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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by johnj on May 19, 2002, at 11:51:06
Hi Ron,
Is the sam-e still working well for you? I know your were thinking about 100 mg tablets and was wondering if you ever found a 100 mg tablet or divided a tablet? I tried to switch to another TCA, but any increase in meds hits me with a horrible batch of side effects so the cross-over is proving to be very tricky. I finally had to go back on my old dosage of tranzene(benzo) since the anxiety just became too great. Somewhat disappointing, but I am still thinking about a trial of sam-e since the switch to the TCA proved to difficult. I just don't know if it is something a person on benzo's should do or not? I don't know if sam-e would cause more anxiety or not, I would like to find something that would give me more energy, but not send me into overdrive. Finding something to help with the anxiety/depression has been extremely frustrating since I am so med sensitive. I hope Colin is fairing well in cyber jail. Take care and let me know how the sam-e is doing.
Johnj
Posted by Ron Hill on May 21, 2002, at 15:45:40
In reply to Ron Hill--How is the sam-e going?, posted by johnj on May 19, 2002, at 11:51:06
John,
Thanks for your post. Sorry that it has taken me a couple of days to get back to you.
> Is the sam-e still working well for you? I know your were thinking about 100 mg tablets and was wondering if you ever found a 100 mg tablet or divided a tablet?
John, as you recall, about six weeks ago I began to periodically experience an extremely irritable mood which flashed into episodes of rage. I felt sure that the foul mood was caused by one or more of the vitamins and/or supplements that I was taking and, therefore, I began the process of trying to identify the culprit.
The first thing I tried was to reduce my daily SAM-e dose from 200 mg to 100 mg. The irritability seemed to subside somewhat, but not a lot. However, I also began to feel depressed. So after three or four days at the lower dose, I resumed the 200 mg/day of SAM-e and I began removing a vitamin or supplement one-by-one from my daily dose matrix looking for the "bad egg(s)".
However, that process was taking too long and I was not willing to subject my wife to any further rage. Therefore, ten days ago, I pulled the plug and stopped all vitamins and supplements (including SAM-e). Of course, I continued taking my medication (600 mg/day Lithobid).
A day or so after I quit taking the vitamins and supplements I cycled into a very deep dark depression. No rage, but lots of depression. I think it was the discontinuation of the 200 mg/day of SAM-e that contributed most to the depression. I continued to abstain from all vitamins and supplements for the duration of the depressive episode which lasted four days.
In the five days that have elapsed since I came out of the depression, I have consistently felt great. No depression and no irritability. Each day I am slowly (and methodically) adding an appropriate amount of a particular vitamin, mineral or supplement (e.g. phosphatidyl serine, omega-3 PUFA's, myo-inositol, SAM-e, etc) to determine by trial and error what helps and what causes problems. As it currently stands, I plan to add SAM-e to the matrix last. This will likely occur in about two weeks.
If it turns out that SAM-e is the culprit that causes the irritability, then I am going to feel a little sheepish since I was such an outspoken advocate for the benefits of SAM-e. Further, if it is the SAM-e, I wonder why it worked great for six months before this irritability problem came about? Also, what's up with the fact that I seem to be doing great without the SAM-e now, whereas, six months ago it was essential to my mental health?
Here's one possible speculation: Years of various AD trials drained my body's SAM-e tank bone dry. By taking 200 mg/day of supplemental SAM-e, my tank was refueled over time. However, after about six months, my tank was completely filled to the brim and it began to overflow. The overflow caused irritability. When I quit SAM-e cold turkey I went into depression for a few days because my body had gotten accustom to being spoon fed the SAM-e as a dietary supplement and it took a couple days for my body to retrain itself to manufacture SAM-e and/or draw out of the tank. Of course, this word picture is all pure conjecture on my part and likely has little or no basis in fact.
I also wonder if the irritability is caused by low relative amounts of GABA compared to serotonin and dopamine. In other words, since SAM-e raises serotonin and dopamine, perhaps GABA becomes out of balance with SE and DA after an extended period of SAM-e supplementation.
>I tried to switch to another TCA, but any increase in meds hits me with a horrible batch of side effects so the cross-over is proving to be very tricky. I finally had to go back on my old dosage of tranzene(benzo) since the anxiety just became too great. Somewhat disappointing, but I am still thinking about a trial of sam-e since the switch to the TCA proved to difficult. I just don't know if it is something a person on benzo's should do or not?
I personally think that SAM-e would go well with a benzo. When I was going through my "irritable mood syndrome" adding a benzo was something I seriously considered. My rational goes back to the GABA imbalance conjecture discussed above. The benzo would have helped me by increasing the available GABA. I've never been on a benzo and I would rather not because of the difficulty associated with withdrawal. Therefore, instead of a benzo, I was considering either Neuronin or Gabtril (moodstablizers) to augment my Lithobid and elevate my GABA levels.
John, refresh my memory by posting your dx, a list of the meds you have tried and your reactions to them, and a list of your current meds. After I get the information, let's talk more regarding the efficacy of a SAM-e trial for you.
>I don't know if sam-e would cause more anxiety or not, I would like to find something that would give me more energy, but not send me into overdrive.
John, tell me what you mean by "overdrive". Do you mean worry and fear or do you mean hyperactivity or something else?
>Finding something to help with the anxiety/depression has been extremely frustrating since I am so med sensitive.
Define what you mean by "anxiety". Is it worry or fear or irritability or something else? Have you tried Serzone?
>I hope Colin is fairing well in cyber jail.
Me too! Hope he got the ball and glove that Beardy sent to him.
-- Ron
Posted by johnj on May 21, 2002, at 16:58:05
In reply to Re: SAM-e Status » johnj, posted by Ron Hill on May 21, 2002, at 15:45:40
Ron,
First I am sorry to hear you had a depressive episode, they are the worst of worst and I feel for you.
My dx consists of mainly depression, but what the docs have ignored is the anxiety/panic to my problem. My first treatment was needed after I experienced a few days, in 1992, of anxiety which consisted of worry, lack of concentration, jumpy, etc., basically read the diagnosis for anxiety disorder and it is me. After a few days of that I had a massive panic attack late one Sunday night and by Monday morning I couldn’t eat or barely function and I had this nagging panic/anxiety inside. I can admit it now, but I quickly became suicidal, had the fear I was just going crazy, became withdrawn, and even started to fear I might hurt somebody. Essentially, I became the exact opposite that I was before the attack. It was the strangest thing, it was as if my mind knew what would scare me the most. It was as if my flight or fight mechanism was turned on and there was no way to turn it off, that is where I believe my abnormal thoughts originated, sort of like I couldn’t run so I had to “fight” at some primitive level. I was living abroad so some of it was situational. I was losing my job, dating a great woman, whom I did marry, and was struggling with what to do in life(I still struggle with that!)
My current regime is
50 mg of nortryptline
600 mg of lithobid—booster for AD
7.5 mg of tranzene, and
3 days ago started to split another 7.5 mg of tranxene after lunch and late afternoon.The anxiety came back and I just wasn’t sleeping so I have returned to the benzo dose I was at about 2 years ago.
The strange thing is I quit remeron 2 weeks ago(too sponge-headed on it) and added 20 mg of imipramine which was GREAT for 5 days and then BOOM, anxiety. I wanted to quit the nortryptline and switch to imipramine because I believe the norty. is causing me problems when I work out(something Colin has had some experience with too). But, any higher dose of a TCA and side effects hit me hard. I didn’t sleep one wink last Thursday and sweated most of the night, but didn’t feel so bad mood wise just anxiety for no reason. However, since I added the extra 7.5 mg of tranzene I feel better, but not something to write home about yet.So the meds I have tried are:
Remeron—30 mg, then up to 45 and even more spaced out. When down to 15 and actually felt ok for a few weeks, but seemed to get more depressed as I lowered the dose.
Imipramine---not sure what I think of it yet. I wanted to put it in place of nort, but the doc wanted me stable on it before going down on nortryptline, but that won’t work.<Define what you mean by "anxiety". Is it worry or fear or irritability or something else? Have you tried Serzone?>
My anxiety can range from worry(mainly), to fear(ex, am I doing ok at work?, am I a good person?), and does have some irritability which I find the most annoying . Because I hate to bitch at the ones I love. But a lot of it is just baseless worry I guess, kind of hard to explain since I always thought that it was all one disorder and know I suspect my anxiety might be a major reason I get depressed. I had times as a youth where I became depressed, but they are all related to worry or anxiety (like being bullied at school). So, I wonder….treat the anxiety and does the depression factor fade?
Nope have not tried serzone, and I understand it does require some benzo dose adjustment so I don’t know if it is what I want right now or not.<John, tell me what you mean by "overdrive". Do you mean worry and fear or do you mean hyperactivity or something else?>
By overdrive I mean causing me to become too anxious and starting feelings of anxiety or worry. It is hard to explain and I am just starting to understand the different components to my illness.
I still want to try and did buy some sam-e. Not sure what to do right now. I want to learn more about anxiety/panic disorder and what supplements etc., may help that aspect. I don’t know if sam-e has any benefit to anxiety/panic???? From what I have read xanax has some AD benefits, and if it was longer lasting it might be a very excellent med for me. When I went off the 7.5 mg of tranzene 2 years ago I had some jumpy legs, but otherwise it wasn’t too bad. Need to go, talk to you soon Ron. Take care of yourself.
Johnj
Posted by Ron Hill on May 21, 2002, at 18:43:35
In reply to Re: SAM-e Status(Ron Hill), posted by johnj on May 21, 2002, at 16:58:05
John,
Why haven't you tried any of the SSRI's, Effexor, Welbutrin, etc?
Based on your description of your anxiety symptoms, I think an SSRI would help you tremendously. I can relate to your anxiety symptoms because at times I have similar (albeit less severe) symptoms of fear, worry, and self criticism. A serotonin medicine (SSRI) cures these symptoms for me. I'd still be taking an SSRI except that, for me, SSRI's kill my motivation and cause anhedonia. Have you tried SSRI's?
Also, let me know what you decide about the SAM-e trial. Please keep me posted.
-- Ron
Posted by johnj on May 21, 2002, at 22:28:41
In reply to Re: Why not try an SSRI? » johnj, posted by Ron Hill on May 21, 2002, at 18:43:35
Hi Ron,
Well, I have comtemplated an SSRI back and forth for years; however, my biggest fear is poop out from what I have read. Whether this is bunk or not, I hear that an ssri may damage seratonin receptors. I wish I had proof from a study that could tell me this isn't so. I guess I just have read too much and that causes me some anxiety(ha ha).
I have read some recent materail on benzo's from a couple of sites that Dr. Bob posted and found some info that related well to my situation. Also, it said ssri can sometimes cause panic in some people that never had it before. I just can't try it yet without some explanation of the poop out and the panic aspect. I am very intrigued by the new Celexa coming out,and it is supposed to work for a lot of my symptoms. But, right now I couldn't take a huge setback due to work and studying for an engineering exam. I barely am progressing now with my studies so a larger setback would be devastating. The benzo had worked for 5 to 6 years so I think I will go back for a while. I wish xanax made a extended release version. My original pdoc had trouble with poop out (40%) on ssri's and my new pdoc said 20 to 30 for him. That is jus too risky for me right now.
Please keep me informed of what vitamins and sam-e help/hurt your progress. I wonder if sam-e may be like ginseng in the sense you need a break every few weeks? I hope you can find the irritability culprit whithout too much trouble.I will see if things stablize by my next pdoc visit and then ask about the sam-e. The pdoc said he doesn't use it in his practice, but 2 out of his 100 patients are using it due to med sensitivity. So, at least he isn't against it. take care and may peace find us all.
Johnj
Posted by Ron Hill on May 22, 2002, at 19:38:27
In reply to Re: Why not try an SSRI(Ron Hill), posted by johnj on May 21, 2002, at 22:28:41
Hi John,
I don't want to take up too much of your time 'cause I know you have to study for your test (is it the EIT?). Therefore, I'll be brief.
> Well, I have comtemplated an SSRI back and forth for years; however, my biggest fear is poop out ...
I was not suggesting that you replace your benzo with an SSRI. What I had in mind was replacing the TCA with an SSRI (Zoloft in particular). I hear ya on the poop out. That's what SSRI's do to me. But many people have good success on SSRI's. Colin takes small doses of Zoloft, (speaking of which I hope those e-jail guards are giving him his meds on the correct schedule)!
Back in 1992 why did your pdoc start you on a TCA instead of an SSRI? If I were you (which I'm not, and I'm not a pdoc either), I'd ditch the TCA and add 25mg/day of Zoloft and 200 mg/day of SAM-e. From there you may have to increase one or both. And as long as I'm telling you my opinions, I've always had a feeling that you are bipolar. BEWARE: My feelings are often wrong.
Study well!
-- Ron
Posted by johnj on May 23, 2002, at 20:03:45
In reply to Re: Why not try an SSRI » johnj, posted by Ron Hill on May 22, 2002, at 19:38:27
Hey Ron:
<I don't want to take up too much of your time 'cause I know you have to study for your test (is it the EIT?). Therefore, I'll be brief.>
Yes, it is the EIT, and it has been a long time since I have taken some of the classes and it has been overwhelming to say the least. But,they do have an environmental engineering session in the afternoon now so I feel much better since that is what my masters degree is in. I just study when I can and feel like it. I really look forward to bouncing ideas off of each other so this board has been great for me, and I check it often when I am not out of the office, and I appreciate all the info you have provided.
<I was not suggesting that you replace your benzo with an SSRI. What I had in mind was replacing the TCA with an SSRI (Zoloft in particular). I hear ya on the poop out. That's what SSRI's do to me. But many people have good success on SSRI's. Colin takes small doses of Zoloft, (speaking of which I hope those e-jail guards are giving him his meds on the correct schedule)!>I understood what you meant about the benzo's and to tell you the truth I feel pretty decent since I upped my dose to the original dose I started back in 92. The anxiety has diminished significantly and I get some energy and motivation back. The sedation will take some time to get used to but that is the price.
<Back in 1992 why did your pdoc start you on a TCA instead of an SSRI? If I were you (which I'm not, and I'm not a pdoc either), I'd ditch the TCA and add 25mg/day of Zoloft and 200 mg/day of SAM-e. From there you may have to increase one or both. And as long as I'm telling you my opinions, I've always had a feeling that you are bipolar. BEWARE: My feelings are often wrong.>
I don't know why she started me on a TCA and at the time I had no clue about meds. Funny you say that about being bipolar I have OFTEN wondered about that. I know I wouldn't fit the "typical" bipolar, but it sounds like there are many different types and levels. Before I do anything else I am going to wait until that damn test is over(I might need a couple of additional benzo's for that!). My thought is to keep the benzo, lithium, and get off the TCA and add sam-e(I may even add some sam-e now just to test the waters). I will also increase my excercise as I do this in the hope this will be enough. This might be a pipe dream, but I will consult my doc when the time comes and see what he thinks. I am under the impression that anxiety plays a HUGE role in my illness, and maybe, just maybe if I can control that beast I can do other things to help myself(excercise). However, the ssri idea is still floating in my head. I do like most of what I have read about Celexa, and since they have a new version coming out I will watch it closely. Right now, I do feel better since I stopped the remeron. That stuff did some funky things to me and even the sleep it gave me isn't worth the sponge brain feeling I had.
<Study well!>
THANKS!!! take care Ron. Let me know how the vitamin adjustment is going.I was sorry to see Colin jailed....where are the internet lawyers when you need them? Maybe Dr.B will let him out early with good behavior. I might get slapped on the wrist for this, but the nature of this board is bound to be a little volatile at times due to our circumstances. Have a good one Ron.
Johnj
Posted by Ron Hill on May 24, 2002, at 9:25:03
In reply to Re: Why not try an SSRI, posted by johnj on May 23, 2002, at 20:03:45
Posted by disney4 on October 6, 2002, at 12:47:48
In reply to Re: SAM-e Status » johnj, posted by Ron Hill on May 21, 2002, at 15:45:40
Hi,
I am new to this board, and new to Sam-E. My Dr. wanted me to try it after a failed trial of almost all new AD meds due to side effects. I bought the Nature Made, and it is working. For depression the tosylate disulfate is the form used in the research. Many brands have come out with this form, and are considered pharmeceutical grade. The two I am considering are Jarrow, which are made in Italy, and states pharm. grade right on the package, and the Source Naturals, which don't, but I have heard they have passed the lab test. Jarrow probably has too, and I think they are a better name, but I'm not sure. Do you have any more info? Also the price is right for both brands.
Posted by katz on October 7, 2002, at 18:40:43
In reply to Re: SAM-e Status » Ron Hill, posted by disney4 on October 6, 2002, at 12:47:48
Hello Disney! Welcome to Babbleland! I am an occassional but infrequent poster here. I recently did a trial of SAM-e for depression, anhedonia and dysthymia. My results were atypical. Instead of giving me energy, the SAM-e made me extremely sleeply. Infact I was sleeping around the clock. I was taking 800 mg SAM-e RX ultra (with B vitamins included). Needless to say, I was very disappointed with the result. I would be interested to know if anyone else has had this experience.
I'm glad the SAM-e is working well for you. Wishing you continued success and good health,
Kathy
Posted by disney4 on October 8, 2002, at 6:59:43
In reply to Re: SAM-e Status » disney4, posted by katz on October 7, 2002, at 18:40:43
> Hello Disney! Welcome to Babbleland! I am an occassional but infrequent poster here. I recently did a trial of SAM-e for depression, anhedonia and dysthymia. My results were atypical. Instead of giving me energy, the SAM-e made me extremely sleeply. Infact I was sleeping around the clock. I was taking 800 mg SAM-e RX ultra (with B vitamins included). Needless to say, I was very disappointed with the result. I would be interested to know if anyone else has had this experience.
>
> I'm glad the SAM-e is working well for you. Wishing you continued success and good health,
>
> Kathy
I think the Sam-E is working, although I am very tired too. I had the same responce to Luvox, so this may mean i am having a good AD effect from the Sam-e. At this point I'm not really sure, but I have to stick with it, because I have so many side effects from script AD's. I have tried them all. I ordered the Source Naturals brand, and now am somewhat apprehensive about how it compares to the Nature Made. I have heard it passed the Consumer Labs test, and I noticed the active ingrediant is exactly the same form of Sam-e. It will save me a lot of money. I also ordered their B vitamins, in the form Ron Hill suggests.
This is the end of the thread.
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