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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by smith562 on March 27, 2005, at 20:02:54
Hey Mitch,
I have been following your and B-Cats posts on taking "micro" doses cymbalta. I have seen/heard many individual talk about taking hefty to normal size antidepressant doses when they were younger .... now only to require "micro" dose or no ads as they get older. My question is do you think individuals with bipolar or bipolar spectrum illness tend to require less antidepressant with age?
If *yes*, is this due to kindling and the solidification of bipolarness (or another way to put it increasing sensitivity to ads as bipolar tendency concrete) .... or that as hormone levels decrease with age, one needs less ad? Thanks.
Smith
Posted by Phillipa on March 27, 2005, at 21:15:11
In reply to Mitch: Med Dose with Age, posted by smith562 on March 27, 2005, at 20:02:54
What an interesting question. I'm not bipolar, but I'm older and now I don't "feel" the AD's. I can't wait to hear what the experts say. Fondly, Phillipa
Posted by Ritch on March 28, 2005, at 11:08:55
In reply to Mitch: Med Dose with Age, posted by smith562 on March 27, 2005, at 20:02:54
> Hey Mitch,
>
> I have been following your and B-Cats posts on taking "micro" doses cymbalta. I have seen/heard many individual talk about taking hefty to normal size antidepressant doses when they were younger .... now only to require "micro" dose or no ads as they get older. My question is do you think individuals with bipolar or bipolar spectrum illness tend to require less antidepressant with age?
>
> If *yes*, is this due to kindling and the solidification of bipolarness (or another way to put it increasing sensitivity to ads as bipolar tendency concrete) .... or that as hormone levels decrease with age, one needs less ad? Thanks.
>
> Smith
Hmmm. Interesting idea. I don't think in my case that the AD use sparked more *kindling*, I just think that the *serotonergic* antidepressants in particular just happen to make for very effective mood nitroglycerine. When I first tried Prozac long ago, I went from 20mg/day to 2.5mg/day within a month-- adjusting the dose down because I was hypersensitive to it. That's what I think it is--just hypersensitivity. I think there is a LOT of people out there crushing, chopping, mixing, etc., to "create" their own personalized doses. There is still a lingering question of.. IF you are hypersensitive to a med.. should you be taking it at all? I don't know. I have recently stopped my mini-dose of Celexa. My head has gotten a lot quieter since and I'm far less testy. But, I feel less creative and blah without it somehow. I just read about that "ACID" syndrome (antidepressant induced chronic irritability syndrome) that was posted here recently, and it got me to thinking. They mentioned in there... that they withdrew the AD's and after a couple of months it all settled down. I haven't noticed any panic anxiety returning (but I'm usually not depressed at this time of year and that's when I get the panic-when I'm depressed). It's almost like I *miss* the irritability somehow. Come to think of it.. I remember several years ago noticing that when I "recovered" from depression in the springtime it was when I started getting angry. Another thing I've noticed.. the serotonergics seem to "color" my mood. I think that's what they call mood lability. There would be some sort of mood theme (out of several colors to choose from), that would "permeate" my being the entire day or several days. I'm noticing that starting to fade away.. Don't know if this is going to work or not-I'm willing to give it a try (staying off AD's). I don't know if this helps or not--- Mitch
Posted by ed_uk on March 28, 2005, at 11:32:13
In reply to Re: Mitch: Med Dose with Age » smith562, posted by Ritch on March 28, 2005, at 11:08:55
Hi Mitch,
Do you think you'll start to need more clonazepam for your anxiety now you've come off citalopram?
Btw, you mentioned that you used to take Thorazine or Mellaril. I think you took a low dose but I'm not sure. How did you respond? Were they effective for your anxiety, hypomania and irritability? Did you have a lot of side effects? I've tried Thorazine but not Mellaril, it's not used much anymore because of the cardiac risks. Have you ever taken any other typical APs like Haldol?
Regards,
Ed.
Posted by Ritch on March 28, 2005, at 14:26:21
In reply to Re: Mitch: clonazepam » Ritch, posted by ed_uk on March 28, 2005, at 11:32:13
> Hi Mitch,
>
> Do you think you'll start to need more clonazepam for your anxiety now you've come off citalopram?
>
> Btw, you mentioned that you used to take Thorazine or Mellaril. I think you took a low dose but I'm not sure. How did you respond? Were they effective for your anxiety, hypomania and irritability? Did you have a lot of side effects? I've tried Thorazine but not Mellaril, it's not used much anymore because of the cardiac risks. Have you ever taken any other typical APs like Haldol?
>
> Regards,
> Ed.Hi Ed, yes-I have been concerned that I'm going to need more clonazepam after coming off citalopram. So far, so good, though. The panic thing really does happen the worst when I'm in the middle of a seasonal depression and I don't have that to worry about for at least two months or more. The first AP I took was Thorazine 25mg along with lithium about 25 years ago. I was using the Thorazine mainly to control my temper. It worked really well for *that*, but it made my depression clearly worse, and did *nothing* for panic. Then I went off it and was just taking lithium + benzo (for panic). The lithium wasn't getting a good enough handle on my euphoric manias and temper (dysphporic) so we started 10-20mg of Mellaril every day (with lithium + Valium). I say "manias" because although they didn't last nowhere near long enough to be considered manias (4+days), they often approached the intensity as some BPI manias I've seen in others. They often would just last a few hours. Not long enough to attract much attention-I've had to leave work a couple of times back then because I was just getting giddy -way over the top, got a lot of traffic tickets, etc. Anyhow, I really *liked* the low-dose Mellaril, it seemed to have an AD effect the Thorazine didn't have. I was on that one more than any others. But, I developed some retinal pigmentation and a cataract when on it. Never got rapid heartrate or EPS on that one-severe stuffy nose though. I tried Haldol *once*-severe EPS and esp. akathisia-horrible-never again. Mellaril was the most tolerable AP I've ever tried even compared to the newer ones.
Posted by ed_uk on March 28, 2005, at 15:24:01
In reply to Re: Mitch: clonazepam » ed_uk, posted by Ritch on March 28, 2005, at 14:26:21
Hi Mitch!
> So far, so good, though.
:-)
>The panic thing really does happen the worst when I'm in the middle of a seasonal depression and I don't have that to worry about for at least two months or more.
It sounds like you might need to increase the clonazepam temporarily in a few months, but that you won't need a higher dose all the time.
>I developed some retinal pigmentation and a cataract when on it.
Is your vision still affected? Apparantly some people get brownish-coloured vision. What did you do about the cataract?
>Mellaril was the most tolerable AP I've ever tried even compared to the newer ones.
Practically the entire population of the UK was on Mellaril at on time! Hardly anyone takes it now.
Kind regards,
Ed.
Posted by Phillipa on March 28, 2005, at 16:24:40
In reply to Re: Mitch: clonazepam » ed_uk, posted by Ritch on March 28, 2005, at 14:26:21
Did you know they use Thorazine for intractable hiccups? Fondly, Phillipa
Posted by ed_uk on March 28, 2005, at 17:22:43
In reply to Re: Mitch: clonazepam, posted by Phillipa on March 28, 2005, at 16:24:40
Hi P!
LOL, yes i did, Haldol too.
Ed xxx
Posted by Phillipa on March 28, 2005, at 17:34:00
In reply to Re: Mitch: clonazepam » Phillipa, posted by ed_uk on March 28, 2005, at 17:22:43
Hi Ed! Where is everybody? You're here that's good! Fondly, Phillipa
Posted by ed_uk on March 28, 2005, at 18:10:59
In reply to Re: Mitch: clonazepam » ed_uk, posted by Phillipa on March 28, 2005, at 17:34:00
I don't know!
Ed xxx
Posted by Ritch on March 28, 2005, at 18:37:40
In reply to Re: Mitch: thioridazine » Ritch, posted by ed_uk on March 28, 2005, at 15:24:01
> >I developed some retinal pigmentation and a cataract when on it.
>
> Is your vision still affected? Apparantly some people get brownish-coloured vision. What did you do about the cataract?Yeah, the cataract is still there, but it is real tiny and I barely notice it. I get it checked every year. I can't remember which eye has the pigment-but yes my vision is "tinted" slightly different in one eye than in the other-I don't know which is "normal" though!
Posted by Ritch on March 28, 2005, at 18:39:14
In reply to Re: Mitch: clonazepam, posted by Phillipa on March 28, 2005, at 16:24:40
> Did you know they use Thorazine for intractable hiccups? Fondly, Phillipa
I wonder if the "intractable" hiccups are actually a complex tic thing? I get tics from some stimulants, most notably methylphenidate and dexmethylphenidate.
Posted by ed_uk on March 28, 2005, at 19:12:41
In reply to Re: Mitch: thioridazine » ed_uk, posted by Ritch on March 28, 2005, at 18:37:40
Hi Mitch!
>I barely notice it..
I'm glad to hear it :-)
Best regards,
Ed.
Posted by barbaracat on March 28, 2005, at 22:54:04
In reply to Mitch: Med Dose with Age, posted by smith562 on March 27, 2005, at 20:02:54
I've been thinking about Cytochrome P450 hepatic enzymes alot lately and wonder if many of us have genetic issues with drug detoxification. Cymbalta clears through isozymes CYP2D6 and CYP1A2. CYP2D6 is the big player in all antidepressant metabolism (other drugs as well, but across the board in ADs -- but not mood stabilizers). If something is going on that inhibits this enzyme, there's going to be alot more of the med circulating. This could be an interraction with other meds or foods, but perhaps it's more a genetic disorder. Perhaps bipolars have genetic abnormalities that interfere with metabolizing many of our naturally occurring chemicals?
Maybe these disorders show up later in life for some of us, and rather than high doses of ADs early on causing problems, it's more likely that we were able to clear them more efficiently then and not now. If bipolars either genetically, through drug interractions, food allergies, or for whatever other reason, experience CYP2D6 inhibition then it's no wonder we have nasty reactions to ADs. They're circulating much longer before clearing, a little goes a long way, and at the standard doses they give to unipolars - yikes!
This makes more sense to me than any theory on receptor disregulation or anything due to neuronal damage. Now that we know that neurons regenerate (thank God, thought I was stuck with my lot), I trust there's been enough turnover since when I 'damaged' them with high doses.
A genetic bipolar relationship with inhibition of metabolic enzymes breaks down somewhat on why the symptoms would be cyclically occurring. For instance, it would make sense if adrenaline clearance was inhibited, causing excessive anxiety with the resultant depressive crash, i.e., classic bipolar. But you'd expect this to be a contstant state and not have periods of normalcy in between. So any thoughts would be appreciated.
I am still getting a very positive response, now up to 13 pellets. Figure I'll stay at that number a while for good luck. - Barbara
>
> I have been following your and B-Cats posts on taking "micro" doses cymbalta. I have seen/heard many individual talk about taking hefty to normal size antidepressant doses when they were younger .... now only to require "micro" dose or no ads as they get older. My question is do you think individuals with bipolar or bipolar spectrum illness tend to require less antidepressant with age?
>
> If *yes*, is this due to kindling and the solidification of bipolarness (or another way to put it increasing sensitivity to ads as bipolar tendency concrete) .... or that as hormone levels decrease with age, one needs less ad? Thanks.
>
> Smith
This is the end of the thread.
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