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Dr. Bob is Robert Hsiung, MD,
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Posted by RocketMan on December 3, 2009, at 12:33:08
In reply to Re: Going back to old-school - lithium., posted by SLS on December 2, 2009, at 5:51:06
Scott, I agree with you lowering your dose to 300mg. Also, have you considered reducing your lamictal from 200mg to 150mg. I've been thinking about your regime and have a theory that the lamictal may be preventing the parnate/nortrip from achieving their potential due to a "top heavy" restriction from lamictal? Maybe even reducing it to 100mg if you realize some benefit after reducing down to 150mg. I think sometimes one drug can interfere with the overall success when not dosed properly. Low dose lithium/lamictal may prove more of a benefit, nothing to lose, and much to gain.
Just a suggestion.
Regards, Rick
Posted by SLS on December 3, 2009, at 21:58:26
In reply to Re: Going back to old-school - lithium., posted by RocketMan on December 3, 2009, at 12:33:08
> Also, have you considered reducing your lamictal from 200mg to 150mg.
I think I'll try that, if for no other reason but to see if I can reduce the cognitive impairments I experience. I don't know how much of it is due to the depression and how much is produced by the Lamictal. I'll need to establish the lowest effective dose of lithium first, though.
Interesting theory.
- Scott
Posted by SLS on December 4, 2009, at 8:15:46
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by SLS on December 3, 2009, at 21:58:26
Well, at least I know that lithium is doing something positive. After being at 300mg for a few days, my depression worsened. After increasing the dosage to 450mg, I improved again. I'm still disappointed that I am not in remission, of course. However, I am grateful for any improvement in my condition that these drugs can offer.
- Scott
Posted by RocketMan on December 4, 2009, at 12:14:22
In reply to Re: Going back to old-school - lithium., posted by SLS on December 4, 2009, at 8:15:46
Glad the increase to 450mg offered some improvement! It is still a relatively small dose so that's a positive in itself. You may find your ability to exersice is not inhibited although a bottle of gatorade and a banana wouldn't hurt as well. ;)
On another note, I have always had this underlying need to fit myself into the bipolar 2 spectrum. After many unsuccessful trials with full-dose mood stabilizers, and help from my p/doc, I have learned that a-typical depression is more of my "flavor" and responds to the lower dosing of stabilizers. My p/doc has insisted that keeping my lamictal at 100mg is more than enough to aide in lifting depression along with the other meds I take. He says too high of a dose can hinder the therapeutic gains that may be recognized. I know when I increase my lamictal over 100mg, I get an immediate lift for several days and then the lid is screwed down.....depression sets in! As I previously mentioned, lithium at 300 -450 mg and lamictal 100mg may be a worth while trial. But, as you pointed out, it is just a theory. Best of luck with your recovery.** Rick
Posted by Phillipa on December 4, 2009, at 19:41:54
In reply to Re: Going back to old-school - lithium., posted by RocketMan on December 4, 2009, at 12:14:22
Rick you get the three day response to meds also? Phillipa
Posted by RocketMan on December 4, 2009, at 20:17:50
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by Phillipa on December 4, 2009, at 19:41:54
> Rick you get the three day response to meds also? Phillipa
Yes, more often than not...unfortunately :-(
I recall a med switch about 7 years ago where I went from 6 months of Luvox straight over to Effexor 75mg. That is the best I have felt in 22 years..... it lasted a short 3-5 days.
Posted by Phillipa on December 4, 2009, at 21:13:26
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by RocketMan on December 4, 2009, at 20:17:50
Another piece of the puzzel first was when I discovered the majority of the patients on the psych unit I nursed on had thyroid disorders, now there is autoimmune involved, and this three day response? Please brains not mine put the missing piece in this puzzel. Love Jan
Posted by RocketMan on December 4, 2009, at 21:24:54
In reply to Re: Going back to old-school - lithium. » RocketMan, posted by Phillipa on December 4, 2009, at 21:13:26
> and this three day response? Please brains not mine put the missing piece in this puzzel. Love Jan
Not to take from Scott's thread, but I've often wondered if the 3 day response was akin to a form of mini ECT? Kinda of scrambling the chemicals for a short period of time. I know it would be impractical, and maybe unethical to have a prescription for 10 different A/D'S taken on a rotating weekly schedule, but, if anyone has ever tried, I would certainly like to here from them!!!!
*Rick*
Posted by Phillipa on December 4, 2009, at 21:28:41
In reply to Re: Going back to old-school - lithium. » Phillipa, posted by RocketMan on December 4, 2009, at 21:24:54
Rick you know I had been thinking the same thing. Brilliant minds work sinergesically!!!!! Love Jan wonder what Scott will think. Maybe this will allow him to find that missing link???
Posted by Questionmark on December 10, 2009, at 4:17:52
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 4, 2009, at 7:42:42
I just happened to look through this thread.
What a great little discussion this was. I'd have to say, as i often do, that i agree with Linkadge on this. And he lays it out brilliantly in this post i think.
But yeah for years i've thought the notion that *having a manic reaction on a drug equals you are bipolar* seemed wildly off base and over-simplistic. Kind of like the idea of, "If you take a stimulant and feel calm and focused then you have ADHD; if you take one and feel restless and energetic then you do not have ADHD."
Ah, psychiatry.
Brilliant, brilliant post. So many good points.
> >Yeah. Those with occult bipolar spectrum >disorders.
>
> Well if your definition of bipolar is an individual who has a manic epsode in response to an antidepressant then yes. Otherwise its just a drug reaction.
>
> >Even depression can be parsed using the
> >body's reaction or non-reaction to the >administration of the drug, dexamethasone.
>
> This is rarely used for diagnostic purposes. Even such, a certain response to dexamethasone does not conclusively indicate depression. The patient could have cushings disease for instance and react to dexamethasone in a similar manner to depression. Do they necessarily have depression? No. That is the danger in trying to classify drug reactions as diseases.
>
> >I just don't think that this kind of mentality >went into the decision reached by William Potter >(NIH) in 1992 to understand my illness as being >a variety of bipolar disorder.
>
> Who knows peoples motives. Have you ever noticed that ever since drugs like seroquel have been approved for bipolar depression, there is this big push on internet banners for patients to consider whether they might have bipolar depression. The drug de jour defines how we classify mental illnesses. We are in a perod of AD backlash. Everyone's got bipolar depression now because a) their SSRI pooped out or b) they had a manic response to an antdidepressant. Keep in mind the SSRI's can cause extreme akathesia for some patients. Many of the symptoms of extreme akathesia overlap well with mania - namely irritability, psychomotor agiation, insomnia, etc. etc.
>
> >Perhaps. The question is whether or not it is >downstream from the pharmacological actions of >the drug. Wellbutrin and Prozac hit different >targets even though many downstream effects are >the same.
>
> This is exaclty what I am saying though. If the patient was bipolar already, one would expect the mood elevation itself to accelerate the cycle.
>
> >I have never heard that. Stimulating, yes. It >might be closer in effect to methylphenidate
> >(Ritalin) or amphetamine (Dexedrine).
>
> Exaclty, drugs which people abuse to get high. People high on stimulants have symtpoms identical to manic episodes.
>
> >I do understand where you are coming from with >all of this. If you really want to do some >digging, you might want to try some empirical >research. For example, at what rate does the >general population respond to amphetamine with a >manic episode versus people who seek treatment >for depression.
>
> Anyone who abuses amphetamine is more or less having a manic episode. Elevated mood, increased energy, goal directed behaviors, increased hedonic capacity, less need for sleep, pressure of speech, grandiose ideas, you name it - its all the same thing.
>
> >If Manji can make rats "depressed", I guess he >can make them "manic". How would he go about >making a person manic? Where on the Net can I >find the Manji quote you cited?
>
> He has done losts of work in rats and what he notices is that high dose amphetamines do cause behavior which is used as a model for amphetamines. How do you think all of these bipolar and schizophrenic drugs are identified? By they activity in reducing the manic like excitement caused by stimulants. Stimulants cause a more rapid elevation in signal transduction systems than antidepressants do. Lithium and valproate direclty block the transducton wherase the AP's block the receptor induced transduction.
> Antidepressants also elevate protein kinase C. Actually, the SSRI's have more potent effects on PKC than bupropion does.
>
> If you could relieve depression without causing mania then do you really have bipolar?
>
> Take yourself for instance, what if you initially took (and got well on) bupropion and not nortriptyline. If you never had a manic response to this drug and remained well, would you still be bipolar????
>
> What about agomelatine? I personally think this drug will have an extrelly low propensity to cause mania. No monoamine reuptake. 5-ht receptor blockade. Completely different profile. I think if drugs like this were used more often for depression we'd have fewer manic reactions and ultimately fewer bipolar diagnosis.
>
>
> Linkadge
>
>
Posted by Questionmark on December 10, 2009, at 4:32:30
In reply to Re: Going back to old-school - lithium., posted by SLS on December 4, 2009, at 8:15:46
Just wanted to say, best of luck to you.
Posted by SLS on January 20, 2010, at 9:29:58
In reply to Re: Going back to old-school - lithium. » SLS, posted by Questionmark on December 10, 2009, at 4:32:30
I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.
- Scott
Posted by floatingbridge on January 20, 2010, at 10:51:07
In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58
Best wishes Scott--!
Improvement--good. I wish this was an easier process for you.
fb
Posted by Phillipa on January 20, 2010, at 22:26:10
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 20, 2010, at 10:51:07
Things are looking up excellent!!!!! Phillipa
Posted by hopefullynow on January 23, 2010, at 6:49:20
In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58
Hi Scott!
I'm looking forward for your posts, i read that you exchanged Nardil with Effexor and i wonder that Nardil ineffectiveness combined at that time with lithium, producet that sucky feeling of flatness and detached feelings.
Maybe one AD which really brighen mood at a time(hope this time for you, to be venlafaxine), combined with a modest dose of lithium would have moodstabilizer and augumentor properties without anhedonia and flattening moods.
This summer i did a course of lithium (300-450 mg/day)and it gave me that kind of feelings.Later on, when i already stopped Li, I found out that the AD which I was then, were no longer gave any benefits, completely ineffective.I suppose that if the AD worked, it should take care of nasty feelings, that Li produces.I really appreciate your tenacity Scott and I wish you all the best.I hope i'll hear from you some time soon that you'll restart the workouts...;).
> I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.
>
>
> - Scott
Posted by floatingbridge on January 23, 2010, at 14:22:13
In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58
Hi Scott, after rereading this thread, I had a few thoughts. At thanksgiving, you had baseline improvement at about 40%. What is the current estimate?
I forget when you began the effexor--how is it? Probably too early to judge.
I don't see any stimulant on board (except for effexor--is that enough?)--any
reason for that? Off of parnate, would segeline add some neuroprotection in addition to low-dose lithium?Miraprex or another dopamergenic (is that a word?). Would you consider this type of add-on?
To me, the history of this thread doesn't seem to indicate a great threat of inducing mania, except as you've noted,
and cycling. So you used to be ultra-rapid or somewhat 'disorganized'?What are your current doses? Ricker has suggested less lamictal. I don't know....
Wondering if the pharmaceutical lid is
too heavy. Dopamine? Maybe abilify isn't quite right.Hope you receive this comments as they were--notes from another pilgrim.
I'm following your progress; I find your patience a good model. Wishing you success in your current lithium trial.
Hope today is a decent one,
fb
> I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.
>
>
> - Scott
Posted by desolationrower on January 24, 2010, at 18:55:56
In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58
i think a little lithium is a good thing. i take a small sliver of a pill still.
-d/r
Posted by SLS on January 25, 2010, at 13:43:03
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 23, 2010, at 14:22:13
I don't know what's going on with me anymore.
My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.
I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.
Does anyone know what countries agomelatine is available in?
- Scott
Posted by Bob on January 25, 2010, at 14:28:24
In reply to Re: Going back to old-school - lithium., posted by SLS on January 25, 2010, at 13:43:03
> I don't know what's going on with me anymore.
>
> My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.
>
> I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.
>
> Does anyone know what countries agomelatine is available in?
>
>
> - ScottScott,
I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.
You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?
Agomelatine is supposedly being brought to the US as Valdoxan, but seems to have been in phase III trials forever and a day. Apparently upon reading about it just, there appears to have been some controversy over its approval in Europe.
http://en.wikipedia.org/wiki/Agomelatine
Posted by SLS on January 25, 2010, at 19:19:01
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on January 25, 2010, at 14:28:24
Hi.
Thanks for the the agomelatine information.
> I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.
For awhile, things seemed to be headed in the right direction. At some point, though, I began to gradually lose the antidepressant effect.
> You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?
I feel more of a mood-brightening effect with Nardil than I do with Parnate. I guess you could say that Nardil is a better treatment for anhedonia. That's not to say that I would continue to respond to Nardil indefinitely. One of my doctors had a patient that needed to switch between the two drugs on a regular basis.
I guess I'm stuck with Effexor for another two weeks. This is probably a good thing, though. It forces me to give it a reasonable chance to work. In the meantime, I get to experiment with Adderall. My doctor hopes that it will help with cognitive impairments.
- Scott
Posted by SLS on January 25, 2010, at 19:38:39
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 23, 2010, at 14:22:13
Hi FB.
> Hi Scott, after rereading this thread, I had a few thoughts. At thanksgiving, you had baseline improvement at about 40%. What is the current estimate?
20% - 25%
> I forget when you began the effexor--how is it? Probably too early to judge.
Probably. A few days ago, I experienced a significant improvement that lasted for about a day. Nothing since. If things follow my usual pattern of response, that brief improvement is all I can expect.
> I don't see any stimulant on board (except for effexor--is that enough?)--any
> reason for that?I just started taking Adderall today.
> Off of parnate, would segeline add some neuroprotection in addition to low-dose lithium?
I experienced an irritable type of dysphoria with Emsam. I stopped taking it after 3 or 4 days.
> Miraprex or another dopamergenic (is that a word?). Would you consider this type of add-on?
I haven't tried Mirapex yet. I tried bromocriptine (Parlodel) a long time ago, but it did very little to improve my depression.
> To me, the history of this thread doesn't seem to indicate a great threat of inducing mania, except as you've noted,
> and cycling. So you used to be ultra-rapid or somewhat 'disorganized'?I exhibited a dramatic mood-swing between depression and euthymia that followed a regular cycle of 11 days. I would spend 8 days depressed followed by 3 days of euthymia. The switch between one state and the other took about 45 minutes.
> What are your current doses? Ricker has suggested less lamictal. I don't know....I tried going lower on Lamictal, but I began to deteriorate. 200mg seems to be the minimal effective dosage for me.
Right now, I'm taking:
Effexor 300mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mg
Adderall 20-40mg> Wondering if the pharmaceutical lid is
> too heavy. Dopamine? Maybe abilify isn't quite right.Someone here suggested that I give Zyprexa a try. I have been on it in the past. It would help for the better part of the first week, then nothing. I haven't tried it in combination with my current medications, though.
> Hope today is a decent one,I survived it without incurring too many bruises. It was a decent day.
:-)
- Scott
Posted by Phillipa on January 25, 2010, at 20:05:52
In reply to Re: Going back to old-school - lithium. » floatingbridge, posted by SLS on January 25, 2010, at 19:38:39
Scott I babbled you it's available. Love Phillipa
Posted by Bob on January 25, 2010, at 21:54:48
In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on January 25, 2010, at 19:19:01
> Hi.
>
> Thanks for the the agomelatine information.
>
> > I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.
>
> For awhile, things seemed to be headed in the right direction. At some point, though, I began to gradually lose the antidepressant effect.
>
> > You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?
>
> I feel more of a mood-brightening effect with Nardil than I do with Parnate. I guess you could say that Nardil is a better treatment for anhedonia. That's not to say that I would continue to respond to Nardil indefinitely. One of my doctors had a patient that needed to switch between the two drugs on a regular basis.
>
> I guess I'm stuck with Effexor for another two weeks. This is probably a good thing, though. It forces me to give it a reasonable chance to work. In the meantime, I get to experiment with Adderall. My doctor hopes that it will help with cognitive impairments.
>
>
> - ScottWell, at least you have the ability to add and subtract meds without too much trouble it seems. I can't take the switches you talk about as I'm just waaaaaay too sensitive.
Posted by floatingbridge on January 25, 2010, at 22:56:57
In reply to Re: Going back to old-school - lithium., posted by SLS on January 25, 2010, at 13:43:03
Scott, good luck with the adderall--a positive response would be great.
Would you be able to continue adderall if you switched to nardil?
And would any of the above rule out zyprexa?
Seeing your percentages in black and white is very sobering. You must know, and have been told, how strong you are.
Best,
fb
please keep us apprised....
> I don't know what's going on with me anymore.
>
> My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.
>
> I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.
>
> Does anyone know what countries agomelatine is available in?
>
>
> - Scott
Posted by Stephen Martin on April 22, 2010, at 15:02:42
In reply to Re: Going back to old-school - lithium., posted by linkadge on July 3, 2009, at 18:21:31
> 25mg is a lowish dose of 5-htp. I have used it intermittently with an MAOI without problem (not sure about with nortriptyline though).
>
> >What do you think about taking N-acetylcysteine >(NAC)?
>
> I personally don't like the stuff - but it depends on your symtpoms. I found NAC made me very irritable. Alpha lipoic acid was better (for me at least).
>
> You might try sleep deprivation in combination with lithium. There is some evidence of sustaining the AD effect of lithium with periodic SD.
>
> I remember when I was taking lithium + clomipramine. I would be fine for about 4 days then start to crash into depression. At this point I would skip the evening medication dose, pull an all nighter and take meds as usual the next night. This would last for another 4-5 days.
>
> It can be a little taxing on the system (you have to prepare a completely stress free day the next day). But it quickly got me out of a bad funk.
>
> Its great though. I remember feeling like trash (all anxious, worthless, hyper ruminative), then about 2:30 something started to shift over the course of about 5 minutes. Then all of a sudden..normal.
>
> Linkadge
>
>
>
>
>
>
>
>
>That bit on sleep deprivation is quite interesting, indeed! That lends some creedance to the theory that depression and bi-polar depression have a connection to disruption of the circadian rhythm - in other words, the depressed person isn't as 'awake' as they ought to be during the day; contrarily, Manic patients typically encounter insomnia. It the same with seasonal affective disorder - the reduced daylight in winter confuses the brain's clock into thinking it should sleep more, etc.
Interesting stuff.
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