![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by platinumbride on July 9, 2004, at 1:41:35
I am really at a loss as to where my medication can go now. The last real relief I had was celexa and lamictal two years ago. Pooped out.
I got good results for a while from zoloft, and once from paxil, but after a lot of extra weight from all these, they pooped.
I am BPII, so we concentrated on finding the right mood stablizer. After topamax, trilpetal and lamictal.....I come up with a zero.
Lexapro was a joke, but I thank it for at least another 20 lbs.
Remeron - same deal, just gained more weight from it.
My forray into the world of maoi was a low dose selegiline. It got my blood pressure up and made me a chronic insomniac, but i guess the blood pressure thing makes all maois a no go (fine, my doc won't prescribe parnate anyway)
Wellburtin seemed to be similar: while I had the insomnia and anxiety, I got some energy. When those SEs abated, I was left with little but a pill that took away my desire to chain smoke.
Tricyclics are out of the question, it seems, because I am 100 lbs over weight now.......
So...what is a girl to do?
Because I am having some issues with my menstrual cycle, my pdoc doesn't want to try more stuff, lest they mask any true hormonal issues. OK....I can wait...
But really, what am I waiting for?
I toy with trying effexxor again, but if it didnt work the first 6 week trial, why would it work now?
Same is true of prozac.......but I only did that for 3 weeks...couldn't afford to up the dosages.
Zonegran seems to be the next possible MS, but I had n o luck with topamax, so why should this work? Lithium scares me, and depakote is out of the question. Apparently it can also wreak havoc with the menstrual cycle.
So I just put band aids on things. I take neurontin and klonopin for the anxiety that comes from knowing that if there is not more to life than all this, it is really not worth living. Then I smoke pot to make it all even better for the moment.....
This is no life.
But I really want to get better.
So I am asking if there are options I am missing, and if someone can help.My pdoc just pulls suggestions out of a hat, and is very anti-effexxor. He is inclined to put me on a high dose of zoloft (the drug I was taking when I tried to commit suicide!!! ) (Not blaming the drug, but why would another 100 mgs help????)
Please share experiences and such.........
It is looking so very bleak to me......I spend more time than I care to trying to end my life and make it look like an accident. Surely I was put on this earth to do more than just that.Thanks,
D
Posted by DanielJ on July 9, 2004, at 7:16:58
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Sometimes when you reach the "end of the rope", well, just start again at the other end. AD's like Zoloft etc. aren't that bad as far as side effects. Once it has been out of your system for a while it should work again. Weight gain goes with a lot of these drugs. It just is going to require a lot of discipline and maybe excercise too. Sounds like a pain in the butt but I think doing that with a positive approach can really work. There is no perfect med or combo of meds so pick the one or ones that you can live with and just keep on goin'.
Posted by SLS on July 9, 2004, at 8:02:41
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
> This is no life.
> But I really want to get better.
My initial reaction to your post is one of frustration. I don't think your doctor is aggressive enough to get you well. I don't think he wants it bad enough. Do you? You gotta want it bad enough to endure discomfort and inconvenience.
Tricyclics are out of the question? Because of weight? Who's determination was this - your's or your doctor's?
How high was your blood pressure with selegiline? Who told you that getting high blood pressure from selegiline indicates that you would get high blood pressure from Nardil? What did you do to treat the insomnia? Insomnia has always been a good sign for me that the treatment would be effective. The only time I ever got well, I was treated with a combination of Parnate + desipramine. I couldn't sleep for a single minute over the course of two weeks. So we treated the insomnia as aggressively as we treated the depression. I ended up taking two sleeping medications.
How high did you go with Effexor? Did you try adding either Wellbutrin or Remeron to it? What combinations of antidepressants have you tried? How high did you go with Lamictal?
Have you played with lithium or thyroid along the way?
What dosage of Zoloft did your doctor want to raise you to? If you haven't tried 200mg, you haven't really tried it. If you haven't tried 300mg of Effexor, you really haven't tried it. What does your doctor have against Effexor, by the way? He won't prescribe Parnate? Go see someone else.
I think you need to get a handle on the weight issue. I don't think you can afford to allow it to prevent you from attaining remission from depression. I don't think you can afford to exclude all of the tricyclics.
There are a zillion things you can do. Where do you want to start? How far are you willing to go? How aggressive are you willing to be?
I got pissed off reading your post. You should get pissed off at the limitations your doctor places on your chances of getting well.
- Scott
Posted by DanielJ on July 9, 2004, at 9:28:51
In reply to Re: end of rope » platinumbride, posted by SLS on July 9, 2004, at 8:02:41
I think everyone could help more if we knew your initial diagnosis. I'll give an example of what not to do first. At 15yrs old his P Dr suspected my son was ADD and ADHD.(we had already described symptoms of schizophrenia to him also) He put my son on Abilify and Lexapro. On these 2 not only did he not sleep much, now he didn't sleep at all. He left home and wandered the neighborhood at night several times causing us to have to go find him at 3:00 am etc. The next visit both my son and us nixed the Abilify and Lexapro so he started my son on Zyprexa. Lo and behold he could sleep again and things improved a bit. He still was edgy and frustrated though and his anger and frustration seethed beneath the surface, and his Dr started him on klonopin to ease that condition. Relief was only temporary though and he ended up in a crisis center where they replaced his Klonopin with Zoloft and gradually increased his Zyprexa to 20mg from 10mg. When he came home in 2 weeks he was better but still wrapped a little tight. A month later the Dr upped his Zoloft from 50 mg to 100 mg. In a couple of days he was doing goofy stuff like lying down in the front yard and acting almost drunk for about 3 weeks until I chopped the end off 1 of his 100mg Zolofts making it about 75mg.
from then on things improved and in 2 months he was back in the larger high school he once swore he would never go to. He has gained weight but seems stable and happy now.
It took my wifes and my own unflinching determination to get him where he is now. Sometimes going with our own ideas above the Dr.'s and telling the Dr. what was really going on. Disagreeing with him when we thought he was wrong too! But.. we still have the same Dr. and we are not going to give him the boot either.
You have to formulate a plan and go from there. If you need to change Dr's, do it and get a fresh diagnosis. About the meds, remember the drugs themselves don't usually cause the weight gain, they increase the appetite and also can cause a ho hum attitude toward excercise and activity. Start with a daily walk to get you going on an activity program. A mile will do for starters. Do something fun too. Evaluate yourself one day at a time to monitor your progress. Improvements sometimes come slowly, but they do come. Good Luck and God Bless!
Posted by platinumbride on July 9, 2004, at 10:01:12
In reply to Re: end of rope » platinumbride, posted by SLS on July 9, 2004, at 8:02:41
Dear Scott,
Thank you......you gave me some things to think about, really. I have appreciated your posts many times.....
Diane
Diane
Posted by Sad Panda on July 9, 2004, at 10:27:23
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Hi D,
Do you get hypomania much?
I wouldn't exclude the TCA's, they are many & varied. Nortriptyline or Clomipamine would be my pick from the collection. I wouldn't exclude Depakote, I think it's safer & more reliable than Lamictal. Also, the MAOI Nardil nearly always lowers bloodpressure.
Cheers,
Panda.
Posted by Laree on July 9, 2004, at 11:21:42
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Have you thought about going back on Celexa (worked wonders for me, too) & Lamictal? How long have you been off of that combo for? If it's been months/years, you might want to see if it would work having lost tolerance again for them...
This happened to me with Lexapro; it worked wonders for me & then pooped out 2 different times at 20 mg. I've cycled through w/Zoloft a few times & it was good (@50 mg.), but last time I actually felt it made my depression worse (@100 mg.)! I know it isn't recommended but I didn't take it one day to see how I felt--and I felt SO MUCH BETTER! So I asked my pdoc if we could switch to something else; I was put on Wellbutrin (per my request), but I had a very hard time coping last winter with that as my only anti-depressant. Turns out I really DO need an SSRI for my seasonal affective disorder, so the WB was a mistake! Finally the depression got so bad that I asked to give Lexapro another go since it had been the most successful agent ever in aiding my SAD (which I have had since childhood).
There have been times in which my pdoc will suggest upping the dosage to an Rx that doesn't seem to be ellicitng good/much (initial) results; I suppose this is logical from their standpoints--but if you're sure on yours & you know that the drug just does not agree with you, I have found staying firm, listening to your body/mind and any negative messages it's receiving from the drug, and being honest & direct (w/your pdoc) has worked for me. The way I look at it is this: If I feel anxious and still depressed on a certain dose of an Rx, side effects will probably only get worse with an increased dosage.
Please, listen to yourself (while respecting your pdocs judgement, of course)!
Hang in there!!
Best,
L.
> I am really at a loss as to where my medication can go now. The last real relief I had was celexa and lamictal two years ago. Pooped out.
>
> I got good results for a while from zoloft, and once from paxil, but after a lot of extra weight from all these, they pooped.
>
> I am BPII, so we concentrated on finding the right mood stablizer. After topamax, trilpetal and lamictal.....I come up with a zero.
>
> Lexapro was a joke, but I thank it for at least another 20 lbs.
>
> Remeron - same deal, just gained more weight from it.
>
> My forray into the world of maoi was a low dose selegiline. It got my blood pressure up and made me a chronic insomniac, but i guess the blood pressure thing makes all maois a no go (fine, my doc won't prescribe parnate anyway)
>
> Wellburtin seemed to be similar: while I had the insomnia and anxiety, I got some energy. When those SEs abated, I was left with little but a pill that took away my desire to chain smoke.
>
> Tricyclics are out of the question, it seems, because I am 100 lbs over weight now.......
>
> So...what is a girl to do?
>
> Because I am having some issues with my menstrual cycle, my pdoc doesn't want to try more stuff, lest they mask any true hormonal issues. OK....I can wait...
>
> But really, what am I waiting for?
>
> I toy with trying effexxor again, but if it didnt work the first 6 week trial, why would it work now?
>
> Same is true of prozac.......but I only did that for 3 weeks...couldn't afford to up the dosages.
>
> Zonegran seems to be the next possible MS, but I had n o luck with topamax, so why should this work? Lithium scares me, and depakote is out of the question. Apparently it can also wreak havoc with the menstrual cycle.
>
> So I just put band aids on things. I take neurontin and klonopin for the anxiety that comes from knowing that if there is not more to life than all this, it is really not worth living. Then I smoke pot to make it all even better for the moment.....
>
> This is no life.
>
> But I really want to get better.
> So I am asking if there are options I am missing, and if someone can help.
>
> My pdoc just pulls suggestions out of a hat, and is very anti-effexxor. He is inclined to put me on a high dose of zoloft (the drug I was taking when I tried to commit suicide!!! ) (Not blaming the drug, but why would another 100 mgs help????)
>
> Please share experiences and such.........
> It is looking so very bleak to me......I spend more time than I care to trying to end my life and make it look like an accident. Surely I was put on this earth to do more than just that.
>
> Thanks,
>
> D
Posted by sooshi on July 9, 2004, at 12:11:19
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Hi Diane,
I know exactly what you are feeling, and you are not alone...many of us have been where you are, and there IS hope.
I think Scott's post said it best...there are LOT's of other options out there that your pdoc has NOT tried, OK?
About Zonegran, the drug I am currently taking: I would say the ONLY thing it has in common with Topamax is weight loss! Other than that, they are like night and day!! I had HORRID side effects with Topamax, and got little to no benefit from it. The ONLY side effect I got from Zonegran was sleepiness when I first started it! But it has been the only MS I have ever been able to tolerate, and it has had excellent anti-depressive properties for me. I don't know whether it would work for you or not, but I just wanted to clarify this for you...Topa and Zonegran are NOT the same drug!
Whatever you decide, good luck to you, and keep us posted,
Sooshi
Posted by Racer on July 9, 2004, at 14:55:03
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
Hey, darling star, I'm fully behind Scott in saying that your pdoc really doesn't seem to have a lot of motivation towards getting you well in a timely manner. Here are a few things that struck me about your post, and I'll end with an example of something that worked for me in dealing with doctors.
1. Sometimes when a med poops out, a vacation from it can restore its potency for you. In fact, I read recently that that's actually what's prescribed for MAOI poop-out -- a week off, then go back on it. Seems to work for many people. The mixed news about it all is that SSRIs and other newer ADs seem to have more of a problem with poop-out. The TCAs and MAOIs seem to be more stable in that regard.
2. As someone already said, Nardil is known for reducing blood pressure. The hypertensive crisis is the Big Deal side effect, so a lot of doctors kind of gloss over the hyPOtensive effects, or even forget that they exist, so all MAOIs are not out for you.
3. TCAs can cause weight gain, but that doesn't mean that they always *do* -- your mileage will vary on that one, so you might give one a try.
4. There's a lot of conflicting literature about weight gain and ADs, with a lot of people saying exactly what DanielJ said: "Oh, it's not the drug itself, it's food cravings and sluggishness." I've been told that myself, and even quite recently, by people who really *should* know better in the first place, and who really should have known better than to say it to me even if it were true. I think you know enough about my history to know this, but one drug I was on started the weight gain before the AD effects kicked in. I was working out 2 1/2 hours per day, lots of aerobic exercise, lots of weights, and eating about 500 calories per day. Gaining weight under those circumstances was, as you can imagine, devastating. And the doctor's response -- "Oh, you must be eating more because you're feeling better!" -- was even worse. Afterwards, though, it did at least relieve me to realize that it wasn't just that I was greedy and lazy and that's why I was gaining the weight. Yes, the drugs themselves, to one extent or another, can cause weight gain directly. If you can't talk to this pdoc about the weight gain openly, can you find another doctor who will take it seriously as a real concern? There really are some mitigating tactics that can be tried, now that some research studies about the mechanisms of that weight gain have started to be done. Some of the options are probably not gonna seem a whole lot better than the problem itself, but a good, engaged pdoc can help you find a solution that you can live with.
5. Just so that it's perfectly clear: I'm with Scott in being angry at your pdoc. He is playing it safe in his choices, and maybe if he got a little more aggressive, you'd get a bit more relief. Can you change to another? (I seem to remember that you've got limited choices there, though, so it may not be possible for you. In that case, forget I said this and read down to my example at the end.)
6. On almost every drug I've ever taken that worked, it took a dosage about 150% to 200% of what the doctor expected. It's possible that you haven't had much success lately because your dosages have just been too low. You might try some of the same drugs again at higher dosages, to see if that helps.
Now for my example:
I was on 225mg of Effexor XR, and crying, and hysterical and suicidal and just miserable. The pdoc for the county (I'm uninsured, remember) said that she was "satisfied with the way the drugs are working -- you're just not responding appropriately." She also said that no one was ever given more than one AD at a time, and a bunch of other absolute rubbish. At any rate, she then kicked me out of the psychiatric program to the GP program for medication management -- meaning that the doctor I saw there would just continue the drug that the pdoc had prescribed. Imagine how I felt, right?
First appointment with the GP, I went with a spreadsheet of all the drugs I'd been on, the side effects from each, the effectiveness of each, etc. I also went armed with a suggestion: since I'd had a good response to the one SSRI I'd taken, but the side effects had been problematic at the very high dose, and the Effexor at the time was working a bit, but without side effects, how about adding a low dose of an SSRI to the Effexor and see whether that would bring about remission?
So, I had the history for her to see; I had a suggestion for a possible solution; and I got what I wanted twofold -- the GP listened and thought it was worth a shot, and the combination did provide remission. Which, after about a year pooped out. {sigh} Yeah, it happens. I can't advise you there. The best I can say is to approach the pdoc as much like a scientist as you can without stepping on his toes. Tell him what you've told us, about the drugs that have worked best for you over the years, and see if just presenting it as a sort of list might help give him some new ideas.
Another thing that has helped me was Scott's list of medications and which neurotranmitter systems they hit. That led me to do some more research on the matter, and *all* the drugs that have helped me have hit the same systems. Knowing that helps me figure out which drugs are worth a shot and bring it up with my doctor. If you haven't checked it out, do. I don't have the URL, but I'm sure Scott will post it for you.
Best luck. You know you're a charm for me, right? Since my wedding band wouldn'tbe the same without you?
Posted by zeugma on July 9, 2004, at 18:47:43
In reply to Re: end of rope » platinumbride, posted by Racer on July 9, 2004, at 14:55:03
Another thing that has helped me was Scott's list of medications and which neurotranmitter systems they hit. That led me to do some more research on the matter, and *all* the drugs that have helped me have hit the same systems. Knowing that helps me figure out which drugs are worth a shot and bring it up with my doctor. If you haven't checked it out, do. I don't have the URL, but I'm sure Scott will post it for you>
I have it on hand, so I'll beat him to it: http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
I agree with what the other posters have said, and with what Racer said about non-SSRI's being less liable to poop out. Desipramine is a tricyclic that causes minimal weight gain. But I wouldn't dismiss any of them, because they are too valuable as therapeutic options.
Nardil and Marplan (available again, fortunately) don't have the stimulant metabolites of selegilene that probably raised your bp. As Racer said, they are more likely to produce hypotension, as are many of the TCA's.
Posted by platinumbride on July 10, 2004, at 9:13:59
In reply to Re: end of rope, posted by DanielJ on July 9, 2004, at 9:28:51
I'm really overwhelmed by this outpouring of help and support.
It's a bit of a blow - just considering that my doc's laissez-faire personality is showing itself to be a detriment is very depressing to me. (Racer, you know about this........and finally I leave him for therapy, and I can't find a damn therapist here who has an open practice or will treat a patient with a history of suicide!!!!!!!!)
Racer, my amiga, you are also correct when you remember that I am limited in finding a new p-doc. There is ONE on my plan and I'm hearing from my family doc that he is no good. Maybe my family doctor will prove to be a help with meds- dunno........Do I want to get better? Well, a part of me does - the part that remembers what it is like to truly be alive - not the walking dead I have been so often in my life - not the woman who sabatoges herself at every juncture and says why bother. Not the woman who weighs 240 lbs but has a panic attack if she acts as she should when she wants to lose weight, and exercises in addition to going easy on the food.
Sorry that this has gone into psycho babble psychology territory......
I printed that list of meds - thank you Zeg. I cried to think of the long and thought out posts of everyone, and find myself very grateful to you Racer, for your repeated strength and generosity of spirit.
So I guess now, in addition to begging some f----ing shrink to counsel me even though I have a suicidal history, I can wait until I have girly hormones tested and then MAYBE find a drug I can tolerate in terms of side effects and maybe even help me. (Racer, I got that from you)
There must be a doctor I can see somewhere who has a large patient profile and feels comfortable prescribing from a larger pool of drugs than my current doc. I mean, maybe it isnt;' so great that I have to come up with ideas of what might work based on things I read here and then get a yay or a nay from the doc. I just don't know....
I do know that I am grateful for the help you have given me on this board time and time again,.....
Diane
Posted by SLS on July 10, 2004, at 10:01:30
In reply to Re: end of rope, posted by platinumbride on July 10, 2004, at 9:13:59
Hi Diane.
What symptoms were determinant in diagnosing you as bipolar II?
Maybe we can help get you through this without you having to change doctors just yet.
- Scott
Posted by snapper on July 10, 2004, at 13:01:23
In reply to Re: end of rope » platinumbride, posted by SLS on July 10, 2004, at 10:01:30
Just a side note... but I truly think that if more or a significant number of our attending pdocs were as thoughtful, understanding, compassionate and caring as the people who frequent this board are,many if not most of us would not be nearly as sick and suicidal as we are. I don't make that statement as a broad and sweeping general thing, but rather as a idea of 'fact' that most of 'us' do find it an intense, horrific and at most times... dealing with the BS of having to deal with severe mood and anxiety dis-orders to be a constant sickening uphill struggle that certainly makes 'living' a minute by minute, hour by hour and day by day existance seem like more than a pain in the ass than it is worth. I am sorry if my post is off subject and may sound ultra negative...but I also have a feeling that many if not most of you guys out there, know exactly how I feel and what I am trying to say. The good news is,is that we can be truly thankful for this place and each other.Knowing that 'we are not alone' in this struggle, at least gives me a 'little' bit of hope!So, in summation(sp)?.... I too feel like I am at the 'end of the rope', every single day. But knowing that the support that exists here, does exist, helps me realize that no matter how 'short the end of the length of rope seems',I some how know that there is room enough for me to keep 'hangin on' then there is room enough for all of you out there too! Hope everyone has as good a weekend as possible and best of luck to all in their quest to find the 'right' med. or meds to help them feel better. Even if it is only partial or temporary!
Peace to all
Snapper
Posted by Racer on July 10, 2004, at 14:19:36
In reply to Re: end of rope, posted by platinumbride on July 10, 2004, at 9:13:59
I don't know that I can offer any practical advice for you, but I can offer caring -- and email correspondence if you ever want it. babbler39 at excite dot com. Drop me a line if you'd like to take me up on it.
Posted by platinumbride on July 10, 2004, at 20:24:21
In reply to Re: end of rope » platinumbride, posted by SLS on July 10, 2004, at 10:01:30
Hi Scott,
I don't really understand the Bipolar II diagnosis....I think it means moody and unpredictable, never fully manic, but sometimes really hapy - even in the midst of depression.
The guy has known me for almost 10 years, and even during a time when was often exhuberant - yet come to think of it, still in the middle of depression that was threatening my ability to be effective as an artist and seeker of singing jobs..
So I guess one day he thought "hey, when she's not in a suicidal depression, her moods are pretty changeable - even if she does lean toward the very depressed side of the spectrum"
He made this diagnosis a year and a half ago.
Scott, you are very kind.
Diane> Hi Diane.
>
> What symptoms were determinant in diagnosing you as bipolar II?
>
> Maybe we can help get you through this without you having to change doctors just yet.
>
>
> - Scott
Posted by SLS on July 10, 2004, at 23:15:05
In reply to Re: end of rope, posted by platinumbride on July 10, 2004, at 20:24:21
Hi Diane.
I hope you have a little bit more rope to work with today.
> I don't really understand the Bipolar II diagnosis....I think it means moody and unpredictable, never fully manic, but sometimes really hapy - even in the midst of depression.
How much of yourself do you see in the following description?
http://www.mentalhealth.com/dis1/p21-md05.html
Main page: http://www.mentalhealth.com
Being moody and unpredictable (mood lability) can be a component of a bunch of different things, including borderline personality disorder. Maybe you just have atypical unipolar depression, in which there is transient mood reactivity in response to positive stimuli. Perhaps you are simply an incredibly positive person with a wonderful sense of humor who manages to squeeze a few rays of sunshine through the otherwise opaque murk of melancholic unipolar depression. Some people don't place very much importance on diagnosis. I do. As best as is currently possible, a diagnosis helps one choose a direction in treatment. If your diagnosis of bipolar is incorrect, you might be wasting precious time experimenting with mood stabilizers. I have no reason to believe that your diagnosis is in error, but it would be nice to feel confident that you are being treated for the right illness.
There are still a gazillion things you can try. Fortunately for you, the odds are still in your favor that you will find something that works. That you have been partially or transiently responsive to medication in the past is a good indicator of this. It might take awhile, but you'll get there. One step at a time. (I'll bet you're a Parnate + lithium girl).
- Scott
Posted by platinumbride on July 11, 2004, at 1:27:28
In reply to Re: end of rope » platinumbride, posted by SLS on July 10, 2004, at 23:15:05
> Hi Diane.
>
> I hope you have a little bit more rope to work with today.It was a tough day, but there were moments of beauty.....it seems that no matter what, there always are. Beauty isn't always happy. Rachmaninov can be painful but it always evokes a sense of the old Platonic Beautiful.
Thank you for your kind words.
>
> > I don't really understand the Bipolar II diagnosis....I think it means moody and unpredictable, never fully manic, but sometimes really hapy - even in the midst of depression.
>
> How much of yourself do you see in the following description?
>
> http://www.mentalhealth.com/dis1/p21-md05.html
>
> Main page: http://www.mentalhealth.comI think that Bipolar II is not a correct diagnosis. I have never believed it, but I just went along with it. The notion of Borderline Personality disorder has always been too scary for me to deal with. I figured that if the same damn medication was used for everything, what did it matter?
>
> Being moody and unpredictable (mood lability) can be a component of a bunch of different things, including borderline personality disorder. Maybe you just have atypical unipolar depression, in which there is transient mood reactivity in response to positive stimuli. Perhaps you are simply an incredibly positive person with a wonderful sense of humor who manages to squeeze a few rays of sunshine through the otherwise opaque murk of melancholic unipolar depression.I think (and have thought for a while) that that is more accurate - but why question the guy with the MD who barely charged me a cent and helped get me out of the hospital by working closely (though 300 miles away) with the docs in there?
Some people don't place very much importance on diagnosis. I do. As best as is currently possible, a diagnosis helps one choose a direction in treatment. If your diagnosis of bipolar is incorrect, you might be wasting precious time experimenting with mood stabilizers. I have no reason to believe that your diagnosis is in error, but it would be nice to feel confident that you are being treated for the right illness.
>
> There are still a gazillion things you can try. Fortunately for you, the odds are still in your favor that you will find something that works. That you have been partially or transiently responsive to medication in the past is a good indicator of this.Why is this true?
It might take awhile, but you'll get there. One step at a time. (I'll bet you're a Parnate + lithium girl).
Why can't I just be a friggin' Ivory Girl???? ha ha
And see? Lithium is a mood stablizer? So what does the diagnosis matter?Would you feel OK emailing me? How do you know so much about this stuff? Is it dreaded personal experience?
ospinawoman at hotmail dot com
Diane
> - Scott
Posted by SLS on July 11, 2004, at 8:04:23
In reply to Re: end of rope » SLS, posted by platinumbride on July 11, 2004, at 1:27:28
> > There are still a gazillion things you can try. Fortunately for you, the odds are still in your favor that you will find something that works. That you have been partially or transiently responsive to medication in the past is a good indicator of this.
> Why is this true?It means that your system is "plastic" to a degree. "Plastic" means that your brain is capable of change; it can be molded into a new shapes. It is a term used figuratively. I remember one poor soul who didn't respond in the slightest to anything except a procaine challenge. Now *that* is treatment refractory. I hope he is doing well. He was a research patient at the NIMH, NIH while I did my time down there. I went there to try a few investigational drugs. They didn't really help too much. Besides, the drugs are no longer available unless you are a lab rat.
> > It might take awhile, but you'll get there. One step at a time. (I'll bet you're a Parnate + lithium girl).
> Why can't I just be a friggin' Ivory Girl???? ha ha
> And see? Lithium is a mood stablizer? So what does the diagnosis matter?In this situation, you would be using lithium not as a mood stabilizer at dosages of 900-1500mg, but as an augmenting agent at dosages of 300-600mg. Lithium helps the antidepressants work better. The Parnate + lithium is just a guess, but it serves to demonstrate that there are things you haven't tried yet. I know someone who is doing wonderfully with a combination of Effexor 150mg + lithium 900mg. Neither drug by itself worked.
See? The rope is getting longer.
- Scott
Posted by platinumbride on July 11, 2004, at 11:11:09
In reply to Re: end of rope, posted by Sad Panda on July 9, 2004, at 10:27:23
Hi Panda,
I dont' know if it is hypomania or just occasional feelings of being OK. The line blurred some time ago.
It does seem that there are many tcas. Why do you recommend the ones you did?
D
> Hi D,
>
> Do you get hypomania much?
>
> I wouldn't exclude the TCA's, they are many & varied. Nortriptyline or Clomipamine would be my pick from the collection. I wouldn't exclude Depakote, I think it's safer & more reliable than Lamictal. Also, the MAOI Nardil nearly always lowers bloodpressure.
>
> Cheers,
> Panda.
>
>
>
Posted by Sad Panda on July 12, 2004, at 10:13:15
In reply to Re: end of rope, posted by platinumbride on July 11, 2004, at 11:11:09
> Hi Panda,
>
> I dont' know if it is hypomania or just occasional feelings of being OK. The line blurred some time ago.
>
> It does seem that there are many tcas. Why do you recommend the ones you did?
>
> D
> > Hi D,
> >
> > Do you get hypomania much?
> >
> > I wouldn't exclude the TCA's, they are many & varied. Nortriptyline or Clomipamine would be my pick from the collection. I wouldn't exclude Depakote, I think it's safer & more reliable than Lamictal. Also, the MAOI Nardil nearly always lowers bloodpressure.
> >
> > Cheers,
> > Panda.
> >
> >
>Hi D,
The diagnosis is important from the point of view that it determines what meds to try. Unipolar people take antidepressants, Bipolar people nearly always start out with a mood stabilizer.
The TCA's are many & varied. Amitriptyline is the drugs with the best record as an antidepressant, but it has the worst side effects. Clomipramine is an underutilized TCA that has less side effects, but probably is the best TCA. Nortriptyline is an active metabolite of Ami that has most of the goodness with a lot less of the TCA side effects.
Cheers,
Panda.
Posted by sexylexy on July 12, 2004, at 15:17:02
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
PBride,
Do you have chronic depression? I know that it seem drugs have not worked for you. Have you ever considered Electro Shock Therapy. I am not sure if you are familiar with it, I know it sure does sounds scary but I have seen it help a good amount of people with chronic depression. They send low waves of electricity to your brain and it stimulates your serotonin, dopamine and nuer...( can't think of the other chemical) production. Side effects are usually not too bad, and I have seen people get it, they lay in a bed and most of the time do not even flintch when it is administered. It may be worth looking up.
Best of Luck no matter!
Lexy
Posted by chemist on July 12, 2004, at 16:05:51
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
hello there, chemist here. i wanted to post only to say that i think the level of support - as you note in subsequent posts - in this community is of tremendous value, and it's due to all those folks who reply to our posts. anyhow, what i'm getting at is, thanks to all posters and, in this particular case, my hat is off to all those who have come to your rescue with very valid and workable alternatives to which i can hardly augment. my best to you, and of course should you need to shoot an email, please do so to the following address: todd at lanczos dot cm dot utexas dot edu. with warmest wishes and a request to keep 'em coming, tjm aka chemist
> I am really at a loss as to where my medication can go now. The last real relief I had was celexa and lamictal two years ago. Pooped out.
>
> I got good results for a while from zoloft, and once from paxil, but after a lot of extra weight from all these, they pooped.
>
> I am BPII, so we concentrated on finding the right mood stablizer. After topamax, trilpetal and lamictal.....I come up with a zero.
>
> Lexapro was a joke, but I thank it for at least another 20 lbs.
>
> Remeron - same deal, just gained more weight from it.
>
> My forray into the world of maoi was a low dose selegiline. It got my blood pressure up and made me a chronic insomniac, but i guess the blood pressure thing makes all maois a no go (fine, my doc won't prescribe parnate anyway)
>
> Wellburtin seemed to be similar: while I had the insomnia and anxiety, I got some energy. When those SEs abated, I was left with little but a pill that took away my desire to chain smoke.
>
> Tricyclics are out of the question, it seems, because I am 100 lbs over weight now.......
>
> So...what is a girl to do?
>
> Because I am having some issues with my menstrual cycle, my pdoc doesn't want to try more stuff, lest they mask any true hormonal issues. OK....I can wait...
>
> But really, what am I waiting for?
>
> I toy with trying effexxor again, but if it didnt work the first 6 week trial, why would it work now?
>
> Same is true of prozac.......but I only did that for 3 weeks...couldn't afford to up the dosages.
>
> Zonegran seems to be the next possible MS, but I had n o luck with topamax, so why should this work? Lithium scares me, and depakote is out of the question. Apparently it can also wreak havoc with the menstrual cycle.
>
> So I just put band aids on things. I take neurontin and klonopin for the anxiety that comes from knowing that if there is not more to life than all this, it is really not worth living. Then I smoke pot to make it all even better for the moment.....
>
> This is no life.
>
> But I really want to get better.
> So I am asking if there are options I am missing, and if someone can help.
>
> My pdoc just pulls suggestions out of a hat, and is very anti-effexxor. He is inclined to put me on a high dose of zoloft (the drug I was taking when I tried to commit suicide!!! ) (Not blaming the drug, but why would another 100 mgs help????)
>
> Please share experiences and such.........
> It is looking so very bleak to me......I spend more time than I care to trying to end my life and make it look like an accident. Surely I was put on this earth to do more than just that.
>
> Thanks,
>
> D
Posted by platinumbride on July 12, 2004, at 22:12:25
In reply to there's plenty of rope on this board... » platinumbride, posted by chemist on July 12, 2004, at 16:05:51
Posted by platinumbride on July 13, 2004, at 14:42:03
In reply to end of rope, posted by platinumbride on July 9, 2004, at 1:41:35
I just got off the phone with my doc. The only thing I am mildly pleased with at this point is that he is going to put me on 600 mgs of lithium. He won't touch tcas or maois. The aD will be zoloft (again) but this time at 200 mgs or more if he has to.
I guess it is worth mentioning that it looks more and more like I have some endocrine problems too. For his tastes, my prolactin levels are high. However, planned parenthood must have different standards and says they are normal. Whatever...
Thanks again to all who have posted.
If this combo doesnt work I guess I will have to find a way to get to a bigger city where there will be shrinks who aren't so afraid of things like parnate or tcas/For now it is all "as the stomach turns"...
Diane
Posted by chemist on July 13, 2004, at 16:22:18
In reply to Re: end of rope, posted by platinumbride on July 13, 2004, at 14:42:03
> I just got off the phone with my doc. The only thing I am mildly pleased with at this point is that he is going to put me on 600 mgs of lithium. He won't touch tcas or maois. The aD will be zoloft (again) but this time at 200 mgs or more if he has to.
>
> I guess it is worth mentioning that it looks more and more like I have some endocrine problems too. For his tastes, my prolactin levels are high. However, planned parenthood must have different standards and says they are normal. Whatever...
>
> Thanks again to all who have posted.
> If this combo doesnt work I guess I will have to find a way to get to a bigger city where there will be shrinks who aren't so afraid of things like parnate or tcas/
>
> For now it is all "as the stomach turns"...
>
> Dianewell, hello there, diane....i am pleased that your doctor ordered a med you are happy with, and perhaps the higher dose of zoloft will do something the lower dose didn't. in any event, you are on the right track, please keep us informed of your progress, and all the warmest wishes for a speedy ``recovery,'' chemist
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