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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 john1022 on December 9, 2003, at 13:39:41
Ok here is my question, and I will do my best to explain what I am trying to figure out. I very much appreciate any help with trying to understand some of these concepts and what might possibly be going on with me.
I have some kind of chemical imbalance where insomnia seems to be the most serious problem. I also have felt a little off and had a little anxiety since the insomnia problem started. I am assuming this imbalance could have to do with the 5ht2 receptor.
This happened to me years ago and I took Effexor and felt 100% back to normal and sleeping like a baby within a month of taking the Effexor.
Now I am trying to figure out which anti-depressant I should try next. I recently had a bad reaction to Effexor, so that might be out of there.
Basically, will something like Remeron or Lexapro with 5ht2 antagonism actually "fix" the 5ht2 receptor imbalance, or is it more like it is just masking the insomnia problem with antagonism? (does antagosism help correct an imbalance?)
I am just curious, because I know Effexor has no antagonism affect, but has a stimulating inhibitory effect which causes insomnia in some, but in my case it fixed the insomnia within a month. So I am wondering if I actually need the reuptake properties moreso than the antagonism to "fix" the imbalance instead of mask it.
I am wondering if by blockading/antagonizing the 5ht2 receptor if it is not getting worked on or having the serotonin kind of stay on the receptor longer like it should?
Or in fact will antagonism of the 5ht2 receptor in Remeron be even more effective in keeping the serotonin in the receptor for longer period of time before being releases and maybe even helping more with the imbalance?
Basically my question is, does antagonism fix an imbalance like reuptake inhibition is theorized to, or does it just mask the problem and when I stop taking the Remeron will I go back to having sleeping problems?
I am just worried because Effexor once fixed me and now I cannot really take it because of it causing more depression and anxiety and seemed to be having an opposite effect last time I took it. The doc say I am BP, but wouldn't a manic reaction be more of an uppy, fast talking, excited reaction to the anti-depressant? Will I be able to add a mood stabilizer first and then try Effexor again?
I appreciate any and all help at trying to understand my problem and to understand how antagonism vs reuptake inhibition work. Thank you so much
Posted by linkadge on December 9, 2003, at 19:47:11
In reply to Antagonism -VS- Reuptake differences w/ AD's?, posted by john1022 on December 9, 2003, at 13:39:41
You've asked quite a few questions, and I'll see how I can help.
For starters, when you restart an antidepressant, many times it will work, but it takes a lot longer to kick in for the second time. When you say you felt 100% better, you were remembering how you felt on your final dose, not your first dose.I quit Celexa, and when I restarted it, it took a good 6 months to get back to where I was when I quit it. When you restart a drug, it doesn't start where it left off.
Secondly I had a similar reaction to starting Celexa for the second time. I was feeling so crappy that when I started it for the second time
I thought I would feel 100% immediately, because I could *remember* what It like to feel 100% before I actually felt 100%, thats my theory as to why it made me manic.After a few months, that normalized, and I remembered what normal was. So if you are going to try effexor again, I would stick it out.
Perhaps combine it with a sleeping pill, or trazodone, which is a ht2a repecptor antagonist.
---------------------------------------------
As far as your concerns about how the receptors work is like this. All the brain receptors are constantly chaning their density and affinity in responce to how much neurotransmitter they are receiving.Insomnia can be caused by multiple neurotransmitter imballences. As a rule of thumb, when a drug makes you feel better, sleep is normally the result. Even effexor which initally activates the receptor, can improve sleep in depressed patient because of its ability to work as an antidepressant.
Anyhow, the insomnia tends to lessen as time progreses because the recptor itself adjusts itself to the increased availabliltiy of serotonin, and improved sleep comes with time.
If you take a drug like rememeron, it will initally make you feel very drowsy irritable and sluggish, because it will block the 5ht2a receptor. But over time, the receptor adjusts itself to the decreased availability of serotonin, and the overdrowsyness will subside.
I personally don't recomend Remeron, while it did help sleep very much, it wasn't a good antidepressant for me, it did not help my mood very much. (that doesn't mean it won't help you)
My advice is this: If effexor worked, then go back to effexor. The longer you stick with it the more your brain will re-recognize how it behaved with it. If you feel manic on it then lessen the dose. If you were really bipolar then you probably woul've gone truely manic the first time you took it.
Try to focus on the present time, don't try to recapture anthing. If insomnia is persistant, then perhaps try the addition of Trazodone, which is a 5ht2a receptor antagonist, which can promote sleep, until your mood normalizes.
Are you taking Effexor right now ? I read an artical that said that rebound mania can actually be an temporary inflamitory reaction to the drug.
Try taking advil in addition to Effexor, for a few days, and see what this does. It's worth a shot.
Feel free to ask any more questions, cause
I think I had the same reaction you're having.
Linkadge
Posted by john1022 on December 9, 2003, at 20:24:58
In reply to Re: Antagonism -VS- Reuptake differences w/ AD's?, posted by linkadge on December 9, 2003, at 19:47:11
Thanks Linkadge
I am currently not taking Effexor because of the extremely bad reaction I had on it the third time (had the same reactions with Elavil, Inositol and Fish oil)
I am not sure if it a "true" manic reaction. When I restarted it, Effexor made everything 100x worse. The depression was not bad to begin with, it gave me MAJOR depression when I restarted it and intense anxiety.
It made my sleep worse, it made me twitch, it made my ears ring, made me have songs in my head constantly, slurred speech, reduced cognition, my ears ache, ring and gave me sensitivity to sound and gave me suicidal ideation when there was originally none whatesoever. When I stopped these things went away only leaving me with slight depression, anxiety, insomnia and ear problems all to a extremely lesser degree. Honestly I don't think it would have gone away if I would have continued it, but I could be wrong, because the 2 weeks I took it I got worse each day.
Would all the symptoms I am describing be considered a "manic" episode? I thought a "manic" episode would be considered more of a up mood, extreme agilation, talktiveness whereas this seemed to be a major depressive episode.
I am hoping I can add a mood stabilizer and then possibly give Effexor a try again. It was a pretty severe reaction, whereas the first time I took it I had zero side effects and felt completely better after a few weeks. I am a little worried that I won't be able to take an antidepressant ever again because of all these terrible reactions I am having.
I appreciate all your suggestions though and would love to hear what else you have to say. I think it is a great suggestion like you mentioned that if I do try Effexor again to start at a lower dose and to tirate up. I will definitely follow your advice. Thanks for taking your time to answer my question, very much appreciated. take care
Posted by john1022 on December 9, 2003, at 20:31:31
In reply to Re: Antagonism -VS- Reuptake differences w/ AD's?, posted by john1022 on December 9, 2003, at 20:24:58
"It was a pretty severe reaction, whereas the first time I took it I had zero side effects and felt completely better after a few weeks."
but like you said, I won't necessarily expect to feel better within a few weeks this time around because it may take longer. I just wasn't expecting to have such an extremely negative reaction before getting better.
Posted by linkadge on December 10, 2003, at 10:04:10
In reply to Re: Antagonism -VS- Reuptake differences w/ AD's?, posted by john1022 on December 9, 2003, at 20:24:58
Well here's my experience if it helps.
I was doing 100% on Celexa alone and fish oil. I thought I could go on just the Fish oil and no celexa.
When I discontinued the Celexa, I managed on just the fish oil fairly well. I was pretty blue however.
So I decided to restart to the Celexa (while maintaining the high dose of Fish oil.Here are the symptoms I had.
1. Very intese colors.
2. Racing mind, unable to focus, mind chattering
3. Insomnia (wake up in middle of night thinking
it was morning
4. Paranoia
5. Terrible guilt - feeling like God was mad
at me for wanting to feel better than I was
on just fish oil (as if this was normal, and
I wanted more)
6. Terrible dizzyness, like sombody was pushing me
from behind. Unsteadyness.
7. No euphoria, but many thoughts at once.
8. An intensity about everything, like a
pressure in my head.
9. Terrible akathesia - internal restlessness.From this the doctor though I was bipolar and gave me lithium. I never felt right for about
6 months. I tapered off the lithium and slowly back on the Celexa.It took a long time, but slowly the symtpoms reduced, and my mood went back to normal.
It may be that you don't need a mood stabalizer or at least perhaps one for long enough to adjust back to the effexor.
Please I know this is a shot in the dark, but go to a health food store and pick up a product called Quercetin (around 500mg per pill). I know it sounds crackpot, but this product does have some strong antimanic properties. It is a protein kinase C inhibitor like Depakote and Lithium.
It is not addictive, and has helped me adjust back on Celexa many times. I really think it's worth a shot.
Linkadge
Posted by john1022 on December 10, 2003, at 13:23:44
In reply to Re: Antagonism -VS- Reuptake differences w/ AD's?, posted by linkadge on December 10, 2003, at 10:04:10
Thanks Linkadge. I will probably give Quercetin a shot if I don't think I am having any luck with this lithium orotate.
I also might try the Depakote in the future to see if it helps with the musical tinnitus, ear ringing and hyperacusis (sensitivity to sound). I am wondering if all of the above has to do with some kind of seizure that might be helped by an anti-seizure med while also giving me the anti-manic properties that I have.
I think it has helped stablize me a little bit. You have been very helpful.
Posted by john1022 on December 10, 2003, at 13:25:51
In reply to Re: Antagonism -VS- Reuptake differences w/ AD's?, posted by john1022 on December 10, 2003, at 13:23:44
"I think it has helped stablize me a little bit. You have been very helpful."
oops I accidently jumped around in my post there. I meant to say that I think lithium orotate has helped stabilize me a little bit and to say thanks for the help.
So would you or anyone else know if my reaction to Effexor would be considered a "manic" reaction?
This is the end of the thread.
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