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How Long Does Sulpiride Take To Show Effect?
Question: Dear Dr. Sheppe,
My name is XXXXXXX I am on Lexapro 15 mg, Klonopin 3 mg, Keppra 1000mg, Solian (amisulpride) 100mg and Sulpiride 25 mg. I've been told that Sulpiride take 2 weeks to start working. I would like to know if it's like that. I think there was a mistake in your last letter, since Sulpiride was given to me to "stop" dopaminergic activity of Solian, so i guess that Sulpiride (not amisulpiride) cannot boost dopaminergic activity.
Thanks beforehand, XXXXXXX
My name is XXXXXXX I am on Lexapro 15 mg, Klonopin 3 mg, Keppra 1000mg, Solian (amisulpride) 100mg and Sulpiride 25 mg. I've been told that Sulpiride take 2 weeks to start working. I would like to know if it's like that. I think there was a mistake in your last letter, since Sulpiride was given to me to "stop" dopaminergic activity of Solian, so i guess that Sulpiride (not amisulpiride) cannot boost dopaminergic activity.
Thanks beforehand, XXXXXXX
Brief Answer:
Private Consultation
Detailed Answer:
Hello XXXXXXX and thanks very much for the questions.
To answer your first question, it takes Sulpiride about 7-10 days to start working, but can take up to 4-6 weeks to take full effect. So you may start feeling effects already, but it may take time for these effects to maximize.
To answer your question about Sulpiride's actions, I actually did not type a mistake. Let me explain in more detail. Sulpiride at HIGH doses indeed blocks D2 receptors and decreases the amount of dopamine acting on those receptors. This leads to a reduction in the positive symptoms of schizophrenia, such as auditory hallucinations. However, at LOW doses (less than 100mg), Sulpiride blocks presynaptic dopamine autoreceptors, which leads to a slight increase in the amount of dopamine in the system. This increased dopamine leads to more energy, treatment of depression, and treatment of OCD, without worsening the positive symptoms.
I think some of the confusion here is that both Solian and Sulpiride are partial agonists. Neither strictly increases or decreases dopmaine. Rather, they increase dopamine when it is low and decrease it when it is high. We are trying to find a combination that adjusts your dopamine in both directions to result in improvement in clinical symptoms. You are on amisulpride to treat obsessions as well as depression. This has been working well for you. Sulpiride is an augmenting agent designed to improve OCD symptoms while also improving depression symptoms. They work together in harmony.
Does this make sense?
Dr. Sheppe
Private Consultation
Detailed Answer:
Hello XXXXXXX and thanks very much for the questions.
To answer your first question, it takes Sulpiride about 7-10 days to start working, but can take up to 4-6 weeks to take full effect. So you may start feeling effects already, but it may take time for these effects to maximize.
To answer your question about Sulpiride's actions, I actually did not type a mistake. Let me explain in more detail. Sulpiride at HIGH doses indeed blocks D2 receptors and decreases the amount of dopamine acting on those receptors. This leads to a reduction in the positive symptoms of schizophrenia, such as auditory hallucinations. However, at LOW doses (less than 100mg), Sulpiride blocks presynaptic dopamine autoreceptors, which leads to a slight increase in the amount of dopamine in the system. This increased dopamine leads to more energy, treatment of depression, and treatment of OCD, without worsening the positive symptoms.
I think some of the confusion here is that both Solian and Sulpiride are partial agonists. Neither strictly increases or decreases dopmaine. Rather, they increase dopamine when it is low and decrease it when it is high. We are trying to find a combination that adjusts your dopamine in both directions to result in improvement in clinical symptoms. You are on amisulpride to treat obsessions as well as depression. This has been working well for you. Sulpiride is an augmenting agent designed to improve OCD symptoms while also improving depression symptoms. They work together in harmony.
Does this make sense?
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Prasad
Dear Dr. Sheppe,
Thank you very much for your answer, it makes sense. I think maybe there is a mistake from my psychiatrist, since he decided to give me Sulpiride 25 to stop dopaminergic activity, so, i am not so sure that dopamine could be adjusted in both directions. Are there typical antipsychotics which can just stop dopaminergic activity?¿Is there one you could suggest?
Thanks again, XXXXXXX
Thank you very much for your answer, it makes sense. I think maybe there is a mistake from my psychiatrist, since he decided to give me Sulpiride 25 to stop dopaminergic activity, so, i am not so sure that dopamine could be adjusted in both directions. Are there typical antipsychotics which can just stop dopaminergic activity?¿Is there one you could suggest?
Thanks again, XXXXXXX
Brief Answer:
Private Followup
Detailed Answer:
There are indeed. Haloperidol is a potent D2 blocker, and is widely used. There are potential side effects to be aware of, but there is nothing better for strong D2 blockage. There are other strong D2 blocker like Thorazine and Prolixin, but Haloperidol is what I'd recommend if you're looking for strong D2 blockage.
Keep me updated to let me know how you're doing with any changes!
Dr. Sheppe
Private Followup
Detailed Answer:
There are indeed. Haloperidol is a potent D2 blocker, and is widely used. There are potential side effects to be aware of, but there is nothing better for strong D2 blockage. There are other strong D2 blocker like Thorazine and Prolixin, but Haloperidol is what I'd recommend if you're looking for strong D2 blockage.
Keep me updated to let me know how you're doing with any changes!
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Dr. Sheppe,
Thanks a lot for your answer. I have a last question. Perphenazine can be a good alternative?
Thanks, XXXXXXX
Thanks a lot for your answer. I have a last question. Perphenazine can be a good alternative?
Thanks, XXXXXXX
Brief Answer:
Private Followup
Detailed Answer:
Yes indeed, perphenazine is a high potency D2 blocker similar to haloperidol. It would be an acceptable alternative. It is also available in intermittent injection form so you wouldn't have to take a pill everyday, which is convenient.
Dr. Sheppe
Private Followup
Detailed Answer:
Yes indeed, perphenazine is a high potency D2 blocker similar to haloperidol. It would be an acceptable alternative. It is also available in intermittent injection form so you wouldn't have to take a pill everyday, which is convenient.
Dr. Sheppe
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Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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