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Do Benzos Help Rebuild Serotonin?

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17 hours ago, Schlep said:

 

Maybe I should be looking at the mildest stimulant. Any ideas?

Wellbutrin makes me more jittery than stimulants, but not more anxious. Then again, I have ADHD. However, Wellbutrin causes me seizures, but I have nocturnal epilepsy.

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On 12/14/2018 at 1:09 AM, mikl_pls said:

Wellbutrin makes me more jittery than stimulants, but not more anxious. Then again, I have ADHD. However, Wellbutrin causes me seizures, but I have nocturnal epilepsy.

The Abilify doesn't seem to be working out well for me, and I'm going through some weird stuff on it that's making me worse. What would be the next logical med to try next? (Already been through clonazepam, Ativan long term, and brief trials of seroquel, zyprexa and gabapentin.) I'd prefer some suggestions on fast acting meds that stay in your system for only a short amount of time to minimize suffering from any potentially adverse reactions. My Abilify experience was somewhat clean at first, so maybe something in that direction. It would also be helpful to know of any actions that Abilify might have in common with benzos, and maybe get one step closer to identifying what factors keep giving me these adverse reactions.

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4 hours ago, Schlep said:

The Abilify doesn't seem to be working out well for me, and I'm going through some weird stuff on it that's making me worse. What would be the next logical med to try next? (Already been through clonazepam, Ativan long term, and brief trials of seroquel, zyprexa and gabapentin.) I'd prefer some suggestions on fast acting meds that stay in your system for only a short amount of time to minimize suffering from any potentially adverse reactions. My Abilify experience was somewhat clean at first, so maybe something in that direction. It would also be helpful to know of any actions that Abilify might have in common with benzos, and maybe get one step closer to identifying what factors keep giving me these adverse reactions.

What was the issue with abilify? If it was promising, perhaps another aap that features dopamine agonism, like Rexulti?

perhaps we need the big guns to weight in, but I don’t read abilify as having any overlap with benzodiazepines. It seems to be an agonist or antagonist of various serotonin receptors that provide some antidepressant or anxiolytic effects. Nothing directly at the gaba level.

How about a high dose, 45mg of Remeron? It’s much less sedating at high doses. I personally found it unbearable, but everyone is different. Also hits the various serotonin receptors without being a reuptake inhibitor. The a2 blocking increases adrenergic, serotonin and dopamine activity.

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16 minutes ago, argh said:

What was the issue with abilify? If it was promising, perhaps another aap that features dopamine agonism, like Rexulti?

perhaps we need the big guns to weight in, but I don’t read abilify as having any overlap with benzodiazepines. It seems to be an agonist or antagonist of various serotonin receptors that provide some antidepressant or anxiolytic effects. Nothing directly at the gaba level.

How about a high dose, 45mg of Remeron? It’s much less sedating at high doses. I personally found it unbearable, but everyone is different. Also hits the various serotonin receptors without being a reuptake inhibitor. The a2 blocking increases adrenergic, serotonin and dopamine activity.

Thanks, I forgot about Remeron, but there seem to be concerns about taking it with nortriptyline. Has anyone ever used a low dose (of it or anything else in its class) to augment a tricyclic?

Edited by Schlep

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6 hours ago, Schlep said:

The Abilify doesn't seem to be working out well for me, and I'm going through some weird stuff on it that's making me worse. What would be the next logical med to try next? (Already been through clonazepam, Ativan long term, and brief trials of seroquel, zyprexa and gabapentin.) I'd prefer some suggestions on fast acting meds that stay in your system for only a short amount of time to minimize suffering from any potentially adverse reactions. My Abilify experience was somewhat clean at first, so maybe something in that direction. It would also be helpful to know of any actions that Abilify might have in common with benzos, and maybe get one step closer to identifying what factors keep giving me these adverse reactions.

 

1 hour ago, argh said:

What was the issue with abilify? If it was promising, perhaps another aap that features dopamine agonism, like Rexulti?

perhaps we need the big guns to weight in, but I don’t read abilify as having any overlap with benzodiazepines. It seems to be an agonist or antagonist of various serotonin receptors that provide some antidepressant or anxiolytic effects. Nothing directly at the gaba level.

How about a high dose, 45mg of Remeron? It’s much less sedating at high doses. I personally found it unbearable, but everyone is different. Also hits the various serotonin receptors without being a reuptake inhibitor. The a2 blocking increases adrenergic, serotonin and dopamine activity.

I second what argh said about there being no overlapping actions with Abilify with benzodiazepines. It's a dopamine D2, D3, and 5-HT1A partial agonist, and antagonist at many other receptors.

If you want to go in the direction of antipsychotics, they're not really fast acting like you said, but they would be in the direction of Abilify. Maybe low-dose Seroquel (watch out for weight gain), Geodon, Zyprexa (watch out for weight gain), or low-dose Stelazine, Compazine, possibly even very low-dose Thorazine if need be.

If you want something non-antipsychotic, may I recommend Ativan/Vistaril, BuSpar, Trileptal, or possibly Topamax.

Also, I forget what you said your reaction to the SSRIs were, but augmenting the Pamelor with Zoloft is a very common combo. Augmenting with Effexor would be another good option too, but it might be a little stimulating, and hence might exacerbate your anxiety, especially with higher doses of Effexor (150 mg and above).

Remeron is a good idea too, but I think 30 mg might be a better dose as 45 mg may be too stimulating, but that's just my opinion. 15 mg would be too sedating for sure.

The only interaction between Pamelor and Remeron that is indicated in Epocrates is the possibility of serotonin syndrome, and Pamelor doesn't have that much action on serotonin reuptake inhibition (more so on norepinephrine reuptake inhibition), so you should be okay to augment Pamelor with Remeron.

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On 12/23/2018 at 10:01 PM, mikl_pls said:

The only interaction between Pamelor and Remeron that is indicated in Epocrates is the possibility of serotonin syndrome, and Pamelor doesn't have that much action on serotonin reuptake inhibition (more so on norepinephrine reuptake inhibition), so you should be okay to augment Pamelor with Remeron.

I'm curious if there are specific symptoms that could help you tell if you're suffering stems from a deficiency of dopamine or serotonin. 

And what are the chances that my depression/anxiety might be related to thyroid activity? My very first pdoc apparently checked my thyroid pretty early when I first developed my condition nearly three decades ago, and I think I remember being on synthroid for about a year. I was an inpatient twice this year and  there's no evidence my thyroid was ever tested. Did the thyroid just stop being taken seriously by the psychological community recently? And has synthroid ever been commonly used as an augment? 

I'd like to note that I'm only suspecting a thyroid condition for the recent escalation of my anxiety/depression, but not the condition in general. Is there any way the thyroid might be to blame for my current non-responsiveness to benzos?

Edited by Schlep

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1 hour ago, Schlep said:

I'm curious if there are specific symptoms that could help you tell if you're suffering stems from a deficiency of dopamine or serotonin. 

And what are the chances that my depression/anxiety might be related to thyroid activity? My very first pdoc apparently checked my thyroid pretty early when I first developed my condition nearly three decades ago, and I think I remember being on synthroid for about a year. I was an inpatient twice this year and  there's no evidence my thyroid was ever tested. Did the thyroid just stop being taken seriously by the psychological community recently? And has synthroid ever been commonly used as an augment? 

I'd like to note that I'm only suspecting a thyroid condition for the recent escalation of my anxiety/depression, but not the condition in general. Is there any way the thyroid might be to blame for my current non-responsiveness to benzos?

Thyroid is still tested for psych issues. I got tests immediately after my first psych appointment, just to ensure it wasn’t hormonal. This was about a year ago.

https://www.health.harvard.edu/newsletter_article/when-depression-starts-in-the-neck

tldr, yes thyroid issues can cause issues. Thyroid meds can also help even if you do not have a thyroid condition.

Edited by argh

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Cytomel (T3) can be helpful in depression and especially in BP depression cuz it doesn't typically cause cycling like ADs can. I think they can use it for MDD and other unipolar mood issues as well 

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Here are more resources for your consideration. His references don't quite copy over when pasted, but you can find them on the site itself.

http://psycheducation.org/treatment/thyroid-and-bipolar-disorder/high-dose-thyroid-hormone-as-a-mood-stabilizer-in-bipolar-disorder/

Emphasis (mine) bolded.

"Most of the open-trial data on this treatment approach has focused on patients with rapid cycling bipolar disorder. The Berlin randomized trial described above focused on bipolar depression. Treatment-resistant” depression, whether bipolar or unipolar (a very difficult distinction in this group of patients), may also respond to this approach."

http://psycheducation.org/treatment/thyroid-and-bipolar-disorder/

"Two studies have shown that people with bipolar depression were less likely to get better if they had low thyroid levels, whereas the ones with higher levels responded pretty well.Cole, Frye The same phenomenon was recently shown in “unipolar” depression.Gitlin,Abulseoud These four studies are the basis for a treatment approach you could consider, particularly if depression is your main problem: gently pushing your thyroid status toward the “hyperthyroid” end of normal, if you happen now to be toward the hypothyroid end of normal.  This idea is logical but surprisingly untested. There is only a preliminary test with no control group.Lojko"

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So what could cause hypothyroidism?  Age? Can you just develop an immune disorder later in life? Or is it a condition commonly occurring with depression/anxiety? 

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13 minutes ago, Schlep said:

So what could cause hypothyroidism?  Age? Can you just develop an immune disorder later in life? Or is it a condition commonly occurring with depression/anxiety? 

I would not say it is common for mental illness to cause hypothyroidism but hypothyroidism can be a cause of depression.

https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284 :

  • Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto's thyroiditis. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland.

    Scientists aren't sure why this happens, but it's likely a combination of factors, such as your genes and an environmental trigger. However it happens, these antibodies affect the thyroid's ability to produce hormones.

  • Over-response to hyperthyroidism treatment. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications. The goal of these treatments is to get thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up lowering thyroid hormone production too much, resulting in permanent hypothyroidism.
  • Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you'll need to take thyroid hormone for life.
  • Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.
  • Medications. A number of medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric disorders. If you're taking medication, ask your doctor about its effect on your thyroid gland.

Less often, hypothyroidism may result from one of the following:

  • Congenital disease. Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland didn't develop normally for unknown reasons, but some children have an inherited form of the disorder. Often, infants with congenital hypothyroidism appear normal at birth. That's one reason why most states now require newborn thyroid screening.
  • Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland.
  • Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland. Left untreated, hypothyroidism increases the risk of miscarriage, premature delivery and preeclampsia — a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.
  • Iodine deficiency. The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential for the production of thyroid hormones. Too little iodine can lead to hypothyroidism, and too much iodine can worsen hypothyroidism in people who already have the condition. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States.

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Yes, all those causes are a bit dramatic. Couldn't the thyroid just develop a simple disorder like every other organ in the body? 

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It can be simple Happend to me from (we think) lithium...it was very manageable...and I have several family/friends who treat it with no issues 

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Posted (edited)

Okay, now after 26 years nortriptyline is starting to affect me adversely and it looks as though I might need to switch antidepressents. I think my problem is a sensitivity to dopamine (I've read that nortriptyline is a dopamine agonist on a certain part of the brain, and I'm having the same problems as I had with benzos and Abilify.)

So the first criteria would be that the new med doesn't alter dopamine. Second criteria would be something I could make an easy switch to. I tried amitriptyline a few years ago and couldn't handle it, so that's out. Are there any drugs very close to nortriptyline that don't affect dopamine? What would be the next logical choice?

As far as the second criteria, I've been looking at http://wiki.psychiatrienet.nl/index.php/SwitchAntidepressants, and see these as possibilities:

 fluoxetine, bupropion, citalopram, clomipramine, dosulepine, doxepine, imipramine, maprotiline, sertraline. venlafaxine.

I'm not sure how many meet the first criteria yet. 

(I'm also going to post this in it's own thread on the AD forum.)

Edited by Schlep

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16 minutes ago, Schlep said:

Okay, now after 26 years nortriptyline is starting to affect me adversely and it looks as though I might need to switch antidepressents. I think my problem is a sensitivity to dopamine (I've read that nortriptyline is a dopamine agonist on a certain part of the brain, and I'm having the same problems as I had with benzos and Abilify.)

So the first criteria would be that the new med doesn't alter dopamine. Second criteria would be something I could make an easy switch to. I tried amitriptyline a few years ago and couldn't handle it, so that's out. Are there any drugs very close to nortriptyline that don't affect dopamine? What would be the next logical choice?

As far as the second criteria, I've been looking at http://wiki.psychiatrienet.nl/index.php/SwitchAntidepressants, and see these as possibilities:

 fluoxetine, bupropion, citalopram, clomipramine, dosulepine, doxepine, imipramine, maprotiline, sertraline. venlafaxine.

I'm not sure how many meet the first criteria yet. 

You probably would want to shelve the bupropion and consider an SNRI. So something like Effexor, Pristiq, Cymbalta or Fetzima

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44 minutes ago, argh said:

You probably would want to shelve the bupropion and consider an SNRI. So something like Effexor, Pristiq, Cymbalta or Fetzima

Yeah, I figured the bupropion wouldn't be good. Is there any reason why SNRI's are preferred? 

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17 minutes ago, Schlep said:

Yeah, I figured the bupropion wouldn't be good. Is there any reason why SNRI's are preferred? 

Nortriptyline appears to work on  SERT and NET (reuptake inhibitors).SNRIs work on those specific receptors but do not antagonize 5HT2A/C, histamine or alpha 1 andrenergic receptors, which nortriptyline does. I believe 5HT2C antagonism releases dopamine, which you said you wanted to avoid.

 

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Posted (edited)
20 hours ago, argh said:

Nortriptyline appears to work on  SERT and NET (reuptake inhibitors).SNRIs work on those specific receptors but do not antagonize 5HT2A/C, histamine or alpha 1 andrenergic receptors, which nortriptyline does. I believe 5HT2C antagonism releases dopamine, which you said you wanted to avoid.

 

Sounds promising. Is it at all plausible to consider switching to a med without tapering the nortriptyline (and what meds would be best, if so.)? I remember an old pdoc saying something about being able to go straight from nortriptyline to Zoloft. I know she was contrasting this with the washout method of switching from nortriptyline to Prozac (which I had attempted), but the impression I got was that it was a one day switch. Have people done that with Zoloft or other meds?  

Update: I was able to take some Zyprexa last night  (2.5 mg), and it seemed to calm the anxiety a bit (and nortriptyline was also lowered by 25g over the past two nights.) I've read that Zyprexa is also 5HT2A antogonist, so does this throw my theory into question?  

Edited by Schlep

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On 1/8/2019 at 8:05 PM, Schlep said:

Sounds promising. Is it at all plausible to consider switching to a med without tapering the nortriptyline (and what meds would be best, if so.)? I remember an old pdoc saying something about being able to go straight from nortriptyline to Zoloft. I know she was contrasting this with the washout method of switching from nortriptyline to Prozac (which I had attempted), but the impression I got was that it was a one day switch. Have people done that with Zoloft or other meds?  

Update: I was able to take some Zyprexa last night  (2.5 mg), and it seemed to calm the anxiety a bit (and nortriptyline was also lowered by 25g over the past two nights.) I've read that Zyprexa is also 5HT2A antogonist, so does this throw my theory into question?  

Zyprexa is also a dopamine antagonist, but encourages dopamine release in other brain areas.

Edited by mikl_pls

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2 hours ago, mikl_pls said:

Zyprexa is also a dopamine antagonist, but encourages dopamine release in other brain areas.

I think Zyprexa is the only thing I've felt have a direct alleviating effect on anxiety that was similar to the way clonazepam used to work on me.  

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