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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 thinkingitover on November 22, 2009, at 13:01:56
So I just tried to get on the Namenda bandwagon for OCD. It's being studied and touted as a potential "weapon" against OCD... welll I didn't find it so joyful after 2 days of extreme agitation and 3 hours of poor sleep a night, despite taking Bendryl AND my Klonopin. I have a hypothesis that the dopamine stimulation was just too much (in addition to being an NMDA antagonist, it is also a D2 agonist). Finally I went down on my zoloft recently, so that could also have played a role... but boy that was intense!
Does anytone have any thoughts/hypothese on this?
Posted by Sigismund on November 22, 2009, at 13:40:04
In reply to Namenda anxiety and agitation- my hypothesis, posted by thinkingitover on November 22, 2009, at 13:01:56
A new weapon in the armementarium against OCD?
Yeah, I've got a stack I can't work out what to do with.
How much did you take?
Posted by SLS on November 22, 2009, at 15:05:25
In reply to Namenda anxiety and agitation- my hypothesis, posted by thinkingitover on November 22, 2009, at 13:01:56
> in addition to being an NMDA antagonist, it is also a D2 agonist
I could come up with only one study that reports this. This study is frequently cited in other literature. Where can I find corroborative studies?
Thanks.
- Scott
-------------------------------------------------Synapse. 2008 Feb;62(2):149-53.
Memantine agonist action at dopamine D2High receptors.Seeman P, Caruso C, Lasaga M.
Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada M5S 1A8. philip.seeman@utoronto.ca
Memantine is reported to improve symptoms in moderate cases of Alzheimer's disease and Parkinson's disease, but is also known to trigger psychosis in some Parkinson patients. Because these clinical features suggested a possible dopamine component of memantine action, we measured the potency of memantine on the functional high-affinity state of dopamine D2 receptors, or D2(High). Using [(3)H]domperidone to label D2 receptors, the memantine dissociation constant at D2(High) was 917 +/- 23 nM for rat striatal D2 receptors and 137 +/- 19 nM for human cloned D2Long receptors. The memantine dissociation constant for striatal N-methyl-D-aspartate (NMDA) receptors labeled by [(3)H]MK 801 was 2200 +/- 400 nM. Memantine stimulated the incorporation of [(35)S]GTP-gamma-S into D2-expressing Chinese Hamster Ovary cells with a dissociation constant of 1200 +/- 400 nM. Memantine, between 200 and 2000 nM, directly acted on D2(High) to inhibit the release of prolactin from isolated anterior pituitary cells in culture. Because the memantine potencies at NMDA receptors and dopamine D2(High) receptors are of a similar order of magnitude, it is likely that the clinical features of memantine can be attributed to its action at both types of receptors. (c) 2007 Wiley-Liss, Inc.
-----------------------------------------
Posted by thinkingitover on November 22, 2009, at 15:06:51
In reply to Re: Namenda anxiety and agitation- my hypothesis » thinkingitover, posted by Sigismund on November 22, 2009, at 13:40:04
only 5 MGS
Posted by thinkingitover on November 22, 2009, at 15:08:23
In reply to Re: Namenda anxiety and agitation- my hypothesis » thinkingitover, posted by SLS on November 22, 2009, at 15:05:25
Hey Scott,
This is what I found too, as well as a reference from my PDOC. What are your thoughts... not enough evidence?
Any other perspectives? What about the 5htp3 stimulation?
Posted by SLS on November 22, 2009, at 15:35:53
In reply to Re: Namenda anxiety and agitation- my hypothesis, posted by thinkingitover on November 22, 2009, at 15:08:23
Hi.
> This is what I found too, as well as a reference from my PDOC. What are your thoughts... not enough evidence?
Well, someone has to be first, right?
:-)
The article was published in 2007, so it is hard to know if anyone has tried to reproduce the results.
> Any other perspectives? What about the 5htp3 stimulation?
I really don't know enough about it.
Memantine gave me an energy boost and an improvement in mood during the first week of treatment. Thereafter, it made my depression moderately worse. I really don't have an explanation for this reaction, but I would not exclude from consideration D2 agonism.
- Scott
Posted by thinkingitover on November 22, 2009, at 16:08:57
In reply to Re: Namenda anxiety and agitation- my hypothesis » thinkingitover, posted by SLS on November 22, 2009, at 15:35:53
Thanks for your input Scott, my PDOC has been trying to come up with new ideas for OCD and GAD treatments because even small amounts of SSRIS cause rapid weight gain and metabolic syndrome symptoms for me (which you would expect more from something like an AP like Zyprexa). I'm usually 163lbs and am now 220, so go figure. We're running out of ideas.
Posted by g_g_g_unit on November 22, 2009, at 21:45:56
In reply to Namenda anxiety and agitation- my hypothesis, posted by thinkingitover on November 22, 2009, at 13:01:56
you might want to try a higher dose. memantine became more anxiolytic the higher i went; there was a huge difference between 5mg and 10mg for example (5mg did the same thing to me as you).
a lot of OCD studies are touting 20mg as a theraputic dose, though i've found a couple where 10mg was used successfully. personally, i found 10mg to be ideal, though a little inconsistent in effect - i'm thinking of possibly revisiting it at that dose, albeit in conjunction with an AD.
Posted by SLS on November 23, 2009, at 6:20:06
In reply to Re: Namenda anxiety and agitation- my hypothesis » SLS, posted by thinkingitover on November 22, 2009, at 16:08:57
> Thanks for your input Scott, my PDOC has been trying to come up with new ideas for OCD and GAD treatments because even small amounts of SSRIS cause rapid weight gain and metabolic syndrome symptoms for me (which you would expect more from something like an AP like Zyprexa). I'm usually 163lbs and am now 220, so go figure. We're running out of ideas.
What about combining Parnate with Klonopin and possibly Namenda? That should address your concerns of weight gain. Although not universally known as an antiobsessional, Parnate has shown efficacy in a few studies. It is also effective in GAD. Perhaps the Klonopin, a benzodiazepine drug that is sometimes chosen for GAD, would also minimize the anxiety you experience with Namenda. Perhaps the anxiety is a startup effect, and would disappear with time.
- Scott
Posted by thinkingitover on November 23, 2009, at 19:53:40
In reply to Re: Namenda anxiety and agitation- my hypothesis » thinkingitover, posted by SLS on November 23, 2009, at 6:20:06
> > Thanks for your input Scott, my PDOC has been trying to come up with new ideas for OCD and GAD treatments because even small amounts of SSRIS cause rapid weight gain and metabolic syndrome symptoms for me (which you would expect more from something like an AP like Zyprexa). I'm usually 163lbs and am now 220, so go figure. We're running out of ideas.
>
> What about combining Parnate with Klonopin and possibly Namenda? That should address your concerns of weight gain. Although not universally known as an antiobsessional, Parnate has shown efficacy in a few studies. It is also effective in GAD. Perhaps the Klonopin, a benzodiazepine drug that is sometimes chosen for GAD, would also minimize the anxiety you experience with Namenda. Perhaps the anxiety is a startup effect, and would disappear with time.
>
>
> - ScottThanks for the recommendation Scott! I am going to discuss this with the doc and we'll see what we can do.
Posted by Rosy Crucifiction on November 27, 2009, at 13:04:27
In reply to Namenda anxiety and agitation- my hypothesis, posted by thinkingitover on November 22, 2009, at 13:01:56
I wonder if the bad Namenda experiences have to do with excessive dosages. I know I felt better after a few days (rough first 3-4) then worse over time, like Scott and many others.
This is the end of the thread.
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