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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by ed_uk on July 2, 2005, at 14:40:01
In reply to Re: What all medications have you taken Denise ??, posted by Denise1966 on July 2, 2005, at 12:39:58
Denise,
You haven't tried many meds! There's many more you could try :-)
~Ed
Posted by linkadge on July 2, 2005, at 18:32:17
In reply to Re: What all medications have you taken Denise ?? » Denise1966, posted by ed_uk on July 2, 2005, at 14:40:01
Surprisinly I am not doing too bad! I feel more normal than have in a long time. I feel sharper, I am able to play the piano again, I'm jogging, I'm preparing each day for school in the fall.
I have my lows still, but they feel natural/controllable and not those totally f*d up med induced lows.The longer I am off the meds, I am more convinced that my brain is *not* permanently dammaged by drugs.
8 months ago I was talking ECT too. But that wasn't me talking it was my misunderstanding talking.The doctors don't know how the meds work, but they know, even less, how ECT works, and many times doesn't work.
Just take a look at this board. Sure you have Mr. Scott is doing ok on ECT, but then again Sebastian doesn't recomend it. I would say that Mr Scott's case is atypical.
People I know had it done in Toronto, they are just not the same people. I cannot put my finger on what it is that is gone, but somethig is destincly GONE. They are just not the same people.
Remember Larry? Remember how smart he was? He was like the smartest guy on this site. He has read a lot, and I trust everything that guy says. ECT is the one thing that Larry woudn't touch with a 10 foot pole. LArry wasn't anti-med either. Larry was PRO-RECOVERY. Larry would take anything that would help him get better long term. And Larry thrived too. He was so loaded up with the natural crap, that when the meds failed he had something to fall back on. (Larry is my hero BTW!)There is sufficiant evidence to suggest that it causes irreversable neurological dammage, and I don't care what anyone says to the contrary.
There are so many med combinations you havn't tried yet. SO many.
Personally, I would like to find out what Dr. Manjii's opinion on ECT is. I would be very interested in that.
Linkadge
Posted by 4WD on July 2, 2005, at 22:20:14
In reply to Re: What all medications have you taken Denise ??, posted by linkadge on July 2, 2005, at 18:32:17
Linkadge
Are you completely off all meds? Except the Periactin?
Marsha
Posted by linkadge on July 3, 2005, at 1:45:09
In reply to Re: What all medications have you taken Denise ?? » linkadge, posted by 4WD on July 2, 2005, at 22:20:14
Yes, I've been completely off meds for a solid 3+ months.
I only take my precious periactin periodically.
Linkadge
Posted by ed_uk on July 3, 2005, at 5:56:29
In reply to Re: Scott's meds » ed_uk, posted by SLS on July 2, 2005, at 14:07:45
Hi Scott,
Did you see my post (above) about clonidine?
~ed
Posted by SLS on July 3, 2005, at 9:01:48
In reply to SCOTT!!! » SLS, posted by ed_uk on July 3, 2005, at 5:56:29
> Hi Scott,
>
> Did you see my post (above) about clonidine?
>
> ~edOops, no I haven't. Which one?
Are you guessing that clonidine might be worth a try because idazoxan and Remeron make me feel worse?
- Scott
Posted by SLS on July 3, 2005, at 9:05:49
In reply to Re: What all medications have you taken Denise ??, posted by linkadge on July 3, 2005, at 1:45:09
Hi Linkadge.
I am very happy that your level of overall function has been better lately. It would be wonderful if you could enter school with a sturdy concentration.
> Yes, I've been completely off meds for a solid 3+ months.
>
> I only take my precious periactin periodically.I must have missed something. What does Periactin do for you? One of Baron Shopsin's last words to me in 1986 when he had to leave his practice was "Periactin". I never tried it.
- Scott
Posted by ed_uk on July 3, 2005, at 10:03:04
In reply to Re: SCOTT!!! » ed_uk, posted by SLS on July 3, 2005, at 9:01:48
Hi Scott :-)
My post (to you) about clonidine.......
http://www.dr-bob.org/babble/20050702/msgs/522581.html
>I must have missed something. What does Periactin do for you? One of Baron Shopsin's last words to me in 1986 when he had to leave his practice was "Periactin". I never tried it.
Here's the thread I started about Periactin - Linkadge replied ........and talked about his experience with Periactin...........
http://www.dr-bob.org/babble/20050627/msgs/521042.html
~Ed
Posted by linkadge on July 3, 2005, at 15:53:35
In reply to Re: What all medications have you taken Denise ?? » linkadge, posted by SLS on July 3, 2005, at 9:05:49
I use periactin as a sleep aid on occasion.
I had to select my courses for the fall. I entered a state of panic that I've never experienced before.
Didn't expect it, was doing so well.
Small set back.
Linkadge
Posted by Denise1966 on July 4, 2005, at 5:49:15
In reply to Re: What all medications have you taken Denise ?? » Denise1966, posted by SLS on July 2, 2005, at 13:17:04
Hi Scott (SLS)
Ok, well maybe my little list looks a bit pathetic when compared to yours :-) but I'm not sure I want to spend another 5 or 10 years going through all the different possibilities and combinations of possibilities. I've seen your recent thread where you say that trileptal seems to be pooping out on you.
Thanks for you're response though, I've answered you're questions below.
I'm 39 years of age, my biological clock is at 5 to midnight and I might want to have babies someday, there is no way I would be prepared to have them now. also I'm tired of feeling like my life is wasting away, so think I might just go with ECT, if I don't try then I'll never know. I'm sure I remember you saying you had ECT and it didn't work, what type did you have and was it really that bad?
What is your current diagnosis? Depression Unipolar
Is there any history of bipolar disorder in your family? No
Describe your depression as best you can.
OK, well when it first started again about 4 years ago first thing I noticed was extreme lack of motivation, loss of interest, problems with concentration, general vague back and Neck pains (which is always a big characteristic with me), flying off the handle at work at the least little thing, feeling cold all the time, suicidal ideations, very agitaged at time although also apathetic. Loss of appetite, sleep ok though but bad dreams.
At what age did you experience your first episode? 17
How long has the current episode lasted? 4 years, 2 years ago though felt an improvement after trying Nardil then stopping and then going on 40mg of Seroxat.
Has there ever been any rapid-cycling? No
Have you ever demonstrating hypomania? No
Which drugs helped the most? In the past any SSRI or Tricyclic seemed to work, now nothing really, Seroxat a little but not enough and Zyprexa helps with the anxiety and sometimes with the motivation.
Which drugs made your depression worse? All of them initially over the last 4 years. Apart from Lamictal and Lithium, rTMS which had no affect at all. Couldn't even tell I was taking anything on them.
What is your shoe size? :-) 5.5, I've also got my profile and pic on remedyfind.com under Denise1904 as I gave my feedback on there on rTMS. Incase you need any further details.
Also, I thought you were going to give mifepristone a trial, what happened to that idea?
Denise
Posted by SLS on July 4, 2005, at 7:06:13
In reply to Re: What all medications have you taken Denise ??, posted by Denise1966 on July 4, 2005, at 5:49:15
Hi Denise.
Well, as I've said before, it appears that the drugs chosen for you were judicious and followed a course of varying mechanisms. I am curious, though, what combinations you have tried.
I would not dissuade you from trying ECT at this point. Still, I don't think you are at the point in treatment to take on procedures with substantial great risk. My feelings about the risks of ECT are mixed. I haven't even decided which hemisphere of the brain is best stimulated in unilateral treatments, although unilateral right seems to be most often used today. Mine was unilateral left followed by bilateral. I read something recently done by Harold Sackeim MD and Sarah Lisanby MD indicating that high dosage right unilateral is as effective as bilateral but with a much reduced occurence of cognitive side effects.
------------------------------------------------
Arch Gen Psychiatry. 2000 May;57(5):425-34. Related Articles, Links
A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities.
Sackeim HA, Prudic J, Devanand DP, Nobler MS, Lisanby SH, Peyser S, Fitzsimons L, Moody BJ, Clark J.
Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA. has1@columbia.edu
BACKGROUND: Controversy persists about the use of right unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT). While RUL ECT results in less severe short-term and long-term cognitive effects, there is concern that it is less efficacious than BL ECT. METHODS: In a double-blind study, 80 depressed patients were randomized to RULECT, with electrical dosages 50%, 150%, or 500% above the seizure threshold, or BL ECT, with an electrical dosage 150% above the threshold. Depression severity and cognitive functioning were assessed before, during, immediately after, and 2 months after ECT. Compared with baseline, responders had at least a 60% reduction in symptom scores 1 week after ECT, and were monitored for relapse for 1 year. RESULTS: High-dosage RUL and BL ECT were equivalent in response rate (65%) and approximately twice as effective as low-dosage (35%) or moderate-dosage (30%) unilateral ECT. During the week after the randomized phase, BL ECT resulted in greater impairment than any dosage of unilateral ECT in several measures of anterograde and retrograde memory. Two months after ECT, retrograde amnestic deficits were greatest among patients treated with BL ECT. Thirty-three (53%) of the 62 patients who responded to ECT relapsed, without treatment group differences. The relapse rate was greater in patients who had not responded to adequate pharmacotherapy prior to ECT and who had more severe depressive symptoms after ECT. CONCLUSION: Right unilateral ECT at high dosage is as effective as a robust form of BL ECT, but produces less severe and persistent cognitive effects.
---------------------------------------------------------------
> Also, I thought you were going to give mifepristone a trial, what happened to that idea?Well, I was all set to proceed, but I started responding to Trileptal. All the paperwork is complete, the FDA granted me an IND, and I can begin treatment within a month if it were necessary. I must first more fully explore Trileptal by pushing the dosage. I moved up my appointment to see my doctor to later this week. I really would like to jump up from 900mg to 1200mg. I am so tempted to self-medicate, but I think it is important to exercise a little discipline at this point. I can't sit too long on the mifepristone thing, though. I believe there is a limit as to how long the IND remains in effect.
- Scott
Posted by Denise1966 on July 4, 2005, at 11:46:06
In reply to Re: What all medications have you taken Denise ?? » Denise1966, posted by SLS on July 4, 2005, at 7:06:13
Scott,
Thanks for this, hopes the increase works eventually. I was just going to ask for high dose Right Unilateral (if I get the choice :-)) as I daren't take the risk (yet) with Bilateral.
I'm really interested in this Deep Brain Stimulation as well. I think 4 out of 6 is a really great result, no matter how small the sample and the fact that the results are so instant is even more exciting.
Linkadge was saying that some of the people he's known who've had ECT were never quite the same did any people make that comment about you after you'd had it. Or did you never feel quite the same yourself after having it, I guess my real question is did you regret having it?
Combinations I tried were
lithium and SSRI
lithium and tricyclic
Lamictal and SSRI
all of the above plus Zyprexa now and again.
Denise
Denise
Posted by SLS on July 4, 2005, at 12:55:08
In reply to SLS, posted by Denise1966 on July 4, 2005, at 11:46:06
Hi Denise.
To recall with 20/20 hindsight my decision making process regarding ECT is tempting. Since it didn't work, I wish I had never had it. I don't know the degree to which it has produced long-lasting impairments in memory. Memory impairment is a primary symptom of my condition, and occured prior to ECT. My memory and cognitive function are worse now than prior to my having had ECT, but my depression has grown worse overall. Bilateral ECT really produced a significant change in my cognition and memory that the unilateral did not. Still, I wouldn't rule out having ECT again. Max Fink, MD, told me that the type of treatments I had in 1991 have since been refined and are more efficacious. He also hinted that RU is better than LU, but there are some who select hemispheres based on dominance. He really wanted me to buy his book to have my questions answered.
I'm not sure what to make of DBS yet. VNS received good press when it first became available. It doesn't appear that VNS is living up to the original excitement it produced five years ago. I have seen some amazing demonstrations with DBS used in Parkinsons Disease. I think with DBS, they will eventually discover which types of depression are most likely to respond to it. I have to do a bit more investigating to decide if bipolar depression has a higher or lower rate of success. I don't know how to interpret your symptom cluster. It has features that seem more typical than atypical or possibly a mixture of the two. You might respond better to TCA and MAOI than to SRI. I would certainly explore MAOI before going for ECT.
Do you feel better in the morning or in the evening?
Do you feel significantly better for short periods when something good happens?
Do you ruminate incessantly over things?
What happened to Wellbutrin?
As far as combinations are concerned, I don't see that you have combined one or more antidepressants with complementary mechanisms of action. That leaves a whole world unexplored.
SRI + Remeron
SRI + Wellbutrin
SRI + TCAI'm still unclear about lithium. How did it affect you?
I am currently taking:Lamictal 150mg
Parnate 80mg
nortriptyline 100mg
Abilify 10mg
Trileptal 900mgHopefully I'll get to increase the dosage of Trileptal to 1200mg by this time next week.
- Scott
Posted by linkadge on July 4, 2005, at 16:19:55
In reply to Re: SLS » Denise1966, posted by SLS on July 4, 2005, at 12:55:08
I don't believe it promotes wellness.
When Sebastian said something like:
"After ECT, I didn't know what depression was,
then again, I didn't know what anything was for that matter"That is exactly the way that the people I know today who've had ECT are. They are just not the same people. I can't put my finger on what's gone.
ECT is like cutting a bad spot out of an apple by using a dirt shovel. There is a lot of collateral dammage. And that dammage could significantly put you into a tremendously worse depression the next time it hits.
Linkadge
Posted by Denise1966 on July 5, 2005, at 2:37:45
In reply to Re: SLS, posted by linkadge on July 4, 2005, at 16:19:55
Linkadge,
Yes but I think that the affects you're referring to are more likely to occur after having bilateral ECT. Hopefully unilateral ECT won't be as bad.
Kind Regards.....Denise
Posted by linkadge on July 5, 2005, at 19:08:13
In reply to Re: Linkadge, posted by Denise1966 on July 5, 2005, at 2:37:45
The only reason unilateral doesn't seem to do as much harm is because it doesn't affect the language portion of the brain, ie declaritive memory remains intact.
That doesn't mean that equal problems are not caused in other brain areas.
It might not affect your language, logic etc, but could still affect your spatial, musical, abilities etc.
I'm sorry, I don't trust it. I will not say any more because it is not helpful to your state, I know.
I belive strongly that its principle mechanism of action is attained by causing brain dammage.
I know you've probably categorized me now, as one of "those" people, but I'm really not.
Infact, I'd rather you try amphetamine, heck even go splurge on methamphetamine! But please don't have ECT.
I've said my part, I will say no more.
Linkadge
Posted by 4WD on July 5, 2005, at 22:06:32
In reply to Re: What all medications have you taken Denise ??, posted by linkadge on July 3, 2005, at 1:45:09
> Yes, I've been completely off meds for a solid 3+ months.
>
> I only take my precious periactin periodically.
>
> Linkadge
I can only imagine what you must have gone through - getting off all that stuff. I am proud of you for the courage and strength it must have taken. Whether we on this board think that only meds can help us or alternatively think that meds are the worst evil, I don't think anyone can deny that you must have a great core of inner strength and determination. THat's what's going to get you through, Linkadge. You're going to be okay.Marsha
Posted by 4WD on July 5, 2005, at 22:14:02
In reply to Re: What all medications have you taken Denise ?? » Denise1966, posted by SLS on July 4, 2005, at 7:06:13
> Also, I thought you were going to give mifepristone a trial, what happened to that idea?
>
> Well, I was all set to proceed, but I started responding to Trileptal. All the paperwork is complete, the FDA granted me an IND, and I can begin treatment within a month if it were necessary. I must first more fully explore Trileptal by pushing the dosage. I moved up my appointment to see my doctor to later this week. I really would like to jump up from 900mg to 1200mg. I am so tempted to self-medicate, but I think it is important to exercise a little discipline at this point. I can't sit too long on the mifepristone thing, though. I believe there is a limit as to how long the IND remains in effect.
>
>
> - Scott
Is there any pressing reason why you couldn't do the mifepristone trial anyway? I mean, wouldn't it be great it if worked so well you could lower or stop some of the other meds? Or if it just worked anyway, Trileptal and all? Or do you have to be off meds before the trial?Marsha
Posted by SLS on July 6, 2005, at 5:53:35
In reply to Re: What all medications have you taken Denise ?? » SLS, posted by 4WD on July 5, 2005, at 22:14:02
> > Also, I thought you were going to give mifepristone a trial, what happened to that idea?
> >
> > Well, I was all set to proceed, but I started responding to Trileptal. All the paperwork is complete, the FDA granted me an IND, and I can begin treatment within a month if it were necessary. I must first more fully explore Trileptal by pushing the dosage. I moved up my appointment to see my doctor to later this week. I really would like to jump up from 900mg to 1200mg. I am so tempted to self-medicate, but I think it is important to exercise a little discipline at this point. I can't sit too long on the mifepristone thing, though. I believe there is a limit as to how long the IND remains in effect.
> >
> >
> > - Scott
>
>
> Is there any pressing reason why you couldn't do the mifepristone trial anyway? I mean, wouldn't it be great it if worked so well you could lower or stop some of the other meds? Or if it just worked anyway, Trileptal and all? Or do you have to be off meds before the trial?I guess I don't want to expose myself to risk and side effects that mifepristone might produce. Blocking all of your cortisol receptors for a week sounds pretty radical. If it ain't broke, don't fix it. My only real concern with not trying it right away is that my IND might time-out after a month or so. I'm happy things are progressing slowly enough that I get to try increasing the Trileptal at least one more time.
- Scott
Posted by linkadge on July 6, 2005, at 6:29:17
In reply to Re: What all medications have you taken Denise ??, posted by SLS on July 6, 2005, at 5:53:35
Before I went of meds, I made an extensive list of every single alternative method that has helped me in the past.
I am treating my condition symtomatically with many different supplements. They don't all fully replace the SSRI, but as a whole, I feel more capable in my life.
Linkadge
Posted by SLS on July 6, 2005, at 7:01:19
In reply to Re: What all medications have you taken Denise ??, posted by linkadge on July 6, 2005, at 6:29:17
Hi Linkadge.
> I am treating my condition symtomatically with many different supplements.What is your current regime, if you don't mind my asking?
Thanks.
- Scott
Posted by linkadge on July 6, 2005, at 15:51:37
In reply to Re: What all medications have you taken Denise ??, posted by SLS on July 6, 2005, at 7:01:19
Cool, I am taking (A lot right now, but I will have to reduce it soon for money reasons)
Morning: Folic Acid 1mg
B12 100mcg
Anthocyannins 75mg (Neurotrophic)
EPA 1g, DHA 500mg
Alpha Lipoic Acid 100mgNoon Turmeric Extract (moderate MAO-A -)
Fo-Ti 2g (moderate MAO-B -)
Rosermarry leaf (Acetylcholinsterase -)
Night Taurine 1000mg
ginger Root,(BDZ, substance P-)
Magnesium 100-200mg
Quercetin 1g (PKC-, MAO-A-, COMT-)
Melatonin 0,5-1.0mg
Posted by SLS on July 6, 2005, at 21:01:07
In reply to Re: What all medications have you taken Denise ??, posted by linkadge on July 6, 2005, at 15:51:37
That's a heck of a regime! Thanks for posting it.
- Scott
> Cool, I am taking (A lot right now, but I will have to reduce it soon for money reasons)
>
>
> Morning: Folic Acid 1mg
> B12 100mcg
> Anthocyannins 75mg (Neurotrophic)
> EPA 1g, DHA 500mg
> Alpha Lipoic Acid 100mg
>
> Noon Turmeric Extract (moderate MAO-A -)
> Fo-Ti 2g (moderate MAO-B -)
> Rosermarry leaf (Acetylcholinsterase -)
>
>
> Night Taurine 1000mg
> ginger Root,(BDZ, substance P-)
> Magnesium 100-200mg
> Quercetin 1g (PKC-, MAO-A-, COMT-)
> Melatonin 0,5-1.0mg
>
>
Posted by linkadge on July 7, 2005, at 6:24:22
In reply to Re: What all medications have you taken Denise ?? » linkadge, posted by SLS on July 6, 2005, at 21:01:07
Well, it changes daily! The act of changing it gives me a small sence of controll.
Linkadge
Posted by 4WD on July 7, 2005, at 13:59:20
In reply to Re: What all medications have you taken Denise ??, posted by SLS on July 6, 2005, at 5:53:35
> > > Also, I thought you were going to give mifepristone a trial, what happened to that idea?
> > >
> > > Well, I was all set to proceed, but I started responding to Trileptal. All the paperwork is complete, the FDA granted me an IND, and I can begin treatment within a month if it were necessary. I must first more fully explore Trileptal by pushing the dosage. I moved up my appointment to see my doctor to later this week. I really would like to jump up from 900mg to 1200mg. I am so tempted to self-medicate, but I think it is important to exercise a little discipline at this point. I can't sit too long on the mifepristone thing, though. I believe there is a limit as to how long the IND remains in effect.
> > >
> > >
> > > - Scott
That makes a lot of sense. I don't know what exactly would happen without cortisol for a week. Very fatigued? Hypervigilant immune system?
This is the end of the thread.
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