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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 290 to 314 of 317. Go back in thread:
Posted by SLS on April 25, 2012, at 21:43:34
In reply to Re: Adding Parnate and prazosin., posted by Twinleaf on April 25, 2012, at 5:58:29
> This is the best news ever. It seems as though right from the beginning there has been something about Prazosin's effect on you which made you very hopeful about it. Do you think it's the effect it may be having on the traumatic component of your depression? Or is it more its synergy with the other medications? In any event, it's wonderful to hear.
Thanks, Twinleaf!
I'll give your excellent questions some more time to consider.
I have a few ideas, but nothing definite. I think the mind/brain gets into the habit of dissociating in response to trauma, both external and internal. Once established, the dissociative processes in the brain might remain active, even after the traumas are resolved. The brain gets "stuck" in a dissociative, vegetative depressive state.
The addition of prazosin felt like I had added a robustly effective antidepressant that produced greater clarity of thought. It is very "clean" cognitively. The only two side effects I have is mild orthostatic hypotension and a loss of libido.
- Scott
Posted by Ron Hill on April 27, 2012, at 3:56:59
In reply to Re: Adding Parnate and prazosin. » Twinleaf, posted by SLS on April 25, 2012, at 21:43:34
> and a loss of libido.
-----------
Scott,Loss of sexual desire only, or ED plus lack of sexual desire?
-- Ron
Posted by SLS on April 27, 2012, at 13:44:37
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Ron Hill on April 27, 2012, at 3:56:59
> > and a loss of libido.
> -----------
> Scott,
>
> Loss of sexual desire only, or ED plus lack of sexual desire?
>
> -- Ron
Prazosin has reduced my sexual desire. This is not an uncommon side effect with this drug. I have no problems with erection and orgasm. The hardware works just fine.
- Scott
Posted by SLS on May 3, 2012, at 7:30:34
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 24, 2012, at 18:51:05
> Best day yet!
>
> Woohoo!Not the best day yet.
Woohoo?
:-(
- Scott
Posted by Phillipa on May 3, 2012, at 20:38:01
In reply to Re: Adding Parnate and prazosin., posted by SLS on May 3, 2012, at 7:30:34
I don't like the sad face? What's going on? Phillipa
Posted by SLS on May 11, 2012, at 16:31:46
In reply to Re: Adding Parnate and prazosin., posted by SLS on May 3, 2012, at 7:30:34
> > Best day yet!
> >
> > Woohoo!
> Not the best day yet.
>
> Woohoo?
>
> :-(
Better days are here.:-)
I reduced my dosage of prazosin from 12 mg to 8 mg. I found that the higher dosage produced some lethargy, fatigue, and tremulousness. I thought the tremulousness would abate, but it hasn't. The lethargy and fatigue have disappeared. I now take prazosin 4 mg b.i.d. This seems to be adequate so far. I don't think once-a-day dosing would work. The half-life of prazosin is just a few hours.
I am gaining more confidence in my treatment regime. The periodic dips in mood are disconcerting, but not at all hellish. They can last from a few minutes to a few days. There is no obvious cycle.
I am still hopeful that I will eventually achieve remission. It won't happen overnight, though. It will probably take another year. I can be patient if I am convinced that the process continues in a positive direction. My goal is to go to work and meet people. I won't have to wait another year to do these things, though.
- Scott
Posted by Phillipa on May 11, 2012, at 20:40:44
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on May 11, 2012, at 16:31:46
Why a year? Don't feel could be sooner? Phillipa
Posted by SLS on May 12, 2012, at 0:54:49
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on May 11, 2012, at 20:40:44
> Why a year? Don't feel could be sooner? Phillipa
Things seem to move very slowly for me. Whenever I experience an acute, robust antidepressant response to treatment, it never lasts. I'm lucky to be responding at all. I'll take what I can get, even if that means my CNS takes a few years to find a functional equilibrium. It can take an athlete a year or more to recover from a major injury. MDD and BD represent major assaults on the brain.
- Scott
Posted by Phillipa on May 12, 2012, at 19:44:52
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on May 12, 2012, at 0:54:49
True. Have you thought of testing yourself with an online course of some interest to you? Phillipa
Posted by SLS on June 21, 2012, at 15:52:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on May 11, 2012, at 16:31:46
> I am still hopeful that I will eventually achieve remission. It won't happen overnight, though. It will probably take another year. I can be patient if I am convinced that the process continues in a positive direction.
I added Topamax in an effort to accelerate my response to treatment. It would be nice to achieve remission within a month or two rather than within a year or two. I am following the titration schedule recommended for the treatment of migraine to minimize cognitive side effects. I am planning on taking 100 mg/day.
- Scott
Posted by uncouth on June 21, 2012, at 16:06:17
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on June 21, 2012, at 15:52:33
what is logic behind topamax?
Posted by Tomatheus on June 21, 2012, at 16:57:30
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on June 21, 2012, at 15:52:33
Good luck, Scott, and feel free to keep us updated on how you've been doing.
Tomatheus
Posted by SLS on June 21, 2012, at 19:16:23
In reply to Re: Adding Parnate and prazosin + Topamax, posted by uncouth on June 21, 2012, at 16:06:17
> what is logic behind topamax?
For now, I am going along with my doctor's hunch that my illness is, in part, being driven by "developmental PTSD". This is why prazosin was chosen. More recently, Topamax has been reported to be helpful in PTSD. I tried Topamax without prazosin several years ago. Much to my surprise, I felt somewhat better on it. However, my response to it was deemed inadequate and it was discontinued. I agreed with my doctor that Topamax was worth another look, now that I am taking a different combination of drugs. If Topamax does not accelerate my rate of recovery, I am considering memantine, ketamine, and rTMS as treatment adjuncts.
I once saw Topamax 100 mg/day successfully treat a nasty case of mixed-state hypomania. I think Topamax might be overlooked for the treatment of certain cases of bipolar disorder.
- Scott
Posted by SLS on June 21, 2012, at 19:17:37
In reply to Re: Adding Parnate and prazosin + Topamax, posted by Tomatheus on June 21, 2012, at 16:57:30
> Good luck, Scott, and feel free to keep us updated on how you've been doing.
>
> Tomatheus
Thanks. Your support is important to me.
- Scott
Posted by creepy on June 25, 2012, at 8:30:37
In reply to Re: Adding Parnate and prazosin + Topamax » uncouth, posted by SLS on June 21, 2012, at 19:16:23
I rapid cycled on 50mg topamax.. might be a little rough titrating up to 100.
I was a hyper-responder when I took it though. at 50mg I had some really intense side effects most dont get until higher doses. Maybe something else I was taking at the time raised my levels? Dunno.
Its supposedly good at taming angry outbursts in PTSD. But whether thats due to calming a mixed state or something else like slowing the amygdala I have no idea. I get the feeling the docs dont either! =(
Zoloft has been good on my PTSD, but my body seems to respond by 'somatizing' the depression so now I have pain and fatigue.
What symptoms make your doc think you have PTSD?
Andrenergic drugs will of course make you jumpy and hyperaroused.
Posted by SLS on June 25, 2012, at 16:44:53
In reply to Re: Adding Parnate and prazosin + Topamax, posted by creepy on June 25, 2012, at 8:30:37
Hi Creepy.
> I rapid cycled on 50mg topamax.. might be a little rough titrating up to 100.
Were you steadily depressed prior to beginning Topamax?
> I was a hyper-responder when I took it though. at 50mg I had some really intense side effects most dont get until higher doses. Maybe something else I was taking at the time raised my levels? Dunno.
What sorts of effects did you experience?
> Its supposedly good at taming angry outbursts in PTSD.
I didn't know that. I have seen it do this for bipolar disorder, mixed-state.
> But whether thats due to calming a mixed state or something else like slowing the amygdala I have no idea.
That's an interesting thought.
> I get the feeling the docs dont either! =(
I know.
> Zoloft has been good on my PTSD, but my body seems to respond by 'somatizing' the depression so now I have pain and fatigue.
Experiencing the somatic symptoms of depression or drug side effects is not the same thing as "somatization".
> What symptoms make your doc think you have PTSD?
Childhood history of physical abuse and neglect.
He thinks that I might have "developmental PTSD", and that this, in part, is driving the depression and creating a biological substrate for my presentation of rapid relapse upon response to antidepressant treatment.
http://www.positivehumandevelopment.com/developmental-ptsd.html
- Scott
Posted by SLS on July 4, 2012, at 5:39:00
In reply to Re: Adding Parnate and prazosin + Topamax » creepy, posted by SLS on June 25, 2012, at 16:44:53
So far, so good.
I raised the dosage of Topamax to 75 mg yesterday (25 mg t.i.d.). I will remain there for a week before increasing to the target dosage of 100 mg. It doesn't appear that I am having any cognitive or memory impairments that are in addition to those that are integral to the depression itself. I cannot be sure that the Topamax is helping, though. Of course, it is early. Unless there is true magic in these pills, I will not continue taking them.
I remain partially improved since adding the prazosin. However, I would like to accelerate my rate of recovery and help to attain full remission. If Topamax is not effective in filling this role, I am thinking about trying either ketamine or rTMS.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
Topamax 75 mg
- Scott
Posted by uncouth on July 4, 2012, at 9:48:35
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on July 4, 2012, at 5:39:00
Scott you ever try VERY high dose memantine...it woudl take a while to escalate, but im on 50-60mg...changing my life. BP2
Posted by Tomatheus on July 4, 2012, at 13:09:28
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on July 4, 2012, at 5:39:00
Thanks for the update, Scott. I am continuing to hope that you notice some benefits from the Topamax, and I think it's good that you have some ideas on how to proceed if the Topamax doesn't work out.
I hope you're having a good holiday,
Tomatheus
Posted by SLS on July 4, 2012, at 19:38:25
In reply to Re: Adding Parnate and prazosin + Topamax, posted by uncouth on July 4, 2012, at 9:48:35
> Scott you ever try VERY high dose memantine...it woudl take a while to escalate, but im on 50-60mg...changing my life. BP2
Wow! That's quite a bit.
I haven't tried it, but I will certainly put it back on my list of things to try next.
Thanks.
- Scott
Posted by SLS on July 9, 2012, at 19:37:12
In reply to Re: Adding Parnate and prazosin + Topamax » uncouth, posted by SLS on July 4, 2012, at 19:38:25
I increased my dosage of Topamax to 100 mg today. I have nothing significant to report.
- Scott
Posted by SLS on July 12, 2012, at 18:56:54
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on July 9, 2012, at 19:37:12
> I increased my dosage of Topamax to 100 mg today. I have nothing significant to report.
After two days at 100 mg, I must sadly report that I am a dunce (more so than usual). Since there is no hint of any additional improvement resulting from the addition of Topamax at this point, I am going to discontinue it. I might rechallenge after the weekend just to make sure that the cognitive blunting I experienced was due to the Topamax and not a temporary worsening of my depression.
- Scott
Posted by Tomatheus on July 13, 2012, at 0:13:09
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on July 12, 2012, at 18:56:54
> After two days at 100 mg, I must sadly report that I am a dunce (more so than usual). Since there is no hint of any additional improvement resulting from the addition of Topamax at this point, I am going to discontinue it. I might rechallenge after the weekend just to make sure that the cognitive blunting I experienced was due to the Topamax and not a temporary worsening of my depression.
I'm sorry to hear this, Scott. Assuming that rechallenging your system with Topamax yields results that suggest that at least some of your cognitive blunting may be due to the medication, will this mean that either ketamine or rTMS will be next for you? And if you don't mind me asking, to what extent would you say your symptoms are improved now (on your current regimen) over the way you felt when your symptoms were at their worst? Or in other words, about how far would you say you still have to go before you reach your goal of remission?
Tomatheus
Posted by SLS on July 13, 2012, at 5:36:29
In reply to Re: Adding Parnate and prazosin + Topamax » SLS, posted by Tomatheus on July 13, 2012, at 0:13:09
> > After two days at 100 mg, I must sadly report that I am a dunce (more so than usual). Since there is no hint of any additional improvement resulting from the addition of Topamax at this point, I am going to discontinue it. I might rechallenge after the weekend just to make sure that the cognitive blunting I experienced was due to the Topamax and not a temporary worsening of my depression.
> I'm sorry to hear this, Scott.Thanks.
My case history, like so many of ours, has been a litany of one disappointment after another.
> Assuming that rechallenging your system with Topamax yields results that suggest that at least some of your cognitive blunting may be due to the medication, will this mean that either ketamine or rTMS will be next for you?
I will need to find out who is working with ketamine and what treatment protocol they are using. Some use one large dose. Others use a series of smaller doses. Cost is an issue. Cost is also an issue with rTMS, but I might be able to appeal to Medicare for having it done. I understand that some people have managed to get their insurance companies to pay for it.
> And if you don't mind me asking, to what extent would you say your symptoms are improved now (on your current regimen) over the way you felt when your symptoms were at their worst?
On my better days, I would say that I am 35% improved. In the past, I assigned this value to a smaller degree of improvement. I tend to overrate myself. It wasn't until I began to feel significantly better on prazosin that I realized how sick I really was. My "old" 35% was probably closer to being 20%. These are not insignificant numbers. 20% = 1/5; 35% = 1/3. Being one third of the way there feels pretty good compared to baseline, but I want it all. One thing that frustrates the hell out of me is that I still cannot read fast enough to keep up with the lyrics on the monitor when singing karaoke. I make quite a few mistakes while singing, but the crowd is very forgiving. Right now, singing karaoke is my only recreational social activity. I need a lot of coaxing to take the microphone. At first, I refused to sing unless I could do it while sitting in my seat. I still get enough stage fright to see the microphone shake in my hand. The real question is, why do I do this to myself? :-) I'm not quite sure, but I'll just have some fun with it while I can. I sang in choirs while in public school, and had rock-star fantasies like so many others did.
I am currently looking at using doxazosin instead of prazosin. Prazosin has a half-life of only 3 hours. Doxazosin has a half-life of 22 hours. The two drugs are brothers, and the latter is now being studied for PTSD. I would prefer to have a steady blood level throughout the day. I often have days in which I cycle up and down. I don't know if the short half-life of prazosin is responsible for this, but I would like to run the idea by my doctor.
http://findarticles.com/p/articles/mi_hb4345/is_4_37/ai_n31616383/
- Scott
Posted by Twinleaf on July 13, 2012, at 10:16:16
In reply to Re: Adding Parnate and prazosin + Topamax » Tomatheus, posted by SLS on July 13, 2012, at 5:36:29
If you are a "new" patient who has never had it before, it is worth trying to use Medicare; occasionally, it does get covered. Itis also possible to ask your pdoc to write to Neurostar asking for compassionate use; they occasionally grant that.
I do hope you will try it, as it is aimed at hypoactive frontal lobes, and I think I remember quite a lot of blue on your scan. According to my pdoc, under- active frontal lobes are most effectively treated with rTMS and ketamine.
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