Posted by JohnX2 on March 13, 2002, at 19:45:34
In reply to Re: High Dose Prozac, posted by SLS on March 13, 2002, at 18:42:18
Hi Scott,This is my opinion. Take it with a grain of salt, you've been through so much, I can't even imagine how much heart and determination you have. I consider myself a persistent person, but you really inspire me.
Anyways, I think its important to understand that everbody is different and that there is a bell shape curve so to speak of responses. There is going to be people on the fringe of these statistical curves that don't fit into the standard "flow chart" diagnosis. So I wouldn't be too concerned about what label is applied to your illness and more concerned about how it needs to be treated.
For example, I say my disorder is treated with membrane stabilizers and chemical boosters. This is what works for me. You can use this to treat a number of labels: bipolar, depression, epilepsy, anxiety. Whatever. Who cares about the label.
What is important from a scientific approach, is to look at your response to medications and make flexible changes in treatment aproaches based off those responses.
For a long time you have been stuck with this persisestant poop out snag. And now you even had clear cut manic sympoms with very clear cut cycling. Without putting a label on it, and just thinking about chemistry, there are certain classes of medicines to try that are best suited to stabilize and improve these situations. Now it just so happens that they usually are used for Bipolar Disorder. That doesn't mean you are Bipolar. It just means your odds of improving your situation improve substantially if you use novel techniques to steady your mood and control poop out rather than beat down the standard antidepressant path (unless they come up with something else in the mean time, endocrine etc).
I found some interesting links on theories behind treatment resistant depression/bipolar/ultra radian cycling/poop out and posted them way down below (with your name on it). A lot of things I see on this stuff suggests strategies regarding regulation of synaptic plasticity and calcium channels.
So I hope you get in with some good doctors.
At least it sounds like your getting in some
fun. Except the wild mood swings must suck?BTW, I think that antipsychotic med you were looking at is very interesting.
please take care and stay in touch.
Let us now if you go down any nover treatment paths to help with the cycling or poop out.
(I hope you do).Best Wishes
John> Hi John.
>
>
> > My own oops. I didn't read your follow up oops. I figured you should have known better on this one. ;)
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> You overestimate me, my friend.
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> > BTW, are you onto the Nardil trial?
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> No. Not yet.
>
> I had been taking:
>
> Lamictal 300mg
> Effexor 300mg
> nortriptyline 75mg - 100mg
>
> I've switched from nortriptyline to imipramine because there was no stable therapeutic window for me. 75mg is too little and 100mg is too much. No amount of finessing seemed to work. Taking too much of nortriptyline feels in some ways worse than taking too little. I experienced a more crushing depression along with anxiety. I first attempted the switch while I was still taking Effexor. I felt better during a two-day washout period before beginning imipramine. I even experienced a small withdrawal rebound improvement, which is typical for me. Unexpectedly, I reacted badly to the addition of imipramine within the first few days in a way similar to the exacerbation produced by nortriptyline. Imipramine and I are buddies, and I respond quite predictably when taking it.
>
> I discontinued the Effexor in the hopes that it was responsible for adulterating actions of tricyclics. I then went back to nortriptyline to see if would respond well to it in the absence of Effexor. I liked the way I felt on nortriptyline during the brief periods when it helped. In addition, I would have preferred to combine Nardil with the tricyclic having the more mild anticholinergic effects. No such luck. Same window thing. Sooo, I switched back to imipramine, raised the dosage to 300mg., and added back the Effexor. Logical, I think. It has only been 2 days of taking Effexor, so we'll see.
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> > And have you always been diagnosed Bipolar?
>
> No. I arrived at the Columbia Presbyterian (NYC) research program depressed and ultra-rapid cycling. 8 days of a severe anergic depression followed by 3 days of euthymia. No mania, though. I was diagnosed with atypical unipolar depression. Then, 5 years later during my only extended period of euthymia (6 months), which was brought about by a combination of Parnate and desipramine, mania began to appear. It developed into a psychotic mixed state over the course of 2 or 3 months. Still, my doctor continued to treat me as a unipolar. It wasn't until I entered the NIMH program that the word bipolar was used. William Z. Potter came to this conclusion after a brief interview with me. I don't know what else he based his opinion on. I suppose he read through my case history.
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> I sometimes wonder if I have something other than affective disorder causing my symptoms. Something "organic". I don't know. Maybe a brain tumor or an endocrine malfunction or some weird autoimmune thing.
>
> I'm not married to the bipolar diagnosis. I would welcome any input. Some people might consider me to be unipolar with drug-induced manias. Others define this pattern as a subtype of bipolar disorder. I would favor the second diagnosis because of the 2-year period of rapid-cyclicity, the anergic presentation with reverse-vegetative symptoms, and brief mild improvements brought about by lithium and gabapentin monotherapy, and the addition of valproate to MAO inhibitors. I'm sure H. Akiskal would find some bipolarity in there somewhere.
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> > Do you maintain Lamictal with the other medicine trials?
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> Yes. It helps me maintain a mild improvement when used in combination with a tricyclic or MAOI. I have tried several times to reduce the dosage below 300mg, but I deteriorate within two days.
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> > You couldn't pry Lamictal out of my cold dead fingers. ;0
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> I hope I never get the chance to try.
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> I do appreciate your input and value your knowledge and understanding. I have learned quite a bit from you, and I'm sure that I'll continue to.
>
>
> - Scott
poster:JohnX2
thread:27771
URL: http://www.dr-bob.org/babble/20020313/msgs/97838.html