Question:
Has anyone tried Amisulpride/Solian for dysthymia/depression in
conjunction with an AD? I have been doing some research on it and it
looks like a good bet to help lift the life destroying effects of
chronic dysthymia. There are a few studies that have shown this D2 and
D3 effecting med helps with the negative effects of schizophrenia
(social withdrawl, anhedonia, isolation) at low doses and with postive
schizophrenia effects (psychosis, hallucenations) at higher doses. It
enhances dopaminergic neurotransimission by preferentially blocking
presynaptic dopamine autorecpters at low doses.
Answer:
Has anyone tried Amisulpride/Solian for dysthymia/depression in
conjunction with an AD? I have been doing some research on it and it
looks like a good bet to help lift the life destroying effects of
chronic dysthymia. There are a few studies that have shown this D2 and
D3 effecting med helps with the negative effects of schizophrenia
(social withdrawl, anhedonia, isolation) at low doses and with postive
schizophrenia effects (psychosis, hallucenations) at higher doses. It
enhances dopaminergic neurotransimission by preferentially blocking
presynaptic dopamine autorecpters at low doses. At higher doses,
amisulpride antagonises postsynaptic dopamine d3/d3 receptors,
preferentially in the limbic system rather than the striatum, thereby
reducing dopaminergic transmission. There is, according to research,
alot of overlap between the treament of the negative effects of
schizophrenia and depression. I can post references if anyone is
interested. It also has a low rate of weight gain and cognitive imparment when
compared with risperidone, which I am currently on. It helps with
social functioning as well.
I am seeing my pdoc in two days and I am going to ask him about it. Any
info with reguard to Amisulpride and depression would be greatly
appreciated, and I'll let you know what he says about it. If you are writing from the USA, Amisulpride is not available in this
countyr. Amisulpride sounds like a typical "atypical" antipsychotic, with its
combination of agonism and antagonism. The dopamine antagonism may
help with psychosis, but I don't see any reason why it would help with
depression. Dopamine agonism can help with anhedonia, but you'll get
more dopamine agonist effect from a medication which is free of
antagonism. In short, it seems to me that Amisulpride might make an
effective antipsychotic medication, but I don't see advantages for
anhedonic depression relative to other dopaminergic medications. That
doesn't mean it wouldn't work, but I don't see why it would work
better, or even as well. On the other hand, the whole area of dopaminergic medications seems
unfamiliar to most psychiatrists...
I am on Solian and I have found it to be the wonder drug that pulled
all the others together. There has recently been some research that it
may not be safe - the drug company itself sent out a warning - but my
doc and I figure the benefits way outdo the potential dangers. Plume is right - it is not available in the US.
Research shows that it has anti-depressant properties and in some cases
with better results or comprable results to other ADs. It is pretty
cheap in this country too for the low dose you would need to treat
depression. 50 - 100 mg will suffice and it was really quick acting. I
was suicidal and really depressed and within a week I was fine (if not
a day or two), 2 weeks I was working and I have only had a few bad days
since then - usually I could attribute them to something.
It is definitely my drug of choice, but I am on 2 other ADs as well.
The tail has pulled me back to myself.
I am glad things are working well for you. I was wondering what other
drugs you are on? I am not sure about getting the amisulpride, as I
live in Canada and it requires special access. And I know my doc
isn't big on paperwork, but heres hoping.
Nom, I was wondering what other dopaminergic meds you might recommend I
ask about. I am hoping to give that system a lift in my brain, but I
woefully uneducated about it. Joseph, you have a few choices. First, the most common, but also the weakest, is Wellbutrin
(bupropion). It is mildly dopaminergic, and significantly boosts
norepinephrine. The latter causes a significant energy boost.
Second, there are the MAO inhibitors. Parnate, Nardil, and Marplan
boost all three of the standard set of serotonin, norepinephrine, and
dopamine. This means they are dopaminergic from a chemical point of
view, but the subjective effects of increase in dopamine concentration
can largely be suppressed by the serotonin boost. As a practical
matter, then, if you are looking for a meaningful dopaminergic effect,
they aren't the way to go.
A fourth MAOI, selegiline, is powerfully dopaminergic. It also
increases norepinephrine concentration. The result is a major boost in
energy (from norepinephrine) and libido (from dopamine), and the
dopamine increase generally acts to counteract anhedonia (inability to
feel pleasure). The drawback is that you can't take a number of
common, even non-prescription, medications with it (e.g., cough syrup,
decongestants, and prescription drugs like Demerol). Unlike the other
MAOIs, though, you can usually eat your normal diet, though this is
something to look at closely on a per-case basis.
Although on paper, selegiline resembles Wellbutrin in its set of
affected neurotransmitters, it is much more powerfully dopaminergic.
The above medications act to increase the concentration of dopamine in
the brain. Also, since dopamine is a precursor to norepinephrine, they
also increase norepinephrine concentration. An alternative approach,
instead of increasing dopamine concentration, is to supply a chemical
that acts much like dopamine in the brain. This is what medications in
the category of dopamine agonists do. There are quite a few of these
(cabergoline, bromocriptine, pramipexole, etc.). They are routinely
prescribed for people with Parkinson's disease, but have subjective
effects with respect to depression that are similar to those that
result from increasing dopamine concentration. Since they are not
norepinephrine precursors, they do not increase energy level (which
can be good or bad, depending on what you're after).
There is no obvious "right" dopamine agonist to take. The choice is
probably governed more by what insurance covers than anything else.
Cabergoline is supposed to be the one most easily tolerated, with the
least side effects (dopamine agonists tend to cause nausea), but aside
from that, I believe they are pretty much equivalent.
I personally take a combination of selegiline and cabergoline. I need
a strong dopaminergic effect, and a significant norepinephrine
increase for energy (my depression was anergic and anhedonic). The
combination lets me fine-tune the dopaminergic and noradrenergic
effects. So I never use cough syrup or decongestants, but this has
been a very small price to pay for the benefits. (I really like these
two medications.)
