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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by SalArmy4me on March 2, 2001, at 9:12:59
Before you give up on medical treatment, there is hope for you in newer medications and newer combinations. I once found relief in a very new drug called Mirapex. Here are some more options that you may not have thought of:
Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
Lamotrigine - good side-effect profile; most antidepressant properties
Carbamazepine - less side effects than Lithium or divalproex sodium
Topiramate - the newest mood-stabilizer; it promotes weight loss
Desipramine - the least side-effects of all the Tricyclics; one of the SNRIs
High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
Buspirone - an effective antidepressant and anxiolytic at high doses.
Dopamine Agonists - Pramipexole has two studies on it (I take it).
"Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, RemeronProzac
Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (i took pindolol
Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc
Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel
Provigil - a stimulant that is possibly effective
Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine.
I hope that gives you hope!
Posted by NikkiT2 on March 2, 2001, at 13:23:31
In reply to Medications Combinations You May Not Know About, posted by SalArmy4me on March 2, 2001, at 9:12:59
Come to the UK - you can only get combos IN hosoital!!!
Posted by JahL on March 2, 2001, at 15:26:35
In reply to Re: Medications Combinations You May Not Know About » SalArmy4me, posted by NikkiT2 on March 2, 2001, at 13:23:31
> Come to the UK - you can only get combos IN hosoital!!!
Too right. What's that all about? The received wisdom in the UK seems to be that all depressions can be resolved by SSRIs or Lithium or ECT.
State-funding creates a complacent environment in which there is little incentive for docs to keep up with medical advances, or try novel (read:'risky') approaches. If you don't 'fit' their limited treatment algorithm you are abandoned (at least I was). Shame on you for not getting better.
Any UKers out there continually coming up against a brick wall, I would (tentatively) advise to cut your losses & (funds permitting) try & consult a good US pdoc (tho' I appreciate this will be logistically impossible 4 many). I have.
US pdocs seem happy to engage in pre-screenig calls; I imagine a UK pdoc would baulk at the idea (can *afford* to remain aloof/removed).
Did I mention I don't think much of UK pdocs?
Jah.
Posted by NikkiT2 on March 2, 2001, at 15:44:25
In reply to Re: UKpdocs., posted by JahL on March 2, 2001, at 15:26:35
Hi jah!!
yeah, if you've been following my posts, my pdoc has tried me on just about every ssri, none have really worked (effexor did for a while, but only a few months) and now he's just going on and on about hospitalising me and maybe ect... idiot!
Unfortunately I have *NO* money so going US isn't an option at the moment.. I'm kind of at the end of my road right now.. need a way out!
Nikki x
Posted by JahL on March 2, 2001, at 16:21:31
In reply to Re: UKpdocs. » JahL, posted by NikkiT2 on March 2, 2001, at 15:44:25
Hi Nikki.
> > my pdoc ... he's just going on and on about hospitalising me and maybe ect.
Don't do it ,please! I have had friends (+ my mum) on NHS units and they all seem to come out worse. There seems to be no distinction made btwn affective disorders & serious psychiatric conditions such as schizophrenia, and subsequently no segregation. Schizophrenics have all my sympathy but if they are ill enough to be hospitalized I would not like to be confined with them.
(Hospitalization is the only option for some tho'...)
ECT, though undoubtedly v. effective, seems like the proverbial sledgehammer, when you have *so* many meds yet to try.
> >...idiot.
You know it.
> > Unfortunately I have *NO* money so going US isn't an option at the moment.. I'm kind of at the end of my road right now.. need a way out!
All its cost me so far is the price of a plane fare+1x consult fee+1 night @ motel. I consult my pdoc by e-mail & 3 months on, he's yet to charge me any further consult fees. Legend!
Maybe we could start a NikkiT2 fund...
Jah.
Posted by NikkiT2 on March 2, 2001, at 16:50:11
In reply to Re: UKpdocs. » NikkiT2, posted by JahL on March 2, 2001, at 16:21:31
When I say *no* money - believe me I mean it - my bank removed all services to me this week when I hit 20k debts worked up over the past 3 years... ouch!!! I now have nothing and all my debits will be blocked now (including mortgage!)
We do normally visit the US once a year, but this year theres no chance (have thankfully paid for flights to thailand in June though!!!)
As to the hospital - thats what I feel - the no segragation - I'll be in with everyone. I understand there is a good depression unit though (I live in London luckily) but theres no knowng whether I can get in there as it isn't my two local hospitals... Oh lordy!!!
Nikki x
Posted by JahL on March 2, 2001, at 17:20:00
In reply to Re: UKpdocs. » JahL, posted by NikkiT2 on March 2, 2001, at 16:50:11
> > I hit 20k debts worked up over the past 3 years...
WOW.
> > As to the hospital - thats what I feel - the no segragation - I'll be in with everyone. I understand there is a good depression unit though (I live in London luckily)
If by that you mean the Maudsley unit, well it was seeing two of their resident jokers (one a prof no less!) that got me straight on a plane to the US. No hesitation in branding them criminally ignorant; I got up & walked out towards the end; neither of them understood basic psychopharmacology. I also walked out on a so-called treatment-resistant expert, fresh out of Maudsley (stuck-up c*w). (I have excellent relations with all other docs, pdocs-honest.)
Hoping you win the lottery,
J
Posted by Pandora on March 2, 2001, at 22:41:24
In reply to Medications Combinations You May Not Know About, posted by SalArmy4me on March 2, 2001, at 9:12:59
Goodness! How many different meds are you actually taking right now? I realize that poly-drug therapy has advantages, but from reading several of your most recent posts, it sounds as if you're on quite a few.
> Before you give up on medical treatment, there is hope for you in newer medications and newer combinations. I once found relief in a very new drug called Mirapex. Here are some more options that you may not have thought of:
>
> Nefazodone - great for sleep; no sexual dysfunction; no anticholinergics side-effects.
>
> Lamotrigine - good side-effect profile; most antidepressant properties
>
> Carbamazepine - less side effects than Lithium or divalproex sodium
>
> Topiramate - the newest mood-stabilizer; it promotes weight loss
>
> Desipramine - the least side-effects of all the Tricyclics; one of the SNRIs
>
> High-dose Venlafaxine - at higher doses Venlafaxine affects more chemicals than SSRIs.
>
> Buspirone - an effective antidepressant and anxiolytic at high doses.
>
> Dopamine Agonists - Pramipexole has two studies on it (I take it).
>
> "Power Combinations" - Remeron+Effexor; Wellbutrin+Remeron, RemeronProzac
>
> Augmentation of anything you have tried before with Lithium, Pindolol, or Buspar (i took pindolol
>
> Foreign medications to the US: the RIMA Moclobemide; Reboxetine; Amisulpride, etc
>
> Atypical Neuroleptics/Antipsychotics with antidepressant properties: Risperidone, Olanzapine, Seroquel
>
> Provigil - a stimulant that is possibly effective
>
> Irreversable MAOIs - Phenelzine, Tranylcypromine. Extremely Effective.
>
> MAOI-B - Selegiline, an antidepressant almost comparable to Phenelzine.
>
> I hope that gives you hope!
Posted by Pandora on March 2, 2001, at 22:47:42
In reply to Re: UKpdocs. » JahL, posted by NikkiT2 on March 2, 2001, at 16:50:11
Nikki - I've always wanted to visit the UK... scrape together airfare and you can visit me in Texas... then you can give me a place to stay in the UK! : )
Seriously, I didn't realize that mono-drug therapy was the only option there... usually I think of everywhere outside America to be more open to "novel" medical approaches.
Best of luck.
Posted by NikkiT2 on March 3, 2001, at 8:32:53
In reply to Re: UKpdocs. » NikkiT2, posted by JahL on March 2, 2001, at 17:20:00
Oh well!!! I kjnow there is also one in West London called The Castle, but thats only day center, and you can't get in there till you've been in hospital!!! Bloodly NHS!!
Nikkix
Posted by NikkiT2 on March 3, 2001, at 8:34:50
In reply to Re: UKpdocs. » NikkiT2, posted by Pandora on March 2, 2001, at 22:47:42
LOL - If you ever make it to London you're more than welcome to a futon in the lounge!! :o)
Well, if you go into hospitaln they will do combos, but apparently "they're too dangerous for an ordinary pdoc to try on an outpatient basis"...
Grrrrrrrrrrrr
Nikki x
ps - The UK is well behind in mental health issues - I am under threat of the sack from work as my illness (and sick leave) isn't justified as a real illness!!!!!!!!!!
Posted by Leonardo on March 4, 2001, at 7:58:22
In reply to Re: UKpdocs. » Pandora, posted by NikkiT2 on March 3, 2001, at 8:34:50
Hi Nikki
I'm in the UK nr London and have had 2 years of pretty poor service from the NHS. I *hope* I have finally found the correct diagnosis for myself, and found a specialist who will give me the right treatment. I did have to go private in the end, but his charges were not excessive.
I haven't seen your earlier posts to understand your symptoms, but in my case the depression is I think mostly caused by previously undiagnosed adult ADHD. Like you I am in dire straits at work and could be out of a job soon if I can't sort myself out.
FWIW I have tried various med combos myself, and although I did better on these than by following my previous Pdocs instructions, they were in no way a solution. I do believe now that the trick for most people is to find one med which gives you a pretty good response by itself, and add things if necessary. I think it is less likely that you will find a solution by mixing various meds which individually don't work.
I tried 6 antidepressants with little if any effect. I have now tried Ritalin and dexamphetamine, both of which had a very good initial effect. I'm going for dex now under the supervision of my new Pdoc.
Feel free to mail me if you want more info.
Good luck!
Leonardo
> LOL - If you ever make it to London you're more than welcome to a futon in the lounge!! :o)
>
> Well, if you go into hospitaln they will do combos, but apparently "they're too dangerous for an ordinary pdoc to try on an outpatient basis"...
>
> Grrrrrrrrrrrr
>
> Nikki x
>
> ps - The UK is well behind in mental health issues - I am under threat of the sack from work as my illness (and sick leave) isn't justified as a real illness!!!!!!!!!!
Posted by jb on March 10, 2001, at 1:28:17
In reply to Medications Combinations You May Not Know About, posted by SalArmy4me on March 2, 2001, at 9:12:59
Hi. Could you tell me at what dosage you found Selegiline comparable to Nardil. I currently take Nardil 60 mg/day. As you know, it is non-selective for MAO-A and MAO-B. Further, it is a hydrazine MAO, which gives it certain different actions on GABA. GABA seems to be the focus of newer meds, such as pregablin, a much stronger successor to gabapentin. It seems that Selegiline would have to be taken at higher dosages, such as 40 mg/day plus, to become significantly non-selective for MAO-A and MAO-B. Would appreciate more details about your experience of selegiline vs. Nardil.
Thanks a lot!
JB
This is the end of the thread.
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