> So, what do you think, undopaminergic? What did memantine do for you in this respect, creativity?
>There is certainly an improvement thereof in the short term, but I need more time to determine whether it is persistent or subject to tolerance. My observations are currently further confounded by the simultaneous use of a SSRI (escitalopram), which I suspect may be dampening what might otherwise turn into the kind of hypomanic flight of ideas noted with amantadine.
> Did you seem to suffer any cognitive impairment from the memantine?
>I've found that starting at a high dose (20 mg or more) can produce a state of cognitive impairment, and - for lack of a better term - a sense of intoxication. I also note that Scott reports a similar experience of feeling drunk after a 40 mg dose. Fortunately, a high level of tolerance develops rapidly (within a day or two) to these adverse effects.
Posted by Sigismund on May 1, 2008, at 20:20:17
In reply to Re: Creativity? for undopaminergic and others, posted by undopaminergic on May 1, 2008, at 2:31:08
What about sleep?
Are low doses more stimulatory than high ones?
Posted by undopaminergic on May 2, 2008, at 19:48:59
In reply to Re: Creativity? for undopaminergic and others » undopaminergic, posted by Sigismund on May 1, 2008, at 20:20:17
> What about sleep?
>No unusual trouble noted so far.
> Are low doses more stimulatory than high ones?
Maybe. I haven't explored doses higher than 30 mg, but as I've noted elsewhere, there can be initial sedation or feelings of drunkenness before tolerance develops and the stimulant effect becomes more distinct.
This is the end of the thread.
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