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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Ame Sans Vie on March 2, 2005, at 6:25:47
Gosh, I hope I haven't been away so long that no one remembers me, lol. I've been spending most of my computer time offline studying computer programming and have sadly neglected the Psycho-Babble community -- hope you'll all forgive me! :-)
Anyways, I have no clue how long ago my last post was. But my medications haven't changed since then, until just one week ago. I had been taking selegiline 10mg, Adderall 60-90mg, dextromethorphan polistirex 60mg, Klonopin 8mg and varying doses of DL-phenylalanine. I believe I was also taking Xanax XR last I posted. Well, the selegiline, while working great for a while (and, perhaps most importantly, allowing me to quit smoking once and for all), started to decline in effect about two months ago. Worse though was that the high dose of amphetamines was causing me to pick at my skin, which apparently is a common side effect, but not one I was willing to live with. Too bad as I believe I could have gotten by just fine without the selegiline if the Adderall hadn't turned against me.
Last week I got a referral to a psychiatrist who's new to the area (a good thing since I've been to every last one of them around here) and was able to see him the very next day. I expressed my interest in trying Parnate, which is pretty much my last option at this point but something I've wanted to try for years. No one was willing to prescribe it until I described my situation to him, and he was extremely understanding. He told me to just quit the selegiline, dextromethorphan, and DLPA, wean off the Adderall, and today I have an appointment in two hours to start Parnate. He even said he'd make sure my pharmacy has it in stock for me before I come to see him today! I think I'm going to like this guy -- my last pdoc was getting fed up with me, I think, and was definitely beginning to treat me like a second-class citizen.
Anyway, I'll be glad to hear from any of you and am anxious to hear how you all are doing! Ciao!
~Michael
Posted by ed_uk on March 2, 2005, at 7:25:26
In reply to Back in the saddle..., posted by Ame Sans Vie on March 2, 2005, at 6:25:47
Hi Michael,
Yes, I remember you!
>I had been taking selegiline 10mg, Adderall 60-90mg, dextromethorphan polistirex 60mg, Klonopin 8mg and varying doses of DL-phenylalanine. I believe I was also taking Xanax XR last I posted.
>today I have an appointment in two hours to start Parnate. He even said he'd make sure my pharmacy has it in stock for me before I come to see him today!Where on earth do you find your pdocs? What country do you live in? The only drug my pdoc will prescribe is Effexor.
Ed.
Posted by Ame Sans Vie on March 2, 2005, at 7:41:49
In reply to Re: Back in the saddle..., posted by ed_uk on March 2, 2005, at 7:25:26
> Hi Michael,
>
> Yes, I remember you!Hi there! I remember you too -- how are things going?
> >I had been taking selegiline 10mg, Adderall 60-90mg, dextromethorphan polistirex 60mg, Klonopin 8mg and varying doses of DL-phenylalanine. I believe I was also taking Xanax XR last I posted.
> Where on earth do you find your pdocs? What country do you live in? The only drug my pdoc will prescribe is Effexor.I'm in the U.S. -- Texas, to be precise. I suppose the pdocs in my area are pretty sympathetic... they've been willing to try me on everything from fentanyl to pramipexole to methamphetamine for depression and have no qualms about prescribing high doses of benzos... I really can't explain it. It's a bit of an anomaly; I realize a lot of people don't have these sorts of resources.
I've heard that doctors in the U.K. are wary of MAO inhibitors, but I had no idea to what an extent! I mean, Effexor's a mediocre drug at best... what are their opinions on TCAs?
Well, I've got to head out the door right this second, but I'll be sure to check back when I get home! Take care!
~Michael
Posted by katalina on March 2, 2005, at 11:03:18
In reply to Re: Back in the saddle..., posted by Ame Sans Vie on March 2, 2005, at 7:41:49
Hey there!
Nice to see your name again. I read many of your posts. I believe you led me to augment my adderall (which is now dexedrine) with dexalone caps.
I'm happy to hear you have found a "non-conforming" pdoc who is willing to prescribe what you want. My neuro used to be very open to my sort of "writing my own scrips" if you will, until recently. I think he deals mostly with epileptic and parkinsons patients whom don't question anything he prescribes and at first I was a pleasant change for him, coming in armed with information (mostly extracted from psycho babble) and we could have an intelligent exchange about pharmaceuticals, etc. which led him to giving me what I asked for.
Anyway, he kind of "turned" on me in January, when I lost my bottle of klonopin helping my sister move out of her apt. I think it got thrown out. I have never misused any meds in the past or asked for early refills, but when I called his office explaining the situation, the nurse called back and said "Dr. Smith is concerned you may be abusing your meds and suggests you be more careful with them in the future. If you're having withdrawal symptoms he advises you go to the ER" What the ^%&$?? I was so blown away by that, I felt betrayed. I don't know if he was having a bad day or if I was the 10th person that day to call with a "story" about losing pills, but I was furious.
ANYWAY, I don't know why I'm purging this now in this post, nonetheless, but I just wanted to say that I always enjoyed your posts and advice. I don't post that often (I stay at home with my two preschoolers who hate it when I'm online - basically the reason I need to be medicated ha ha).
My cocktail du jour is
60 mgs. dexedrine spans (after 3 years of 50 mgs. of Adderall XR)
50 mgs. desipramine (newly added, not sure if it's therapeutic, or even if I need it. I've been anti ssri/snri lately and wanted to try a tca, but I don't know if this has enough (or any for that matter) serotonin in it. I think I need prozac again to be honest, but I'm afraid to call and ask)
2.5 mgs. klonopin (usually .5 during the day and 2 mgs. before bed)
dexalone (dextromorphan) (one or two caps a day - is that enough? And do you really think it warded off tolerance? So hard to tell what is real and what we think is real sometimes).I also take enough supplements to choke a small horse. Rhodiola, Tyrosine, Taurine, Theanine, NAC, 5-HTP, SAME, PS, multi-vitamin, mineral, antioxidants, etc., etc. I could probably own beach front property if I ditched my vitamin regime. (O.K., slight exaggeration, maybe not owe my soul to mastercard is more accurate). *sigh*
Oh well. Nice to have you back, I hope the Parnate is everything you hope it to be. It's always nice to have something new to try to put our hopes into, isn't it? (I don't mean for that to sound sarcastic if it does.) I just mean it's always good to have one in the bank if you know what I mean - just that safety net to know there's something out there that we haven't tried yet, that could be the magic solution.
Sorry for my epic length, somewhat inpertinent post. I wish you the best with the Parnate and hope you keep us posted!
Katalina
Posted by Phillipa on March 2, 2005, at 16:46:09
In reply to Re: Back in the saddle..., posted by katalina on March 2, 2005, at 11:03:18
I don't know you, but it seems a lot of others do and have a great respect for you, so I think I'll follow this Thread. Nice to know you. Fondly, Phillipa
Posted by TheOutsider on March 2, 2005, at 17:00:13
In reply to Re: Back in the saddle..., posted by Phillipa on March 2, 2005, at 16:46:09
Good to see you back with us!
Your lively posts and knowlage made babble more interesting.Keep posting
Posted by Ame Sans Vie on March 3, 2005, at 12:37:13
In reply to Re: Back in the saddle..., posted by katalina on March 2, 2005, at 11:03:18
Hi! It's nice to see your name again too!
> I think he deals mostly with epileptic and parkinsons patients whom don't question anything he prescribes and at first I was a pleasant change for him, coming in armed with information (mostly extracted from psycho babble) and we could have an intelligent exchange about pharmaceuticals, etc. which led him to giving me what I asked for.
Yeah, that's always a nice thing, isn't it? Especially when so many psychiatrists/neurologists/etc. these days fall into one (or more) of three categories -- 1) stuck in the days of TCAs, 2) "staying safe" by sticking with SSRIs and Effexor without exception, or 3) willing to experiment throughout the range of antidepressants, but deathly afraid of benzodiazepines, stimulants, or novel therapies.
> Anyway, he kind of "turned" on me in January, when I lost my bottle of klonopin helping my sister move out of her apt.
Ugh, I've had that happen to me once with the doctor I just ditched... I think that may have been the start of the decline in our good rapport.
> I think it got thrown out. I have never misused any meds in the past or asked for early refills, but when I called his office explaining the situation, the nurse called back and said "Dr. Smith is concerned you may be abusing your meds and suggests you be more careful with them in the future. If you're having withdrawal symptoms he advises you go to the ER" What the ^%&$?? I was so blown away by that, I felt betrayed. I don't know if he was having a bad day or if I was the 10th person that day to call with a "story" about losing pills, but I was furious.
That's ridiculous -- hard to get yourself to the E.R. when you're in the process of enduring a grand mal seizure!
> ANYWAY, I don't know why I'm purging this now in this post, nonetheless, but I just wanted to say that I always enjoyed your posts and advice.
Thank you, I really appreciate that. :-)
> 60 mgs. dexedrine spans (after 3 years of 50 mgs. of Adderall XR)Just curious, how have you found the duration of action of the Spansules to compare to Adderall XR? And are you using the brand or generic? I used the generic dextroamphetamine sulfate SR before I began taking Adderall but was very disappointed with the 4-5 hours each dose seemed to affect me.
> 50 mgs. desipramine (newly added, not sure if it's therapeutic, or even if I need it. I've been anti ssri/snri lately and wanted to try a tca, but I don't know if this has enough (or any for that matter) serotonin in it.
I haven't looked very deeply into the pharmacology lately, but to my knowledge it has very minimal (if any) effect upon serotonin. It's action seems restricted to noradrenaline reuptake inhibition which also results indirectly in increases of dopamine function throughout certain areas of the forebrain in which dopamine and noradrenaline share common pathways. If you *do* end up feeling a definite therapeutic effect from desipramine but still feel you could use that serotonin "kick", perhaps Tofranil (imipramine) would be worth a try? Desipramine is, after all, a metabolite of imipramine -- desmethylimipramine.
> I think I need prozac again to be honest, but I'm afraid to call and ask)
I understand the feeling. I've had positive experiences with Prozac in the past (especially compared with all other SSRIs) and found it to work very well along with amphetamines.
> dexalone (dextromorphan) (one or two caps a day - is that enough? And do you really think it warded off tolerance? So hard to tell what is real and what we think is real sometimes).
I think weight plays a big role in proper dosage, but one or two caps (I believe they're 30mg apiece?) should be sufficient. I personally believe quite strongly that it prevented tolerance in my case, and my psychiatrist used it in other patients taking various amphetamines (Adderall, Dexedrine, DextroStat and Desoxyn) as well as methylphenidate. He mentioned to me that it worked wonderfully in all but one patient taking the amphetamines (who had a bad reaction, possibly consistent with serotonin syndrome) though it didn't help his methylphenidate patients much.
> I also take enough supplements to choke a small horse. Rhodiola, Tyrosine, Taurine, Theanine, NAC, 5-HTP, SAME, PS, multi-vitamin, mineral, antioxidants, etc., etc. I could probably own beach front property if I ditched my vitamin regime. (O.K., slight exaggeration, maybe not owe my soul to mastercard is more accurate). *sigh*lol, I hear you -- I probably should have mentioned my supplement regimen in my above posts. I'm taking acetyl-l-carnitine, phosphatidylserine, phosphatidylcholine, Suntheanine, trimethylglycine, alpha lipoic acid, sublingual B-12/B-6/folic acid, chelated cal-mag tablets, and separate timed-release "green-food" multivitamin/multimineral and B-vitamin supplements.
> Oh well. Nice to have you back, I hope the Parnate is everything you hope it to be. It's always nice to have something new to try to put our hopes into, isn't it? (I don't mean for that to sound sarcastic if it does.) I just mean it's always good to have one in the bank if you know what I mean - just that safety net to know there's something out there that we haven't tried yet, that could be the magic solution.
>
> Sorry for my epic length, somewhat inpertinent post. I wish you the best with the Parnate and hope you keep us posted!Yes, it's very nice indeed, and I have my hopes very high for this one! Keep your fingers crossed for me! :-)
Take care,
~Michael
Posted by Ame Sans Vie on March 3, 2005, at 12:39:48
In reply to Hale to the Chief!, posted by TheOutsider on March 2, 2005, at 17:00:13
Thanks to the both of you for the warm welcome back!! :-)
~Michael
Posted by Phillipa on March 3, 2005, at 17:46:24
In reply to Re: To Phillipa and TheOutsider, posted by Ame Sans Vie on March 3, 2005, at 12:39:48
You're welcome! Fondly, Phillipa
Posted by Sarah T. on March 3, 2005, at 23:04:04
In reply to Re: Back in the saddle..., posted by katalina on March 2, 2005, at 11:03:18
Hi Katalina. When you were helping your sister move, did you also hire a moving company? I've had things stolen by a few "professional" movers. Some movers have been very good, but there are a lot of bad apples. I also know of someone who had some medicines stolen from her bedroom when she had a new mattress delivered by one of those stores that sells only mattresses. The store contracted out to some other company for mattress delivery, and I gather that many of the mattress delivery men were transient/temporary workers or day laborer-types, and it's difficult to track those guys down.
Posted by Sarah T. on March 3, 2005, at 23:19:31
In reply to Back in the saddle..., posted by Ame Sans Vie on March 2, 2005, at 6:25:47
Hi Michael. I'm glad you're back. Next time,don't go away for such a long stretch!
I do remember that you'd been on Prozac at some point. Do you think that Prozac causes less apathy than some of the other ssri's?
I hope things go well on Parnate. Remember to be very strict about the MAOI diet and drug interactions. Aged and fermented foods are the big "no-no's" and there are some other ones to avoid as well. Fresh food is best.
Please let us know how you are.
Posted by jasmineneroli on March 4, 2005, at 0:10:01
In reply to Hale to the Chief!, posted by TheOutsider on March 2, 2005, at 17:00:13
Michael!!!!!!! I've missed you so much.
I don't come here too often now, myself. I always loved your well written posts. You had loads of ideas!
Computer programming? What about your artistic endeavours, still doing that?
You sound very cheerful. It's good to have you back.
TTYL
Jas
Posted by temoigneur on March 4, 2005, at 22:23:22
In reply to Re: To Phillipa and TheOutsider, posted by Ame Sans Vie on March 3, 2005, at 12:39:48
> Thanks to the both of you for the warm welcome back!! :-)
>
> ~MichaelHi Michael, I sent this email a while ago, I think maybe to your yahoo account, I know with mine I get so much mail I never check it, anyway..
Hey Michael how are you doing. Are you in school right now, I remember your french, perhaps you're launched in a carreer, you always seemed cogent, and knowledgeable. How is your family, mine is so so, I'm going to the Anxiety Disorder Conference in Seattle next month, should be informative:)
I haven't been on the anxiety boards that much recently, so i don't know if you are still in contact, but I have anxiety OCD.... I was asking you about tramadol while i was trying nardil. I went on Tramadol, but I thing the NRI properties it shares with effexor were making me quite anxious. As explained below, I'm on Clomipramine, but tricyclics, are like a sledghammer, it certainly has controlled my OCD well, but I sleep most of the day, and have little/no ambition to do much of anything.
I was wondering, with your knowledge of anxiolytics and drugs, is there anything you might recommend addiing to clomipramine, below I've explained some of the complications I've had with stimulants/SSRI's etc. Thanks so much.
Ben
After, ridiculous anxiety - being almost driven to suicide numerous times in the past year, I've come upon clomipramine for OCD/Anxiety. It has all but abolished the horrible OCD/Anxiety along with clonazepam, 3mg t.i.d. but I'm tired all the time, I just want to sleep all day; my mind is relatively dull, and I can see sleeping my way into my sixties, if I don't get something that would give me some inertia. I have little/no ambition, or drive to do very much and as I'm on disability, I can just sleep all day and ponder what life would be like without the disease. But I had a good mind, got my ARCT in piano, I'd like to be a Nurse-Practitioner, but this is impossible being so dull and drowsy.
Anyway, is there any conceivable combo Clomipramine + SSRI or bromocriptine that may allow me to retain clinical gains, and start living again. Basically looking for something to give me my energy and creativity without the torment of Anxiety and OCD. Has anyone observed that their anxiety is aggravated by SNRI's or Stimulants. I cannnot tolerate any stimulants, On Ritalin I displayed bipolar symptoms, Dexadrine made me extremely anxious, as did provigil.
My psychiatrist has noted that noradrenergic medications cause an increase in anxiety for me. Does anything strike anyone that might help with energy, I found all SSRI's to be stimulating, to the point where I couldn't sleep, which is why I'm somewhat interested in some combination of SSRI + Clomipramine. The SSRI's alone helped for 4 months, then did little for my anxiety, but it's hard to compare because
While on the SSRI's I was in school, under a great deal of pressure - and have no significant commitments now on clomipramine. Thanks so much - also, if you're neurotic and want a protypical response profile for different medications, I would be happy to submit my experience:)
This is the end of the thread.
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