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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 72. Go back in thread:
Posted by SLS on August 8, 2016, at 15:14:28
In reply to Re: bit by bit, almost there..., posted by Escapee on August 8, 2016, at 14:33:50
> >Almost no depression at all. YET!
>
> Spoke too soon.What's happening?
- Scott
Posted by Escapee on August 9, 2016, at 3:52:10
In reply to Re: bit by bit, almost there... » Escapee, posted by SLS on August 8, 2016, at 15:14:28
> > Spoke too soon.
>
> What's happening?
>
>
> - Scottbattery died. had a bad night too....16 more days
Posted by Escapee on August 9, 2016, at 4:12:32
In reply to Re: bit by bit, almost there... » SLS, posted by Escapee on August 9, 2016, at 3:52:10
Just ordered some 5-HTP online. Hopefully here by tomorrow. Ive used it before when switching meds with good effect. Doesn't last long. 7-10 days, but it has helped to break through downward spirals.
Posted by Escapee on August 9, 2016, at 14:57:18
In reply to Re: bit by bit, almost there..., posted by Escapee on August 9, 2016, at 4:12:32
And now im drinking. Sh*t loads. I'm tense, nervous when outside and am drinking like a fish with little effect. What a mess. gotta do something. Try and get a bed in a psych ward? Will they take me? Will I have to lie and say i'm suicidal or will that hang on my conscience and pull me even lower. Should have organized this all 1st. But no chance of the f**king NHS bast*rds doing that.........................................................................................................................................................................................
Posted by Escapee on August 9, 2016, at 15:52:13
In reply to Re: bit by bit, almost there..., posted by Escapee on August 9, 2016, at 14:57:18
Heres my last post on the subject. Thanks to all the helpfull comments and sugestions! I'm so f*ckin gratefull. How f*ckin kind. Now all go do one.
Posted by shadowtom2 on August 9, 2016, at 19:11:21
In reply to Re: bit by bit, almost there..., posted by Escapee on August 9, 2016, at 14:57:18
It definitely sounds like you're in a dark place, Escapee, and I find it to be quite troubling that the last day or two have been as difficult for you as they've been. If you've yet to reach out for assistance from a mental health professional, I'd strongly encourage you to do so. I'll be keeping you in my thoughts in hopes that you'll get yourself back to being in a better state of mind. I think that you can get through this, but please, get in contact with someone with the expertise to help guide you through this difficult period.
Tom (the former Tomatheus)
Posted by Escapee on August 10, 2016, at 8:44:07
In reply to Re: bit by bit, almost there... » Escapee, posted by shadowtom2 on August 9, 2016, at 19:11:21
Yea yesterday was bad. Apologies for my outburst everyone.
Three nights in a row now, since starting it, the diphenhydramine has given me throbbing headaches at night. I guess coz i still got other ADs floating around my system. Nightmares too since i started it.
I see my GP on Friday. Ive had a congested airways now for 3-4 months. Not coughing but still blocked. Thats why im going but I intend on asking for some sleepers. Zopiclon perhaps. I cant up the amitriptyline as that would defeat the object. Same with clonazepam.
My last 150mg of bupropion today (had it). That will probably begin to help sleep. I still have other meds, ready for augmentation (instead of chucking them). I've never had suicidal idealization so am not worried about ODing. I'm about to take some pregablin. 100mg to start with (remember, right now I need help with sleep & stress/irritation). Hope it helps to chill me out.
I could kill for a 'smoke' right now. Gotta stop drinking in the evening too. I cant even drink more than 2-3 beers. Then I bloat and that's that. Gives me wretched heartburn too. I think a 30day course of thiamine 100mg is in order. I'm just so board with my days right now. Ive never felt time lag so bad. I've already ordered some 'activated' B6, B12 & Folate (P-5-P, Methyl B12 & Methyl Folate) . Mainly for the B6 to keep any Nardil B6 interference at bay.
Eating less by the day. Not healthy I know, but hey! I'm loosing weight fast (still overweight). I have all the micro-nutrients I need. I gotta stay out of hospital. I can't go in, not with Social anxiety this bad! Lets see what this pregablin does - GULP!
Posted by Escapee on August 10, 2016, at 9:16:31
In reply to Re: bit by bit, almost there... » shadowtom2, posted by Escapee on August 10, 2016, at 8:44:07
Ah my 5-HTP has arrived. Need to get off the ADs 1st. Start it sat or sun.
Posted by Escapee on August 10, 2016, at 9:23:41
In reply to Re: bit by bit, almost there..., posted by Escapee on August 10, 2016, at 9:16:31
Posted by shadowtom2 on August 10, 2016, at 11:20:48
In reply to Re: bit by bit, almost there... » shadowtom2, posted by Escapee on August 10, 2016, at 8:44:07
Thank you for the update, Escapee. I think it's good that you seem to be doing at least somewhat better today than how you were doing yesterday, and it's also good to see that you have an appointment with your GP scheduled for Friday. As far as the changes that you've been making to your regimen of medications and supplements are concerned, I do hope that things will go at least reasonably smoothly for you. I am, however, not in a position to give advice on how to proceed with the changes that you're making to your regimen other than to say that contacting your GP at any time when you think that you might need professional guidance is something that I'd recommend considering. It is, of course, my hope that everything will go at least reasonably well for you over the next few days and that the discussions that you'll have with your GP and any other members of your GP's medical staff on Friday will serve you well.
Take care,
Tom
Posted by Escapee on August 10, 2016, at 11:33:11
In reply to Re: bit by bit, almost there... » Escapee, posted by shadowtom2 on August 10, 2016, at 11:20:48
Thanks shadowtom2.
Dont worry about lack of advice. I haven't asked for any. Ive simply welcomed peoples comments. Anyone may jump in any time if they think they can help, whatever it is. I just wanna write this stuff down. And though I'm not looking for answers (as you can see I'm making the decisions here) I feel more 'safe' & comfortable writing it down where others can see. Makes me feel less alone.
Posted by Escapee on August 10, 2016, at 17:08:38
In reply to Re: bit by bit, almost there... » shadowtom2, posted by Escapee on August 10, 2016, at 11:33:11
The 5-HTP & Pregablin make such a difference. Phew
Posted by shadowtom2 on August 10, 2016, at 17:24:44
In reply to Re: bit by bit, almost there..., posted by Escapee on August 10, 2016, at 17:08:38
> The 5-HTP & Pregablin make such a difference. Phew
I'm glad to hear that these things are helping you, Escapee. I wish you the best of luck as you continue to make your way through the treatment-related transitions that you're going through.
Tom
Posted by Escapee on August 10, 2016, at 17:33:10
In reply to Re: bit by bit, almost there... » Escapee, posted by shadowtom2 on August 10, 2016, at 17:24:44
Can't sleep. Gonna take another 150mg pregablin.
This is my last post on this thread. The threads a total mess. Looks awful on the board. If Dr. Bob or any Administrator could please delete the whole thread Id much appreciate that. I feel greatly embarrassed.
Probably update after I've started Nardil. Though I'm also thinking Parnate, possibly....
Posted by shadowtom2 on August 12, 2016, at 9:49:54
In reply to Re: bit by bit, almost there..., posted by Escapee on August 10, 2016, at 17:33:10
Escapee,
I know that you wrote that you won't be making any more posts to this thread, but I wanted to say that if you'd like to check in with us at any point to let us know how you're doing, you could most certainly feel free to do so. I hope that you've been finding yourself doing at least reasonably well over the last few days, and I also hope that you'll find resuming Nardil (or possibly going with Parnate) to be beneficial.
Tom
Posted by SLS on August 13, 2016, at 7:19:12
In reply to Re: bit by bit, almost there..., posted by Escapee on August 10, 2016, at 17:33:10
> This is my last post on this thread. The threads a total mess. Looks awful on the board.
What is it about this thread that you find a total mess? I guess you would have to post again here in order to answer my question. Oh, well.
Take care of yourself and don't beat yourself up, if that's what you are doing. Be merciful on yourself.
- Scott
Posted by Escapee on August 13, 2016, at 8:39:51
In reply to Re: bit by bit, almost there... » Escapee, posted by SLS on August 13, 2016, at 7:19:12
> > This is my last post on this thread. The threads a total mess. Looks awful on the board.
>
> What is it about this thread that you find a total mess? I guess you would have to post again here in order to answer my question. Oh, well.
>
> Take care of yourself and don't beat yourself up, if that's what you are doing. Be merciful on yourself.
>
>
> - Scott
>
>
>
>Embarrassment. Hardly any replies. Anyway im doing much better already. I'm using 1.5mg clonazepam + 300mg pregablin per day. Also 300mg L-5-HTP + nootropics. At least none of those will upset the 2 week washout. Also managed to squeeze 7 days of zopiclone outa my doc. That was difficult i tell ya! I'm going out soon, in the sun. 1st time out the house in a few weeks. Thanks for your post. You are most kind :)
Escapee
Posted by Escapee on August 16, 2016, at 16:50:41
In reply to Re: bit by bit, almost there... » Escapee, posted by shadowtom2 on August 12, 2016, at 9:49:54
Depression worsening. Called my Psych docs Secretary this afternoon. Explained my situation. Asked for call back. No such luck.
The pathetic 3.75mg zopiclone pills do diddly sh*t so I add 100mg diphenhydramine in the morning, which helps me sleep the day away. Then 150mg diphenhydramine at night. Bed by 12, waking at or before 6am. Whole empty day ahead so I repeat. Try to have a few drinks in the eve to help me get online and write something on FB for a while, but its all self destructive posts and mean, unforgivably hateful posts. Makes me feel good tho. Go to bed, ready for the whole cycle to repeat itself the next day.
Still taking Quetiapine 100mg at night. Also 150mg clonazepam + 150 pregablin + 200mg 5-HTP AM and 150mg pregablin + 300mg 5-HTP late PM.
Far from suicidal I'm getting more irritated and angrier by the day. Good job I'm isolating and there is nobody around me. I wouldn't trust myself otherwise. Might stop the 5-HTP tomorrow as this may be worsening the anger. That stuff has 2 guises. Works great at 1st but can give the opposite effect if taken over 5-7 days.
Posted by Escapee on August 16, 2016, at 16:55:31
In reply to Re: bit by bit, almost there... » Escapee, posted by shadowtom2 on August 12, 2016, at 9:49:54
Cant eat solids either. On a liquid diet, and can just about eat yogurt.
Posted by Escapee on August 20, 2016, at 12:06:34
In reply to Re: bit by bit, almost there..., posted by Escapee on August 16, 2016, at 16:55:31
OD'd last night. Obviously im still here. Did it all wrong
Posted by Escapee on August 27, 2016, at 5:58:45
In reply to ..........., posted by Escapee on August 20, 2016, at 12:06:34
To start with I had an awful time 2 weeks prior to Thursdays appointment.
When I decided to switch from Marplan (isocarboxazid) to Nardil (phenelzine) I called my doc's secretary and I emailed her a detailed (but not complicated) plan to reduce all my med dosages and which ones I was stopping & keeping. She said she would forward the email to my doc. With no reply via mobile or landline, Email or post that was enough for me to carry on titrating everything downwards.
When I finally started washout, the start of the 2nd week went bad. I admitted myself to A&E (suggested by NHS Direct 111) for 1 night asking if they could give me a bed in the psychiatric in-patient ward. There declined my request. They gave me a bed for the night (actually it was a lovely soft reclining leather chair) and I went home the next day. Next night I went in again doped to the eye balls on Quetiapine & Zopiclone. It was technically an OD compared to my prescribed dosage of 150mg. 700mg to 800mg maybe more quetiapine plus 7.5mg Zopiclone but I never intentionally meant to end my life. No way! But I did want a long deep sleep. Never thought much of it until my legs went like jelly And my head spun. So I called for ambulance and again they kept me in for the night.
I was seen by several 'liaison' psychiatrists. They were all very helpful, except when the last Psych came to discharge me and dropped the bomb. She said she had spoken to my Pdoc and said he was shocked and said he never told me to come off anything and for me to get back on everything ASAP! His plan was to simply cross-titrate the MAOIs! I could not believe it. So the secretary never forwarded my email? And if he never read the email how did he know I wanted to switch the phenelzine?? Did I mention it and forgot? Dam
So I went back on everything except for Marplan. Couple dose changes. Amitriptyline up to 100mg instead of 150 & Clonazepam from 4 to 2.5mg.
Since 12+yrs ago they are still the same 15mg pills. They need refrigeration, smell LUSH & are deep orange colour. Can't remember them being that strong a colour, plus I actually had the Nardil brand pills. I thought I used to get generic phenelzine. Memory loss perhaps.
I'm just glad I'm back on Nardil. I wonder what will happen.....
Escapee
Posted by SLS on August 27, 2016, at 9:22:24
In reply to Started Nardil, posted by Escapee on August 27, 2016, at 5:58:45
> I'm just glad I'm back on Nardil. I wonder what will happen.....
I am sure you know that Nardil often becomes less effective once it is discontinued and restarted. If this is the case with you, I wouldn't become too demoralized. This is what happened to me. There are multiple augmentation strategies that are available to treat this circumstance. First things first. I don't think it makes sense to add anything to phenelzine until you reach a dosage of 1.0 mg/kg body weight.
- Scott
Posted by Escapee on August 27, 2016, at 11:09:56
In reply to Re: Started Nardil » Escapee, posted by SLS on August 27, 2016, at 9:22:24
> > I'm just glad I'm back on Nardil. I wonder what will happen.....
>
> I am sure you know that Nardil often becomes less effective once it is discontinued and restarted. If this is the case with you, I wouldn't become too demoralized. This is what happened to me. There are multiple augmentation strategies that are available to treat this circumstance. First things first. I don't think it makes sense to add anything to phenelzine until you reach a dosage of 1.0 mg/kg body weight.
>
>
> - ScottYou are right Scott. But one can only hope. It has been over 12yrs tho.
Biggest mistake ever made was coming off Nardil, at the time at least. I realized it never actually stopped working as once stopped my SA soared thru the roof. But the depression was stubborn. But compared to the Isocarb I only tried a few addons/augmentations with Phenelzine- modafinil, trimipramine, L-tryptophan (Optimax), bupropion, lamotrigine... My doc at the time had said he'd read of a study done using sertraline to augment phenelzine. It was offered to me, but he said he'd given it to one other patient who suffered 'annoying' side effects tho nothing serious. Anyway I declined, but remembered.
Most augmentations tried with Isocarb were never tried with Phenelzine. I'm surprised he wanted me to stay on all other meds whilst cross titrating. Maybe coz he is cautious of my sometimes stubborn depression.
Quetiapine fine, may even help prevent mood swings which I experienced 1st time round on phenelzine. From really outgoing to curtains drawn teary gloomy with little explanation, only to perk up again the next day. I thought maybe it was short-lived med-induced Bipolar? Doc said it wasn't.
I'm far from hoping for a miracle, but optimistic nonetheless. I know my docs fine to take it to 120mg if necessary.
Mind you my docs most familiar with tranylcypromine (Parnate) than any of the other MAOIs. So that's a pretty good safety net I'd say. The combinations are seemingly endless between the 3 irreversible MAOIs & addons/augmenters which would shock most GPs and others a-like.
I'm surprised to see you follow the 1mg per kg weight rule. I dont buy it. And the patients info slip STILL says a maintenance dose of as low as one tablet (15mg) every other day. What is that about and why does it still appear on the slip when the slip also states: last revised on 04/2015! I mean, was that how they used to, or still do (some doctors) prescribe it successfully?
The food interactions are still totally outdated too! Don't eat yogurt??? I eat a 450ml pot of live yogurt every day.
Craziness.Escapee
Posted by SLS on August 27, 2016, at 13:55:17
In reply to Re: Started Nardil » SLS, posted by Escapee on August 27, 2016, at 11:09:56
I think it is a dangerous game to add any SSRI to phenelzine. My impression is that it will result in serotonin syndrome almost every time.
The 1 mg phenelzine/kg body weight serves pretty well. That leaves me at 90 mg/day, which just so happens to be optimal for me. 75 mg/day is too low, and increasing the doaage produces no further improvement. The formula is a guideline - nothing more. Some people will need more; others will need less. I have gone to 120 mg/day. You need to be careful with phenelzine, though. The ratio of dose/blood level is not linear. Phenelzine inhibits its own metabolism, so every 15 mg increase in dosage will produce a larger and larger increase in blood level. It is much easier to overdose on phenelzine than on tranylcypromine.
Because you have not taken phenelzine in so long, I don't think you can necessarily expect that it will not work well. In the past, some doctors would have their relapsing patients discontinue phenelzine for three or more months in order to recapture a response to it. One of my doctors had a patient switch back and forth between phenelzine and tranylcypromine once a relapse occurred for each one.
I think you can be cautiously optimistic.
- Scott
Posted by Escapee on September 6, 2016, at 19:08:23
In reply to Re: Started Nardil » Escapee, posted by SLS on August 27, 2016, at 13:55:17
> I think it is a dangerous game to add any SSRI to phenelzine. My impression is that it will result in serotonin syndrome almost every time.
>
> The 1 mg phenelzine/kg body weight serves pretty well. That leaves me at 90 mg/day, which just so happens to be optimal for me. 75 mg/day is too low, and increasing the doaage produces no further improvement. The formula is a guideline - nothing more. Some people will need more; others will need less. I have gone to 120 mg/day. You need to be careful with phenelzine, though. The ratio of dose/blood level is not linear. Phenelzine inhibits its own metabolism, so every 15 mg increase in dosage will produce a larger and larger increase in blood level. It is much easier to overdose on phenelzine than on tranylcypromine.
>
> Because you have not taken phenelzine in so long, I don't think you can necessarily expect that it will not work well. In the past, some doctors would have their relapsing patients discontinue phenelzine for three or more months in order to recapture a response to it. One of my doctors had a patient switch back and forth between phenelzine and tranylcypromine once a relapse occurred for each one.
>
> I think you can be cautiously optimistic.
>
>
> - ScottThanks for your input! I will talk to my doc about the relapse method you explain.
I can feel Nardil working already. A bit speedy but that happened last time before my mood lifted and the anxiolitic effect kicked in.
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