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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by McPac on June 16, 2003, at 16:26:13
Do you think that if you were to lower your lithium to, say, only 300 mg/day...or even 300 mg/every other day....that your irritability would get much worse?
Does increasing your lithium also reduce irritability/anger for you?
Thanks!
Posted by Ron Hill on June 17, 2003, at 20:20:37
In reply to Ron, posted by McPac on June 16, 2003, at 16:26:13
Hi McPac,
> Do you think that if you were to lower your lithium to, say, only 300 mg/day...or even 300 mg/every other day....that your irritability would get much worse?
No. I would become hypomanic but I doubt that irritability would emerge.
> Does increasing your lithium also reduce irritability/anger for you?
No. In fact, there have been times when I thought Lithobid actually made my irritability worse. I'm not so sure that’s true, but lithium certainly does not treat my irritability. YMMV.
However, here is what does work for me. I use 125 mg doses twice or three times a day of niacin for my irritability. Reliable sources tell me that niacinamide is even better than niacin for irritability, so I plan to try niacinamide soon.
-- Ron
Posted by ace on June 18, 2003, at 0:26:27
In reply to Ron, posted by McPac on June 16, 2003, at 16:26:13
Posted by McPac on June 18, 2003, at 18:25:21
In reply to Mcpacster- how are you bro?! (nm) » McPac, posted by ace on June 18, 2003, at 0:26:27
Major dilemma for me dudes.......
Zoloft WORKS for my ocd BUT I get terrible anger FROM ZOLOFT (ssri's in general, it seems).....(I don't know for sure if I'm bipolar...but the Zoloft DOES definitely cause me terrible anger/irritability problems...I take lithium to counter the Zoloft anger effect....I would LOVE to find an anti-dep. that worked well for BOTH depression AND OCD......now, Zoloft DOES work well for both my depression and OCD BUT I get that terrible anger/irritability problem....right now I'm probably going to increase the Zoloft (feeling 'down' and obsessive somewhat) and therefore I am FORCED to increase the lithium as well (to counter the Zoloft-induced anger/irrit)...if I could just find a good anti-dep. that also worked for ocd (the ssri's give me the bad reaction that I mentioned, I don't want an anti-psychotic, the old tca's were okay for depression but not much for ocd.....I have NO choice but to increase my Zoloft and then increase the lithium to counter the Zoloft side effects! It's a terrible 'catch-22'/can't win situation....Ace, I could try the Nardil....but I'm always out and about, eating out, eating at friend's houses, at work, get-togethers, etc., and when I took Nardil I was always afraid of eating something wrong...I wouldn't eat much...I never like to even tell anybody about my problems at all...if I were on Nardil I would constantly have to watch what I ate and everywhere I went I'd be having to explain to everybody why I couldn't eat 'this or that' when they offered me something....it would be easier if I were always home but I'm always eating with somebody, somewhere and having to worry over everything I put in my mouth would drive me nuts....but I do remember Nardil very fondly though, worked well for my depression and I think it worked well for my ocd too(wasn't on it too long though, can't remember the ocd part as well)......anyway, that's my dilemma......take care!!!!
Posted by McPac on June 18, 2003, at 20:30:21
In reply to Mcpacster- how are you bro?! (nm) » McPac, posted by ace on June 18, 2003, at 0:26:27
Another poster sent me this info below....Ace, do you know about these "reverse maoi's"???
"You mention having fond memories about Nardil. I don't have the names of the meds at my fingertips, but I know there are reversible MAOIs out there. Think they're referred to as RIMAs. They allegedly have very similar effects, less side-effects including the food thing. There was one mentioned on this board a few times but not available in the States. I'll find my notes and get back to you".
Posted by McPac on June 18, 2003, at 22:49:10
In reply to Re: Bipolar Irritability » McPac, posted by Ron Hill on June 17, 2003, at 20:20:37
>>>>>>Do you think that if you were to lower your lithium to, say, only 300 mg/day...or even 300 mg/every other day....that your irritability would get much worse?
>>>>>>>>>>>No. I would become hypomanic but I doubt that irritability would emerge.
>>>>>>>>>I wonder if I'm the only person in the world 'trapped' on lithium---having to use it mainly to offset Zoloft-induced anger? Well, lithium is a mood stabilizer, and Zoloft definitely destabilizes my moods, so I guess it makes sense that the lithium could help counter the Zoloft anger?
I can't take the niacin, due to the Pfeiffer clinic reason that I told you about a couple of weeks ago.Psych meds suck....I'll take a Glock or Ruger instead
Posted by ace on June 19, 2003, at 1:19:41
In reply to Ron/Ace, Re: Mcpacster- how are you bro?!, posted by McPac on June 18, 2003, at 18:25:21
> Major dilemma for me dudes.......
> Zoloft WORKS for my ocd BUT I get terrible anger FROM ZOLOFT (ssri's in general, it seems).....(I don't know for sure if I'm bipolar...but the Zoloft DOES definitely cause me terrible anger/irritability problems...I take lithium to counter the Zoloft anger effect....I would LOVE to find an anti-dep. that worked well for BOTH depression AND OCD......now, Zoloft DOES work well for both my depression and OCD BUT I get that terrible anger/irritability problem....right now I'm probably going to increase the Zoloft (feeling 'down' and obsessive somewhat) and therefore I am FORCED to increase the lithium as well (to counter the Zoloft-induced anger/irrit)...if I could just find a good anti-dep. that also worked for ocd (the ssri's give me the bad reaction that I mentioned, I don't want an anti-psychotic, the old tca's were okay for depression but not much for ocd.....I have NO choice but to increase my Zoloft and then increase the lithium to counter the Zoloft side effects! It's a terrible 'catch-22'/can't win situation....Ace, I could try the Nardil....but I'm always out and about, eating out, eating at friend's houses, at work, get-togethers, etc., and when I took Nardil I was always afraid of eating something wrong...I wouldn't eat much...I never like to even tell anybody about my problems at all...if I were on Nardil I would constantly have to watch what I ate and everywhere I went I'd be having to explain to everybody why I couldn't eat 'this or that' when they offered me something....it would be easier if I were always home but I'm always eating with somebody, somewhere and having to worry over everything I put in my mouth would drive me nuts....but I do remember Nardil very fondly though, worked well for my depression and I think it worked well for my ocd too(wasn't on it too long though, can't remember the ocd part as well)......anyway, that's my dilemma......take care!!!!
Hey McPacter!,
Lets sort this out brother. OK, first you asked about the RIMA's - there is one that I know of called MOCLOBEMIDE (Aurorix). This MAOI is a 'newer' one. Now, I have heard this is used for OCD, depression, and anxiety. I've heard some very good anecdotes about it. Some people require higher doses as time goes on to maintain therapeutic efficacy but don't worry about for now. With Moclobemide the food restrictions are far less (I'm not even sure you have any).OK, something struck me on the head about your comments with Nardil. I think it maybe a manifestation of OCD - ie your worrying about the food. I could be wrong so call me a piece of dogfood if I am! But anyhow, with Nardil I had the same worry's before- but they were baseless. At the resturants I really believe you wouldn't have to frig around to much with menues - just avoid the cheese and soy sauce and a few others. I can say I do not notice AT ALL the food restrictions, although I don't eat out much (no $$!!!)
Here are some thoughts on meds
1. Augment Zoloft with Trazadone
2. Augment Zoloft with Anafranil low dose
3. Augment Zoloft with low dose benzo
4. Augement Zoloft with Buspar
5. Augment Zoloft with GabapentinTry... these replacements for Zoloft
1. Moclobemide
2. Tramadol
3. Trazadone
4. (the MIGHTY) Nardil
5. Parnateof course you can augment the above. ALL of these drugs I mention have shown efficacy in OCD and depression (Not sure of Gabapentin for depression but)
I think you might be better off finding a new 'main' drug and then considering augmentation if need be.
But it's no good what is happening- we don't want therapeutic response at the expense of you getting angry and irratable.
Tell us what you think brother!
Ace.
Posted by McPac on June 19, 2003, at 3:39:59
In reply to Re: Ron/Ace, Re: Mcpacster- how are you bro?! » McPac, posted by ace on June 19, 2003, at 1:19:41
Hey McPacter!
>>>>>>>Hi Ace!
Lets sort this out brother. OK, first you asked about the RIMA's - there is one that I know of called MOCLOBEMIDE (Aurorix).
>>>>>Ace, I don't think it's approved in the U.S.?
This MAOI is a 'newer' one. Now, I have heard this is used for OCD, depression, and anxiety. I've heard some very good anecdotes about it. Some people require higher doses as time goes on to maintain therapeutic efficacy but don't worry about for now. With Moclobemide the food restrictions are far less (I'm not even sure you have any).
>>>>>>>>>I don't think there are any food restrictions for the "Moc".
OK, something struck me on the head about your comments with Nardil. I think it maybe a manifestation of OCD - ie your worrying about the food. I could be wrong so call me a piece of dogfood if I am!
>>>>>>>Ace, EXCELLENT observation on your part brother...EXCELLENT (in fact, I wondered if somebody might think that!)....but the answer is No, it's not an ocd thing. I just eat out so much---at work, with friends, restaurants, wherever---that I would always be faced with foods that I wouldn't know how I'd react to....and as for food, I'll eat just about anything without hesitation...I like to grub, lol....the RIMA's (like "Moc") would solve that problem (no food restrictions)...but I don't think it's US approved (typical---keep the good drugs out to protect the crummy ssri monopoly, lol)
But anyhow, with Nardil I had the same worry's before- but they were baseless. At the resturants I really believe you wouldn't have to frig around to much with menues - just avoid the cheese and soy sauce and a few others. I can say I do not notice AT ALL the food restrictions, although I don't eat out much (no $$!!!)
Here are some thoughts on meds
1. Augment Zoloft with Trazadone
2. Augment Zoloft with Anafranil low dose
3. Augment Zoloft with low dose benzo
4. Augement Zoloft with Buspar>>>>>Ace, I have read that Buspar is added to SSRI therapy for people that can't tolerate the ssri-induced anger/irrit. problem but I've never read anybody here mention that....don't really know if it is effective for that
5. Augment Zoloft with GabapentinTry... these replacements for Zoloft
>>>>>>>I'd love to find a replacement but it's got to work for both depression AND ocd...without the anger effect...
1. Moclobemide>>>>>>>>>>I think that's the one I'd like to try! (Again though---no FDA approval in U.S.? Gee, that blows.
2. Tramadol>>>>>>>>I'll have to read up on that one Ace.
3. Trazadone>>>>>>>>>>>>Ditto! (have to read up on it)
4. (the MIGHTY) Nardil>>>>>>>>>Nardil IS awesome! (I don't remember exactly how effective it was for me for ocd...I wasn't on it too long....but I ALWAYS remembered it VERY favorably.
5. Parnate
of course you can augment the above. ALL of these drugs I mention have shown efficacy in OCD and depression (Not sure of Gabapentin for depression but)
I think you might be better off finding a new 'main' drug and then considering augmentation if need be.
>>>>>>>>>>>>You may be right Ace...I've LONG thought this but the Zoloft works so well for my ocd and depression; but I HATE the side effects....these ssri's INDUCE anger/irrit. in me and I know that I'd be better off without THAT effect! But the ocd always screws alternative choices up---there are tons of anti-dep's BUT finding one that works great for depression and OCD significantly reduces the choices!
But it's no good what is happening- we don't want therapeutic response at the expense of you getting angry and irratable.
>>>>>>>>I agree....there's got to be a better way
Tell us what you think brother!
>>>>>>>>>>I'd like to try something like Moclobemide (or Reboxetine--NOT approved here either! what a joke!)......that sounds good...but no FDA approval.........I'll have to read about Tramadol and Trazadone (just no anger effect, please!) I am NOT angry/irritable by nature...this is drug-induced and it bites the giant one!......Take care Ace!
Posted by McPac on June 19, 2003, at 12:02:20
In reply to Re: Ron/Ace, Re: Mcpacster- how are you bro?! » McPac, posted by ace on June 19, 2003, at 1:19:41
"Try... these replacements for Zoloft
1. Moclobemide
2. Tramadol
3. Trazadone
4. (the MIGHTY) Nardil
5. Parnate">>>>>>>>> Ace, "Moc" looks the BEST for depression but I read that it increases Norepinephrine...isn't that bad for most OCD'ers (read that most ocd'ers have too high of NE levels)....not approved anyway in US......As for Trazadone(Desyryl)(I knew it by the Desyryl name)---took it years ago (it was way too weak for me, did nothing) As for Tramadol, it says on-line it is a "pain" med...for pain relief?.....A reverse MAOI sounds VERY good to me (like Nardil without the food restriction!) but I don't know about "Moc" and the norepinephrine thing.......tons of anti-dep's out there but great ocd meds seem very hard to come by....you know how all ssri's can pretty much work well for ocd (for most folks, ssri's (and Anafranil which has SRI properties too) are the first-line anti-ocd defense; the serotonin thing is always implicated in ocd and that's what has worked for me), anyway, I'm just wondering if it will turn out that a LOT of anti-dep's, regardless of their mechanisms of action, will work for ocd IF they work for depression too...in other words, once the depression goes the ocd will leave with the depression....or does the med have to have the serotonin-effect??? I know that the only meds that worked well for my ocd all had the effect on serotonin (even Nardil affects serotonin, just via a different mechanism, right?)....oh well, still searching for Zoloft replacement (and NOT finding it easy at all)...Take care brother!!!!
Posted by McPac on June 19, 2003, at 14:10:44
In reply to Ace, Re: Mcpacster- how are you bro?!, posted by McPac on June 19, 2003, at 12:02:20
Looked again just now at this list:
"Try... these replacements for Zoloft
1. Moclobemide
2. Tramadol
3. Trazadone
4. (the MIGHTY) Nardil
5. Parnate">>>>>>>>> #1 not fda approved here (may not work for ocd anyway)
#2 pain reliever??
#3 Desyryl, was very weak and ineffective for me
#4 food crappola (somebody was just telling me that a place that I go to w/ family a lot makes their spaghetti sauce with cheese melted IN the sauce...you'd be thinking, "well, I can eat this, I just won't put cheese on it" but it's cooked in the sauce so you'd never even know it was there....wayyyyyyy too many hidden food products out there, believe me, I'd be the unlucky sap that would need to be rushed to the hospital for eating something wrong and I just couldn't stand having to wonder every time I wanted to eat anything if I'd have a bad reaction, that would drive me nuts (again, I'll eat anything now, no problem, but if I were on an maoi THEN I couldn't stand wondering if I'd get that reaction). I think I have no choice but to stick with Zoloft and see if I increase the lithium if that will counter the anger (it seems to counter most of it)....ocd ruins everything....tons of AD choices for depression 'alone' but not a lot of good ones at all really for ocd....take care Ace! I'm rambling, lol, and got to go!
This is the end of the thread.
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