Abilify- Stanford Clinic Patients

Hoosierfans

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From the recent article out of Ohio State: https://www.mdpi.com/2218-273X/11/2/185/htm

“Finally, these studies found that the EBV dUTPase protein modulates tryptophan, serotonin, and dopamine metabolism and use in vitro and in vivo. The EBV dUTPase may alter kynurenine catabolism in microglia in vitro by increasing the expression of indoleamine 2,3 dioxygenase (IDO1) and kynurenine-3-monooxygenase (KMO), suggesting that there is an increase synthesis of quinolinic acid. Quinolinic acid, an agonist of NMDAR, can cause overstimulation that results in neuronal toxicity. Furthermore, the data suggest the EBV dUTPase protein increases the expression of GTP cyclohydrolase (Gch1), and down-regulates both tryptophan hydrolase 2 (Tph2) and tyrosine hydrolase (Th). Gch1 is the rate limiting enzyme necessary for the synthesis of tetrahydropterin (BH4), a substrate required for serotonin and dopamine synthesis by Tph2 and Th, respectively. Furthermore, the dopamine receptors Drd1 and Drd5, as well as the serotonin transporter gene Slc6a4, were also down-regulated. These results suggest that the decreased synthesis and recycling of dopamine and serotonin coupled with the increased degradation by astrocytes and microglia could result in low levels of these neurotransmitters ultimately leading to cognitive defects and increased oxidative stress. The dopaminergic and serotonergic neurotransmitter systems are reported to play a critical role in the regulation of emotion and mood, and have been implicated in a wide spectrum of neuropsychiatric disorders. Specifically, EBV dUTPase simultaneously down-regulated key genes involved with dopamine and serotonin synthesis as well as key transporters and receptors required for signaling by these molecules. Low dopamine levels are associated with fatigue, attention deficits, decreased motivation and depression [122], while low serotonin levels are associated with fatigue, cognitive impairments, anxiety and digestive problems [123]. These are common symptoms associated with ME/CFS. Morris et al. [124,125] proposed that alterations in tryptophan catabolism may contribute to a variety of symptoms observed in several neuroimmune disorders including ME/CFS.”
 

Hoosierfans

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If anyone wants to experiment with dopamine precursors, find 3 mg of manganese daily, which is a dopamine precursor, noticeable improves mood and enthusiasm a bit. There are several dopamine precursors (tyrosine, B6, vit C, folic acid, zinc, copper, magnesium and iron), but manganese is the only one I have found which has a noticeable effect.
Great idea Hip, I may try some manganese. I believe @Learner1 found some pretty decent help from a big dose of tyrosine.
 

bensmith

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From the recent article out of Ohio State: https://www.mdpi.com/2218-273X/11/2/185/htm

“Finally, these studies found that the EBV dUTPase protein modulates tryptophan, serotonin, and dopamine metabolism and use in vitro and in vivo. The EBV dUTPase may alter kynurenine catabolism in microglia in vitro by increasing the expression of indoleamine 2,3 dioxygenase (IDO1) and kynurenine-3-monooxygenase (KMO), suggesting that there is an increase synthesis of quinolinic acid. Quinolinic acid, an agonist of NMDAR, can cause overstimulation that results in neuronal toxicity. Furthermore, the data suggest the EBV dUTPase protein increases the expression of GTP cyclohydrolase (Gch1), and down-regulates both tryptophan hydrolase 2 (Tph2) and tyrosine hydrolase (Th). Gch1 is the rate limiting enzyme necessary for the synthesis of tetrahydropterin (BH4), a substrate required for serotonin and dopamine synthesis by Tph2 and Th, respectively. Furthermore, the dopamine receptors Drd1 and Drd5, as well as the serotonin transporter gene Slc6a4, were also down-regulated. These results suggest that the decreased synthesis and recycling of dopamine and serotonin coupled with the increased degradation by astrocytes and microglia could result in low levels of these neurotransmitters ultimately leading to cognitive defects and increased oxidative stress. The dopaminergic and serotonergic neurotransmitter systems are reported to play a critical role in the regulation of emotion and mood, and have been implicated in a wide spectrum of neuropsychiatric disorders. Specifically, EBV dUTPase simultaneously down-regulated key genes involved with dopamine and serotonin synthesis as well as key transporters and receptors required for signaling by these molecules. Low dopamine levels are associated with fatigue, attention deficits, decreased motivation and depression [122], while low serotonin levels are associated with fatigue, cognitive impairments, anxiety and digestive problems [123]. These are common symptoms associated with ME/CFS. Morris et al. [124,125] proposed that alterations in tryptophan catabolism may contribute to a variety of symptoms observed in several neuroimmune disorders including ME/CFS.”

This is interesting but why do snris not help people more? Or would they be using some other kind of action to help the system?

I guess abilify might do this with some other mechanism.
 
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Hoosierfans

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This is interesting but why do snris not help people more? Or would they be using some other kind of action to help the system?

I guess abilify might do this with some other mechanism.
Well SNRIs work on norepinephrine and dopamine, not serotonin and dopamine. For me personally, when I first got sick w mono, it indeed was Effexor (SNRI) and Florinef (bc of POTS) that took me from bedridden to working full time again (and I maintained that for about 4 years).

We still don’t know all the mechanisms of Abilify, but it does work on the serotonin and dopamine systems, has some kind of anti-inflammatory effect and (I think) I saw somewhere that it has a positive effect on the mitochondria. So maybe it’s hitting several of the right “pathways”...albeit (with the neurotransmitter pathways) ones that might be subject to over saturation / down regulation.

The interesting thing on that last point (down regulation) is that if down-regulation was the cause of poop-out, I would think you would expect to see withdrawal symptoms...not just that it “stops working.” You’d see withdrawal similar to what happens w benzos or SSRIs. 🤨
 

bensmith

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Huh ok. Yes that’s a good point on down regulation. Do you still see benefit from snris then?
 

leokitten

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Just noticed that @leokitten is on moclobemide. Interesting....

I took moclobemide for over two months on its own before starting Abilify. I didn’t notice really any improvements to my ME symptoms during this time (and two months is long enough for drugs like this to show some effect).

I’m hoping though it has some synergistic effect with Abilify, but it really seems Abilify is what’s really driving the improvements in ME symptoms.
 

leokitten

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If anyone wants to experiment with dopamine precursors, find 3 mg of manganese daily, which is a dopamine precursor, noticeable improves mood and enthusiasm a bit. There are several dopamine precursors (tyrosine, B6, vit C, folic acid, zinc, copper, magnesium and iron), but manganese is the only one I have found which has a noticeable effect.

And very importantly vitamin D, there’s quite a bit of research showing it’s importance wrt dopamine levels and regulation.
 
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pattismith

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@Hip

this paper is about antipsychotic drugs for non psychiatric illnesses. Some alternatives to Aripiprazole may be possible...
For each drug, there is a short paragraph about effect on brain Dopamine...

1615756678876.png
 

Hip

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this paper is about antipsychotic drugs for non psychiatric illnesses. Some alternatives to Aripiprazole may be possible...
For each drug, there is a short paragraph about effect on brain Dopamine...

Most antipsychotics will work on dopamine, as the dopamine theory of schizophrenia posits that an over-active dopamine D2 receptor drives the positive symptoms of schizophrenia. Whereas the negative symptoms of schizophrenia are thought due to D1 under-activation.

Traditional antipsychotics work by blocking D2 in a blunt way, but these third generation antipsychotics use the more subtle dopamine system stabilization mechanism, and don't just uniformly block D2, but rather block the strong dopamine signals on D2, but let the weaker dopamine signals through.


If this dopamine system stabilization is the mechanism by which Abilify helps ME/CFS, then other dopamine system stabilizer drugs may work equally well for ME/CFS. Dopamine system stabilizer drugs include:

Amisulpride
Aripiprazole
Brexpiprazole
Cariprazine
Pridopidine
OSU61612

The first four are all third generation antipsychotics. The last two are not available as licensed drugs.
 

Hip

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That Abilify Facebook group is running an interesting poll on the side effects of Abilify experienced by ME/CFS patients. One of the most common side effects appears to be increased irritability.

I find this side effect strange, as when I started very low-dose amisulpride, it profoundly reduced the very high levels of irritability I had as an ME/CFS symptom. In fact that was one of the greatest blessings I derived from amisulpride, as my irritability was really severe, the sort of military-grade irritability that you normally only find in autistic kids (who are often given antipsychotics to help control this horrendous irritability).

So funny how I found amisulpride greatly reduced irritability, whereas Abilify ME/CFS patients are reporting increased irritability.
 

leokitten

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So funny how I found amisulpride greatly reduced irritability, whereas Abilify ME/CFS patients are reporting increased irritability.

Abilify definitely reduced my ME related irritability, because it’s improved my ME symptoms which are a principal cause of ME irritability. I’m not on the FB group, what percentage of poll responders are reporting it?
 

Hip

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I’m not on the FB group, what percentage of poll responders are reporting it?

I am not sure how to determine the percentage votes on FB polls, but irritability was the second most reported side effects with 10 votes so far.

I cannot see how many people voted into total, so not sure how to calculate the percentage, and no percentage info is given. Typical naff Zuckerberg.

The most reported side effect was weight gain with 11 votes.

Then in decreasing incidence: Insomnia has 9 votes, tachycardia 6 votes, restlessness or agitation 5 votes, headache 3 votes, and it goes on with dozens of other side effects.

The poll can be found here for those who are members of the group.
 

leokitten

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Most antipsychotics will work on dopamine, as the dopamine theory of schizophrenia posits that an over-active dopamine D2 receptor drives the positive symptoms of schizophrenia. Whereas the negative symptoms of schizophrenia are thought due to D1 under-activation.

Traditional antipsychotics work by blocking D2 in a blunt way, but these third generation antipsychotics use the more subtle dopamine system stabilization mechanism, and don't just uniformly block D2, but rather block the strong dopamine signals on D2, but let the weaker dopamine signals through.

Actually this is not completely true. The definition of “atypical” antipsychotic is because of the additional actions on serotonin receptors and the serotonin hypothesis of schizophrenia. Many atypical antipsychotics have partial agonism at the 5-HT1A receptor, and partial agonism or antagonism at other serotonin receptors.

Current Concepts and Treatments of Schizophrenia. Stępnicki et al. Molecules. 2018.

You can see the easy overview in that linked doc I sent too https://s1.q4cdn.com/460208960/files/News/2021/Zacks_SCR_Research_01132021_RVPH_Vandermosten.pdf

Btw the intensity of yellow color and number of pluses means intensity of partial agonism, and blue corresponding intensity of antagonism. I believe they try to combine the affinity and intrinsic activity into one visual summary. They wrote in the footnote, “Antagonism and inverse agonism are indicated by blue color whereas partial agonism by yellow. The number of crosses and color intensity are correlated to binding affinity.
 

Hip

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Many atypical antipsychotics have partial agonism at the 5-HT1A receptor, and partial agonism or antagonism at other serotonin receptors.

That's interesting, but also a little strange.

Agonism of 5-HT1A and 5-HT2A by drugs like LSD, DMT, mescaline and psilocybin induces potent psychedelic trips.

You would think the last think a schizophrenic needs is psychedelic effects.



I got interested in 5-HT1A and 5-HT2A because of the reduction of expanded consciousness / spiritual feelings that I began to suffer from after being hit with ME/CFS. I wanted to figure out why ME/CFS and brain fog can so dampen higher consciousness, and 5-HT1A and 5-HT2A looked like they might be the culprits, as these receptors have been linked to transcendent personal experiences.

There is apparently a reduced number of 5-HT1A receptors in ME/CFS.
 

leokitten

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That's interesting, but also a little strange.

Agonism of 5-HT1A and 5-HT2A by drugs like LSD, DMT, mescaline and psilocybin induces potent psychedelic trips.

You would think the last think a schizophrenic needs is psychedelic effects.

I don’t think it can be thought of working via this type of deductive reasoning. Everything must be taken together, all receptor targets, affinities, occupancies, and intrinsic activities must be evaluated together.

https://psychopharmacologyinstitute.com/publication/5-ht1a-receptors-in-psychopharmacology-2123

And remember too it’s partial agonism, not full agonism and/or serotonin release.
 
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Hip

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I don’t think it can be thought of working via this type of deductive reasoning. Everything must be taken together, all receptor targets, affinities, occupancies, and intrinsic activities must be evaluated together.

True, the picture is usually more complicated than just a single pathway or effect.

Just found this statement in Wikipedia:
5-HT1A receptor activation has been shown to increase dopamine release in the medial prefrontal cortex, striatum, and hippocampus, and may be useful for improving the symptoms of schizophrenia and Parkinson's disease.

So that may explain why 5-HT1A agonism helps schizophrenia, as it triggers dopamine release elsewhere.
 

percyval577

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If anyone wants to experiment with dopamine precursors, find 3 mg of manganese daily, which is a dopamine precursor, noticeable improves mood and enthusiasm a bit. There are several dopamine precursors (tyrosine, B6, vit C, folic acid, zinc, copper, magnesium and iron), but manganese is the only one I have found which has a noticeable effect.
Do you have any lit for the Mn thing? I would be very interested.
 

Hip

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Do you have any lit for the Mn thing? I would be very interested.

I don't have any specific links about manganese.

I discovered manganese has mild antidepressant effects for me by accident, after trying this essential mineral.

Originally I took 40 mg daily, as that was the dose my Swanson manganese capsules provided, but found even if I took it in the morning, it would cause difficulty in getting to sleep. So then I reduced the dose, and found 3 mg in the morning still provides a mood boost without any insomnia issues.
 

leokitten

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I am not sure how to determine the percentage votes on FB polls, but irritability was the second most reported side effects with 10 votes so far.

I cannot see how many people voted into total, so not sure how to calculate the percentage, and no percentage info is given. Typical naff Zuckerberg.

The most reported side effect was weight gain with 11 votes.

Then in decreasing incidence: Insomnia has 9 votes, tachycardia 6 votes, restlessness or agitation 5 votes, headache 3 votes, and it goes on with dozens of other side effects.

The poll can be found here for those who are members of the group.

I wonder what dose those who report irritability are taking vs those who don’t, and very importantly those in the group who are also taking an SSRI/SNRI or MAOI antidepressant with Abilify, to see if concomitant use of these shows reduced irritability.
 
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