Psycho-Babble Medication Thread 1079343

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Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 11, 2015, at 16:24:53

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 15:11:08

>lamictal (somewhat effective)

What was your dose?

>lyrica (very effective, but poops out after a week)

How did it effect you? Less anxiety?

what made you think it pooped out?

>geodon (effective, then dropped in effectiveness)

Your symptoms worsened. I doubt the Geodon lost effectiveness.

>The cocktail that resolved my problems 2 years ago was the following, but I was a zombie that slept a lot and didn't talk much

Geodon
Lamictal
Lyrica
Remeron
Klonopin

That's a bipolar person's regimen. If I were to venture a guess, I would say you're bipolar 2 because of all the anxiety.

>Insidon

Opipramol acts as a high affinity sigma receptor agonist - a mechanism shared by Luvox.

Based on your response to past medications, I would strongly recommend you seek treatment for bipolar disorder.

When treating bipolar disorder it is essential that you start with a mood stabilizer. You responded to Lamictal in the past-I would encourage you to start treatment with it.

Once your mood is stabilized and you still have an excess of anxiety, I would recommend starting an SSRI as this is the best way to treat anxiety. If you have adequate mood stabilization, you shouldn't react to them as you did in the past.

OR, you can take the Remeron, as you have had success with this in the past.

I wouldn't mess with the Geodon. Antipsychoticss are not designed to treat anxiety.

I would instead recommend Keppra, Riluzole or Zonegran-all are glutumate inhibitors and have anxiolytic properties.

Your reaction to 5ht1a agonists is simply bipolar.

Eric

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 11, 2015, at 17:01:16

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by phidippus on June 11, 2015, at 16:24:53

I was at 150mg of Lamictal

Lyrics totally erased the anxiety, but then it dropped in how well it worked about 2 weeks in.

I responded to the Geodon similar to SSRIs. Felt great for 2-3 days and then the effectiveness dropped.

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 11, 2015, at 17:05:14

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 17:01:16

150 is on the low side. I would try lamictal again and push it to 300/400 mg.

Eric

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 11, 2015, at 17:35:28

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by phidippus on June 11, 2015, at 17:05:14

I've been up to 400, but it didn't do much for the anxiety. I'm just saying 150 was the dose I was on in my cocktail

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 12, 2015, at 13:45:23

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 11, 2015, at 17:35:28

Well, at 150 it wasn't quite therapeutic. I'd like to see how you feel with more Lamictal.

Do you ever get racing thoughts?

Eric

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 17:06:26

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by phidippus on June 12, 2015, at 13:45:23

It, along with 4 other drugs, was therapeutic. It wasn't therapeutic earlier on when I was at 400mg and it was just that and an AD.

I tried zonegran too for weight loss (didn't do anything for the anxiety). I am very interested in your suggestion of rilozule.

No racing thoughts. In the past, it was either panic or the feeling that something was wrong, but I didn't know what. Sometimes I was a hypochondriac though. Now, my anxiety centers around guilt. 2 things that I think I've done wrong. They are ruminating thoughts and obsessive. When my anxiety goes away, then the guilt goes away. It's very bothersome.

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 12, 2015, at 17:49:31

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 17:06:26

400 mg and an AD? Well, that's a fine recipe for treating GAD or OCD.

So, from your history, SNRIs and SSRIs seem to worsen your anxiety. Remeron works but makes you flat.

hmmm.

Now a review of your symptoms: panic and a free floating anxiety (feeling something is wrong) in the past. Hypochondriasm. Guilt around two things you think you've done.

I would diagnose you with GAD and OCD based on these symptoms. Hypochondriiasm and the guilt you're experiencing is definitely OCD. Panic and free floatinng anxiety may be due to the OCD but may also stem from GAD.

I would focus on treating the OCD. First, I would find a therapist who specializes in OCD and in particular, treating it with ERP. This is first line treatment for OCD. Second line treatment is a SEROTOGENIC AD. OCD entails a defecit of serotonin in regions of the brain and a surplus of dopamine in others (primarily the nucleas accumbens). SO you have to treat the lowered levels of serotonin with a serotogenic AD. IF SSRIs and SNRIs are backfiring on you, it would be best to try your alternatives: Clomipramine and Mirtazpine. You can also try Trazandone. Viibryd and Brintellix are aternatives, but you seem to think 5ht1a agonists cause you problems...Also, remember it takes higher doses of ADs to treat OCD properly. For instance, if you're taking Remeron, you'd take as much as 90 mg-dosages up to 120 mg have been reported.

To lower dopamine and if their isn't enough response to an AD, the APA recommends augmentation of an AD with an AAP (low dose). Geodon seemed to work well for you when coupled with Remeron.

SO, if you're on an AD and an AAP and you're still having issues with the OCD, the APA recommends the addition of a glutamate inhibitor. You happened upon this strategy when you were taking Remeron, Lamictal (a glutamate inhibitor) Geodon and whatever else you were on. You reported this combination helps.

Other glutamate inhibitors yo can use to treat your OCD are: Zonegran, Topemax, Riluzole, Lyrica, Keppra, Lamictal, memantine, Gabapentin...

Lyrica worked for you for obvious reasons

Now, there are other medicationns you can take to combat the OCD and they are: Tramadol, Dextroamphetamine, Caffeine, Morphine and ondansetron.

How do I know all this? I'm an OCD coach :)

Eric

ps. what are these things you are feeling guilt about?

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 18:43:44

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by phidippus on June 12, 2015, at 17:49:31

In the span of this thread, I've been diagnosed with bi-polar (because of the way I respond to SSRIs) GAD and OCD.

My whole story started with a panic attack out of the blue. A whole bunch of stress and a change in medication seemed to trigger a panic attack in the middle of the night 9 years ago. I had about 10 panic attacks. I was so obsessed with how my body felt because that's that a panic attack will do to you. I resolved those by figuring out I needed to stop fearing a panic attack. Those went away without medication, but by that time I figure that out, it had gone into my body as a constant vibration (somatic) I started to have GAD (free floating anxiety). In an attempt to solve that problem I became a "hypochondriac" to try and figure out how to solve the anxiety. After 5 years, I finally find the right cocktail, then start tapering off all my meds. Feeling better with each med going by the wayside. I switched from a liquid formulation of Klonopin to the pill form when after I had dropped from 2mg to .5mg to stay there for a month and stabilize. Well, it would appear that the compound pharmacist had added a little extra klonopin to the liquid formulation because 3 days after I made the switch to pill form, I had an anxiety attack out of the blue. I've since figured out that the liquid formulation has about 10% more klonopin in it than the pill form, so I think the change triggered withdrawal anxiety.

My anxiety attack was because I thought I was unintentionally being dishonest to a business contract, where I had no thought of that for months prior. I did lots of legal research to see if I was in the wrong, but I wasn't. I would have no anxiety for days and then another anxiety attack would happen when the same thought would crop up. This happened several times until i was just ruminating on it all day long. Trying to solve a problem that I had already solved.

I started lyrica and within 2 days, the anxiety was demolished. No guilt. nothing. Then as I explained previously, the lyrica would poop out after a week. So I added Insidon which helped tremendously. I was on the lowest dose - 50mg (Insidon doesn't touch the 5ht1). I had a normal response to it. No cycling with a gradual improvement. For the last 2 weeks, I've been feeling about 85-90% normal. I increased my dose of Insidon to 100mg a couple days ago and I've been feeling normal. I'm notorious for poop out so we'll see. I also returned to my dose of 2mg of klonopin because this latest episode was caused because of withdrawal.

A fantastic article to explain how I respond to SSRIs is entitled Treatment-Resistant Anxiety Disorders: Neurotrophic Perspectives by Jeremy Coplan. It's a free article in Psychiatric Times. http://www.psychiatrictimes.com/articles/treatment-resistant-anxiety-disorders-neurotrophic-perspectives

I actually spent $600 for an initial visit with him in NY (I lived in VA). He really saw Lamictal as the key to treating treatment resistant anxiety. He uses the term tachyphylaxis, which described me to a tee. The article is fascinating and may help many out there.

I know OCD is on the anxiety spectrum, but I wouldn't say I have the disorder. I'm going to see a pdoc in one week.

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 19:07:42

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 18:43:44

Come to think of it, after I had mood stabilizers on board, I did not cycle on ADs, I would just have poop out after about 2-3 days. This would happen on each dose increase too. I couldn't sustain treatment response. Is there anything to do for that?

Anafranil looks interesting because it has very weak affinity for 5ht1

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by phidippus on June 12, 2015, at 19:21:41

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 19:07:42

>I couldn't sustain treatment response. Is there anything to do for that?

How long were you on the AD?

So you think you're cycling. Describe it to me.

Eric

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by SLS on June 12, 2015, at 21:07:13

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 19:07:42

> Come to think of it, after I had mood stabilizers on board, I did not cycle on ADs, I would just have poop out after about 2-3 days. This would happen on each dose increase too. I couldn't sustain treatment response.

This pretty much describes me, too. That sort of tachyphylaxis can put you on an emotional rollercoaster.

I don't know what to do about this. I am currently considering tissue stimulation techniques. rTMS looks interesting. I should be able to stay on my current drug regime during treatment.

Parnate 100 mg/day
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/day


- Scott

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 21:30:55

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by SLS on June 12, 2015, at 21:07:13

Yes, an emotional roller coaster is an understatement. I would feel great and have hope that I had found a proper treatment and then back to square one. Someone on the outside would probably describe it as a placebo response, because that's how it appears, but it only mimics the cycle. It's very physical.

How soon do you experience tachyphylaxis (poop out) on a med? It would happen to me after 3 days on an ssri/tricyclic and geodon. It would happen to me after about a week on lyrica?

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 21:36:56

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by phidippus on June 12, 2015, at 19:21:41

I'm not cycling now. I haven't in 5 years or so. I cycled on lexapro & cymbalta at the very beginning of treatment before I added mood stabilizers. I would feel great, then too great (manic), then really bad anxiety, then normal, then depressed (not in any particular order) I would do this hourly or daily or over several weeks. The more the drug isolated serotonin (i.e. lexapro) the worse it was. Lexapro made me feel possessed and suicidal several types. It really was a devil drug for me. The other ADs, after I had mood stabilizers would work for a couple days and then stop and do the same thing with each dosage increase. I assume that is my serotonin receptors down regulating to compensate. I was on an AD (including Remeron) for 6 or so years. Now the only anti-depressant I'm on now is Insidon (Opipramol)

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 12, 2015, at 21:39:50

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by SLS on June 12, 2015, at 21:07:13

What are you suffering from?

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by SLS on June 13, 2015, at 0:01:23

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 21:39:50

I suffer from chronic bipolar depression with drug-induced psychotic mania. It is a variant of bipolar 1 disorder.

Regarding tachyphylaxis, if a drug is going to produce a robust improvement, I must be on it for 10 - 13 days before it emerges. My mood switches from depressed to euthymic within hours. Unfortunately, the improvement disappears just as rapidly after 3 days. The best I can do now is to take six drugs and maintain an inadequate partial improvement in mental energy. I once responded very well for over 6 months on a combination of Parnate 60 mg/day and desipramine 150 mg/day. Unfortunately, mania emerged and the antidepressants were discontinued. I relapsed into depression 2 months later. I no longer responded to treatment after that.


- Scott

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 13, 2015, at 0:31:54

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by SLS on June 13, 2015, at 0:01:23

Yes, we have very similar responses. I'm sorry to hear that. It's maddening. I have one way that boosts serotonin, norepinephrine and dopamine without the tachyphylaxis. Pardon me if you've already heard of it.

Have you been tested to find out if you have the MTHFR genetic polymorphism? I have two parts of the gene that are affected. When I started the treatment, my depression disappeared in 2 days. Simply google bipolar and MTHFR. There are a tone of resources out there that explains the connection. The treatment is methylfolate and methyl B12. Takes a couple weeks to find the right dose, but it seems to lift all the neurotransmitters for me without the tachyphylaxis. I wonder if it would be helpful for you.

Here's just one of a ton of articles https://www.psychologytoday.com/blog/the-integrationist/201409/genetic-mutation-can-affect-mental-physical-health

Deplin is the prescription strength dose of methylfolate, but I wouldn't recommend starting with that. You can get lower doses over the counter. No one I talk to in real life knows about this, but it may be different on this board.

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by SLS on June 13, 2015, at 6:03:46

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 13, 2015, at 0:31:54

Thanks for the tip!

> Yes, we have very similar responses. I'm sorry to hear that. It's maddening. I have one way that boosts serotonin, norepinephrine and dopamine without the tachyphylaxis. Pardon me if you've already heard of it.
>
> Have you been tested to find out if you have the MTHFR genetic polymorphism? I have two parts of the gene that are affected. When I started the treatment, my depression disappeared in 2 days. Simply google bipolar and MTHFR. There are a tone of resources out there that explains the connection. The treatment is methylfolate and methyl B12. Takes a couple weeks to find the right dose, but it seems to lift all the neurotransmitters for me without the tachyphylaxis. I wonder if it would be helpful for you.
>
> Here's just one of a ton of articles https://www.psychologytoday.com/blog/the-integrationist/201409/genetic-mutation-can-affect-mental-physical-health
>
> Deplin is the prescription strength dose of methylfolate, but I wouldn't recommend starting with that. You can get lower doses over the counter. No one I talk to in real life knows about this, but it may be different on this board.

I tried Deplin twice in combination: once with Nardil, and once with Parate. I felt an immediate boost in mood and energy with Nardil, but not so much with Parnate. I eventually discontinued Deplin because it actually began to make my depression worse. I recovered immediately upon stopping it. Deplin made me feel worse when I tried it again recently.


- Scott

 

Re: Medications that don't touch the 5HT1 receptor? SLS

Posted by SLS on June 13, 2015, at 6:10:40

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by SLS on June 13, 2015, at 6:03:46

What about taking methylene blue? It is not a unique idea.

I started taking methyl-B12 a few months ago. Perhaps I oculd add back the Deplin to see what happens.


- Scott

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 13, 2015, at 8:07:20

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 21:30:55

>How soon do you experience tachyphylaxis (poop out) on a med? It would happen to me after 3 days on an ssri/tricyclic

ADs typically take 4-6 weeks to start working.

I would consider the placebo effect.

Eric

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by phidippus on June 13, 2015, at 8:14:18

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 21:36:56

>The other ADs, after I had mood stabilizers would work for a couple days and then stop and do the same thing with each dosage increase.

Are you telling me that you would start an AD and it would work for a couple days then stop? If this is the case then I'd say you were experiencing a placebo effect because you need to take an AD for about 6 weeks before it really starts working.

If you had been on an AD for 6 weeks, what was the dose and which AD were you taking?

> I assume that is my serotonin receptors down regulating to compensate.

Its not that simple.

Eric

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by SLS on June 13, 2015, at 10:06:11

In reply to Re: Medications that don't touch the 5HT1 receptor? tiopenster, posted by phidippus on June 13, 2015, at 8:07:20

> >How soon do you experience tachyphylaxis (poop out) on a med? It would happen to me after 3 days on an ssri/tricyclic
>
> ADs typically take 4-6 weeks to start working.
>
> I would consider the placebo effect.

Certainly, everyone has their right to consider the placebo effect to explain tachyphylaxis. For some people, this might be true. However, for lots of people, it is not. Insisting on dismissing a patient's report of a transient improvement with medication can be confusing and belittling. It is insulting and displays ignorance of the variable phenomenology of biological mood disorders. Ever hear of ultradian rapid cyclicity? In the absence of medication, people with this presentation can complete a mood cycle between mania and depression within 24 - 48 hours without fail. I would not be inclined to call this a placebo effect, especially when someone presents this way as their untreated baseline as their index condition.


- Scott

 

Re: Medications that don't touch the 5HT1 receptor?

Posted by tiopenster on June 13, 2015, at 11:22:57

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by SLS on June 13, 2015, at 10:06:11

I agree with you Scott.

This article describes our rapid tachyphylaxis.

http://www.psychiatrictimes.com/articles/treatment-resistant-anxiety-disorders-neurotrophic-perspectives

 

Re: Medications that don't touch the 5HT1 receptor? SLS

Posted by phidippus on June 14, 2015, at 16:49:11

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by SLS on June 13, 2015, at 10:06:11

I asked that he consider the placebo effect.

If a patient takes a pill that normally takes weeks to work and reports an improvement within the first few days, I'm inclined to suspect a placebo effect. Especially if the improvement is transitory.

I see this all the time amongst patients taking antidepressants, especially for anxiety disorders. Though it may be a variable phenomenon, this pattern certainly exists.

>Ever hear of ultradian rapid cyclicity?

I am an ultradian rapid cycler, with many mood shifts within a 24 hour period.

>I would not be inclined to call this a placebo effect, especially when someone presents this way as their untreated baseline as their index condition.

I have no idea what the patients's untreated baseline is. Nor do you. But I'm inclined to think placebo effect based on experience with many patients.

>Insisting on dismissing a patient's report of a transient improvement with medication can be confusing and belittling.

I'm not dismissing a patient's report of a transient improvement with medication. All I'm saying is "hey, this medication-in the vast majority of cases-takes weeks to work. Its great that you felt better for a few days, but it probably wasn't because of the medication. There is no need to think your medication has stopped working. It hasn't really started."

Also, why shouldn't we diminish a patient's report of a transient improvement? Is an improvement within the first few days of traetment with an antidepressant important? What does that mean that we shouldn't consider the placebo effect?

There's nothing insulting about the placebo effect. Its just something that happens.

Eric

 

Re: Medications that don't touch the 5HT1 receptor? phidippus

Posted by SLS on June 14, 2015, at 19:43:28

In reply to Re: Medications that don't touch the 5HT1 receptor? SLS, posted by phidippus on June 14, 2015, at 16:49:11

This is a bigger issue than I wish to address again. It takes too long.

If you are indeed an ultradian rapid cycler, then you should fully appreciate the potential for the brain to switch affective states over the course of hours. Why shouldn't a drug be capable of provoking a similarly rapid change in mood upon its introduction as a time-limited startup effect? And, yes, the occurrence of a transient improvement "blip" within the first week of treatment was considered to be a good sign of future response by the staff of the Department of Clinical Pharmacology at the NIMH.

What would happen if a postsynaptic neuron were subject to a sudden increase in neurotransmitter as facilitated by a reuptake inhibitor? What would happen to this same neuron as the concentration of neurotransmitter continued to rise and remained chronically high?. What happens to the rate of action potentials generated when a neuron remains depolarized? What must occur for this postsynaptic neuron to resume firing if the concentration of reuptake inhibitor remains constant? How long does it take for these events to occur?

Let me know what you come up with.


- Scott

 

Re: Medications that don't touch the 5HT1 receptor? tiopenster

Posted by porkpiehat on July 5, 2015, at 19:03:43

In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 8, 2015, at 15:47:03

> Yes. Out of the genes that seem to affect mental issues, here are my results
>
> COMT V158 +/-
> COMT H62H +/-
> MAO A R297R +/+
> MTHFR C677 +/-
> MTRR A66G +/+
> BHMT-02 +/+
> BHMT-08 +/+
> CBS A360 +/-
>
> I got tested through 23andme - I would encourage everyone to do it. If you have a problem with your MTHRF - there is a huge chance it is affecting depression, bi-polar and maybe anxiety. I know the COMT and MAO A affect anxiety, but I'm not sure if there is a supplement to treat those like there is to treat MTHFR


OK HOW DO YOU CONVINCE YOUR DOCTOR TO GIVE YOU THIS TEST AND GET YOUR INSURANCE TO PAY!?!?!

I asked my pdoc about genetic testing and somehow she reasoned me out of it. It sounds like a diagnostic panacea.


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