DXM with remeron and a tricyclic

[JohnBoy2000]

My concern is that, due to DXM being an inhibitory NT, it will weaken the effects of my scripted meds.

I have a bottle that supplies 10mg of DXM per 5 ml dose of cough syrup.

Stahls book suggests doses of 10 to 20 mg of DXM at a time.

Basically -are there any problematic interaction with remerson and desipramine here?

 

[Cotcha Yankinov]

Risk of mania, psychosis and serotonin syndrome.

I'm surprised stahl recommends DXM but it has been investigated as a rapid acting antidepressant.

Normally NMDA receptors provide a lot of input to inhibitory interneurons, when those inhibitor interneurons are turned off by DXO, activity and release of monoamines downstream will increase.

 

[sekio]

If you're keeping your doses low then DXM mostly acts as a serotonin reuptake inhibitor

 

[Nagelfar]

Now, IIRC, does DXM act in exception with regard to most other NMDA antagonists (ketamine, PCP) with regard to the kappa opioid receptor? e.g. generally agonism versus inverse/ant-agonism with others? I forget whether I asked this before but I know I read something trying to find a drug that had the prime psychoactive kappa affinity as salvia divinorum along with appreciable NMDA antagonism efficacy; may not, however, and if not I am still looking for such a potential drug.

 

[JohnBoy2000]

If you're keeping your doses low then DXM mostly acts as a serotonin reuptake inhibitor

SRI?

I thought it was glutamate based?

When you say low, like - 10 to 20 mg per dose?

You wouldn't happen to have an information link for the SRI action hypothesis?

 

[Cotcha Yankinov]

The NMDA antagonist effect of the metabolite DXO isn't really appreciable until upwards 100mg of DXM, but there's the matter of liver enzymes -> conversion of DXM to DXO. But I would use caution above 20mg with the current use of other meds.

DXO is also a NRI, at some point NRI can increase the risk of seizures. By the way just to clarify, it is ketamine for depression that is theorized to work via AMPA receptors (Glutamate), separate from its NMDA antagonist effects.

In addition, I believe sigma 1 agonism is thought to play a role in DXM's efficacy as an antidepressant.

 

[JohnBoy2000]

Is ketamine available somewhere/somehow as a nasal spray?

I read over on Dr-Bob someone was administering it this way.

Where does one get ketamine based nasal spray?

 

[Cotcha Yankinov]

IV ketamine therapy is offered in various clinics, and I have heard the practitioners will often times send home their patients with essentially a booster pack of ketamine lozenges. There is some deal with bypassing first pass metabolism with IV (or apparently intranasal) and achieving maximal concentrations of the antidepressant metabolite HNK but my brain is a potato right now