Rozzer

Any experience with Remeron/Mirtazapine or an SSRI??

68 posts in this topic

Never said it was an anti psychotic. Just that it affects the same receptor as the antipsychotic mentioned. Any med that affects that receptor is potentially dangerous considering the study done and the personal experiences. The result of taking that for someone with HPPD can be serious.

Well, the warning is appreciated.

However, it would seem that a person would want to work precisely on the affected synapses. Whether that be 5-HT2A and/or some other ones. After all, would it make sense to have a coronary bypass and replace the blood vessels that are healthy instead of the clogged ones?

The real trick is understanding what has gone wrong for an individual – let alone a whole community.

Perhaps it would seem that the best thing to do is do nothing for a year. Then if you haven’t healed, why not work with some doctors to find help? And whatever medicine they are willing to try – it will have issues and you are the one who has to live with the effects, positive or negative.

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Read the Visual Snow board, it's crazy alot of people have so many visuals from just ssri's…

Again, Remeron is not an SSRI. Also, we have gill here who says Zoloft (an SSRI) actually helps him.

Yes, but it is more of an indirect help. Instead of reducing afterimages, trails, and what not, I just feel a reduced need to fixate on them. I seem to be able to shit my attention easier. In turn then things have gotten better.

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You're right sadly, it would have to be some huge class action lawsuit like valium took back in the days. I still think if they stumble along something it will be because of a drug causing problems that resemble hppd. I mean how many ppl would go out of their way to spend money towards a sickness that's mostly self inflicted. It's hard to imagine how many billions it would take to even start understanding a condition this complicated.

I'm glad hppd isn't bothersome to me lately..... just working, exercising and trying to be a normal member of society. I still use klono as a crutch though and one day true tolerance might hit, can't even think about that.

Later!!!

True!

Glad to hear HPPD isn´t bothersome for you lately! May I ask for how long you´ve had HPPD? I´ve had it for a bit over 5 years now, would rate it as severe. I´ve gotten kind of used to it now though. I´m having hard to remember how life was without HPPD..:wacko:

I use alcohol as a crutch. Does´nt help HPPD much, but takes away a lot of muscle tension and puts the psyche at ease for a while. Still waiting for some proper medication, most surely it´ll be Keppra (from what my doctors think).

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I would not attempt a trial with Remeron. This med affects the 5ht2a receptors. Studies have been done where an anti phsychotic (risperidol?) which affected the same receptor had caused afterimages in people who did not have hppd.

Remeron is not an anti-psychotic, but rather somewhat the opposite.

Virtually every med out there has made someone sick. You have to work with your doctor and decide if the potential benefits outweigh the risks. And most negative side effects pass once you discontinue a med – again low doses reduces the chance of problems.

Never said it was an anti psychotic. Just that it affects the same receptor as the antipsychotic mentioned. Any med that affects that receptor is potentially dangerous considering the study done and the personal experiences. The result of taking that for someone with HPPD can be serious.

True, mirtazapine is classed as an noradrenergic and specific serotonergic antidepressant (NaSSA), which is not a proper medication in a disorder such as HPPD, when the serotonin system is hypersensitive. I know what you mean about potentially dangerous, as in mania and increased risk of psychotic episodes. Like you I´ve had really nasty experiences with such medications. I would advise anyone with HPPD to use SSRI, SNRI, NaSSA or the like since the risks clearly outweigh the benefits.

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Visual,

Well in my case, it's proberbly a bit different than most of you, since I got HPPD from medicine, I've never taking any drugs or anything. But I have the exact same symptoms as you all have, the visual stuff, DP/DR ect. My problems actually started from taking Risperdal in a very short period of time last year, and sadly, the problems only got worse when discontinuing the drug. So if you say that Remeron is the opposite of an anti-psychotic, then maybe that's exactly what I need. I don't know..

I've actually been on it before all these HPPD-like problems started, and I only have possitive things to say about it, but things are different now. Back then I only experienced mild side-effects from it, like dry mouth, a little weight gain..

And besides that, Remeron is proberbly my only chance of getting on something that raises Dopamine levels a bit, because Wellbutrin is only prescribed to help with stop smoking in my country. And I really don't think that I can get any doctor to prescribe it off-label for something they don't understand, and have never heard about.

I don't know, I'm really at a loss here.. I've had these problems for about a year now, I just feel like I have to do something.. My whole life is so messed up because of this..

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Rozzer,

Why did the doctor give you Risperdal?

What other meds have you tried?

What does the doctor want to have you try now?

When you took Remeron, did it help anything? How long after Remeron was it before you took Risperdal?

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Well, I was put on Risperdal for some anxiety issues, so my doc suggested I tried Risperdal. If any of us knew what this horrible drug would do to me, then he would never have suggested an antipsychotic.. It was different route he suggested (The risperdal, insted of xanax or an antidepressant) , and he said the drug was old and very well tested. Yeah right, little did he know.. Before I took (and stopped the drug), I have never in my entire life had have problems with DP/DR and all the visual stuff.. I'm actually not the first to suffer from HPPD-like symptoms after taking Risperdal, I found something online about Risperdal causing HPPD in another person, but the symtoms disappeared when she discontinued the drug. Well mine hasn't, it's been a little over a year now. And I haven't touched anything since I stopped the Risperdal..

I haven't tried anything to cure this.

"What other meds have you tried?"

Well, Xanax, Risperdal, Remeron, and for a very short while, Lexapro... This is all of my history with these kind of meds. I didn't take them at the same time, or right after another.. And I haven't taken any of them since the onset of my hppd-like symptoms.

"When you took Remeron, did it help anything? How long after Remeron was it before you took Risperdal?"

It's proberbly been 10 years or so since I took Remeron, so I hope I remember this correctly.. This was way before I started suffering from these HPPD-like symptoms, I remember I was going through some issues, had problems with insomnia, and suffered from mild/medium depression.. As I wrote before, I remembered Remeron was very good in helping me sleep.. It could have done more, I don't know.. Once my sleeping paterns became normal, I remember things were clearing up in my life back then.. I was proberbly on it for about 6-8 months (I'm not exactly sure, can't remember). So I would proberbly say there was about 9-10 years in between I took Remeron and Risperdal..

"What does the doctor want to have you try now?"

Well my doctor seems as much baffled by this as I am.. I only took Risperdal for about 3-4 weeks before discontinuing it last year, I haven't touched anything since.. But up until now, he dosn't want to put me on any kind of medication. He's afraid it might make things worse.. In the beginning he was very certain that this would resolve by itself.. That I was just being very sensitive to the drug, or it was some kind of withdrawal thing. But it unfortunetely has never cleared up by itself. In the last year he's arranged for me to have my eyes checked, and get a MRI-scan of the brain.. My eyes where good, and the scan was normal.. So from my point of view, he dosn't really know what to do now at all. He has never heard about this before, an certainly not from taking Risperdal for such a short period of time.

So that's it, my sad story..

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Would you describe you visual symptoms? (snow? frames? motion problems? contrast problems? walls bow or ‘breathe’? auras or starbursts?)

Do you have muscle spasms, particularly in upper back and calves?

How is your sense of smell? Same? Less? More?

Tinnitis?

Do you have a restless agitation, perhaps RLS?

Dietary issues – food sensitivity? digestive problems?

[ Sorry so many questions but it could be useful ]

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"Sorry so many questions but it could be useful"

I don't mind at all, in fact, I really appreciate that you are trying to help, so thank you!!! I just hope that I can give an informative answer, since english isn't my native language and I don't know all the "technical terms". As I wrote in my earlier post, I'm kinda stuck. So if I could forward some ideas to my doctor then I would at least be doing something...

"Dietary issues - food sensitivity? digestive problems?"

None at all, not that I've noticed anyway..

"Do you have a restless agitation, perhaps RLS?"

I remember having this A LOT for the weeks that I was on Risperdal, but it subsided a couple of weeks (maybe a month) after I stopped the drug.. So right now, I don't have any of this either..

"Tinnitis?"

I always had this way before taking Risperdal, I would say I suffer from this mildly, and it has not gotten any worse in the last year.. So I don't think it has been affected.

"How is your sense of smell? Same? Less? More?"

I have not noticed anything different about my smell sense, so I would say it's exactly the same...

"Do you have muscle spasms, particularly in upper back and calves?"

No, none of the above. In the first 6 months after stopping the drug, I noticed my eyelids where sometimes twitching, but that's it, and I don't have any problems at the moment with this.

"Would you describe you visual symptoms? (snow? frames? motion problems? contrast problems? walls bow or ‘breathe’? auras or starbursts?)"

Yes, this is where most of my problems are.. I suffer from dense visual snow, I see it everywhere 24 hour a day, I see it when I close my eyes, and of course when they are open (Proberbly like most of you do). This is worse in the evening when it's dark.

I suffer from afterimages (Palinopsia) and burn-ins (Don't know if they are the same).. And if I look at my TV at night in a dim lit room, I'm practically blinded when I look away from the screen, because of the burn-in.

Closed eyed hallucinations, when I go to sleep at night and close my eyes, it's like looking at a lava-lamb.

Light sensitivity, This is proberbly the most disabling part of my condition. This is really bad. I can't go anywhere without sunglasses, and they don't even help that much. I see glare (don't know if this is right word) from everything.. Windows, light coloured buildings, water on the street, car windows and mirrors.. And it blinds me, and hurts really bad.. Both my eyes and head hurts when I'm blinded like this.

When I am in a very bright room (Or looks at the sky), I see a lot of spermy like things wiggling around in my visual field (I'm sorry, I don't know what this is called, I hope you know what I mean, or I'll try to explain better.)

I don't know if walls breathe when I look at them, but they are definitely in motion. But come to think of it, everything white or dark is, this is proberbly because of the snow.. Or the thing I described above.

I would say the first three months after quitting the drug, I suffered terribly from having a VERY dim vision, everything and everywhere was very dark. That changed around three months after stopping. I think it's more normal now, but I don't think it's completely back to normal. But I definitely have contrast problems, I don't know if this is caused by my extreme light sensitivity or snow.. It's not so easy to explain, but the dark seems darker in some way.. I need more lights in my house now than I did before. I'm practically night blind.

I proberbly have some motion problems aswell, but I can't really explain it right.. Almost everytime I open my eyes, it feels like something's wrong, but it's really difficult to explain.. This proberbly could be the DR, or snow, I don't know..

I noticed my pupils seem really big at times, and I don't remember them to be so large, but the ophthalmologist I went to said they where normal.. I don't know, it's just something that have have noticed..

Apart from these visual problems, I also suffer from DP/DR..

I have big problems with insomnia after this drug. My doctor has prescribed me sleeping pills, but I don't like taking them..

I also have problems with dizzyness, nausea. But this is not constant, and could be because of the lack of sleep.

There you have it.. I'm sorry for making it so long.. If you have any more questions, don't hesitate to ask, also just tell me if you want me to explain more...

Thank you for your time...

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415_Style, I've had hppd since 1998 and It's gotten easier to deal with by keeping busy. Having a job where I'm active has always helped me the most along with exercise. I notice when I'm out of work I get extremely depressed and everyday I wake up I feel useless and just lie around all day. Plus having my understanding Wife is such a blessing! I couldn't imagine being w/o her although I would just move to my Dad's beach resort in the Philippines and go diving everyday if she got sick of me lol.

If you told me over 10yrs ago I would still have hppd I would of killed myself. I'm so glad I've fought through it though life is def worth living even with severe hppd you just have to make the best of it.

Also I used to use alcohol as a crutch, but I notice the hangovers are much more severe then prehppd so I rarely drink anymore thank GOD. I was a alcoholic and that just shot me down.

Take care!!

PS if you have a doctor that's willing to prescribe you muscle relaxers like soma or zanaflex for tension headaches and muscle aches it works wonders after a rough day and not so addictive like opiates!!

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Visual, do you have any advice for me.. I'm going to see my doc tomorrow, could be good to bring something usefull... I don't expect you to come up with anything that heals me, but I'd like to bring something to the table tomorrow, because aparently my doc's as blank as I am..

Thanks..

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As for advice, humm. For me, increasing dopamine substantially helped: frames, motion problems, contrast, night blindness, and depth perception. It also helped dim vision, visual snow (very mild for me), light sensitivity, insomnia, sexual function, pain, and moods.

But how to get a doctor prescribe dopamine agonists is more difficult. But most will do Wellbutrin SR because it is classified as an antidepressant. If you have depression, tell your doctor and it may help. Wellbutrin has been VERY helpful but can only take small amounts (look over some of my posts) – it can be too stimulating, but is easily managed (just take less). Again, this is a drug somewhat opposite of Risperdal

Because you have dense visual snow, many with this express that Keppra has helped them. I only just started working with this med and feel that it will be useful from me.

Keppra is classed an anti-seizure and has been used for migraine prevention – note visual snow is sometime classified as a persistent migraine.

So, see if your doctor will work with you with either of these two. It takes no great stretch of the imagination to classify your symptoms as a very mild brain injury/malfunction. As such, Keppra is justified. Also, dopamine agonists can be argued as treatment for damage to dopamine pathways (a form of Parkinsonism, even if you don’t have tremor) – one of my Neurologists is familiar with doing this.

If your doctor is uncomfortable with helping you, ask him about centers that deal with brain injuries – these type of doctors are more familiar with the stuff we suffer.

If I think of some more ideas, I’ll post them. Hopefully others on this forum have some good medication ideas as well.

Wish you success with your appointment tomorrow ...

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Thank you for your advice, I have thought about Keppra myself, and I don't think that it's going to be a problem getting that prescribed. I'll definitely talk it over with my doc. However I don't think it's going to be possible getting prescribed Wellbutrin, since it's only approved to help with discontinuing smoking in my country and as I said before, I don't think I can get any doctor at all to prescribe me a dopamine agonists, off label, for a condition they don't even know, unfortunetely.. That's why Remeron seemed so perfect for me.. Well anyways, I will mention it for him..

Once again, thank your for your advice..

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In my case, the first panic attack begin after i use aropax (SSRI), but it's very weird because i took only one.

Now i took one pill a day and my symptoms are not going worse or better. Im freeze in that 'state of mind'.

I dont know if i need to left the aropax and tray Keepra, but im really sure that my symptoms started when i took the antidepressive's

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I don't want to hijack this thread but I have a question regarding muscle relaxers like what 1998 posted of-

I have taken zanaflex before and no problems. I have a sprained back and neck from over-doing the exercise and so much jaw tension from stress I'm sure that I broke off part of a tooth the other night. I seriously woke myself up to the noise and have very rigid muscles while sleeping. I was prescribed norflex today. I am hesitant of course because it is a variation of zanaflex. Do you or anyone at all have experience with this or think it'd be an issue for hppd? With the kind of heightened tension I'm experiencing lately (especially now that I can't run and exercise for a bit)I can't imagine adding increased hppd symptoms to it...But I'd really like my muscles to heal as well and I'm in serious pain.

Any input from anyone would be so appreciated. Take care all,

val

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My son has Hppd and his DR has put him on Prozac....she seems to know nothing about Hppd and Im scared it may make his worse... anyone taken Prozac, and had positive or negative effects???? He has been on 10m for two months and was raised to 20m but freaked out so now he is back on the 10m. Along with .5 kolonipin.

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My son has Hppd and his DR has put him on Prozac....she seems to know nothing about Hppd and Im scared it may make his worse... anyone taken Prozac, and had positive or negative effects???? He has been on 10m for two months and was raised to 20m but freaked out so now he is back on the 10m. Along with .5 kolonipin.

He is also taking Gabbapinten

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The real trick is understanding what has gone wrong for an individual – let alone a whole community.

So now that I've started on Gapabentin to deal with the muscle tension and heightened physical anxiety (combination of benzo wd and my original HPPD constellation), I've found it to have promise (still at a low dose - 600 TID). Nevertheless, I am both skeptical about whether it can cause a total return to my pre-klonopin cutting experiment state (i.e. effective "curing" of my symptoms) as well as leery of the weight gain side effect. It's too soon to really assess the latter, but I've been working out and dieting like a mad man for the three weeks I've been on it and whereas this would have resulted in a significant body fat reduction previously, I have either stayed the same or gained a bit. I can only imagine what would happen if I hadn't been rabid about my habits. I know some people will say "what do a few lbs matter", but klonopin didn't cause me any weight gain and so I'm used to a solution where I'm comfortable "being me" both mentally and physically.

Anyway, to the point: I'm debating alternatives already (even though I'll give this at least 6 weeks).

There's an SSRI and Keppra. My clinic doc says that SSRIs, specifically Zoloft is the top choice for anxiety and has the least weight gain potential. Why is anxiety important? Cuz my symptoms are muscle tension and a hyper-excited CNS. I'm pretty used to my visuals, don't really care at this point, although for the record, klonopin vastly reduced them.

I then read online (maybe not the best way to get definitive stats) that many people gain weight on Zoloft -- more than I would expect based on my doctor's claims. For example, if you saw that people were gaining 40 lbs on Keppra, you'd be surprised that a large % of people on boards were reporting that given it's just not know for weight gain (perhaps the opposite). Ok, so now I'm doubting both the efficacy, appropriateness and side effects aspects of Zoloft.

Keppra -- Lot of positives on the boards lately about it. Like gabapentin, may work, may not, I have no idea what the stats are there, although many people get at least decent relief from gabapentin (anecdotally).

Back to Zoloft. Why is an SSRI bad for HPPD (as stated in this thread)? I'm guessing because it causes more serotonergic activity and HPPD is related to a class of these receptors. My impression was that there is LESS serotonergic firing amongst a group of inhibitory neurons causing the "noise" blocking mechanism to diminish. Anyway, I'm well aware that there are different types of the same receptor, in different parts of the brain, doing different things, so it's complex. Thus, the rationale for why SSRIs are bad must be experiential, right?

Also, to Visual's point, we're all dealing with overlapping issues. I think the majority here have visuals without physical symptoms (the DSM IV definition of HPPD). Some though have anxiety (psychologica), DP/DR and a mixed bag. So different meds are going to work/not work as they're treating different things. Overall klonopin seems to work best because it's the best storm calmer out there. I figure GABA's inhibitory effects > inhibiting whatever channels Keppra and Gabapentin inhibit.

Yes, but it is more of an indirect help. Instead of reducing afterimages, trails, and what not, I just feel a reduced need to fixate on them. I seem to be able to shit my attention easier. In turn then things have gotten better.

I think Gill has a similar situation to me in that the biggest thing klonopin did for me was to immediately eliminate all the ancillary symptoms (I would classify them as physical, post-hoc). This removes the association of discomfort with visuals and they become, as the people who naturally adapt to HPPD suggest, part of your reality. I can't say that my attention has been shit more easily though ;) .

So, the fact that Zoloft helped him leads me to the question of whether it is effective against anxiety and anxiety-related pathways. It is, of course, used for this, but the question lies in identifying what exactly is causing my hyper-excited CNS (to the point where I have head pressure, muscle tension, panick-attackish tunnel vision). If I had psychological anxiety, it would be pretty evident, but I don't. This is an unusual case of having the physical without the psychological.

Sorry to make this long-winded, but given the aforementioned doctor's view re: Zoloft -- why is it not discussed here as an effective solution to HPPD-related symptoms since many of us suffer from anxiety-based pathologies?

Is it simply cuz Zoloft sucks at anxiety itself or that most HPPDers just don't have anxiety? If Klonopin works so well and doesn't exacerbate the visuals (at the very least), while affecting serotonin to some degree (as well as dopamine, glutamate through GABA), why aren't SSRIs a popular choice?

Thanks for the info -- seeing my pdoc in 2 days and would love to have some HPPD perspective!

rollin

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As far as weight gain (or loss), in general terms anti-seizures tend to reduce appetite. On the other hand, anxiety burns calories yet leads a person to eat more for emotional comfort. So it is difficult to say how a person will react ... complex, complex, complex.

One of the biggest tricks in keeping appetite down is to eat plenty of protein. It is not just vitamins and supplements ... protein. If one is to pick a diet, then choose Zone although it is difficult. Also, Zone tends to emphasize under-calorie for longevity (life extensionism) - but ditch that for now. Work for 30/30/40. Add starvation if you want later, lol. Again, if protein if low, you will never end cravings. Unfortunatly there is nothing quite as tasty as a big bowl of pasta or pizza.

Stimulant neurotransmitters tend to reduce appitite (dopamine, norepinephrine, epinephrine). Whereas serotonin is relaxing (hence can be good for treating anxiety) is historically a weight gainer.

There is a logic to trying an SSRI since with some HPPDers there is evidence of serotonin receptor changes. Yet it doesn't have much tract record for helping HPPD itself. Dopamine meds don't have a tract record either but they don't even have a history yet ... they have rarely been tried (whereas doctors love to hand out SSRIs). Since on the surface it doesn't make sense to give a stimulant to someone with anxiety ... that is another reason most docs don't think of trying them.

Neurotransmitter "balance" is key for each brain system. Unfortunately how each system is affected with HPPD varies - if a system is even affected at all. So you try to balance one and then get side-effects of imbalance elsewhere. SSRIs would be a problem is you have plenty of serotonin anyway. So people like me, Zoloft gives bad anxiety, and Sinemet cuts anxiety even though it is a stimulant. OCD is often treated with an SSRI, so you care less about fixation.

As far as gabapentin for HPPD, IMO it is an assistant med to be used in combination with others.

It is good you are trying stuff anyway. Chronic anxiety is damaging to the brain and needs to be addressed ahead of HPPD (visuals). The trick is to treat both :P

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Great post Visual, very informative as always.

As you said, I have to treat both. The complicating matter is that my HPPD and anxiety are linked in two ways:

1) my visuals and physical symptoms started simultaneously (so it wasn't exactly apparent until recently that I actually had an anxiety-related problem -- just "HPPD")

2) the physical symptoms, which I lump under chronic anxiety have really come about after my attempted benzo reduction so they're at least in part a result of benzo wd (which artificially causes anxiety symptoms if you know what I mean)

Anyway, as I'm trying new meds, just went up to 900mg TID Gabapentin today. You say it's best as an adjunct. Quite right and even though my klonopin dose seemed to have reached a plateau in efficacy (for whatever reason), gabapentin seems to be potentiating it or getting it to work again (so in essence acting as an adjunctive therapy).

My questions, which you answered, regarding SSRIs were of course trying to explore alternative treatments so that I can circumvent the weight (fat) gain I've notice even with a super strict diet and lotssss of exercise. As for diet, since I do mostly resistance training (with cardio in the way of hockey, soccer), I already have a protein heavy diet. Since I've been very health conscious and active (off and on...we all slack a little) for a decade (since my adolescent metabolism abandoned me), I know exactly how to lose a certain amount of fat in a certain time frame. The equation has changed now with this altered metabolism so I find even that even eating a low % of carbs, the only solution to curb the cravings or even just keep the fat gain at bay is with thermogenic stimulants, which goes COMPLETELY contrary to my efforts to fix my mental health issue. Catch-22.

I guess you're also suggesting that Zoloft is likely to cause weight gain (and it is mentioned as a possible side effect although for some reason I get the impression it's the least offending of the ADs).

I wonder why MDMA causes a complete if not extreme loss of appetite if it increases (massively) serotonin. Perhaps because it also enhances dopamine release, but I thought that was secondary.

I think my best best is with Keppra IF it works for me. I know your particular set of circumstances prevented a positive outcome. Perhaps I will have Rene's response to the med. Apparently it's not prescribed much in Canada. My new pdoc (who has finally been helping me get my life back) had never prescribed it and wasn't very familiar with it when I mentioned it as an alternative, yesterday. I would have thought that to treat bi-polar, seizures, etc., it would be quite common. Thankfully she's giving it a look see (can't tell you what a relief it is to be seeing a real open-minded professional). I also spoke to a pharmacist and my M.D. friend who's been on rotation for a year (one of my MD friends who I think is deserving of the title...there are some who I worked with in academia who I am frightened to know have a medical degree). They said the same about Keppra -- not often prescribed outpatient as far as they were aware/hadn't heard much about it.

It also might not be available as leviteracetam, only branded, which could suck big time. Anyway, that all depends on how my gabapentin treatment progresses and whether my new psychiatrist is in favour of it. It would be sweet to be on a drug that treats the anxiety, reduces visuals AND suppresses appetite.

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It seem to me that it would be easier/better to fine-tune your meds if you were to use a DNRI (bupropion) and a SSRI (celexa, lexapro) than a SNRI (effexor).

Kind of off the topic but, I would sort of put Zoloft (even though it is just an SSRI) in the same category of Prozac (SSRI), Zoloft & Effexor, etc. [in terms of effectiveness].

It seems that 1 out of 10 Paxil/Zoloft works. While Celexa and Lexapro seem to be 3-6 out of 10 effective.

Prozac is virtually first-in-class-SSRI so in some ways you could say that many strides have been made since its first appearance on the market.

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I wonder why MDMA causes a complete if not extreme loss of appetite if it increases (massively) serotonin. Perhaps because it also enhances dopamine release, but I thought that was secondary.

MDMA affects many neurotransmitters. Perhaps serotonin reputation for weight gain is mainly that it has a sedentary/relax effect (pre-sleep - which is the time it is naturally most dominant)

You may find tricyclics interesting to work with. Myself, I don't tolerate Zoloft (gives anxiety) and Lexapro mainly just increased my need for dopamine (doubled Sinemet). But tricyclics are often better tolerated by "Parkinsons type people" than SSRI (though there is no hard, fast rule).

Brief antidepressant history: MAOIs are an early class of antidepressants. They are most effective ... but there can be bad reactions when eating certain types of food. Then came Tricyclics. No reaction but more side-effects. Then Prozac (SSRIs) which have less side effects. However they are the least effective of the lot - but you know how it is when the "new boy comes to town".

I find Imipramine (tricyclic ... the predecessor to amitriptaline) to be decent. Only used it a little, but its antidepressant effect works within hours (not 2 months) so can PRN it. Of course this is about antidepressants ... which isn't what your are after.

Perhaps the "mix" of increasing several transmitters is key (which is what you did with MDMA). At this points I'm starting to babble too much ... :o

Best of success!

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Well, you never know until you work with a doc and try things. Have you tried Keppra? What else besides Zoloft and Reboxetine have you tried?

It was a long time since I wrote in this thread, hardly remember it..

I´ll get Keppra soon. I´m currently on 300 mg Wellbutrin, an NDRI, mainly to combat my ADHD. It isn´t working now though. Why I bashed all Dopaminergic substances I can´t remember. Wellbutrin has not affected my HPPD at all, save for the setting in period where visuals flared up to corresponding 25% of an acid trip (melting walls and stuff).

Since you seem very well versed in the subject, do you think if Keppra could keep down the visual increase which Concerta (Methylphenidate) is known to cause? I´m seriously thinking of quitting Wellbutrin which doesn´t make me focused or lowers my ADHD caused aggression anymore. Concerta is known to be a lot more effective.. And I have a green light for it in my diagnose papers "perscribe with special consideration and monitoring regarding increases in HPPD and signs of mood shifts (bipolarity)".

Think Keppra and Concerta would make a good combo for me?

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Seems like a bunch of people starting/recently started Keppra with mixed success so far. I'm seeing my pdoc tomorrow, might be starting it as well although all this uncertainty has given me pause. I'm not sure if there's any conclusive anecdotal evidence on this board that Keppra helps visuals significantly or even to some degree in everyone. I guess it's one of those trial and error things. Personally I think if there are fewer drugs that could help you overall, it's the best route. Ocham's razor and all. That said, if you need Concerta, the only meds that I have heard (experienced one) reduce visuals are klonopin (reduced them for me) and Keppra.

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Seems like a bunch of people starting/recently started Keppra with mixed success so far

This is great because we learn more about our disorder. And for the few that it helps ... fantastic!

I´m currently on 300 mg Wellbutrin, an NDRI, mainly to combat my ADHD. It isn´t working now though.

Did it used to work? And if so, what benefits did you have.

...do you think if Keppra could keep down the visual increase which Concerta (Methylphenidate) is known to cause?

First, are you on Cencerta/Ritalin or have taken it in the past?

Second, haven't read experiences about how this med affects HPPD ... and would appreciate any info on this.

Since it works mainly with DAT and NET, it might not be directly helpful for HPPD since HPPD is considered more a problem in the cerebral cortex (which isn't as much affected by DAT). Any med that inhibits a neurotransmitter reuptake (such as Ritalin with DAT) will cause the brain to counter-react by reducing the amount of the neurotransmitter it produces (dopamine and NE in this case). Even though the brain does this, there will still be a net gain in the activity of the neurotransmitter.

Now with this in mind, it could be possible that when the brain reduces dopamine because of reuptake inhibition, the cerebral cortex suffers further disinhibition making symptoms worse - since it is a system needing dopamine but not using DAT very much.

As for Keppra, it is of a class of drugs called Racetams. Racetams work primarily at the junction of glutamate receptors and cholinergic receptors. http://en.wikipedia.org/wiki/Racetams So one of the relevant effects for HPPDers is its effect on acetylcholine. As mentioned before, there is a balance between acetylcholine and dopamine in many neural systems.

For me, Keppra will briefly improve DR (and muscle spams) ... then brain compensates ... then need more ... then brain compensates more ... then when I stop, it takes about a week to 'recover'. It trashes my memory, but some have reported the opposite.

In the end it is something to try. Hope this was helpful even thought it was rather non-commital, :D

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