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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by JasonL on October 2, 2000, at 10:12:58
Hi,
I've posted a few times lately and I wanted some advice about the meds I'm on. Been on Serzone 400mg and Welbutrin 300 mg for 3 weeks. Added Ritalin 20sr two weeks ago. Of all the meds, Ritalin is the most noticable. It tends to mellow me out. This morning, instead of taking the Serzone and Welbutrin, I just took the Ritalin, to see if I could isolate its effects. Serzone and Welbitrin seem to have noticable effects when I take them (not sure but I suspect because they come in and out of my system pretty fast.) Anyway, within minutes, the Ritalin really made me mellow, more so than when I take the Ritalin with the other meds. (I could really feel the Ritalin by itself, in this case.)
I suspect that a major part of my depression is dopamine related. I've heard a "mellowing" response to Ritalin suggests this.
I've got an appointment with the doc today. He wants to up the Welbutrin to 450 I suspect. As I have been terribly depressed for many years and nothing has really ever worked I wonder what the problem could be? More stimulent/DA enhancers? These are a class of drugs, that up until recently, I have never tried.
And a side note about Dr. Jenson...
I spoke with Dr. Jenson a few weeks ago and he told me that Menninger Clinic in Topeka is using his protocol. Menninger has one of the finest reputations for mental health facilities in the world. (My doctor is considering sending me there.) When I mentioned Dr. Jenson's approach to my doctor however, he shook his head...
I really wonder how I would fair on Ritalin or another stimulent at lower doses of the meds I am on and or trying the the more target specific DA anhancers? JohnL, I recal that Ritalin sent you through the roof, got you really high? I wonder if you are particularly sensative to DA drugs, and that part of your success has been in finding, as you say, "A kinder, gentler, stimulent." Its hard for me to say how my responce is on Ritalin, considering I have been taking it on top of other ADs...
JasonL
Posted by AndrewB on October 2, 2000, at 14:30:23
In reply to Question for JohnL, AndrewB, and others, posted by JasonL on October 2, 2000, at 10:12:58
Jason,
Could you please go over your symptoms and drug tried and your responses to them.
Also has serzone or wellbutrin helped your mood or helped in any other way. How long have you been on them.
Is it possible you have ADD with or without hyperactivity?
After you answers these Qs I try and give you my humble opinion on whether dopaminergics (or possibly other meds) may help you and which ones you should consider trying.
Best wishes,
AndrewB
Posted by JasonL on October 2, 2000, at 17:43:46
In reply to Re: Question for JohnL, AndrewB, and others, posted by AndrewB on October 2, 2000, at 14:30:23
> Andrew,
Thanks for your reply.
Symptoms: anhedonia, hyper-focus (in this case, on depression)apathy towards life, extreme sense of being removed from the world(but can study about drugs like a mad man)confusion about life, see no future, ect.Looking back on my life, I think I have been ADD for a long time. Previous trials of anti-depressents Serzone, Effexor, Remeron, Welbutrin, Lithium, Zoloft have not been successful. Arguably, I never reached the full therepudic doses on most of these drugs.
The longest I have ever been on ADs was two years ago, and it was Welbutrin. I took it for 5 months and didn't notice a thing.
Five months ago I returned home to St. Louis from LA. I came home because I was making no progress and getting worse fast. Inital trials of Celexia made me incredibly suicidal in less than hour. (though I was already having suicidal ideations before I started the Celexia). Interesting, because I had tried celexia 10 months ago with little response, good or bad. Possibly by the time I had gotten home this time around, I was in such a state of panic that I had an over production of certain sites causing the reaction?
I was then put on lithium. I hated the drug, but interestingly, I would feel almost normal a few hours a of the day as the lithium was coming out of my system. But I really most of the day. It was like my body liked the lithium at certain low doses...I used to think that if could get a propper delevery system with lithium so as not to create the peaks and valleys, then I'd have a drug.
Next up: Zoloft for a couple of weeks. Not much help. Dumped it and decided I would not take meds...they had never worked.
Two weeks later I almost went to the hospital. I was in really bad shape. The docs put me on Serzone and Welbutrin. Currently, I am on 400mg of Serzone, 300sr Welbutrin and just today, they bumped me up to 40mg of Ritalin.
Like many on this board, I am fascinated with the DA problems. I think I really have problems in this area. As I said earlier, I have almost this insaitable drive to find a cure for this experience I am going through, a drive that drives me, that I am not in control of...this is what I liken to the hyper focus/ADD problem. I'm not ADHD, never been loud, violent, ect...
Its like I need something to calm me down and remove some of the hyper focus, but something also to bring me into a more natural kind of drive? Hard to explain.
I would say (soory to ramble) that the clues lie in the DA systems...also, as a side note, I realize that DA failures can be patchy...sometimes causing ADD, sometimes narcalepsy...I am twenty seven and here is an interesting thing, I've always had this kind of walk where I wasn't very smooth, kinda jerky. Today I was thinking about my walk in terms of Parkinson's and jerky movement and related DA problems...
I have selegiline and adrafinil waiting to be used.
That's the scoop.
Thanks for listening.
JasonL
Posted by AndrewB on October 2, 2000, at 20:38:12
In reply to Re: Question for JohnL, AndrewB, and others, posted by JasonL on October 2, 2000, at 17:43:46
Jason,
> Symptoms: anhedonia, hyper-focus (in this case, on depression)apathy towards life, extreme sense of being removed from the world(but can study about drugs like a mad man)confusion about life, see no future, ect.
Thanks for the detailed response.
As you know I have no medical training but that doesn't stop me from having opinions. So this is what I have to say.
Why are you on Serzone and Wellbutrin. You've been on Wellbutrin long enough. It has had its chance and it is doing nothing. Also you've been on enough serotenergic agents, they haven't worked. There is no reason to be trying others. There is no reason to be taking Serzone. All you are doing now is making money for the drugs companies and your psychiatrist.
I'm glad the Ritalin is helping. The calming effect may indicate that you have ADD WITHOUT hyperactivity. You need to ask your doc to give you a trial on adderall so you can compare the two and see which serves you best.
Your symptoms of anhedonia, apathy, sense of removal and feeling there is no future may be helped by amisulpride. It has helped others with these symptoms. For my info. piece on amisulpride (along with how to get it) email me at andrewb@seanet.com. If your doctor says he doesn't like the idea of using it, tell him that he has had his chance and that this stuff has been proven safe and effective for dysthymia.
BTW, it sounds like you've got dysthymia. Very often this condition is caused by dopaminergic dysfunction.
Give adrafinil a trial too sometime, it helped JohnL with anhedonia.
Well I think that is enough advice for now. Let me know what you decide to do.
Posted by JohnL on October 3, 2000, at 4:08:31
In reply to Question for JohnL, AndrewB, and others, posted by JasonL on October 2, 2000, at 10:12:58
Jason,
I wish I had some ideas for you. I think what you are doing is the right thing though...comparing different approaches. I think if we limit our choices to just the common garden variety meds that most doctors prescribe, our chances for real recovery are also very limited. Too many possible causes of our symptoms are being ignored. As far as raising the doses of your current meds, I don't know. That certainly could work. But, as you know from Dr Jensen, IF that works it is probably through a domino chain reaction kind of thing, and not a result of correcting the chemical imbalance directly. The end result is higher doses and more side effects and usually a good response, but not a complete response.It's funny what you said about Ritalin and then Adrafinil. My local pdoc is now retired. But last time I saw him a few weeks ago, I mentioned how well the kinder gentler stimulant Adrafinil had worked. He said we should have known, because my euphoric response to Ritalin was the tip-off. That was the clue.
If serotonin meds haven't helped you much, then certainly looking at dopamine instead makes sense. But exactly how dopamine is influenced will make all the difference in the world too...for example, dopamine reuptake, dopamine stimulation, dopamine MAOI, etc. One way might work while another doesn't. But of course, there could be other things involved too. I wish more doctors knew all the intricacies of meds and chemistries the way Jensen does. This stuff all makes sense to him, while it puzzles the rest of us.
I'm glad you got a chance to speak with Dr Jensen. I was glad to hear a major psychiatric institution has embraced his protocols. Hopefully in time there will be lots of Jensens around. It's no secret I too support his protocols. But what amazes me more than anything is his knowledge of the subtle yet profound differences in meds. SSRIs for example...we all accept as fact that one may work while another doesnt. Yet known of us know why that it. But Jensen does know. Each SSRI works in a different way. And each has a different molecular structure that the body either embraces or rejects. Kind of like pieces to a puzzle...they either fit or they don't. And Zoloft for example subtly affects dopamine in the backround. On and on. That stuff amazes me. True cures and full responses I believe are found in those subtle intricacies.
John
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