![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 36 to 60 of 100. Go back in thread:
Posted by chicagokat on September 11, 2012, at 18:54:48
In reply to Re: Need out of the box suggestions, posted by jono_in_adelaide on September 11, 2012, at 18:22:04
Well, the verdiict is in, and it's.....Tramadol!
I gave my pdoc some information on it, and we had a discussion abour it, and I told him I was not desperate for it, that if he wanted to go the Nardil route I was fine with that...but he said with the Tramadol I'll know in days whether it works or not, so he said let's try it for a week.
I'll keep you guys updated on how it goes. And I really want to thank you all for your excellent suggestions and info. You all are great, and I'm really happy I stumbled upon this forum :)
All my best,
Kat
Posted by brynb on September 11, 2012, at 19:09:19
In reply to Re: Need out of the box suggestions, posted by chicagokat on September 11, 2012, at 18:54:48
> Well, the verdiict is in, and it's.....Tramadol!
>
> I gave my pdoc some information on it, and we had a discussion abour it, and I told him I was not desperate for it, that if he wanted to go the Nardil route I was fine with that...but he said with the Tramadol I'll know in days whether it works or not, so he said let's try it for a week.
>
> I'll keep you guys updated on how it goes. And I really want to thank you all for your excellent suggestions and info. You all are great, and I'm really happy I stumbled upon this forum :)
> All my best,
> KatGreat news! I really hope it works for you the way it's worked for me. If indeed it works, you can always speak to your pdoc about adding on the right AD to augment your response and prevent future depressive episodes.
I forgot--have you tried a low dose of Lithium? I like it with Tramadol.
Glad you're hopeful--keep posting about yur progress and hope you feel better soon.
-b
Posted by phidippus on September 11, 2012, at 21:57:56
In reply to Re: Need out of the box suggestions » phidippus, posted by brynb on September 11, 2012, at 18:18:45
"Is it definitely a serotonin releasing agent?"
Yes, indeed. Kind of like Stablon.
What are you taking? what's your diagnosis?
Eric
Posted by phidippus on September 11, 2012, at 22:02:02
In reply to Re: Need out of the box suggestions, posted by chicagokat on September 11, 2012, at 18:54:48
Congratulations! I hope in the end you get back on the Nardil and find the Tramadol a great way to augment your treatment with Nardil.
Eric
Posted by SLS on September 12, 2012, at 2:38:52
In reply to Re: Need out of the box suggestions » chicagokat, posted by phidippus on September 11, 2012, at 22:02:02
> Congratulations! I hope in the end you get back on the Nardil and find the Tramadol a great way to augment your treatment with Nardil.
>
>
> Eric
Just be careful and watch for signs of serotonin syndrome.
- Scott------------------------------------------
Mental status changes
Confusion (51%)
Agitation (34%)
Hypomania (21%)
Anxiety (15%)
Coma (29%)Cardiovascular
Sinus tachycardia (36%)
Hypertension (35%)
Hypotension (15%)Gastrointestinal
Nausea (23%)
Diarrhea (8%)
Abdominal pain (4%)
Salivation (2%)Motor Abnormalities
Myoclonus (58%)
Hyperreflexia (52%)
Muscle rigidity (51%)
Restlessness (48%)
Tremor (43%)
Ataxia/incoordination (40%)
Shivering (26%)
Nystagmus (15%)
Seizures (12%)Other
Diaphoresis (45%)
Unreactive pupils (20%)
Tachypnea (26%)
Hyperpyrexia (45%)
Posted by brynb on September 12, 2012, at 9:16:06
In reply to Re: Need out of the box suggestions » brynb, posted by phidippus on September 11, 2012, at 21:57:56
> "Is it definitely a serotonin releasing agent?"
>
> Yes, indeed. Kind of like Stablon.
>
> What are you taking? what's your diagnosis?
>
> EricHi Eric,
I'm taking 20mg of Lexapro and 300mg of lithium along with 50mg of Tramadol. I also take Valium as a prn, but not often.
I honestly have no idea what my diagnosis is anymore; typically, it was MDD with GAD, but several pdocs thought I was Bipolar 2. My current pdoc is going with MDD/GAD for now, but we've only met 3 times and I don't know if it is a definitive diagnosis. That said, I like him a lot (and have seen enough pdocs as a reference). He's wise and insightful and seems to "get it".
I think I've mentioned to you on other threads before that the only mania I've experienced was from taking Neurontin (pressured/fast speech, reckless spending, crying, hypersexuality, etc.). Otherwise, if anything, I think I am sometimes hypomanic. I've always had anxiety, agitation/irritability and moodiness. And I'm always lethargic. My depression started at 14 (I'm 38 now), and the duration and severity of my episodes got worse with age. Personally, I think I'm leaning toward Bipolar 2 or soft Bipolar, at least as I understand its newer definition (as a spectrum rather than two distinct polarities).
My depression has also been treatment resistant over the years. Everything poops out or just doesn't work. Of all the ADs I've tried (TCAs, NRIs, SRIs), Lexapro has been the most agreeable. But alone, it inevitably stops working and doesn't prevent episodes. I'm doing well on my current combo, and have done well in the past on Lexapro with Trileptal or with Tegretol.
Phew! Sorry, that was long! Thanks if you're still reading! I always say I don't care what my "label" is, but I guess there's something comforting in giving this affliction a name.
I welcome your insights...
-b
Posted by chicagokat on September 12, 2012, at 9:16:22
In reply to Re: Need out of the box suggestions, posted by brynb on September 11, 2012, at 19:09:19
> > Well, the verdiict is in, and it's.....Tramadol!
> >
> > I gave my pdoc some information on it, and we had a discussion abour it, and I told him I was not desperate for it, that if he wanted to go the Nardil route I was fine with that...but he said with the Tramadol I'll know in days whether it works or not, so he said let's try it for a week.
> >
> > I'll keep you guys updated on how it goes. And I really want to thank you all for your excellent suggestions and info. You all are great, and I'm really happy I stumbled upon this forum :)
> > All my best,
> > Kat
>
> Great news! I really hope it works for you the way it's worked for me. If indeed it works, you can always speak to your pdoc about adding on the right AD to augment your response and prevent future depressive episodes.
>
> I forgot--have you tried a low dose of Lithium? I like it with Tramadol.
>
> Glad you're hopeful--keep posting about yur progress and hope you feel better soon.
>
> -b
>Thanks for your kind words, bryn. Yes I have taken lithium; it did nothing for me. Do you know what other ADs are safe with Tramadol?
THanks,
Kat
Posted by brynb on September 12, 2012, at 9:26:05
In reply to Re: Need out of the box suggestions » brynb, posted by chicagokat on September 12, 2012, at 9:16:22
>
> Thanks for your kind words, bryn. Yes I have taken lithium; it did nothing for me. Do you know what other ADs are safe with Tramadol?
> THanks,
> KatHi Kat,
I take Lexapro (20mg). So my combo is Lexapro, Tramadol and Lithium. I know a lot of people who take Lexapro w/ Tramadol. I'm sure most ADs are ok with it (as long as you keep the Tramadol dose low; I never take more than 100mg a day, usually it's 50mg). As you know, there's the risk of SS and seizure when combining Tramadol with an AD, but again, as long as you're cognizant and keep the dose low, I think you'll be fine.
I've always stuck with Lexapro because it was the most agreeable AD for me (more than any TCA, NRI or other SRIs). (And, it's pretty good for PMS symptoms ;)!) I would look around online and see what other people have taken with it.
Good luck!
-b
Posted by AlexCanada on September 12, 2012, at 12:05:07
In reply to Lou's response- » chicagokat, posted by Lou Pilder on September 10, 2012, at 11:10:42
Do you intend to offer any advice or just simply quote her with a spam message?> Kat,
> You wrote,[...I am searching for ideas to suggest to him (the psychiatrist)..intolerable side effects... does anyone have any other ideas?...Thanks for any ideas...].
>
Posted by zazenducke on September 12, 2012, at 12:10:46
In reply to Please stop spamming. » Lou Pilder, posted by AlexCanada on September 12, 2012, at 12:05:07
Posted by AlexCanada on September 12, 2012, at 12:48:16
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Rhodiola Rosea can be worth a try. I have been on few dozen medications and over a dozen supplements. Out of all the supplements/herbals one had worked remarkably well for me for over a year (still to a degree these days but I have to give it a break once in a while). It can work within the first day with full effects after a week or two.
Enhancement in drive, motivation, energy, cognition, and even some restoration of interest. Some say it is a bit like an herbal MAOI but without food restrictions of course. Low doses can be activating, high doses can be sedating.
Stablon may be worth a try as well.
> Hi all,
> I suffer from treatment-resistant depression and I see my pdoc tomorrow afternoon and I am searching for ideas to suggest to him. I have tried all the basic things, and they've all either stopped working for me or had intolerable side effects. This includes:
> SSRIs
> SNRIs
> TCAz
> Atypical antipsychotics
> Mood stabilizers (lithium, lamictal)
> MAOIs (ensam, Nardil Marplan) I should mention that Nardil worked GREAT for my depression and anxietty, but at doses above 45mg it gave me ataxia and I suffered falls...and NO, this was not due to orthostatic hypotension)
> and atypical antidepressants like trazodone and remeron.
> I've also tried ECT, which only made me feel worse.
>
> Right now I'm on Ritalin, and it, too, is giving out on me; I was gonna see how tomorrow goes then give the Ritalin a holiday to see if it will work for me again. I'm aalso on Lyrica for anxiety,, for which it works, but it seems to worsen my depression.
> I was thinking of going back on Lexapro; I was on it last spring, but stopped b/c it wasn't helping my depression, but it occurred to me that it may well have been helping my anxiety, which has come back in force since I stopped the Lexapro.
>
> So does anyone have any other ideas? I've given my pdoc info on Tramadol, but he seems very hesitant to prescribe it.
>
> Thanks for any ideas,
> Kat
Posted by chicagokat on September 12, 2012, at 13:18:27
In reply to Re: Need out of the box suggestions » chicagokat, posted by brynb on September 12, 2012, at 9:26:05
>
> >
> > Thanks for your kind words, bryn. Yes I have taken lithium; it did nothing for me. Do you know what other ADs are safe with Tramadol?
> > THanks,
> > Kat
>
> Hi Kat,
>
> I take Lexapro (20mg). So my combo is Lexapro, Tramadol and Lithium. I know a lot of people who take Lexapro w/ Tramadol. I'm sure most ADs are ok with it (as long as you keep the Tramadol dose low; I never take more than 100mg a day, usually it's 50mg). As you know, there's the risk of SS and seizure when combining Tramadol with an AD, but again, as long as you're cognizant and keep the dose low, I think you'll be fine.
>
> I've always stuck with Lexapro because it was the most agreeable AD for me (more than any TCA, NRI or other SRIs). (And, it's pretty good for PMS symptoms ;)!) I would look around online and see what other people have taken with it.
>
> Good luck!
>
> -b
Hi bryn,
Lexapro has always been the best drug for me too, at least out of the common drugs like SSRIs, SNRIS, TCAs, and the like. It no longer helps with my depression, but it does help with my anxiety. It was great when I took it with Ritalin.Anyways, it's early yet, I know, but so far with the Tramadol I've experienced agitation and irritability. (but like I said, it's early yet, so far I've only had 3 doses of 25mg) I suppose my motivation is a bit better (was able to do a bit mmore cleaning today - fun times lol) but my anhedonia is almost worse...I love to read when I'm done with chores, but today I still feel like I can't be bothered and just want to lie in bed.
Anyways, that's my update on Tramadol. Oh, btw, he has me on Neurontin for anxiety...it made me sleep all morning.
Regards,
Kat
Posted by chicagokat on September 12, 2012, at 13:23:17
In reply to Re: Need out of the box suggestions » chicagokat, posted by AlexCanada on September 12, 2012, at 12:48:16
> Rhodiola Rosea can be worth a try. I have been on few dozen medications and over a dozen supplements. Out of all the supplements/herbals one had worked remarkably well for me for over a year (still to a degree these days but I have to give it a break once in a while). It can work within the first day with full effects after a week or two.
>
> Enhancement in drive, motivation, energy, cognition, and even some restoration of interest. Some say it is a bit like an herbal MAOI but without food restrictions of course. Low doses can be activating, high doses can be sedating.
>
> Stablon may be worth a try as well.
>
>
>
> > Hi all,
> > I suffer from treatment-resistant depression and I see my pdoc tomorrow afternoon and I am searching for ideas to suggest to him. I have tried all the basic things, and they've all either stopped working for me or had intolerable side effects. This includes:
> > SSRIs
> > SNRIs
> > TCAz
> > Atypical antipsychotics
> > Mood stabilizers (lithium, lamictal)
> > MAOIs (ensam, Nardil Marplan) I should mention that Nardil worked GREAT for my depression and anxietty, but at doses above 45mg it gave me ataxia and I suffered falls...and NO, this was not due to orthostatic hypotension)
> > and atypical antidepressants like trazodone and remeron.
> > I've also tried ECT, which only made me feel worse.
> >
> > Right now I'm on Ritalin, and it, too, is giving out on me; I was gonna see how tomorrow goes then give the Ritalin a holiday to see if it will work for me again. I'm aalso on Lyrica for anxiety,, for which it works, but it seems to worsen my depression.
> > I was thinking of going back on Lexapro; I was on it last spring, but stopped b/c it wasn't helping my depression, but it occurred to me that it may well have been helping my anxiety, which has come back in force since I stopped the Lexapro.
> >
> > So does anyone have any other ideas? I've given my pdoc info on Tramadol, but he seems very hesitant to prescribe it.
> >
> > Thanks for any ideas,
> > Kat
>
>Thanks for the tip...I've noticed Rhodiola come up a lot on the forums and have been thinking of trying it....do you think it would be safe with Tramadol? or Ritalin if I fail the Tramadol trial?
I've done some reading, and I found a very interesting study on Magnesium and TRD...wish I had the link for you now, but if you're interested, I'm sure I can find it.
Kat
Posted by phidippus on September 12, 2012, at 17:42:03
In reply to Eric: thoughts? » phidippus, posted by brynb on September 12, 2012, at 9:16:06
300 mg is not a therapeutic dose of Lithium. If you want the most benefit to your mood I'd recommend 900 to 1200 mg.
>I've always had anxiety, agitation/irritability >and moodiness
All of which are features of Bipolar 2. A lot of this will come under control if you take more Lithium.
>And I'm always lethargic
If it is a feature of your depression, increasing your Lithium will help with this. The higher you go up on Lithium, the stronger its antidepressant effects are.
Your Lexapro will also get a boost.
Bipolar 2 is characterized by a lot of depression interspersed with hypomanic episodes. Mania often presents with a lot of anxiety and depression ranges from mild to severe. Often, bipolar 2 presents in mixed states where depression coincides with mania at the same time.
Maybe antidepressants aren't working for you precisely because you are bipolar. They tend to make symptoms worse if you're not on a mood stabilizer.
Try Lithium at the higher ranges and see how you feel.
Eric
Posted by brynb on September 13, 2012, at 8:24:02
In reply to Re: Eric: thoughts? » brynb, posted by phidippus on September 12, 2012, at 17:42:03
> 300 mg is not a therapeutic dose of Lithium. If you want the most benefit to your mood I'd recommend 900 to 1200 mg.
>
> >I've always had anxiety, agitation/irritability >and moodiness
>
> All of which are features of Bipolar 2. A lot of this will come under control if you take more Lithium.
>
> >And I'm always lethargic
>
> If it is a feature of your depression, increasing your Lithium will help with this. The higher you go up on Lithium, the stronger its antidepressant effects are.
>
> Your Lexapro will also get a boost.
>
> Bipolar 2 is characterized by a lot of depression interspersed with hypomanic episodes. Mania often presents with a lot of anxiety and depression ranges from mild to severe. Often, bipolar 2 presents in mixed states where depression coincides with mania at the same time.
>
> Maybe antidepressants aren't working for you precisely because you are bipolar. They tend to make symptoms worse if you're not on a mood stabilizer.
>
> Try Lithium at the higher ranges and see how you feel.
>
> Eric
>
>Thanks, Eric. My doctor and I spoke about bumping my lithium dose up to 600 (I've already had benefits at 300, but I'm fearful of side effects if I go higher). He initially wanted me on 600mg. The irritability is always persistent. I've been doing great on my current med combo, but starting a few weeks ago have been experiencing depressive days again, and even more so over the last few days. It makes me nervous. I don't feel like tweaking meds/doses yet as I've done so well for a while now.
Thanks again.
-b
Posted by phidippus on September 13, 2012, at 15:34:46
In reply to Re: Need out of the box suggestions, posted by SLS on September 11, 2012, at 7:11:58
>What do you think of adding nortriptyline to the >Viibryd?
Are you asking me this?
Eric
Posted by phidippus on September 13, 2012, at 16:29:14
In reply to Re: Eric: thoughts? » phidippus, posted by brynb on September 13, 2012, at 8:24:02
>experiencing depressive days again, and even more >so over the last few days.
This may be cycling.
I take 1200 mg of Lithium and have no side effects.
Eric
Posted by AlexCanada on September 13, 2012, at 17:31:12
In reply to Re: Need out of the box suggestions » AlexCanada, posted by chicagokat on September 12, 2012, at 13:23:17
> Thanks for the tip...I've noticed Rhodiola come up a lot on the forums and have been thinking of trying it....do you think it would be safe with Tramadol? or Ritalin if I fail the Tramadol trial?
>
> I've done some reading, and I found a very interesting study on Magnesium and TRD...wish I had the link for you now, but if you're interested, I'm sure I can find it.
>
> KatI cannot be be absolutely certain but it likely is safe. I say this because even though Rhodiola suppossedly isn't suppossed to be taken with Parnate I was able to take them together successfully without any noticable issues that I can recall. Thus it is ''likely'' even safer when taken w/ Tramadol
Posted by brynb on September 13, 2012, at 21:02:38
In reply to Re: Eric: thoughts? » brynb, posted by phidippus on September 13, 2012, at 16:29:14
> >experiencing depressive days again, and even more >so over the last few days.
>
> This may be cycling.
>
> I take 1200 mg of Lithium and have no side effects.
>
> EricI'm going to call my pdoc tomorrow about it. I'm getting back into the not wanting to leave my apartment mode.
Thanks,
b
Posted by phidippus on September 13, 2012, at 22:39:53
In reply to Re: Eric: thoughts? » phidippus, posted by brynb on September 13, 2012, at 21:02:38
Do not lock yourself up! Go for a walk now and then. Don't get me all worried.
Keep me posted, I'm always available via Babblemail.
Eric
Posted by brynb on September 13, 2012, at 22:48:02
In reply to Re: Eric: thoughts? » brynb, posted by phidippus on September 13, 2012, at 22:39:53
> Do not lock yourself up! Go for a walk now and then. Don't get me all worried.
>
> Keep me posted, I'm always available via Babblemail.
>
> EricThanks so much, Eric. I really appreciate it. I'll definitely keep you posted :).
-Bryn
Posted by gilmourr on September 15, 2012, at 18:52:06
In reply to Need out of the box suggestions, posted by chicagokat on September 10, 2012, at 10:42:19
Sounds like you have a doc that will really go out on a limb for you with meds. In that case, if you can get this it should work well at hopefully.
- MAOI (Nardil 45 mg) - base drug
- Vyvanse - Long acting stimulant (or another)
** titrate up very slowly
- Add a TCA, nortryptilineMAOI + TCA + Stim is VERY powerful.
If you still have anxiety, you can use stelazine 1-2 mg/daily. And that's about it.
If I could get a doctor to prescribe all this, I'd do it in a second.
Posted by ChicagoKat on September 16, 2012, at 14:02:31
In reply to Re: Need out of the box suggestions, posted by gilmourr on September 15, 2012, at 18:52:06
> Sounds like you have a doc that will really go out on a limb for you with meds. In that case, if you can get this it should work well at hopefully.
>
> - MAOI (Nardil 45 mg) - base drug
> - Vyvanse - Long acting stimulant (or another)
> ** titrate up very slowly
> - Add a TCA, nortryptiline
>
> MAOI + TCA + Stim is VERY powerful.
>
> If you still have anxiety, you can use stelazine 1-2 mg/daily. And that's about it.
>
> If I could get a doctor to prescribe all this, I'd do it in a second.Thanks Gilmourr, I'll ask my doc about the combo and see what he says when I see him next Tues.
And you're right; he really is willing to go out on a limb for me...and he really knows his stuff PLUS he's a very kind person. I got really lucky when I found him. :)
Thanks again,
Kat
Posted by phidippus on September 16, 2012, at 14:12:09
In reply to Re: Need out of the box suggestions, posted by gilmourr on September 15, 2012, at 18:52:06
I wouldn't do nortryptaline. Too much norepenephrine when combined with the Vyvanse. Go for the best TCA, Clomipramine.
Eric
Posted by ChicagoKat on September 16, 2012, at 18:17:39
In reply to Re: Need out of the box suggestions » gilmourr, posted by phidippus on September 16, 2012, at 14:12:09
> I wouldn't do nortryptaline. Too much norepenephrine when combined with the Vyvanse. Go for the best TCA, Clomipramine.
>
> EricHi Eric,
I'm curious...what makes Clomipramine the best TCA?
Kat
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.