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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by btnd on January 28, 2003, at 12:55:49
n/t
Posted by sl on January 28, 2003, at 23:57:50
In reply to Is Wellbutrin effective for dysthymia?, posted by btnd on January 28, 2003, at 12:55:49
Sure.
Dysthymia, as I understand it, is a constant low-grade depression. So, since Wb is prescribed for depression, it's definitely an option for dysthymia. :)sl
Posted by JohnL on January 29, 2003, at 4:08:55
In reply to Is Wellbutrin effective for dysthymia?, posted by btnd on January 28, 2003, at 12:55:49
Dysthymia is often unresponsive to serotonin meds. It's just my opinion from observations over the years, but I believe dysthymia is actually a stand-alone condition that should be treated differently than major depression. It looks a lot like depression, but is uniquely different at the same time. It actually looks more like the negative symptoms of schizophrenia than it does major depression. Dysthymia tends to be a reward deficiency syndrome, which is usually not directly related to serotonin, but instead related to dopamine D2 receptors.
In my opinion, what makes dysthymia different from depression is that it involves an irregularity in the dopamine/norepinephrine system. It doesn't usually directly involve the serotonin circuitry.
For example, someone with dysthymia who takes an SSRI may likely complain of emotions being dulled even more than they were to begin with.
Dopamine meds seem better for dysthymia. That being said, Wellbutrin doesn't seem to do a very good job. Its dopamine action is either too weak or in the wrong area of the brain. And often a good response fades to non-response with Wellbutrin.
Natural things to consider for dysthymia: SAMe and/or Rhodiola Rosea (4% Rosavin minimum).
Meds to consider, in no particular order: Zyprexa, Desipramine, stimulants, Adrafinil, Mirapex, or any meds that work on dopamine and/or norepinephrine primarily.
I hate to be in a position where I told you so. But if you go the antidepressant/mood stabilizer route for dysthymia, you will likely be disappointed and waste years of your life. Again though, just observations.
JohnL
Posted by Hattree on January 29, 2003, at 9:12:49
In reply to Re: Is Wellbutrin effective for dysthymia?, posted by JohnL on January 29, 2003, at 4:08:55
Intriguing theory. I've been called dysthymic and/or ADD, and like you have not found SSRIs especially helpful (other than a spot of Zoloft in combination with Lamictal). On three occasions I have tried Wellbutrin, and on each I have become radically depressed within hours of taking the first pill.
Stimulants make me feel great until they don't.
I tried Imiprimine with indifferent results...why Desiprimine and not Imip?
Posted by btnd on January 29, 2003, at 9:51:41
In reply to Re: Is Wellbutrin effective for dysthymia?, posted by JohnL on January 29, 2003, at 4:08:55
> Dysthymia is often unresponsive to serotonin meds. It's just my opinion from observations over the years, but I believe dysthymia is actually a stand-alone condition that should be treated differently than major depression. It looks a lot like depression, but is uniquely different at the same time. It actually looks more like the negative symptoms of schizophrenia than it does major depression. Dysthymia tends to be a reward deficiency syndrome, which is usually not directly related to serotonin, but instead related to dopamine D2 receptors.
>
> In my opinion, what makes dysthymia different from depression is that it involves an irregularity in the dopamine/norepinephrine system. It doesn't usually directly involve the serotonin circuitry.
Well, the thing is I discovered that I have this condition (dysthymia) by using Adderall which relieved ALL of my dysthymic symptoms. After lots of reading through studies I've come to the conclusion that my problem is dopamine related. I agree with your post totally, but I'm trying to find some substitute for Adderall, so I could switch back and forth treatments, and not develop tolerance to any. I've read studies that Amisulpride is a D2/D3 antagonist, is prescribed for schizophrenics and actually works for dysthymia. So maybe this would be a good choice?The study is:
http://www.biopsychiatry.com/dystreat.htm
Posted by JohnL on January 29, 2003, at 17:59:09
In reply to Re: Is Wellbutrin effective for dysthymia? » JohnL, posted by Hattree on January 29, 2003, at 9:12:49
> Intriguing theory. I've been called dysthymic and/or ADD, and like you have not found SSRIs especially helpful (other than a spot of Zoloft in combination with Lamictal). On three occasions I have tried Wellbutrin, and on each I have become radically depressed within hours of taking the first pill.
> Stimulants make me feel great until they don't.
> I tried Imiprimine with indifferent results...why Desiprimine and not Imip?Desipramine because it generally has lesser side effects than its parent, and has more direct action on norepinephrine and d2 rather than serotonin.
Posted by JohnL on January 29, 2003, at 18:03:35
In reply to Re: Is Wellbutrin effective for dysthymia?, posted by btnd on January 29, 2003, at 9:51:41
> > Dysthymia is often unresponsive to serotonin meds. It's just my opinion from observations over the years, but I believe dysthymia is actually a stand-alone condition that should be treated differently than major depression. It looks a lot like depression, but is uniquely different at the same time. It actually looks more like the negative symptoms of schizophrenia than it does major depression. Dysthymia tends to be a reward deficiency syndrome, which is usually not directly related to serotonin, but instead related to dopamine D2 receptors.
> >
> > In my opinion, what makes dysthymia different from depression is that it involves an irregularity in the dopamine/norepinephrine system. It doesn't usually directly involve the serotonin circuitry.
>
>
> Well, the thing is I discovered that I have this condition (dysthymia) by using Adderall which relieved ALL of my dysthymic symptoms. After lots of reading through studies I've come to the conclusion that my problem is dopamine related. I agree with your post totally, but I'm trying to find some substitute for Adderall, so I could switch back and forth treatments, and not develop tolerance to any. I've read studies that Amisulpride is a D2/D3 antagonist, is prescribed for schizophrenics and actually works for dysthymia. So maybe this would be a good choice?
>
> The study is:
> http://www.biopsychiatry.com/dystreat.htm
>
I have tried Amisulpride a bunch of times and it is fabulous each time. It works in about two days, for me. The only side effect is that impotence sets in about day 4 or 5 and then I have to stop. Actually combined with Prozac it is really turbocharged. But yeah, Amisulpride is definitely a hot contender for your symptoms.
Posted by eris-24 on January 30, 2003, at 8:17:28
In reply to Re: Is Wellbutrin effective for dysthymia?, posted by JohnL on January 29, 2003, at 4:08:55
JohnL - I used a search engine to look up Rhodiola Rosea, because I've never heard of it before. I can't find any supplements that contain 4%+ Rosavin; they all contain 0.8%. Can you tell us where you get yours? Or is taking five times the recommended dosage equivalent?
SAMe is prohibitively expensive, but here's some helpful info I found on the net:
"Fortunately, there is a simple, inexpensive way to stimulate the body to make SAMe on its own: a combination of three old fashioned vitamins (folic acid, vitamin B12 and Vitamin B6) together with Betaine TMG [500-1,500 mg daily], another nutritional supplement."
Hope this will help someone.
eris
Posted by chad_3 on January 30, 2003, at 12:30:00
In reply to Re: Is Wellbutrin effective for dysthymia?, posted by JohnL on January 29, 2003, at 18:03:35
Bob (MD) -
You ban people for a curse word or being "insensitive" - your board - your call - very cool.
But I am quite offended (actually "disgusted" is more accurate) that insist to leave free cavalier posts like that below, which recommend neuroleptics for anxiety.
There is no way I could have respect for your decisions on this board.
Please ban me Bob. Let me say the word "fuck" just to be sure that I meet qualifications for being banned.
Thanks.
Chad
http://www.socialfear.com/>
>
> I have tried Amisulpride a bunch of times and it is fabulous each time. It works in about two days, for me. The only side effect is that impotence sets in about day 4 or 5 and then I have to stop. Actually combined with Prozac it is really turbocharged. But yeah, Amisulpride is definitely a hot contender for your symptoms.
>
>
>
Posted by JohnL on January 30, 2003, at 15:07:00
In reply to Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by chad_3 on January 30, 2003, at 12:30:00
Sorry Chad, they were only, as you said, suggestions. I think you then have to take any suggestion or idea to your doctor, right?
As for neuroleptics, there are a half dozen or so newer atypical neuropleptics that are proving to be good at a wide variety of psychiatric symptoms. They are often prayers answered to those patients who have been determined to just try antidepressants or mood stabilizers, and who suffered for too many years or decades. The old neuroleptics had bigtime risks and side effects. The newer ones are safer. There is always a risk/benefit trade off. But for a good many people, both here and out in the world, the newer atypicals have been providing benefits outweighing the risks.
Rest easy, tons of GPs and Pdocs are getting good results with the new neuroleptics.
They're all just names anyway. :-)
Whatever you do, check with your doc first.
Posted by Dr. Bob on January 31, 2003, at 1:31:27
In reply to Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by chad_3 on January 30, 2003, at 12:30:00
> cavalier posts like that below
Please don't post anything that could lead others to feel accused or put down. The last time you were blocked, it was for 1 week, so this time, it's for 2.
Bob
PS: Follow-ups regarding posting policies, and complaints about posts, should be redirected to Psycho-Babble Administration, thanks.
Posted by missinglynxx on January 31, 2003, at 7:45:06
In reply to Re: Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by JohnL on January 30, 2003, at 15:07:00
> Sorry Chad, they were only, as you said, suggestions. I think you then have to take any suggestion or idea to your doctor, right?
>
> As for neuroleptics, there are a half dozen or so newer atypical neuropleptics that are proving to be good at a wide variety of psychiatric symptoms. They are often prayers answered to those patients who have been determined to just try antidepressants or mood stabilizers, and who suffered for too many years or decades. The old neuroleptics had bigtime risks and side effects. The newer ones are safer. There is always a risk/benefit trade off. But for a good many people, both here and out in the world, the newer atypicals have been providing benefits outweighing the risks.
>
> Rest easy, tons of GPs and Pdocs are getting good results with the new neuroleptics.
>
> They're all just names anyway. :-)
>
> Whatever you do, check with your doc first.Very Cool ideas,, JohnL... very well said. And Abilify claims to have a "new Generation" Antipsychotic.. That works for me, the more choices the merrier!! Stay WELL, John
Posted by oracle on January 31, 2003, at 10:32:49
In reply to Re: Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by JohnL on January 30, 2003, at 15:07:00
I think many discount the risk of permanent
neurological disfunction with the new AP's.
Only time will tell, and witht the new drugs
time is something we do not have. So waxing on and
one about their saftey is, to be, just wishful thinking. TD and EPS develop over many years and take many years to show themselves.Few here have seen TD and EPS caused by AP. I have. It is disabling by itself.
However, tese drugs do help some where nothing else will work and in psychotic conditions are the treatment of choice.
Chastizing De Bob for "allowing" these posts is just trying to impose someones specific views on the group.
Posted by Eddie Sylvano on January 31, 2003, at 14:09:02
In reply to Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by chad_3 on January 30, 2003, at 12:30:00
> But I am quite offended (actually "disgusted" is more accurate) that insist to leave free cavalier posts like that below, which recommend neuroleptics for anxiety.
-----------------Whoa... what's the deal? That's the whole point of this board, as far as I can see. People discussing their problems, successes, and questions about medications. Neuroleptics, stimulants, sedatives, antidepressants, anxiolytics... you name it.
Dr. Bob isn't endorsing anyone's suggestions, he merely provides a forum for a relatively small and fragmented audience that would otherwise have no such outlet. If people recommend medications that you disagree with, consider that
1)Just because User A suggests everyone try drug X doesn't mean that anyone can. Physicians are still the required gateway to pharmaceuticals.
2)You can't protect people from themselves anyways. Bad advice comes from all directions, and it's up to the individual to ignore or consider such advice.
3)The people on this board are typically suffering to some extent. They do not (assumedly) take drugs for recreation, but to enable them to live their lives. While it is true that many medications harbor side effects and potentially hazardous complications, these people have deemed such limitations an acceptable cost of addressing a greater disability.
4)The open nature of the forum allows bad advice to be criticized (as you have demonstrated), so that more than one opinion is available.The alternative, as I see it, is to close the forum, or professionally moderate it (which would be infeasible, as it might represent professional medical advice or opinion). FOr that matter, many of the beneficial uses for FDA approved medications aren't endorsed by the FDA, so medically legal moderation would make this board no more than a patchwork of clinical practice guidelines that could be found anywhere. If there were a better way to run this, I'm sure Dr. Bob would be open to suggestions.
To clarify, I'm not criticizing your concern. Permanent damage can be done by neuroleptics, so one should obviously study their profiles thoroughly before pursuing them. I just wanted to illustrate the limitations and benefits of Internet forums.
Posted by windowlight on September 16, 2003, at 9:08:48
In reply to Re: Dr. Bob why do you ALLOW neuroleptic suggestions?, posted by JohnL on January 30, 2003, at 15:07:00
Hi,
I read your post about hair loss and Rhodiola..wondered if you could tell me about your Great discovery. I'm Hypothyroid, and the disease And the meds. are killing my hair!
Thanks!
windowlight
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