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Dr. Bob is Robert Hsiung, MD,
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Posted by mist on July 17, 2002, at 15:26:10
In reply to Re: I disagree., posted by Geezer on July 17, 2002, at 14:16:29
Geezer,
Thanks for the nice civil post even though you disagree.
> When I am at my worst I can't get my head off the desk - but that can ONLY be changed with drug adjustments..
This is what I mean about the false dichotomy. :) Just because psychological and environmental factors are significant in causing a particular depression, doesn't mean meds won't relieve it. It's not either/or. Once it gets to the point where you are actually depressed, the depression is physical. Are meds the only relief in every case? I wouldn't go so far as to say that.
>For me its a matter of chemistry/physiology-genetics
And possibly in your depression that's exactly what it is. My point is that the causes can be different for different people.
> the question is how does one get out of that state. I have tried "talk therapy" on three different occasions, talking didn't reduce symptoms, prolong intervals of wellness or prevent recurrence.
I'm pretty fed up with talk therapy as it's practiced too. In theory I believe something like that could be helpful for some people, but too many therapists lack the ability to be creative or to diverge from the norm. And some of it is just luck. Sometimes it's interpersonal chemistry that makes one therapist better for a particular client than the next. But you can spend your life's income trying to find the right therapist.
How does one get out of that state? I'm less depressed now than I was last year. In a sense, I waited it out and it changed. But I don't recommend that, especially if someone is likely to commit suicide. Even though I have felt suicidal sometimes and have had an almost constant desire to die since I can remember, when I am very depressed I just don't have the energy or ability to plan (let alone carry out) suicide.
At the same time, since I've been depressed since childhood (to varying degrees), I might have a tendency to put up with too much in terms of depression symptoms. To just accept it, even when it's really bad.
I also took 5-HTP at the end of last year. It helped enough that while it didn't resolve all the symptoms, it made a dent in them.
>Any changes in mood, that may be construed a psychological, come as a result of chemistry changes NOT because of cognative therapy.
My belief is that sometimes changing your thinking and circumstances can cause physiological changes. It's a two-way street. It's like blood pressure (I have posted this before :)). Some people use meds to control high blood pressure, some are able to do it by meditating, biofeedback, and other stress reduction measures (as well as dietary changes). My point is that what applies for one person may not apply for the next.
Posted by mist on July 17, 2002, at 15:37:37
In reply to Re: slowed thoughts » mist, posted by Ritch on July 17, 2002, at 13:27:18
Mitch, your description pretty much fits the type of depression I've had. Slowed thoughts can even become stopped thoughts! Sometimes a darkness would come into my mind that felt like it could obliterate it, when I tried to think even one thought or half a thought. Like my thinking would be smothered by this darkness and just stop.
Posted by Geezer on July 17, 2002, at 16:19:15
In reply to Re: I disagree. » Geezer, posted by mist on July 17, 2002, at 15:26:10
Thanks Mist,
I do try to respect the opinions of others and their right to voice them; thanks to you for the same. I think there is a lot to Dr. Bob's policy of "please be civil" - you can use up a lot of energy arguing - not something we always have a lot of.
This is a "hot topic" for me. I am very anxious to see emperical testing and better meds. to treat this illness. At this point psychopharm. is in a very primitive stage, I have been treated since 1962, the meds of today have fewer side effects for some people but are no more effective (talking ADs now, not APs). I got 30 years completed in the Cardiac Pacemaker business before complete disability in 1998. I guess you never give up hope.
Very best regards,
Geezer
Posted by Ritch on July 17, 2002, at 23:34:26
In reply to Re: slowed thoughts » Ritch, posted by mist on July 17, 2002, at 15:37:37
> Mitch, your description pretty much fits the type of depression I've had. Slowed thoughts can even become stopped thoughts! Sometimes a darkness would come into my mind that felt like it could obliterate it, when I tried to think even one thought or half a thought. Like my thinking would be smothered by this darkness and just stop.
Hi,My pdoc thinks I am one of those "limbic-depressive ADHD" subtypes of late (with mixed bipolar). I wouldn't disagree. I have had the best response to low-dose stimulants for bipolar depressions (with NO hypomania). Stims tend to "cascade" into panic for me, unfortunately, after a few weeks. So they are pretty much out-that's OK because panic is the worst feeling I ever have experienced (even worse than the mixed depressive bleakness). So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
MItch
Posted by mist on July 18, 2002, at 0:50:16
In reply to Re: I disagree., posted by Geezer on July 17, 2002, at 16:19:15
>I got 30 years completed in the Cardiac Pacemaker business before complete disability in 1998. I guess you never give up hope.
Your situation sounds difficult, but it's good that you haven't given up. I agree it can be frustrating that the research isn't farther along. We were all born too early. :)
Posted by mist on July 18, 2002, at 1:13:42
In reply to Re: slowed thoughts » mist, posted by Ritch on July 17, 2002, at 23:34:26
>So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
Are these meds effective for you?
I believe I have Limbic ADD (in addition to unipolar depression). I have all the signs of it and have since childhood. I'm hoping to try provigil and see if it does anything, or else Adderal or another stimulant. I'm afraid of ADs because of reactions I've had to them which rendered me as incapacitated as the depression, so until something better comes out I'd rather try other types of meds.
Posted by Dr. Bob on July 18, 2002, at 7:32:55
In reply to Re: I disagree., posted by Geezer on July 17, 2002, at 16:19:15
> You maybe right, it is a bit like arguing politics or religion, everybody has an opinion.
> I do try to respect the opinions of others and their right to voice them; thanks to you for the same.
Thanks to both of you! :-)
Bob
Posted by Ritch on July 18, 2002, at 10:07:53
In reply to Re: slowed thoughts » Ritch, posted by mist on July 18, 2002, at 1:13:42
> >So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
>
> Are these meds effective for you?
>
> I believe I have Limbic ADD (in addition to unipolar depression). I have all the signs of it and have since childhood. I'm hoping to try provigil and see if it does anything, or else Adderal or another stimulant. I'm afraid of ADs because of reactions I've had to them which rendered me as incapacitated as the depression, so until something better comes out I'd rather try other types of meds.
Mist,Yes, they do work reasonably well. After trials of all sorts of "mood stabilizers" Depakote works the best for hypomania and temper outbursts (mixed hypomania-rage reactions) that I can tolerate. The only thing I don't like is a little weight gain (I have countered it with a super low-fat diet and increased exercise, however). Lithium worked better for the depressive side of things, but I have to push the dose up in order for it to control the hypomania and irritability (as well), and when I get the dose of lithium up it becomes tough to tolerate because of the gastrointestinal upset it causes me. Klonopin keeps the panic attacks away and helps with social anxiety. It also seems to settle hypomania as well. But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now). Effexor+Wellbutrin.... Well, the Wellbutrin comes the closest to being a stimulant as possible (of the AD's). All I am really taking that for is so I can stay AWAKE during the day, otherwise I will be yawning, sleepy, etc, all day long (I am just taking 18.75mg). I can't tolerate it as well when I am hypomanic-it is more prone to setting off rages. The Effexor.. well I just take about 12.5 mg a day, that's it. Any more and it will disrupt my sleep and give me bad heartburn and reflux. All the SSRI's aggravate my reflux problems bigtime. I wonder if duloxetine, when it comes around next year, will be weak enough on the serotonergic side for me to tolerate, and yet still be activating and alerting enough for me to concentrate. Wellbutrin by itself is too anxiogenic. Effexor by itself is too "numbing". I never realized just how numbing SSRI's can be until I raised the dose up on the Effexor-whew!
Mitch
Posted by Geezer on July 18, 2002, at 11:00:09
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
Hey Mitch,
I called Lilley about 3 weeks ago. All they would tell me is they have a "target release date" of 2003. If what I have read is correct, Duloxatin should have a 50%-50% effect on serotonin and norep. from the first dose. With Effexor, it is my unserstanding, you have to wade through a lot of serotonin effect before you get to the norep. Correct me if I am wrong.
Geezer
Posted by Ritch on July 18, 2002, at 22:20:22
In reply to Re: slowed thoughts, posted by Geezer on July 18, 2002, at 11:00:09
> Hey Mitch,
>
> I called Lilley about 3 weeks ago. All they would tell me is they have a "target release date" of 2003. If what I have read is correct, Duloxatin should have a 50%-50% effect on serotonin and norep. from the first dose. With Effexor, it is my unserstanding, you have to wade through a lot of serotonin effect before you get to the norep. Correct me if I am wrong.
>
> Geezer
Hi,I was reading a post here recently that mentioned the transporter affinity ratios for Effexor and Cymbalta (duloxetine). Effexor is supposed to have approx. 30x more affinity for serotonin reuptake transporters than NE reuptake transporters, whereas duloxetine is supposed to have approx. 9x more affinity for serotonin reuptake transporters than for NE reuptake transporters. So, I view Effexor and duloxetine as SSRI's that also happen to block NE reuptake to a significant extent. And that's what Effexor *feels* like, anyhow. I have heard all of the stuff about boosting the Effexor dosage to get to a more significant NE reuptake. UGGH, I can't go there, because what is happening is Effexor probably "flattens" out on its ability to block reuptake of serotonin at some point (a saturation effect) and then the blockade of NE reuptake continues to increase significantly with further increased doses. Yuck. I would rather take a selective NE reuptake inhibitor, that happens to block reuptake of serotonin to a *lesser* extent, AND just take a *low* dose of *that* one antidepressant.
Mitch
Posted by mist on July 19, 2002, at 0:53:24
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
>But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now).
I found klonopin effective for social anxiety as long as I didn't take it every day. When I did, it make me more depressed. On an ocassional, as needed basis it was good. I'd like to get another klonopin prescription when I can stand to deal with the medical/mental health establishment again. I'm hoping I can get .25 mg tablets. I'm very sensitive to substances and can't take a high dose of anything.
It's great that you've found a combination of meds that works for you.
Posted by Ritch on July 19, 2002, at 10:22:43
In reply to Re: slowed thoughts » Ritch, posted by mist on July 19, 2002, at 0:53:24
> >But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now).
>
> I found klonopin effective for social anxiety as long as I didn't take it every day. When I did, it make me more depressed. On an ocassional, as needed basis it was good. I'd like to get another klonopin prescription when I can stand to deal with the medical/mental health establishment again. I'm hoping I can get .25 mg tablets. I'm very sensitive to substances and can't take a high dose of anything.
>
> It's great that you've found a combination of meds that works for you.
Mist,You mentioned .25mg tablets-that's what I would like to get. I don't think they make them that small (I thought scored .5mg tabs were the smallest). I feel better just taking .25mg at bedtime on a regular basis instead of .5mg (definitely has lifted some of the depression). However, I just need a 1/4 tablet sometimes during the day (.125mg-PRN basis), and it's a hassle to have to do the tablet microsurgery-especially when the stuff is so cheap anyhow. I still get a good anti-anxiety effect with just a 1/4 tab.
Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
Mitch
Posted by mist on July 20, 2002, at 14:56:42
In reply to Re: clonazepam question » mist, posted by Ritch on July 19, 2002, at 10:22:43
>Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
Mitch, were you able to find out from your pharmacist?-mist
Posted by Ritch on July 20, 2002, at 16:28:17
In reply to Clonazepam in .25mg tabs? » Ritch, posted by mist on July 20, 2002, at 14:56:42
> >Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
>
> Mitch, were you able to find out from your pharmacist?
>
> -mistHi,
Evidently .5mg tablets are the smallest available either in generic or patent Klonopin.
Oh well...
Posted by mist on July 20, 2002, at 22:14:47
In reply to Re: Clonazepam in .25mg tabs? » mist, posted by Ritch on July 20, 2002, at 16:28:17
Posted by bob on July 21, 2002, at 1:04:01
In reply to Too bad. I hate cutting those things too. (nm) » Ritch, posted by mist on July 20, 2002, at 22:14:47
Posted by mist on July 21, 2002, at 19:05:13
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
>Wellbutrin.... (I am just taking 18.75mg).
What is the smallest dose it comes in? Do you have to cut it? (I called my pharmacy and they said 75mg was the smallest they sold.) I'm thinking of taking it (I'm sure I can get a prescription). However, I only feel safe taking a fraction of the smallest amount most other people would take to start.
Posted by Ritch on July 22, 2002, at 10:04:47
In reply to Smallest Wellbutrin dose? » Ritch, posted by mist on July 21, 2002, at 19:05:13
> >Wellbutrin.... (I am just taking 18.75mg).
>
> What is the smallest dose it comes in? Do you have to cut it? (I called my pharmacy and they said 75mg was the smallest they sold.) I'm thinking of taking it (I'm sure I can get a prescription). However, I only feel safe taking a fraction of the smallest amount most other people would take to start.
Yep, 75mg immediate-release is the smallest tab you can get. I have to quarter the tabs with a utility knife. You have to be careful-you have to use quite a bit of pressure on these generic bupropion tabs! The film coating is rather heavy. Even a pill crusher has a tough time with them. I could probably handle taking an intact WB 100mg SR tab right now-it is just that bupropion messes up my sleep so badly. It tends to provoke early-morning awakenings for me.Mitch
Posted by mist on July 23, 2002, at 0:22:53
In reply to Re: Smallest Wellbutrin dose? » mist, posted by Ritch on July 22, 2002, at 10:04:47
Posted by phil_b on October 1, 2002, at 15:37:07
In reply to Hopeful about duloxetine, posted by Mr. Scott on February 3, 2002, at 12:47:28
I just read an article in Medscape about duloxetine (Cymbalta). Apparently it has a "cleaner" side-effect profile meaning that the side effects (as you probably know, there are ALWAYS side-effects), are less and less bothersome. Here are some potential benefits of duloxetine over Effexor:
>duloxetine at 80 mg/day (starting dose is 60) does not induce hypertension
>duloxetine does not produce any clinically significant effects on body weight
>duloxetine was shown to be safe and well-tolerated in a dose range of 40-120 mg/day (administered BID) or at 60 mg daily
>BUT, no differences between treatment groups were detected in female sexual function when it was compared to Paxil; and males experienced greater orgasm delay just like Paxil.
Well, 4 out of 5 is not bad. I am in chronic pain and take Pamelor (nortryptiline), the old fashioned TCA, but it does really help. I really dislike the side effects of Pamelor and am hoping that duloxetine will work better for me. I am also hoping that it can be used in conjuction with Pamelor - using lower doses of each and achieving a better side effect profile.
I contacted Eli Lilly to volunteer for a study using duloxetine but could not because of other meds I am taking (pain meds). I spoke to a study coordinator who told me she was very impressed with the study's findings. It should be available by prescription late this year or early 2003. Apparently, duloxetine is being studied for "stress urinary incontinence" also.
Posted by klp on December 20, 2002, at 20:23:46
In reply to Re: Hopeful about duloxetine, posted by phil_b on October 1, 2002, at 15:37:07
Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
Posted by DaveW on December 27, 2002, at 23:00:28
In reply to Re: Hopeful about duloxetine, posted by klp on December 20, 2002, at 20:23:46
> Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
Atomoxetine has been approved under trade name Strattera as a norepinephrine reuptake inhibitor and according to Lilly will be generally available in January '03. See Strattera.com for info.
Posted by DaveW on December 27, 2002, at 23:21:13
In reply to Re: Hopeful about duloxetine, posted by DaveW on December 27, 2002, at 23:00:28
> > Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
>
>
> Atomoxetine has been approved under trade name Strattera as a norepinephrine reuptake inhibitor and according to Lilly will be generally available in January '03. See Strattera.com for info.Additional note: Keep in mind that atomoxetine and duloxetine are not the same. Duloxetine (Cymbalta) has been issued an "approvable" letter from the FDA, but this does not mean it has been approved for use. It appears that it will work on norepinephrine and serotonin simultaneously. Go to Lilly.com for updates.
>
Posted by Noa on January 1, 2003, at 13:25:28
In reply to Re: Hopeful about duloxetine, posted by DaveW on December 27, 2002, at 23:21:13
Can someone explain the differences between duloxetine and atamoxetine? Also, how are they same/different from reboxetine? Thanks.
Posted by BekkaH on January 1, 2003, at 13:36:40
In reply to Re: duloxetine and atamoxetine, posted by Noa on January 1, 2003, at 13:25:28
Hi Noa,
Duloxetine is both a norepinephrine reuptake inhibitor AND a serotonin reuptake inhibitor. Atomoxetine (Strattera) is a norepinephrine reuptake inhibitor. Reboxetine is also a norepinephrine reuptake inhibitor.
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