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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 78 to 102 of 119. Go back in thread:
Posted by zonked on December 14, 2011, at 21:10:46
In reply to Re: Effexor 450 mg? » zonked, posted by Phidippus on December 14, 2011, at 20:44:44
> Here's your new prescription:
>
> Lithium 1200 mg
> Clozaril 25 mg
> Imipramine 300 mg
>
> EricIF you mean me, Lithium = zombie
Clozaril = no thanks!
Imipramine = still an option. never've been on a TCA except nortrip (extreme anxiety/frustration/rage).I think you meant for SLS. I know he's been on a lot of TCAs and Lithium as well; unknown re: clozaril.
-z
Posted by Bob on December 14, 2011, at 21:57:27
In reply to Re: Effexor 450 mg? » Bob, posted by SLS on December 14, 2011, at 17:43:43
> Hi Bob.
>
> > I currently have the DBS implant.
>
> Does it help?
>
> Thanks.
>
> I'm not in a very good place.
>
>
> - Scott
It's a loooong story. I got implanted in '09 at the Columbia University site in NY. Just like some of the many meds I've taken the device produced myriad effects, some good and most bad... some real bad. I had many little glimpses of hope, especially when the stimulation level was adjusted, but they would always fade away. This is all I would get from any meds in recent years and now I don't even get that.The device was activated for almost exactly one year (I know I was being stimulated during the placebo phase). I don't know what the staff at CU would classify me as but if I had to sum it up in a word it would have to be unsuccessful. Of course the real world requires much more than a single world. I respond much differently to meds and other treatments than it seems many do, and they claim from data and what I've read that at least 50% of people are considered responders to the DBS implant. One thing it did without question was add drive and motivation into the mix, albeit without happiness or joy most of the time for me. I was at the point before the implant however where I didn't have enough energy to do much else except lay on the couch and watch tv all day whilst enduring my mental suffering. So at least on the stimulation I was getting out of the house.
At this point I would recommend it for you as you have now unquestionably tried almost everything you can think of - that is exactly what something like this is intended for as far as I can see. You may be a better candidate than me since you seem to be very tolerant to meds with respect to side effects. I get bountiful and showstopping side effects from just about everything I've ever tried and DBS was no exception.
Anyway, like I said, the story is quite long in full so I'll stop here.
Posted by Phillipa on December 14, 2011, at 22:13:27
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 14, 2011, at 21:57:27
Bob hate to be a pain but if you could at your own pace continue your story many others could hear first hand what you went through. Maybe your own thread on experiences? Just a thought Phillipa
Posted by SLS on December 15, 2011, at 8:49:41
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 14, 2011, at 21:57:27
> The device was activated for almost exactly one year (I know I was being stimulated during the placebo phase).
Did you experience an antidepressant effect when they hit the right spot during the procedure?
- Scott
Posted by Bob on December 15, 2011, at 15:49:28
In reply to Re: Effexor 450 mg? » Bob, posted by SLS on December 15, 2011, at 8:49:41
> > The device was activated for almost exactly one year (I know I was being stimulated during the placebo phase).
>
> Did you experience an antidepressant effect when they hit the right spot during the procedure?
>
>
> - Scott
I was not awake for the procedure. I seem to recall them saying that the operation was no longer done that way (with feedback from an awake patient). I guess they now rely on precise geometric imaging with extensive MRIs and CT scans fro reference. About 6-8 months in when things weren't improving enough they did another CT scan to verify positioning, which they confirmed was where they thought it should be. Amazingly, I was on my way home from the hospital 2 days after the operation.
Posted by Bob on December 15, 2011, at 15:51:30
In reply to Re: Effexor 450 mg? » Bob, posted by Phillipa on December 14, 2011, at 22:13:27
> Bob hate to be a pain but if you could at your own pace continue your story many others could hear first hand what you went through. Maybe your own thread on experiences? Just a thought Phillipa
I'll think about it Phillipa, but I'm not sure I want to commit to all that right now. I am happy to answer specific questions at this point though.
Posted by ed_uk2010 on December 15, 2011, at 16:51:57
In reply to Re: Effexor 450 mg?, posted by SLS on December 13, 2011, at 15:29:41
>So far, Effexor 450 mg is doing nothing for my depression, and is making me feel dazed.
Unfortunately, I think this is common at very high venlafaxine doses. I expect that you will feel better if you taper down to a more normal dose such as 225mg.
I'm sorry it's not helping.
Posted by Bob on December 15, 2011, at 17:20:13
In reply to Re: Effexor 450 mg? » SLS, posted by ed_uk2010 on December 15, 2011, at 16:51:57
Scott...What has your experience been in the past with Imipramine?
Sorry if this has already been asked.
Bob
Posted by hyperfocus on December 15, 2011, at 19:47:14
In reply to Re: Effexor 450 mg? » hyperfocus, posted by SLS on December 8, 2011, at 7:34:09
I was just thinking if you could try to recreate the conditions when you responded to the Nardil + desipramine. It seems for a lot of people what meds they have taken before are a big factor contributing to the response they get from their current meds. And there are a lot of people on PB who seem to have achieved a strong theraputic response when restarting meds that were effective years before. I think the majority of success stories I've read here are with people who restart meds that worked for them in the past, but under new conditions like a lower dose or after a drug vacation. It seems to me that posters who achieve a theraputic response with a new untried med or med combo are in the minority. I agree with ed_uk that a reset might be the best thing.
A reset won't be fun, assuredly. I live in abject dread of the dysphoria that med changes sometimes cause in me. You may have to go in-patient if you decide to do this. But it might be worth the investment. There's no guarantee that introducing a new med or a new combo over the next couple of months will help you. You could look for another treatment vector so to speak, as in not titrating dosages with new meds but trying to recapture what you had with the Nardil + desp. If your condition was relatively med free for about a year when this combo had you heading towards remission then you might want to try recreating this pre-condition.
What meds were you on immediately before the year-long drug vacation? The tapering off these particlar meds might have been a significant pre-condition also.
I wish you the best - somehow we will find a way.
Posted by SLS on December 16, 2011, at 13:50:50
In reply to Re: reset » SLS, posted by hyperfocus on December 15, 2011, at 19:47:14
Hi HF.
> I was just thinking if you could try to recreate the conditions when you responded to the Nardil + desipramine.
It was Parnate that I used in conjunction with desipramine. (No problem).
Your thoughts are very logical and insightful.
I'm afraid to discontinue everything because I doubt that I could live independently without them. My baseline depression has grown more severe as the years have passed. I was 27 when I responded well to treatment. I had been drug-free for at least 9 months prior to that. I don't recall what drugs I had been taking before that.
I once tried to recreate the conditions that produced remission. After waiting a number of weeks, I began taking Parnate and desipramine on the same day. It didn't work. The only thing different was that I wasn't taking Ativan and Halcion for sleep the way I did the first time. Maybe these drugs were important. I doubt it, though.
I am discontinuing Effexor in preparation to return to a MAOI (Nardil or Parnate). I am going to go with Parnate this time so as to minimize weight gain.
I continue to lie to myself that I will ever get well. I am afraid of where the truth would lead me.
- Scott
Posted by ed_uk2010 on December 16, 2011, at 14:51:35
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
>I'm afraid to discontinue everything because I doubt that I could live independently without them.
I don't think you need to discontinue everything but some reductions may be useful.
Have you tried reducing aripiprazole down to 5mg? I was wondering whether you might have more energy on a lower antipsychotic dose.
Posted by SLS on December 16, 2011, at 15:02:04
In reply to Re: reset » SLS, posted by ed_uk2010 on December 16, 2011, at 14:51:35
> >I'm afraid to discontinue everything because I doubt that I could live independently without them.
> I don't think you need to discontinue everything but some reductions may be useful.
>
> Have you tried reducing aripiprazole down to 5mg? I was wondering whether you might have more energy on a lower antipsychotic dose.
Hi Ed.I haven't tried to lower the dosage of Abilify below 10 mg except when attempting to discontinue it. Abilify actually gives me a little more energy and motivation. I find dosages above 10 mg to dull my senses somewhat.
DBS? TMS? TNS? VNS? MST?
I've already tried ECT.
- Scott
Posted by ed_uk2010 on December 16, 2011, at 15:34:19
In reply to Re: reset » ed_uk2010, posted by SLS on December 16, 2011, at 15:02:04
>Abilify actually gives me a little more energy and motivation.
I understand, but a dose below 10mg might actually be optimal. Above 10mg dulls your senses, so are you sure 10mg is the most effective dose for you?
Posted by SLS on December 16, 2011, at 15:50:17
In reply to Re: reset » SLS, posted by ed_uk2010 on December 16, 2011, at 15:34:19
> >Abilify actually gives me a little more energy and motivation.
>
> I understand, but a dose below 10mg might actually be optimal. Above 10mg dulls your senses, so are you sure 10mg is the most effective dose for you?
You're right. I have never stayed at 5 mg.
- Scott
Posted by Bob on December 16, 2011, at 16:10:16
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
> I'm afraid to discontinue everything because I doubt that I could live independently without them. My baseline depression has grown more severe as the years have passed. I was 27 when I responded well to treatment. I had been drug-free for at least 9 months prior to that. I don't recall what drugs I had been taking before that.
>Scott - My baseline deterioration progressed much like yours. After exposure to a few drugs in the early nineties it quickly got to the point where it was quite scary to be off of everything, then it got even worse and I could no longer survive without something in my system. I have no idea whether this is due solely to my illness, solely to the med exposure, or some combination of the two. It sure feels though like something about my brain fundamentally and irrevocably changed after the initial repeat exposures to psychiatric medications.
>
> I am discontinuing Effexor in preparation to return to a MAOI (Nardil or Parnate). I am going to go with Parnate this time so as to minimize weight gain.
>What about something like Imipramine Scott?
> I continue to lie to myself that I will ever get well. I am afraid of where the truth would lead me.
>I don't see where we really have a choice here. For me it's either lie to myself or... well... you know. I'm always reminded of that line from The Shawshank Redemption, "Get busy livin', or get busy dyin'."
Hang in there bro.
>
> - Scott
Posted by Phidippus on December 16, 2011, at 17:23:20
In reply to Re: Effexor 450 mg? » SLS, posted by Bob on December 14, 2011, at 21:57:27
You should try VNS stimulation. I undertsand it provides more direct results because of its mechanism of action.
Eric
Posted by Phidippus on December 16, 2011, at 17:41:36
In reply to Re: Effexor 450 mg?, posted by SLS on December 6, 2011, at 17:34:28
Describe your depression to me. Negative thoughts, no joy? What?
Something's not right with your picture, you know that. You're on a lot of drugs that provide antidepressant benefit, yet you're still stuck? These drugs aren't working for you, period.
You're stuck with the complexity of bipolar depression, correct? I'm assuming you're bipolar because you take Lamictal and Lithium.
Bipolar depression is a different beast. Living with it I have discovered it does not respond to antidepressant therapy the same way regular depression does. There are drugs, though that have proven efficacious for bipolar depression: Zonegran, Riluzole, Ketamine, Opiates, Mirapex, etc.
The combination you are on is not working for you. Stop going back to medications that may have worked in the past. Try to look at your situation with a different perspective. You don't need all these ADs.
Eric
Posted by Phidippus on December 16, 2011, at 17:48:19
In reply to Re: Effexor 450 mg? » Bob, posted by SLS on December 15, 2011, at 8:49:41
Vagal Nerve Stimulation may be more efficacious for the treatment of depression than DBS. You are concious during the procedure and as they tune the device, improvements can be felt. (this goes for both proceddures).
Eric
Posted by Bob on December 16, 2011, at 17:51:20
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 16, 2011, at 17:41:36
> Describe your depression to me. Negative thoughts, no joy? What?
>
> Something's not right with your picture, you know that. You're on a lot of drugs that provide antidepressant benefit, yet you're still stuck? These drugs aren't working for you, period.
>
> You're stuck with the complexity of bipolar depression, correct? I'm assuming you're bipolar because you take Lamictal and Lithium.
>
> Bipolar depression is a different beast. Living with it I have discovered it does not respond to antidepressant therapy the same way regular depression does. There are drugs, though that have proven efficacious for bipolar depression: Zonegran, Riluzole, Ketamine, Opiates, Mirapex, etc.
>
> The combination you are on is not working for you. Stop going back to medications that may have worked in the past. Try to look at your situation with a different perspective. You don't need all these ADs.
>
> Eric
>
I'm not sure where he would get ketamine, opiates, VNS, or DBS for that matter. The only available outlets are studies which involves some luck for getting into. He does need to reset somehow though I think. Short of ECT which seems just to be too much all at once for some (me included), what about rTMS? It might be a little easier to get some treatment with that modality and it just may change the baseline a little.Of course, if he is able to get any of the the aforementioned treatments, then I personally would go for it. Come to think of it, VNS is FDA approved now, so that might be easier to get.
Bob
Posted by Bob on December 16, 2011, at 17:57:58
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 16, 2011, at 17:48:19
> Vagal Nerve Stimulation may be more efficacious for the treatment of depression than DBS. You are concious during the procedure and as they tune the device, improvements can be felt. (this goes for both proceddures).
>
> Eric
Eric,I have the DBS implant and was involved in the St. Jude Medical BROADEN study at Columbia University. Patients are not conscious any longer when the implantation is performed. They did it that way during the initial investigative phase as I understand, but eventually stopped, ostensibly because there was no discernible correlation between those that reported a sudden antidepressant effect in surgery and those that went on to be "responders" to the device stimulation long term.
There is a competing group of studies headed by the Medtronic and the Cleveland Clinic I believe which targets a different area of the brain. Possibly patients are awake during that procedure, but I don't know.
Bob
Posted by Phidippus on December 16, 2011, at 18:07:49
In reply to Re: reset » ed_uk2010, posted by SLS on December 16, 2011, at 15:02:04
VNS.
Eric
Posted by hyperfocus on December 16, 2011, at 20:14:02
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
> I continue to lie to myself that I will ever get well. I am afraid of where the truth would lead me.
The only truth that matters is that you're a good person who tries to help people. That's the only thing human beings really have control of. No one, rich or poor, can will their immune system to function normally or their cancer cells to stop reproducing.
"Blessed are they who have been persecuted
within themselves. It is they who have truly come to know the
Father. Blessed are the hungry, for the belly of him who desires
will be filled."I came across this in the Gospel of Thomas. Maybe it means something. Maybe it doesn't. Who knows. One day you'll look back at this time and feel like all the struggle was worth it.
Posted by Phidippus on December 17, 2011, at 16:19:32
In reply to Re: Effexor 450 mg? » Phidippus, posted by Bob on December 16, 2011, at 17:51:20
>I'm not sure where he would get ketamine, opiates
My doctor has prescribed me both. There's enough research out there to persuade a pdoc.
Scott needs to start over. He's stuck with four medications which are not working.
Eric
Posted by Phidippus on December 17, 2011, at 16:24:45
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
>I continue to lie to myself that I will ever get >well. I am afraid of where the truth would lead me.
Depression is an illusion. It never feels real.
Start from scratch, Scott. Try Zonegran. Take some Tramadol. Try an NMDA antagonist. Ketamine could work real well for you.
I just don't understand why you stay on a cocktail that obviously barely works.
Eric
Posted by SLS on December 17, 2011, at 18:49:31
In reply to Re: reset » SLS, posted by Phidippus on December 17, 2011, at 16:24:45
> I just don't understand why you stay on a cocktail that obviously barely works.
The trick is finding something that will work at all. Something is better than nothing. I know it is frustrating to see me fail to respond to almost everything. I don't mean to be difficult. I just don't know what else to do.
What do you think of using prazosin to treat anergic bipolar depression? How has this drug helped you?
I guess buprenorphine is to be considered in the future. I hope my doctor relents in his opposition to trying it. The Bodkin study is not sufficient for him. I wish I had a couple of oxycodones to experiment with.
Thanks, Eric.
- Scott
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