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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by SLS on June 4, 2000, at 13:40:04
Does anyone have any comments regarding the uses of both Parnate and Nardil for treating depression in bipolar disorder?
Thanks for any input.
- Scott
Posted by Chris A. on June 4, 2000, at 16:23:14
In reply to Parnate or Nardil for Bipolar Disorder ?, posted by SLS on June 4, 2000, at 13:40:04
Scott,
I have a friend with BP I who does very well on a Parnate/Lithium combo. Neither one cut it for me. At the momment I can't remember the specifics.Best,
Chris A.
Posted by SLS on June 5, 2000, at 14:19:02
In reply to Re: Parnate or Nardil for Bipolar Disorder ?, posted by Chris A. on June 4, 2000, at 16:23:14
> Scott,
> I have a friend with BP I who does very well on a Parnate/Lithium combo. Neither one cut it for me. At the momment I can't remember the specifics.
>
> Best,
>
> Chris A.
Chris - Thanks for the information. I really appreciate it. I think your reply has helped me come close to making a decision. I will probably choose Parnate. The last time I was on Parnate, I was also taking desipramine and experienced a partial response. I had some lithium sitting in my junk-drawer, and was considering adding it for a week or so to see what it would do. I know how often it makes a good adjunct to Parnate. It's just that I hate the way it makes me feel. I feel flat, less motivated, and less creative. It squashes my ego and fierceness - my gusto for attacking life and seizing the day. I can't believe I was stupid enough not to try it. This time, I don't plan to exclude it from my list. I will probably put it up higher having read of your friend's success.I hope you find success for yourself - soon.
I added a post along the ECT thread before seeing this one. I was hoping you hadn't tried an MAO inhibitor yet, as this would have been a wonderful stone to turn over. Sorry. Combining an MAOI with a tricyclic often works.
Do you intend to restart Lamictal after ECT? Seeing as how you experienced a partial response to it, I would think it a good idea. It may help to create a base from which to add antidepressants. Had you combined it with anything?
I have been taking 300mg since September, as it is one of the few drugs that gives me any type of long-term relief, as small as it may be. I recently thought to add Neurontin. It has helped a bit, but not nearly as much as I had hoped. After starting it, I ran across an article written by the NIMH describing their recent success with this combination. It might be something for you to consider. You may have more success with it than me, as the case they featured was a bipolar patient whose depression was recurrent rather than unremitting. His response was nearly complete. It seems that you will need something to prevent mania anyway if you want to go back to exploring antidepressants.
I appreciate your reply more than you could know. I sometimes feel as if I rub people the wrong way. I guess I must. I don't get many replies when I ask questions.
Take care.
Love,
Scott
Posted by Chris A. on June 5, 2000, at 15:50:59
In reply to Re: Parnate or Nardil for Bipolar Disorder ? » Chris A., posted by SLS on June 5, 2000, at 14:19:02
Scott,
I have appreciated your replies. Sometimes I feel like I must have offended someone, too, but realize I don't write that often and am pretty foggy headed - can't keep track of threads, etc. You are just the opposite. It is a bit overwhelming to me try to answer too much.It sounds like lamotrigene is a keeper for you. What to combine with it is something you have a better handle on than I do. Frankly, right now, I don't remember what all I have used it in combo with. There have been so many combos!
Have you gone to see one of the consultation experts? I like Steven Dubovsky at the U. of Colo., but haven't been cured yet by his miriad of novel ideas and combos. He is sharp and marchs to beat of a different drummer.
ADs in general seem to cause more problems for me than they address. If I can prevent hypomania, the mixed states and subsequent crashs tend not to follow. Selegiline is less activating for me. Even lamotrigene is suspect in some of the irritability I have experienced. Ziprasidone is on my waiting list of meds to try.
We'll decide what to do post ECT when I see my pDoc next week. Maintenance ECT is a possibility, with my main concern being ongoing cognitive side effects. My Hubby is part of those decisions, too, as he has to live with me. He has an exceptional grasp of bipolar disorder. He should receive a medal of honor. Of course I have to live with him too :).Please hang in there!
Blessings,
Chris A.
Posted by harry b. on June 28, 2000, at 11:45:25
In reply to Re: Parnate or Nardil for Bipolar Disorder ? » Chris A., posted by SLS on June 5, 2000, at 14:19:02
Scott-
I came across your comment below, to Chris A., while
searching the archives for info on MAOIs.IMHO, you don't 'rub people the wrong way'. You
seem to have a vast knowledge of psychiatric ills
and their treatment. When you speak of chemicals,
receptors, and interactions in the brain, I read
the posts hoping to glean some insight but some
of this stuff is way over my head and kind of
intimidating, ie: I don't possess the credentials
to contribute.Also, going thru the archives I noticed that you are more
of a giver than a taker. Most of the questions you
ask are in an effort to understand/help the previous
poster. Other questions you ask seem to be an attempt
to further your knowledge.Take care
hb> I appreciate your reply more than you could know. I sometimes feel as if I rub people the wrong way. I guess I must. I don't get many replies when I ask questions.
>
> Take care.
>
>
> Love,
> Scott
Posted by KarenB on June 28, 2000, at 13:39:59
In reply to SLS, posted by harry b. on June 28, 2000, at 11:45:25
> Scott-
> I came across your comment below, to Chris A., while
> searching the archives for info on MAOIs.
>
> IMHO, you don't 'rub people the wrong way'. You
> seem to have a vast knowledge of psychiatric ills
> and their treatment. When you speak of chemicals,
> receptors, and interactions in the brain, I read
> the posts hoping to glean some insight but some
> of this stuff is way over my head and kind of
> intimidating, ie: I don't possess the credentials
> to contribute.
>
> Also, going thru the archives I noticed that you are more
> of a giver than a taker. Most of the questions you
> ask are in an effort to understand/help the previous
> poster. Other questions you ask seem to be an attempt
> to further your knowledge.
>
> Take care
> hb
>
> > I appreciate your reply more than you could know. I sometimes feel as if I rub people the wrong way. I guess I must. I don't get many replies when I ask questions.
> >
> > Take care.
> >
> >
> > Love,
> > ScottScott,
Ditto what harryb wrote. You certainly don't rub ME the wrong way. It sounds as if, like me, self criticism and insecurity may be part of your depression profile. Don't believe everything you think or feel.
Most of us here are suffering from our illness to one degree or the other, so sometimes I know I back off and don't respond, when my mental state is not the best. Perhaps others do the same. Regardless, please don't take it personally.
You rock, Scott.
Most sincerely,
Karen
Posted by SLS on June 28, 2000, at 15:24:39
In reply to Re: SLS, posted by KarenB on June 28, 2000, at 13:39:59
THANK YOU!
You guys just made me feel worthwhile. Today was worth living.
:-)
Love,
Scott> > Scott-
> > I came across your comment below, to Chris A., while
> > searching the archives for info on MAOIs.
> >
> > IMHO, you don't 'rub people the wrong way'. You
> > seem to have a vast knowledge of psychiatric ills
> > and their treatment. When you speak of chemicals,
> > receptors, and interactions in the brain, I read
> > the posts hoping to glean some insight but some
> > of this stuff is way over my head and kind of
> > intimidating, ie: I don't possess the credentials
> > to contribute.
> >
> > Also, going thru the archives I noticed that you are more
> > of a giver than a taker. Most of the questions you
> > ask are in an effort to understand/help the previous
> > poster. Other questions you ask seem to be an attempt
> > to further your knowledge.
> >
> > Take care
> > hb
> >
> > > I appreciate your reply more than you could know. I sometimes feel as if I rub people the wrong way. I guess I must. I don't get many replies when I ask questions.
> > >
> > > Take care.
> > >
> > >
> > > Love,
> > > Scott
>
> Scott,
>
> Ditto what harryb wrote. You certainly don't rub ME the wrong way. It sounds as if, like me, self criticism and insecurity may be part of your depression profile. Don't believe everything you think or feel.
>
> Most of us here are suffering from our illness to one degree or the other, so sometimes I know I back off and don't respond, when my mental state is not the best. Perhaps others do the same. Regardless, please don't take it personally.
>
> You rock, Scott.
>
> Most sincerely,
>
> Karen
Posted by noa on June 28, 2000, at 16:16:52
In reply to Re: SLS :-) Thanks ! :-), posted by SLS on June 28, 2000, at 15:24:39
Scott, you are cool with me, too.
I think your self doubt might be coming out of having gotten tangled up with some posters who like to push buttons. I am working on not being reactive to them, not responding. It isn't easy, but I think it helps to remain centered.
I agree about the giver vs. taker.
Hope you are ok today.
Posted by shar on June 28, 2000, at 17:15:35
In reply to Re: SLS :-) Thanks ! :-), posted by noa on June 28, 2000, at 16:16:52
Scott,
Ditto what the previous posters have said.I find that I don't always read posts if they are about meds I haven't taken or am unlikely to take (IMHO). So, I am unlikely to respond to any that fall into that category. The posts I've read where you've contributed, you have always provided great information, references, other considerations, etc. and I don't feel like I could add much more than an "attaboy" or something.
A lot of times a poster like you will point out things I never would have thought of. So, I will be delighted if you keep it up!
I don't recall you ever being annoying or unpleasant. I guess you can join the "We Take Everything Personally" club now (it has a vast membership!).
Take care,
Shar
Posted by Chris A. on June 29, 2000, at 21:30:23
In reply to Re: SLS :-) Thanks ! :-), posted by SLS on June 28, 2000, at 15:24:39
Scott,
I'm going bak on lamotrigine, partially due to your encouragement. The pDoc covering wants me to go for a consult at Harvard, since they are supposedly on the cutting edge of bipolar. Do you know the best doc to see there? It would be a major venture for me since I live in the west. I Am back in the hospital - attempted suicide with an impulsive OD, but am ok physically at this point. Out of guilt I didn't ingest all that I intended too. Have to be back on the unit from pass ina few minutes. Thanks for all your help - Scott, Karen JudyChris A.
Posted by mary lee on June 29, 2000, at 22:52:23
In reply to Re: SLS :-) Thanks ! :-), posted by SLS on June 28, 2000, at 15:24:39
> THANK YOU!
>
> You guys just made me feel worthwhile. Today was worth living.
>
> :-)
>
>
> Love,
> Scott
I'm a "lurker" and a real life friend of Scott's. :-)I just HAD to jump in here with my own words of love and
thankfulness for Scott.I suffer from dysthymia with major depressive episodes. With
Scott's help over the last three years, I have been able to
work through meds and many emotional issues to become the
healthier person I am today.Scott's personal strength, integrity, empathy, concern and love
he shares with others is priceless. This illness puts blinders
on us so often that we can't see these things for ourselves.
We need "mirrors" to show us what eludes our view. So this
is a chance to show him again how much value he has in this world.Needless to say, I'm the biggest Scott fan there is! And I just
wanted to take this opportunity to tell Scott, in a place that
means so very much to him, that his friendship is a gift from
the angels.And to all others on the babble board, I wish you peace deep
inside, nestled next to your hearts of gold.With love, respect, and deep admiration,
Mary Lee
Posted by Janice on June 29, 2000, at 23:09:08
In reply to Re: SLS :-) Thanks ! :-), posted by Chris A. on June 29, 2000, at 21:30:23
I'm so glad you're okay, and so sorry to hear of your accident.
The impulsiveness that often coexists with this disorder is certainly one of the most dangerous part of the bipolar illness. I'm sorry you have to experience all the seemingly neverending pain. Chris, I'm happy you're physically okay at least and are already reaching out for more help (one thing we get good at).
Well I hope you manage to put things back with your personal relationships soon. It's so hard for people who don't have bipolar to understand our pain.
Dear Chris, I will pray for you.
I am very sorry for all your pain.Janice
Posted by Janice on June 29, 2000, at 23:17:03
In reply to Re: Parnate or Nardil for Bipolar Disorder ? » Chris A., posted by SLS on June 5, 2000, at 14:19:02
I gotta agree with most of the folks above Scott!
I sometimes feel as if I rub people the wrong way. I guess I must. I don't get many replies when I ask questions.
it's probably because we just don't know the answers Scott,
You definately don't rub me the wrong way. I always think you sound like you have a great sense of humour and are a little intense (a great character combination - to me anyway)
Take care,
Janice
Posted by harry b. on June 29, 2000, at 23:17:45
In reply to Chris A…, posted by Janice on June 29, 2000, at 23:09:08
Stay cool Chris
hb
Posted by SLS on June 30, 2000, at 7:10:25
In reply to Re: SLS :-) Thanks ! :-), posted by Chris A. on June 29, 2000, at 21:30:23
Hi Chris.
> I'm going bak on lamotrigine, partially due to your encouragement. The pDoc covering wants me to go for a consult at Harvard, since they are supposedly on the cutting edge of bipolar. Do you know the best doc to see there? It would be a major venture for me since I live in the west. I Am back in the hospital - attempted suicide with an impulsive OD, but am ok physically at this point. Out of guilt I didn't ingest all that I intended too. Have to be back on the unit from pass ina few minutes. Thanks for all your help - Scott, Karen Judy
Chris A.
Dear Chris,I guess you didn't see my post addressed to you. I selfishly asked you to please stick around solely for the purpose of getting me through *my* tough times. :-) Of course, this isn't a real good reason. I was just hoping to make you smile and have you realize that you are loved and needed by others - certainly by me.
http://www.dr-bob.org/babble/20000619/msgs/38323.html
I understand. No need to apologize. You are not weak. You are incredibly strong and courageous to have made it this far. You have earned mountains of praise, admiration, and respect by those of us who know the real truth about this disease and understand your suffering. I just wish that things didn't have to be so excruciating for you. You have been through so much. You have tried so hard. Believe it or not, you project positive energy, strength, and optimism. I'm glad you are still here.
As far as names are concerned, the one that stands out in my mind is Andrew Nierenberg. I have seen him personally. He is a warm and caring human being. At the very least, he should be able to refer you to the person most appropriate to treat your case.
ANDREW A. NIERENBERG, M.D.
Harvard School of Medicine
Massachusetts General Hospital
Boston, MA
1-617-726-2000
1-617-726-3488 Dept. of PsychiatryI expect to see your name appear on this board in the future - not because I demand that you stick around to post, but because I think that staying alive, getting well, and actualizing a life of rewarding experiences is your true goal.
With love and respect,
Scott
Posted by Chris A. on July 6, 2000, at 19:59:59
In reply to Re: SLS :-) Thanks ! :-) » Chris A., posted by SLS on June 30, 2000, at 7:10:25
Dear Scott,
Thanks for the referral to Andrew Nierenberg and the support. I wish I could be of more support to you through your tough times. Your post that I missed from 6/25 is much appreciated. If I had seen it earlier you could have been responsible for preventing an OD and subsequent hospitalization. I hope that helps you to feel worthwhile, because you are. Is the sulpiride offering any signs of hope? I don't dare touch it because of the TD issues. You are so knowledeable and empathetic that it's tempting to ask you what combo I should be on. Perhaps the lamotrigine combined with the seligiline and Klonipin will help stabilize me at a more tolerable level. Bits and pieces of my memory are beginning to resurface. It is hard to be dumb in a setting where intelligence is at the top of the list (second). I couldn't even figure out how to post here. No more ECT for me - ever. I even questioned my pDoc concerning advanced directives - in case I should forget. My mood is labile- mostly better today, but still struggling. Your prayers are appreciated. The Lord and my family keep me going. Sometimes "family" extends beyond the biological.To perseverance,
Chris A.
P.S Thanks!
Posted by SLS on July 7, 2000, at 7:16:40
In reply to Re: SLS :-) Thanks ! :-), posted by Chris A. on July 6, 2000, at 19:59:59
> Dear Scott,
> Thanks for the referral to Andrew Nierenberg and the support. I wish I could be of more support to you through your tough times. Your post that I missed from 6/25 is much appreciated. If I had seen it earlier you could have been responsible for preventing an OD and subsequent hospitalization. I hope that helps you to feel worthwhile, because you are. Is the sulpiride offering any signs of hope? I don't dare touch it because of the TD issues. You are so knowledeable and empathetic that it's tempting to ask you what combo I should be on. Perhaps the lamotrigine combined with the seligiline and Klonipin will help stabilize me at a more tolerable level. Bits and pieces of my memory are beginning to resurface. It is hard to be dumb in a setting where intelligence is at the top of the list (second). I couldn't even figure out how to post here. No more ECT for me - ever. I even questioned my pDoc concerning advanced directives - in case I should forget. My mood is labile- mostly better today, but still struggling. Your prayers are appreciated. The Lord and my family keep me going. Sometimes "family" extends beyond the biological.
>
> To perseverance,
>
> Chris A.
>
> P.S Thanks!
Dear Chris,I'm glad you're here.
I am so easily intimidated by the intelligence, intellect, and professional and academic accomplishments evidenced by the people on this babble-board. I have tried so hard just to keep up with the simple things in life. I had to drop out of college after my sophomore year because I could no longer read and remember things. I tried to reenter school the following year, but failed miserably. I had been a pretty good student up until then. There is so much that I wanted to learn and do. I still want to. The dementia produced by my illness leaves me feeling below the level of most of the rest of the world. I like when some drug gives me a temporary improvement that includes memory and cognition because I feel as if my I.Q. increases exponentially. It's nice to be part of what's going on. I know how deceptive my words can be. I must push very hard.
I am glad that you were able to find some comfort and consolation in what I wrote to you. Every word is true.
I am not responding to sulpiride the way I had hoped to. I think it is beginning to make me feel cognitively dulled and a bit flat. If it doesn't produce a significant improvement soon, I will be fearful to continue it because of EPS concerns. This sucks. I am beginning to contemplate seeing a new doctor. As much as I respect my doctor's knowledge, I don't think he is any longer focused on treating his few remaining private patients. I live near NYC and Philadelphia, although it is much easier for me to get to NYC. I may give Dr. Nierenberg a call to see if there is anyone here he would recommend. By the way, CNN announced the results of some poll indicating that Massachussetts General was the best medical facility in the U.S. for psychiatry.
Your memory and cognitive skills will return. It may take a month or two, so be patient. Try not to worry about it too much. I know this is much easier to say than it is to do, as there is no guarantee. I don't feel that my bilateral treatments left me with any permanent impairments. You actually sound pretty good. I think I can speak for most of us here when I say that we are here for you.
Speak to ya'...
Sincerely,
Scott
This is the end of the thread.
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