![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 55. This is the beginning of the thread.
Posted by B2chica on March 19, 2016, at 11:35:08
Are tricyclics any good with bipolar depression?
I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
I think it's pristiq just isn't going to work for me annymore.
But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.b2
Posted by Christ_empowered on March 19, 2016, at 12:04:57
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
TCA drugs can be used in bipolar. For a long time, that was the main treatment of depression in bipolar+schizophrenia.
My concern, honestly, would be that TCA drugs are toxic in overdose. The other thing is that suicidal thoughts can sometimes become worse during the first couple weeks...something about how you have more energy, but the depression hasn't really been treated yet, so attempts and such are more likely. I dunno if that's true, or just some shrink folklore I've read.
Amoxapine? Its a potent AD and it metabolizes into loxapine, which is an old school (but possibly somewhat "atypical") antipsychotic. Its supposed to work quickly, and the side effects are different from, say, Tofranil.
I hope things work out for you.
Posted by SLS on March 19, 2016, at 12:27:51
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
I would not make tricyclic antidepressants my first choice. They are supposed to be very liable to produce a mood switch into mania. I think that discontinuing the Pristiq is a good idea for now. You might want to try using Geodon in its place. Geodon has antidepressant properties, even though it is an antipsychotic. Trileptal, which acts as a mood-stabilizer, will help reduce the manic side of a mixed state and reduce cycling.
Have you tried Wellbutrin?
Can you describe your major symptoms?
- Scott
Posted by J Kelly on March 19, 2016, at 15:00:27
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
> Are tricyclics any good with bipolar depression?
>
> I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> I think it's pristiq just isn't going to work for me annymore.
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
>
> b2Hi b2, sorry things are tough right now.
I was looking at an earlier thread for ideas:
"i'm on gabapentin right now for anxiety and it works great. i still have break through, but thats more when i start getting a mixed episode, so the anxiety is induced from that. i had a friend that was on 100mg about 3x a day and that worked great for her. i am on 300mg either 3-5x day depending."
Would this be a good time to go up on the gabapentin?
Regarding the Zyprexa:
"you asked "You dont have any w/d's taking it that way?"
do you mean withdrawls? no i do not. if i'm on ten then i taper to 5 for a day or so then stop. i've been off and on it for many years, easily start up and easily stop. have not ever had issues.
i will notice some let down for about a week. can worsen depression. i have also had a few mood bouce up after coming off it (which was always a blessing for me). but again it may last a week or so but then you are back to your normal symptoms."Can you go back on the Zyprexa at a dose that has worked for you in the past?
I'm sorry I don't know anything about Tricylics.
Good luck :)
Jade
Posted by SLS on March 19, 2016, at 15:24:59
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
I forgot about Lamictal. It can perhaps be used in place of the Geodon I suggested for bipolar depression. Even though Lamictal is considered to be a mood stabilizer, it is often inadequate to treat or prevent mania. You might still need a compound capable of treating the manic side of your mixed state. I have seen Depakote reduce mania very quickly. However, it often leaves one somewhat depressed over time. I prefer the idea of using Trileptal to treat the manic counterpart of a mixed-state. I never used it for mania myself, but I did try it for my chronic bipolar depression. It didn't help, but it didn't hurt, either. I found it to be a very clean drug. There were virtually no side effects. The only caveat is that Trileptal can cause low serum sodium (hyponatremia), which upsets electrolyte balance. This does not occur very often, though. A simple blood test can be used to monitor this.
By the way, I have experienced severe mania on multiple occasions as the result of combining a TCA with Parnate or by taking Nardil alone. First, the drugs were discontinued. (In retrospect, this was probably a mistake). For me, lithium was worthless. Depakote worked very well. So did Zyprexa. The first time this happened, though, these two drugs were not available. So, I had to combine lithium and Klonopin. This helped, but the anti-manic effect was incomplete.
What are your thoughts?
- Scott
Posted by B2chica on March 19, 2016, at 15:43:36
In reply to Re: Tricyclics and bipolar depression, posted by Christ_empowered on March 19, 2016, at 12:04:57
i think were i'm at now an OD would be on my mind and maybe too tempting for me.
but thank you very much for your input.
Posted by J Kelly on March 19, 2016, at 15:54:09
In reply to Re: Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 15:43:36
> i think were i'm at now an OD would be on my mind and maybe too tempting for me.
> but thank you very much for your input.
>Hello b2,
I know we don't know each other but I'm worried about you. The tone of your posts makes me think it would be a good idea for you to get immediate help. I know that's SUCH a hassle. Believe me. But you are going through something that I believe deserves immediate attention.
Can you contact your pdoc for an emergency consult? Maybe an emergency room visit would be helpful at this point. Please take good care of yourself.
Jade
Posted by B2chica on March 19, 2016, at 15:57:44
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 19, 2016, at 15:24:59
hey scott. good to hear from you.
im afraid i really need some 'out of the box' ideas. this pdoc was my old one i trust and respect him very much and has always been able to help me in my worst states... but the other night, i got the feeling even he wasnt sure how to treat this.. i do not have a lot of hope right now. but i'm also trying not to think in the future, too hard to think of all life like this so im staying in the very moment and doing what i can. its a bit long but here are my responses...
thankyou for trying...
b2-i have been on GEodon in past. low dose did nothing higher dose induced psychosis.
-Trileptal was the one med that could have killed me. had tererible reaction (in hospital at time, so i resulted ok.)
-wellbutrin was the one AD that was amazing, unfortunately it pooped out. i have revisited it twice and still no go.
-i was on lamicatal last summer, just as it was starting to work i started to incur breathing difficulty and was taken off.
-i just came off zyprexa, while on it depression was so bad i counldnt work, barely move it supressed my up but only amplified my down.sleep is what we are trying to conquer now. using a tricky combo of ambien lunesta and gabapentin, the first nitght was awesome. last night 2am again, woke at 6:30. so tonight i will take combo earlier. but iwas also experiencing terrible mixed episode yesterday.
ive never felt it to this degree but symptoms yesterday were severe physical energy almost a shaking inside while at the same time exhausted lethargic feeling. cognition was the same full of energy and racing yet, my thoughts seemed to be pulled through mud. i couldnt even hardly explain it to my pdoc.
today, i am down, some inner aggitation, shakey but not the surge of energy as yesterday. i dont even want to keep my eyes open, lids are heavy yet if i lay down to sleep i just stare... my mind wont let me sleep. i cant even get off the couch today. dragging.
i am to call pdoc next week on how im doing.
currently on:
pristiq 100
adderall 20/10
gabapentin 3-4x
for sleep ambien, lunesta gabapentin comboi do wonder if the generics make a difference. i am very sensitive to generics though im not having any negative side effects (except the horrible taste in my mouth from lunesta) but thats liveble if i can get some desired sleep.
> I forgot about Lamictal. It can perhaps be used in place of the Geodon I suggested for bipolar depression. Even though Lamictal is considered to be a mood stabilizer, it is often inadequate to treat or prevent mania. You might still need a compound capable of treating the manic side of your mixed state. I have seen Depakote reduce mania very quickly. However, it often leaves one somewhat depressed over time. I prefer the idea of using Trileptal to treat the manic counterpart of a mixed-state. I never used it for mania myself, but I did try it for my chronic bipolar depression. It didn't help, but it didn't hurt, either. I found it to be a very clean drug. There were virtually no side effects. The only caveat is that Trileptal can cause low serum sodium (hyponatremia), which upsets electrolyte balance. This does not occur very often, though. A simple blood test can be used to monitor this.
>
> By the way, I have experienced severe mania on multiple occasions as the result of combining a TCA with Parnate or by taking Nardil alone. First, the drugs were discontinued. (In retrospect, this was probably a mistake). For me, lithium was worthless. Depakote worked very well. So did Zyprexa. The first time this happened, though, these two drugs were not available. So, I had to combine lithium and Klonopin. This helped, but the anti-manic effect was incomplete.
>
> What are your thoughts?
>
>
> - Scott
>
Posted by B2chica on March 19, 2016, at 16:06:06
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by J Kelly on March 19, 2016, at 15:54:09
thank you for your caring.
i am absolutely sick and tired of hospital. i just cant do that again.the thing is Jade, i have suicidal thoughts and believe me many of them are tempting. but the truth also is that my pull and desire to remain here for my small children is too strong.
honestly i was just going to post about this, how somehow this makes things worse. because before kids i felt like i had this 'release valve' of the Option of suicide.
now that i am actively choosing not to has taken away that 'release valve' and seems to make this pain even more unbearable.i am utterly exhausted from 'feeling'. i feel such a terribl disappointment of who i am these days.. but i know i need to do everything to stay alive. at least that is how i feel for now. i dont know what the future holds for me.
it did not help that i just recently lost a cousin to suicide, about a month ago.. he was in his 50's. so a lot of the responses were 'he held on for a long time', he's at peace now'...
how does that relate to me? cant i be at peace, arent i holding on? and the never ending possibility that it could just as easily have been me... alas it was not.
i am here.
in pain, but here.
Posted by SLS on March 19, 2016, at 16:19:53
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
I am so sorry. I can only imagine how helpless and demoralized you feel right now. You seem to have a glimmer of hope, though. I hope so. A little hope can go a long way.
If you do want to try a tricylic, I think it would be a good idea to take an antipsychotic and/or mood stabilizer before beginning. It might make sense to add Abilify to Pristiq if you haven't done so already. If it doesn't help, you can get then add the tricyclic. I prefer desipramine or nortriptyline because the anticholinergic side effects are relatively mild.
I met one technician at the NIH who was familiar with my case. He said, "If you throw enough crap against the wall, some of it is bound to stick".
At one point, I was taking 7 different drugs. I began to respond to this combination. After awhile, I was able to remove 2 of them and adjust the dosages of those that remained. So far, my response is only partial, but it is significant.
You will save years worth of drug trials by being receptive to throwing more crap against the wall. If Pristiq was helpful, high-dosage Effexor or Cymbalta might actually work better. Many people do better by adding Wellbutrin to these. I actually did better when adding nortriptyline to Effexor.
1. Antidepressants (2 from different categories)
2. Lamictal
3. Antipsychotic (Geodon, Abilify, Saphris)
4. Lithium (low-dosage)
5. Anticonvulsant (Trileptal, Depakote, Topamax)I imagine you've tried most of these, but have you taken them in various combinations?
I don't know. I'm just trying to suggest ways to accelerate your treatment plan. Just because this worked for me doesn't mean that it will work for you.
Hope.
- Scott
Posted by SLS on March 19, 2016, at 16:41:17
In reply to Re: Tricyclics and bipolar depression *Trigger* » J Kelly, posted by B2chica on March 19, 2016, at 16:06:06
I wish I knew what to say. I don't.
All I can say is that I have been in a similar place. For me, caring for my grandmother was enough of a responsibility to prevent me from leaving this world. However, I did have my release valve. I just couldn't use it. I promised myself that I would not kill myself while my grandmother was still alive. She lived to age 99. By this time, I was feeling somewhat better.
I hope you can hold on tight to your memories of remission, as brief as they may have been. Your brain is still capable of working. You know that life can be a grand experience, and that your outlook can change quickly when you respond to treatment.
You must feel extremely alone. You aren't.
- Scott
Posted by B2chica on March 19, 2016, at 16:52:33
In reply to Re: Tricyclics and bipolar depression, posted by SLS on March 19, 2016, at 16:19:53
very helpful. so could i add nortriptyline (or the like) to pristiq?
i would like to lower pristiq as i know that has shifted me into this mixed state, thats why previous doc put me on 10 zyprexa before sending me for second opinion.
my pdoc has mentioned topamanx, though i've been on it before, who knows..i was worried at first as i thought it sort of made my cycle a bit, but hell to be honest im already cycling so wht the heck right?
i would like to try abilify again, but at the time i was also on klonipin and i just remember the terriby anger/rage i got. my T got some of that backlash. anyway, i still thought it was the klonipin.so maybe if i lowered pristiq a bit, added nortriptyline and added topamax...
i can at least suggest this see what he says..yes hope does incredible things. thought i may not have a lot right now, it is only the little bit that is enough.
thank you scott.
Posted by J Kelly on March 19, 2016, at 16:59:16
In reply to Re: Tricyclics and bipolar depression *Trigger* » J Kelly, posted by B2chica on March 19, 2016, at 16:06:06
> thank you for your caring.
I like to think that's why we are here.
> i am absolutely sick and tired of hospital. i just cant do that again.I get this. Three times for me, one forced. Its never fun.
>
> the thing is Jade, i have suicidal thoughts and believe me many of them are tempting. but the truth also is that my pull and desire to remain here for my small children is too strong.
> honestly i was just going to post about this, how somehow this makes things worse. because before kids i felt like i had this 'release valve' of the Option of suicide.
> now that i am actively choosing not to has taken away that 'release valve' and seems to make this pain even more unbearable.I'm so sorry you are feeling this way. I understand. I believe I am still here because of my children. Abandoning them is simply not an option. You are doing the right thing by choosing to remain here for them.
>
> i am utterly exhausted from 'feeling'. i feel such a terribl disappointment of who i am these days.. but i know i need to do everything to stay alive. at least that is how i feel for now. i dont know what the future holds for me.This is so true. Staying alive is the most important goal. We don't know what the future holds but I like to think if we hang on and be brave good things will come to us.
>
> it did not help that i just recently lost a cousin to suicide, about a month ago.. he was in his 50's. so a lot of the responses were 'he held on for a long time', he's at peace now'...
>
> how does that relate to me? cant i be at peace, arent i holding on? and the never ending possibility that it could just as easily have been me... alas it was not.
> i am here.
> in pain, but here.I have more to say about this but not here. Please feel free to babblemail me anytime.
I wish you health and happiness :)
Jade
Posted by SLS on March 19, 2016, at 18:04:10
In reply to Re: Tricyclics and bipolar depression » SLS, posted by B2chica on March 19, 2016, at 16:52:33
> very helpful. so could i add nortriptyline (or the like) to pristiq?
Yup. If in doubt, just be sure to use blood tests for nortriptyline as a guideline to find the right dosage.
With Topamax, it is important to start low and increase the dosage very gradually. You could start at 25 mg/day and move up by 25 mg every week. That may seem ridiculous, but doing so is likely to help you avoid cognitive impairments altogether. You might end up responding to 100 mg/day rather than the 200 mg/day most often targeted. Also, the risk of kidney stones is dosage-dependent. I witnessed a woman in a mixed-state hypomania respond completely to Topamax 200 mg/day. At some point, her dosage was reduced to 100 mg/day and she was fine.
> i would like to lower pristiq as i know that has shifted me into this mixed state
That was my initial thought.
I'm still wondering if Trileptal would help with the manic component of your mixed-state *and* reduce your cycling.
I don't know. Don't exclude Saphris from consideration. Latuda sucks.
Brintellix?
- Scott
Posted by linkadge on March 19, 2016, at 18:15:18
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 19, 2016, at 18:04:10
There is some evidence that TCAs are more effective than SSRIs in terms of core symptoms of depression.
If I was experiencing severe depression, I would take amitriptyline over any SSRI.
That being said, they can induce rapid cycling in some individuals. However, if you are experiencing more mood lability related to severe depression, than I would not hesitate to give a TCA a try. If significant insomnia / anxiety is present, I would start with amitriptyline.
Linkadge
Posted by B2chica on March 19, 2016, at 19:19:45
In reply to Re: Tricyclics and bipolar depression » B2chica, posted by SLS on March 19, 2016, at 18:04:10
good to know about the topamax. i;ll try to remember that and blood tests for nortrip. i think i'll write some notes to take to next appt as i doubt my memory will hold.
trileptal is just not an option. after taking it i had a severe reaction that i thank God i was already in the hospital. i ended up being locked-in for about 10 hours.Saphris helped but only minor and the eating really wasnt too bad as i took it in the afternoon so i just had a decent (or extra) with lunch. at least not at 10 at night.
Yes! Latuda sucks... depression worse.early last year other pdoc chose Fetzima instead of Brintellix... not sure why but that's what she chose. i have not been on brintellix yet so yes, i did forget about that one.
....
as a note, i have had a little reprieve from the exhaustion of feeling everything simultaneously, today was more of a cycle. most of the day extreme langour and about 5-ish i felt that twinge in the pit of my stomach and energy bursts throughout my veins... i've been on three walks. the walks help but only for short time.
all i can think now is another 20 min and i'm going to take my sleep meds. its early but they didnt really work last night so ill take early in hopes that i can get to sleep before 2.i do truly appreciate suggestions. its hard when you dont know what i've been on and that my list of failed meds is so extensive.
i wish there was more research on this stuff.
thanks
scott.
Posted by B2chica on March 19, 2016, at 19:23:00
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 19, 2016, at 18:15:18
yes severe insomnia (both in depressive phase and if mixed mania) and anxiety.
thank you link.
its good to see you and scott are still around here. there arent many names i recognize these days.
b2
> There is some evidence that TCAs are more effective than SSRIs in terms of core symptoms of depression.
>
> If I was experiencing severe depression, I would take amitriptyline over any SSRI.
>
> That being said, they can induce rapid cycling in some individuals. However, if you are experiencing more mood lability related to severe depression, than I would not hesitate to give a TCA a try. If significant insomnia / anxiety is present, I would start with amitriptyline.
>
> Linkadge
Posted by B2chica on March 19, 2016, at 19:24:27
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by J Kelly on March 19, 2016, at 16:59:16
i cant seem to respond, agree much to say...another time.
but thank you for kind words.
b2
Posted by B2chica on March 19, 2016, at 21:43:21
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by SLS on March 19, 2016, at 16:41:17
i think my last pdoc has thoroughly quashed my hope...the small tinder of hope i have left is this new pdoc. he has been with me (a bit off and on) since my dx back in 2003. he is highly intelligent.
but when i sat in my last meeting i had a sense of him perplexed and not sure how anything can really help right now... of course he didnt say that. and to be honest i need to put out there that if there is any pdoc in the nation that can help me...it is this dear one. he is not afraid of medications and not afriad to do 'off label' etc. and i am grateful to him... my heart just dropped alittle at his silence and expression of concern on how to move.i do feel alone, but not in the normal sense with my depression isolating from others. i feel alone in that no one seems to kno2 how to treat me, and in the mean time even waiting that week for the next appt where i clutch despearately to a glimmer of hope, is hell. even one day...today feels like it was about 2 and half days of living sh*t.
but right now, right here. my babies are in bed. even my DH went to bed. me alone time on laptop. i am writing a short fiction novel and have pressured myself as my timelines are getting messed up due to my sickness.
but i digress, that is another diatribe.again, with graciousness, thank you for the help.
b2but i will remember suggestions with adding to and lowering pristiq.
thnx u
Posted by Phillipa on March 19, 2016, at 22:31:36
In reply to Re: Tricyclics and bipolar depression *Trigger* » SLS, posted by B2chica on March 19, 2016, at 21:43:21
B2chica, I know what your girl's mean to you. You will get through this I know you will. I don't post here much but when you you I reach out to you hoping to give you some hope. And with the daylight savings time do you feel this could have triggered this? Among the other things. Phillipa
Posted by B2chica on March 19, 2016, at 23:36:42
In reply to Re: Tricyclics and bipolar depression *Trigger* » B2chica, posted by Phillipa on March 19, 2016, at 22:31:36
thanks P.
no i have been having this trouble for months, i think all of it started (as usual) the first part of november. and to be honest, if my pdoc would have listened to me and approached my sleep issues first instead of messing with the rest ofmy meds, i dont think i'd be in this place now.however about a month ago we had a cousin die, suicide. and i think that really tipped the barrel... he could do it, he had kids, he was bipolar...
the connections and parallels were terribly hard to ignore. i did manage to go to the funeral and i am very glad i did. i think it helped a bit with some closure. But it is still in the forefront of my mind. As his method was same as a coworker/student i lost several years ago...i also lost a family friend last december, she just dropped it was an brain aneurysm, she survived through thanksgiving, but soon after passed. she was a year younger than my husband. she had a child not to much older than my oldest.
and a coupld months before that, a lady in my church group passed away. though with that it was her second bout with cancer. she had one child in one of my childs class.
yes, and one of my husbands uncles died a few months ago as well. though we hadnt seen him in years, i still remember his kindness to me well.So over all, i have had too many funerals as of late.
which, i think i need to stop talking about this as it is triggering me quite badly.
thnx
b2
Posted by SLS on March 20, 2016, at 0:40:38
In reply to Re: Tricyclics and bipolar depression, posted by linkadge on March 19, 2016, at 18:15:18
Would you suggest a TCA for someone who is in a mixed-state? You might be very right, but conventional wisdom is to avoid TCA in bipolar disorder. I suppose it is possible that the "mixed-state" in B2chica's case is actually a melancholic depression with psychomotor agitation. A TCA would work well if this were the case.
- Scott
Posted by Tomatheus on March 20, 2016, at 2:55:28
In reply to Re: Tricyclics and bipolar depression » SLS, posted by B2chica on March 19, 2016, at 15:57:44
> -wellbutrin was the one AD that was amazing, unfortunately it pooped out. i have revisited it twice and still no go.
B2chica,
You might already know this, but data from studies that had been ordered by the U.S. Food and Drug Administration have found that two bupropion products that were previously on the market were not therapeutically equivalent to their brand-name Wellbutrin counterparts. The two bupropion products in question were the 300-mg Budeprion XL tablets (but not the 150-mg Budeprion XL tablets) that were manufactured by Impax Laboratories, Inc., and marketed by Teva Pharmaceuticals USA, Inc., and the 300-mg bupropion HCl ER tablets that were manufactured by Watson. More information regarding the FDA's reviews of various generic bupropion products is available here:
Do you remember if you were taking one of the generic bupropion products that was found to be not therapeutically equivalent to the brand-name Wellbutrin either when the medication seemed to poop out or during the two times when you tried the medication again after that point? Judging from the information in the above link from the FDA's Web site, generic versions of bupropion other than the two that I mentioned in my previous paragraph were found to be therapeutically equivalent to Wellbutrin, but the 300-mg Budeprion XL tablets and the 300-mg bupropion HCl ER tablets made by Watson were not therapeutically equivalent to Wellbutrin. If you took one or both of the generic versions of bupropion that were found to not be therapeutically equivalent to the brand-name version of the medication during the periods when the medication didn't seem to work for you, it might be possible that either the brand-name Wellbutrin or one of the therapeutically equivalent generics could still work for you.
Of course, if you were taking the brand-name version of Wellbutrin or one of the therapeutically equivalent generic versions of the medication when the medication didn't seem to be helping you, then trying Wellbutrin again probably wouldn't make a whole lot of sense, but I just thought that I'd make you aware that two of the generic versions of bupropion that were once available were found to not be therapeutically equivalent to regular brand-name Wellbutrin, just in case you might have been taking one of those versions of the medication that wasn't therapeutically equivalent.
At any rate, I'm pulling for you, and I hope that you'll find something that will work out for you.
Tomatheus
Posted by Lou Pilder on March 20, 2016, at 8:45:05
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
> Are tricyclics any good with bipolar depression?
>
> I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> I think it's pristiq just isn't going to work for me annymore.
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
>
> b2
Friends,
It is written here,[...I am in the middle of hell...].
It has been revealed to me how to be released from the prison of hell. And what you all here that are contributing to this member staying in the midst of hell, could also lead this person to her death.
Friends, be not deceived. The chemicals that the pack of members here are advocating to the member that is in the midst of hell could cause her to kill herself of be killed by the drugs. The psychiatrist that would give these concoctions of death to her knows or should know that fact. You see, when these drugs are combined their effects are increased exponentially. That means that the drugs that could decrease heart or respiration such as central nervous system depressants, could cause heart or respiratory depression to cause death as just one way these drugs kill. By allowing Scott to defame me here and post anti-Semitic propaganda against me here with impunity and promote these drugs with impunity, others could follow him with advocating more drugs. By Mr. Hsiung not interceding here and allowing Scott to defame me and stigmatize me here, Scott could be seen as the leader of the pack that could bring addiction, life-ruining conditions and death here all under the guise of being supportive, for support takes precedence according to Mr. Hsiung.
Who will you follow today? Do you also want to be led to the midst of hell?
Lou
Posted by stan_the_man70 on March 20, 2016, at 9:17:43
In reply to Tricyclics and bipolar depression, posted by B2chica on March 19, 2016, at 11:35:08
Why not try something else?
> Are tricyclics any good with bipolar depression?
>
> I am in the middle of hell with mixed episode. My depression was severe so pristiq was taken back to 100mg, and Zyprexa taken off.
> I think it's pristiq just isn't going to work for me annymore.
> But I've been in poor state so long now, I don't know I have the strength to do multiple med trials.
>
> b2
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