![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by bigcat on January 6, 2006, at 11:03:21
Ahhhhh, remission. Beautiful, beautiful remission. My god I love you all. Take your medecine. Have patience. It won't always be like this. All Things Must Pass. The nature of life is change, and you're doing it right now, and desperate spirals out of control can help the occasional good time feel like the most serene, wonderful gift imaginable. If you're struggling, you'll find relief. Don't envy those who are happy all the time. As hard as it is to believe and as painful and frustrating as it is, there is a noble and profound element to suffering. Endure and persevere. You will. I've tried every med more than once, 15 ECT's, long periods of suicidal ideations, a truly vegetative state. Effexor, Buspar, and Lamictal are working for me. The Effexor has been teasing me, coming in with an amazing rush and fading out miserably. I've been too unmotivated and confused to even bother taking the Buspar and Lamictal, as I thought the occasional, fleeting break-up of the depression was all the Effexor. Maybe the Buspar is finally working, knocking the anxiety out, and freeing my mind to think!!! I love acess to my mind and being kind and responsive to others, and caring for and about myself finally. If this should pass, please remind me to heed my own advise and continue fighting. It's all you can do. Don't give up on meds, but don't think you're mind is totally powerless. Use moments of clarity to dissect your depression and gain insight about destructive thought patterns. The will and thought alone are WAY more powerful than I could ever have imagined. I always thought it was a 100% chemical screw-up, but taming your own mind is possible (with the help of meds, of course). I love and hope for you all. To a brighter day and a clearer vision of your worth and wonder :-). It's in you, even if you don't feel it now. I don't want to offer the cliche that life is worth living, because for many of us, at many times it just does not seem so. But we have, hope for, and understand eachother, even if noone else does, and we know what we're fighting for and what our true selves are capable of. You are all so much better people than you may believe. (My depressive self-loathing is horrendous, one of my most absolutely unbearable symptoms), so I can sympathize with this DEPRESSIVE DELUSION very dearly. Thank you ed. how's the bupe working form you psuedonym? phillipa, we all love you. med empowered, we are all humbled by you. SLS, Declan, all ya'll in the Nardil poopout-and-nothing-else-comes-close club (I thought I was a life member- guess not). Keep pushing for yourselves. I have seen you all progress and forge your own path to recovery, even if the present may seeem bleak. You NEVER KNOW!!. That is all I can promise you, and it's enough to go on. It's been all I've been going on for 7+ years. Thank you, thank you. Free and at peace at last.
-matt-
Posted by MGOLDW on January 6, 2006, at 11:46:17
In reply to FREEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, posted by bigcat on January 6, 2006, at 11:03:21
Congratulations, great post, an inspiration to us all.
Good luck
Posted by ed_uk on January 6, 2006, at 13:08:29
In reply to FREEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, posted by bigcat on January 6, 2006, at 11:03:21
Dear Matt
You sound almost euphoric (hypomanic?) - similar to when you first started the Effexor. I think you might be 'rapid cycling'. You've abruptly gone from being severely depressed to being semi-euphoric then back to being depressed then euphoric again.
Love
Ed
Posted by Tom Twilight on January 6, 2006, at 16:00:08
In reply to FREEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, posted by bigcat on January 6, 2006, at 11:03:21
Hey Matt
Glad your feeling better, you've certainly been through some rough times!
Its good to know that not everyone on this board is perminantly hoplessly miserable.
I hope Eds wrong (no offense Ed) and your not cycling, I don't know much about cycling so I can't really comment
Feeling normal can feel really good after feeling really crap though!
Posted by Phillipa on January 6, 2006, at 18:56:39
In reply to Thats Great!, posted by Tom Twilight on January 6, 2006, at 16:00:08
Congratulations! Hope you are doing well. And for the first time I hope Ed is wrong. Fondly, Phillipa
Posted by Tomatheus on January 6, 2006, at 20:40:57
In reply to FREEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!, posted by bigcat on January 6, 2006, at 11:03:21
Matt,
It is with strong but mixed emotions that I reply to your post. On one hand, I find your post deeply inspiring because I can only imagine how wonderful it must feel to finally achieve remission after years of unsuccessful medication trials. From reading some of your posts, it's my impression that you've struggled terribly in your pursuit of remission, and I find it overjoying to read that you've been able to persevere in the face of so much suffering.
But as overjoyed and inspired as I felt from reading your post, I also came across it with a terrible sense of concern. My concern is basically the same as Ed's, only I speak from my experience with medication-induced cycling. Some of your statements eerily reminded me of my experience with Paxil, especially these two:
> The nature of life is change, and you're doing it right now, and desperate spirals out of control can help the occasional good time feel like the most serene, wonderful gift imaginable.
> The Effexor has been teasing me, coming in with an amazing rush and fading out miserably.
The words and phrases that you used to describe your remission (i.e., "the most serene, wonderful gift imaginable," "an amazing rush") perfectly describe my Paxil-induced hypomanic periods. My response to Paxil was somewhat inconsistent from the beginning, but when I got up to a higher dose (I believe it was 60mg/day), I began experiencing a pattern of definite cycling - hypomanic periods that lasted three to four days followed immediately by depressive periods that lasted just as long. My hypomanic periods did not involve the reckless and dangerous behavior (things such as spending sprees and hypersexual behavior) that tend to accompany hypomania and full-blown mania. My hypomanic periods were relatively mild, but it was the euphoric type of hypomania that I felt, as opposed to the agitated/irritable type. I basically felt happy to be alive on a continuous basis, and I was more productive academically and occupationally than I had ever been. My happiness seemed to be contagious, as people liked to be around me a lot more than I usually do when I'm just depressed and in my own world. It was intoxicating, a perfect way to live, and if it weren't for the fact that I felt terribly depressed as often as I felt hypomanic, I probably would have fought tooth-and-nail to stay on the Paxil indefinitely. But of course, it became impossible to function in the everyday world and to make any plans when I was feeling too depressed to do much of anything half of the time. As wonderful as I felt and as productive as I was when I was hypomanic, the depression was always inevitable. So, of course I had to stop the Paxil, and at that point I was presumed bipolar and put on a series of medications that basically just made me feel worse, and now I've finally discovered a class of antidepressants (MAOIs) that can actually do some good on their own without triggering cycling or hypomania.
Now, as I said, I've read some of your other posts, and I'm aware that you've been through just about every medication out there. So, it sounds like you have more experience than I do in this whole process of trial and error, which means that you probably know more overall about meds than I do. And of course, there is no doubt in my mind that you know yourself and how you respond to meds better than I possibly could. I really, *really* hope you're right in saying that what you're experiencing is a true remission. You definitely deserve no less. But I do have some serious concerns that you may be experiencing some medication-induced cycling. And even if your "ups" aren't the least bit dangerous, please be aware that you *may* be on the roller coaster ride of rapid cycling -- a ride in which depression is just as inevitable as the bliss that you're experiencing now.
Tomatheus
Posted by bigcat on January 6, 2006, at 23:59:56
In reply to Cycling » bigcat, posted by Tomatheus on January 6, 2006, at 20:40:57
Thomaseus and Ed:
You are both absolutely right. It's rapid cycling hardcore. I don't doubt that slightly. I was out of control at work today. Talking more than I have in YEARS combined, literally. I was blatantly hitting on a soon-to-be-wed girl, just soo darn intense, but... brilliant. Yes this may be hypo or manic grandiosity, but there is an element of truth in it. I wrote an email this morning that outlined my political and moral views as I've never been able to express in more than some disassociated phrases, brewing for what seems like a lifetime of inablility to communicate whatsoever. I simply can't believe how my brain is working now. I see through every delusion in life. But alas, this is somewhwat delusional I understand. I'm even viewing the worst of times in a positive light. But, as you said, it's been a WHILE since something this profound has happened to me.I'm a bipolar who only goes hypomanic (or a handful of times full-blown manic) when introducoing new, or high levels of an AD. Nardil and Marplan- initial hypomania (mania on the Marplan). Dexedrene (90mgs)- extremely manic for months. Grandiose delusions. A messianic delusion while on recreational drugs (VERY potent pot, like nothing I've ever inhaled, or even sniffed from a distance). I do feel short of breathe, restless, and twithy now. Is the symptoim "akasthesia"(??). But my ability to concentrate and accomplish things that I've put off as monumental, unthinkable efforts for years, I'm doing at the drop of the hat. I'm insanely creative, and once again grandiose. But it feels so good to be on the other side of the horror, even if it is fleeting. I do think whatever it is will seriously help me understand and deconstruct my depression somewhat better in the future so I can help myself help myself. I'm totally entranced by Buddhist philosophy now, and relate it to every moment.
I appreciate your concern so deeply. I know it is out of care for my well-being that you regretfully, but strongly warned that I may be cycling. Now that I know this, what should I do? Ed, I've backed the Effexor from 600 to 525, Lamictal kept at 225, Buspar at 20. That's my combo. Been taking thorazine and ambien for sleep since I ran out of my sure-bet sleep med, 400-800mgs Seroquel an hour before wanting sleep. I need some, the Mabien and Thorazine aren't helping, but Seroquel is too expensive. I'll "procure" samples anyway I can, and soon. What other suggestions besides possibly adding Lithiuim (?) and obviously backing off the Effexor significantly?? My dad/doc said today that I may only need 37.5 twice a day! I couldn't believe it as I'm so indoctrinated into thinking that more is better, but Effexor may be one that needs a very careful dose tweak. Anyway, I'm hopeful this will resolve itself, and grateful for moments when I don't consider myself a completely worthless and pathetic failure and burden. The plan is to stay on the Effexor, Lamictal and Buspar, backing off the Effexor how much a day/week would you say? See how it goes, or make a drastic reduction and risk an atrocious withdrawal?? I know when I was moving the Effexor dose up and up every few days I was cycling awfully, but my ups were good, not perfect, and my downs were utter despair.
Once again, thank you both for telling me what I already knew, but still have a hard time admitting, because I feel indominably powerful. I have no doubt that Mania is what drove men like Hitler and van Gogh. The energy is so unpredictable, and enhances cognitive functions above a capacity comprehensible to those unfamiliar with the experience. I will admit that the power and freedom are intoxicating, but wearisome. BUUUUTTTTT, maybe things will even out and I'll get the best of both worlds, calm and clairvoyant, steady and stable. Who knows. Right now it's very hard to care. Worry is all I've known for so awfully long. Could the Buspar be the magic bullet?????
Thomaseus- what MAOI is working for you? Nardil is beautiful for me for about a week, and then pisses out each time, even at 90mgs. Marplan rocketed me to the moon on the fourth trial, after three unsucessful attempts, and faded over a couple months into so-so, then nothing.
Eagerly awaiting your responses and demands that I take some downs and Lithiums right about now. I'm hitting up 100-200mgs Thorazine for sleep now. It's all I have. I don't want to take Elavil for rest and screw with the AD combo any more than I have to. Thanks and much love...
-matt-
> Matt,
>
> It is with strong but mixed emotions that I reply to your post. On one hand, I find your post deeply inspiring because I can only imagine how wonderful it must feel to finally achieve remission after years of unsuccessful medication trials. From reading some of your posts, it's my impression that you've struggled terribly in your pursuit of remission, and I find it overjoying to read that you've been able to persevere in the face of so much suffering.
>
> But as overjoyed and inspired as I felt from reading your post, I also came across it with a terrible sense of concern. My concern is basically the same as Ed's, only I speak from my experience with medication-induced cycling. Some of your statements eerily reminded me of my experience with Paxil, especially these two:
>
> > The nature of life is change, and you're doing it right now, and desperate spirals out of control can help the occasional good time feel like the most serene, wonderful gift imaginable.
>
> > The Effexor has been teasing me, coming in with an amazing rush and fading out miserably.
>
> The words and phrases that you used to describe your remission (i.e., "the most serene, wonderful gift imaginable," "an amazing rush") perfectly describe my Paxil-induced hypomanic periods. My response to Paxil was somewhat inconsistent from the beginning, but when I got up to a higher dose (I believe it was 60mg/day), I began experiencing a pattern of definite cycling - hypomanic periods that lasted three to four days followed immediately by depressive periods that lasted just as long. My hypomanic periods did not involve the reckless and dangerous behavior (things such as spending sprees and hypersexual behavior) that tend to accompany hypomania and full-blown mania. My hypomanic periods were relatively mild, but it was the euphoric type of hypomania that I felt, as opposed to the agitated/irritable type. I basically felt happy to be alive on a continuous basis, and I was more productive academically and occupationally than I had ever been. My happiness seemed to be contagious, as people liked to be around me a lot more than I usually do when I'm just depressed and in my own world. It was intoxicating, a perfect way to live, and if it weren't for the fact that I felt terribly depressed as often as I felt hypomanic, I probably would have fought tooth-and-nail to stay on the Paxil indefinitely. But of course, it became impossible to function in the everyday world and to make any plans when I was feeling too depressed to do much of anything half of the time. As wonderful as I felt and as productive as I was when I was hypomanic, the depression was always inevitable. So, of course I had to stop the Paxil, and at that point I was presumed bipolar and put on a series of medications that basically just made me feel worse, and now I've finally discovered a class of antidepressants (MAOIs) that can actually do some good on their own without triggering cycling or hypomania.
>
> Now, as I said, I've read some of your other posts, and I'm aware that you've been through just about every medication out there. So, it sounds like you have more experience than I do in this whole process of trial and error, which means that you probably know more overall about meds than I do. And of course, there is no doubt in my mind that you know yourself and how you respond to meds better than I possibly could. I really, *really* hope you're right in saying that what you're experiencing is a true remission. You definitely deserve no less. But I do have some serious concerns that you may be experiencing some medication-induced cycling. And even if your "ups" aren't the least bit dangerous, please be aware that you *may* be on the roller coaster ride of rapid cycling -- a ride in which depression is just as inevitable as the bliss that you're experiencing now.
>
> Tomatheus
Posted by Tomatheus on January 7, 2006, at 20:29:46
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » Tomatheus, posted by bigcat on January 6, 2006, at 23:59:56
Matt,
See below for my responses to various sections of your post...
> Yes this may be hypo or manic grandiosity, but there is an element of truth in it. I wrote an email this morning that outlined my political and moral views as I've never been able to express in more than some disassociated phrases, brewing for what seems like a lifetime of inablility to communicate whatsoever.
For what it's worth, I agree with you. Those who have never experienced the type of hypomania that you're describing - especially those within the psychiatric establishment - have a tendency to dismiss the productivity and creativity of hypomania as delusions in and of themselves. In other words, it is sometimes said that people only *believe* that they're more productive and creative while they're hypomanic, but in reality they actually aren't. Speaking as somebody who's (probably) experienced something similar to what you're experiencing (like you, I was getting cycling as a result of the inhibition of the reuptake of serotonin and norepinephrine on Paxil), I believe strongly that the benefits of your hypomanic state are real. I'm not saying that hypomania can't be dangerous if it becomes too intense, but I too possessed the capacity to express my thoughts much more clearly, efficiently, and insightfully than ever when I was hypomanic. I was actually able to follow through with the goals that I set, and my ability to write (like yours) was vastly improved. Even in retrospect, I think that there is no question that I accomplished more during the few hypomanic states that I experienced than I've ever been able to accomplish during the same length of time. So, I think it's clear that my ability to accomplish more (if nothing else) was a genuine enhancement in my ability, not just the product of a delusion. Now, *can* delusional thinking emerge as a result of being hypomanic? As you mentioned below, the answer is an obvious yes.
> I simply can't believe how my brain is working now. I see through every delusion in life. But alas, this is somewhwat delusional I understand. I'm even viewing the worst of times in a positive light.
And there you go. Considering that you're viewing the worst of times in a positive light, I would imagine that you're probably wondering to what extent you're seeing other things through a distorted lens. Of course, research has shown that depressives actually have the most realistic perceptions of the world around them, and that even euthymic (e.g., "normal") individuals think somewhat delusionally. So, in that sense, a little bit of slightly "delusional" thinking might not be such a bad thing. I guess it's just a matter of finding a good balance between feeling "good" and being able to perceive things realistically and accurately. Of course, that's a helluva lot easier said than done, especially for people like us.
> I'm a bipolar who only goes hypomanic (or a handful of times full-blown manic) when introducoing new, or high levels of an AD. Nardil and Marplan- initial hypomania (mania on the Marplan). Dexedrene (90mgs)- extremely manic for months. Grandiose delusions. A messianic delusion while on recreational drugs (VERY potent pot, like nothing I've ever inhaled, or even sniffed from a distance).
It seems that the two of us have some similarities in terms of our responsiveness to meds. As I've said, I experienced mood cycling in response to Paxil monotherapy, with hypomanic and depressive states each lasting three to four days and no euthymia in between. I also tried taking a low dose of fluoxetine (generic Prozac) when I was on my Wellbutrin/lithium combo, and I even experienced some low-grade cycling then. So, given my responses to both the Paxil and the fluoxetine, I've steered clear of SSRIs, SSNRIs, and TCAs since then.
Unlike you, I have never experienced any hypomania on an MAOI, but then again, I've never taken Marplan - only Nardil, Parnate, and moclobemide. I'm wondering if your initial hypomania on MAOIs (particularly on Nardil) might have had something to do with the way you started taking the meds. Did you just start taking 45 mg/day (or 60mg/day?) all at once, or did you gradually work your way up to a therapeutic dose 15mg at a time. On Nardil, I gradually worked my way up by taking 15mg/day for a week, then 30mg/day the next week, and then 45 mg/day the week after that. And as I said, I didn't experience any hypomania, but I wonder if I might have felt hypomanic if I had just gone straight to 45mg/day without gradually working my way through the lower doses.
> I do feel short of breathe, restless, and twithy now. Is the symptoim "akasthesia"(??).
I'm not quite sure about this one, but it's my guess that this symptom will probably fade away with the hypomania. I could be wrong, though. Maybe Ed or someone else here could be more helpful with this question.
> I appreciate your concern so deeply. I know it is out of care for my well-being that you regretfully, but strongly warned that I may be cycling.
Thanks. You hit the nail right on the head.
> Now that I know this, what should I do? Ed, I've backed the Effexor from 600 to 525, Lamictal kept at 225, Buspar at 20. That's my combo. Been taking thorazine and ambien for sleep since I ran out of my sure-bet sleep med, 400-800mgs Seroquel an hour before wanting sleep. I need some, the Mabien and Thorazine aren't helping, but Seroquel is too expensive. I'll "procure" samples anyway I can, and soon. What other suggestions besides possibly adding Lithiuim (?) and obviously backing off the Effexor significantly??
I have a feeling that Ed and others here will be able to provide better suggestions than I'll be able to, especially considering that I know next to nothing about Buspar. But I'll throw in a few of my ideas just in case you might find one or two of them somewhat helpful.
First, I agree that you'll obviously need to significantly reduce your dose Effexor. Perhaps the combination of the Lamictal, the Buspar, and the Effexor dose reduction will be enough to reduce the intensity of your cycling.
With respect to lithium, I think it might be worth a try, but I will warn you that lithium doesn't have a reputation for being effective at controlling rapid cycling, whether the cycling is endogenous or medication-induced. As I mentioned earlier, I tried taking fluoxetine at a low dose when I was taking both lithium and Wellbutrin, and I still had some breakthrough cycling. So, even though lithium might be a viable option, keep in mind that it doesn't tend to be great for controlling bipolar-related cycling.
If you hadn't already tried both Nardil and Marplay, I would recommend going with an MAOI because they do have less of a tendency to induce rapid cycling in otherwise unipolar patients than other antidepressants. Obviously, some of what I'm saying comes from my own experience, but there is also some evidence in the scientific literature to support my claim. Clorgyline, an irreversible inhibitor of MAO-A that has been used only in research, has actually been found to be effective at treating endogenous rapid cycling (or in other words, cycling that's not med-induced) in some bipolar patients. But you've obviously already tried the MAOI route without immense success, so it seems that tweaking your combo is probably the most sensible thing to do at this time.
> The plan is to stay on the Effexor, Lamictal and Buspar, backing off the Effexor how much a day/week would you say? See how it goes, or make a drastic reduction and risk an atrocious withdrawal?? I know when I was moving the Effexor dose up and up every few days I was cycling awfully, but my ups were good, not perfect, and my downs were utter despair.
I feel hesitant to give my honest response to this question because I know that Effexor tends to produce extreme withdrawal reactions, and I really don't want to suggest that you do something that might lead to so much suffering. But I'm assuming that you wouldn't have asked the question that you did if you didn't want my honest response. So, here it goes, but please remember that my experience may not be the same as your experience, even though we seem to respond similarly to meds.
When I stopped taking Paxil, I basically did the unthinkable, even though I knew better. So, yeah, I stopped it cold turkey (although I can't remember why). Surprisingly, I experienced absolutely *no* withdrawal reactions. Knowing that it is highly unusual for a patient to stop taking Paxil cold turkey without experiencing any withdrawal, I put quite a bit of thought into the matter and eventually came up with a hypothesis. And my hypothesis is this: because I was constantly cycling, the levels of serotonin and norepinephrine in my brain were constantly changing. In other words, levels of the neurotransmitters were high when I felt hypomanic and low when I felt depressed. Considering that my hypomanic and depressive states only lasted three to four days, my brain never adapted to the increases (or decreases) in the levels of serotonin and norepinephrine. When most individuals take Paxil, the levels of serotonin and norepinephrine increase and remain that way indefinitely. Eventually, the brain adapts to these increases, possibly by downregulating neurotransmitter receptors, releasing fewer neurotransmitters, and/or producing fewer neurotransmitters. If Paxil is discontinued immediately in these patients, they experience withdrawal symptoms until the brain re-adapts itself to adjust to the way things were before the Paxil was taken. Once again, because my brain never adapted to any kind of long-term increase in the levels of serotonin and norepinephrine - there were only short term increases during my hypomanic periods - I never experienced withdrawal. Or at least that's how my hypothesis goes.
So, given my experience, I would not be surprised if you ended up experiencing absolutely no withdrawal symptoms from drastically reducing your dose of Effexor. Like Paxil, Effexor inhibits the reuptake of both serotonin and norepinephrine, but its inhibition of the norepinephrine transporter is stronger than that of Paxil. And of course, your response on Effexor seems to be similar to my response on Paxil. So, yeah, I wouldn't be surprised if drastically reducing your Effexor dose doesn't lead to any withdrawal reactions. But at the same time, considering how horrible withdrawal can be for some people, I don't think I can recommend in good conscience that you actually do risk the withdrawal symptoms. Of course, it's up to you. As I said in my previous post, you know how you respond to meds and changes in meds better than I possibly could, so I would recommend taking my experience into account and using your best judgment.
> Thomaseus- what MAOI is working for you? Nardil is beautiful for me for about a week, and then pisses out each time, even at 90mgs. Marplan rocketed me to the moon on the fourth trial, after three unsucessful attempts, and faded over a couple months into so-so, then nothing.
Actually, I wouldn't say that any of the MAOIs have actually "worked" - not if "working" means working well. What they have done is produced some kind of antidepressant response in me without causing me to cycle or become hypomanic in any way. I know that's not saying much, but I firmly believe that the right antidepressant (possibly, but not necessarily, in combination with a mood stabilizer) is what will get me to a state of remission if I ever get there. Even though I'm technically bipolar, the course of my illness is really best described as an ongoing state of unipolar depression - unless I'm taking an antidepressant that inhibits the reuptake of serotonin and/or norepinephrine. Mood stabilizers have been of little help to me and have sometimes made me worse. What I really need is a medication that produces that antidepressant effect that I need but doesn't go too far. So far, the MAOIs have been the only meds that have produced this effect in me, even though the effect can never seem to last.
Right now, I am taking Nardil. Like you, I have had some success on it, but I have found that this success is usually short-lived. Basically, I also get an antidepressant response each time I raise the dose, but I would say that my responses are just partial responses - in other words, pretty good, but not quite "beautiful." I'm actually considering bouncing back and forth between one dose and another (probably between 60mg and 75mg) as a sort of short-term plan until my pdoc and I can agree on a decent long-term plan. In other words, I would go from 60mg to 75mg, stay at 75mg for about two weeks to get that startup antidepressant response, and then go back down to 60mg for another two weeks, and then repeat that process again. I know it's extremely unorthodox, but I might just do it if I can get my pdoc to be ok with it because it will at least enable me to get a partial response, which I think is the best thing that I can hope for at the moment. The next best option I have (in my opinion) is to try Parnate again. When I took Parnate for the first time, I didn't give it much of a chance because the daytime sedation put me to sleep every afternoon (caffeine or no caffeine), and I ended up sleeping through some university classes that I was taking as a result. So, I had to stop it. I might just try it again if I become so fed up with the Nardil that I decide to join the "poopout club," but I'm really not crazy about the idea of taking a med that will make me have to schedule everything around an afternoon nap. So, I'm kind of in limbo right now, but I'm staying on Nardil for the time being.
What I really hope to be able to take at some point (assuming that it ever becomes available again) is the "old" Nardil that Pfizer manufactured for consumption here in the United States until the fall of 2003. Although some patients noticed no difference between the old and the new Nardil formulations, others were drastically affected by the change - sometimes to the point that they lost their jobs as a consequence of the "new" Nardil's inability to control their symptoms of depression and/or anxiety. A group of patients who were wonderfully responsive to the "old" Nardil (but not the "new" Nardil) has since come together to form a committee, which has been taking action to try to bring the "old" Nardil back to the American market. Additionally, I have developed a working hypothesis of my own concerning patient responsiveness (or lack thereof) to the "new" Nardil, and I've been digging up mounds of research material in hopes eventually finding enough evidence to provide strong support for my hypothesis. It is my prediction that the "old" Nardil will eventually become available once again in the United States, and possibly elsewhere. How long it will take for that to happen (assuming that my prediction will come to pass) is another matter, but I think it will happen at some point. I have reason to believe that the "old" Nardil might provide me with the relief I'm looking for, and I intend to do everything in my power to help make the "old" formulation available once again not only so I can try it, but also so the hundreds (or perhaps thousands?) of patients who were uniquely responsive to the "old" Nardil could once again find the peace of mind that they enjoyed for years (and even decades, in some cases) until it was suddenly just taken away from them.
Considering that you took Marplan relatively recently, I'm guessing that you're in the U.K. Am I correct? I was just wondering so I could get an idea as to what version of Nardil you were taking. But honestly, based on what I've read about the different Nardil formulations being manufactured for consumption in different countries, it seems that the Nardil being made in the U.K. and elsewhere in the world is basically comparable to the "new" Pfizer Nardil in terms of its efficacy and tolerability. So, I doubt that you've ever taken anything comparable to the "old" Pfizer Nardil. And I know that there's no way to guarantee that the "old" Nardil will become available again - and it would certainly be a long shot to say that something equivalent to the "old" Pfizer Nardil will one day become available outside the U.S. - but, if by some chance the "old" Pfizer Nardil or something equivalent to it ever becomes available to you, I would strongly recommend trying it.
But in the meantime, I would recommend focusing on the here and now, which of course means trying to find a way to tweak your current cocktail until you can get a halfway decent response, or possibly something even better. As much as I think that both of us might be responsive to the "old" Pfizer Nardil, I'm sure that you realize there might be a way to achieve remission through some other means. I wish I could have provided you with some better suggestions as to which of these "other means" would be the best, but hopefully you'll find this post to be of some help.
Tomatheus
Posted by ed_uk on January 8, 2006, at 7:54:53
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » bigcat, posted by Tomatheus on January 7, 2006, at 20:29:46
Hi T
>Considering that you took Marplan relatively recently, I'm guessing that you're in the U.K. Am I correct?
Matt lives in the US.
>based on what I've read about the different Nardil formulations being manufactured for consumption in different countries, it seems that the Nardil being made in the U.K. and elsewhere in the world is basically comparable to the "new" Pfizer Nardil in terms of its efficacy and tolerability
UK Nardil has different 'inactive ingredients' to both the 'old' and the 'new' US formulations of Nardil.
>With respect to lithium, I think it might be worth a try, but I will warn you that lithium doesn't have a reputation for being effective at controlling rapid cycling, whether the cycling is endogenous or medication-induced.
Lithium is sometimes (occasionally?) an effective treatment for endogenous rapid cycling. It's not often effective for drug-induced cycling though, but neither is anything else as far as I can tell! There is very little evidence that any drug can prevent medication-induced cycling, although Depakote is a popular choice and it does seem like a reasonable option if withdrawal of the offending AD is not feasible. Combining Lamictal with Depakote is 'tricky' but possible.
>Effexor
Abrupt withdrawal/dosage reduction can induce or aggravate mania in susceptible patients. This is also a problem with many other antidepressants.
>So, given my responses to both the Paxil and the fluoxetine, I've steered clear of SSRIs, SSNRIs, and TCAs since then.
How do you respond to NE-selective ADs such as desipramine?
Regards
Ed
Posted by ed_uk on January 8, 2006, at 10:33:23
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » Tomatheus, posted by bigcat on January 6, 2006, at 23:59:56
Hi Matt
How are you today?
>rapid cycling
How do your depressive episodes on Effexor compare with your depressive episodes before you started Effexor?
> I do feel short of breathe, restless, and twithy now. Is the symptom of akathisia?
It's possible (because you're taking Thorazine), but it could be a symptom of hypomania as well.
>Now that I know this, what should I do? Ed, I've backed the Effexor from 600 to 525, Lamictal kept at 225, Buspar at 20.
I think you need to reduce your Effexor dose substantially. 525mg is still an extremely high dose. I'd reduce the dose in steps of 75mg every few days until you reach 150mg/day, then reduce in steps of 37.5mg until you reach 75mg/day.
When did you start Buspar?
>Been taking thorazine and ambien for sleep since I ran out of my sure-bet sleep med, 400-800mgs Seroquel an hour before wanting sleep.
I think you need to stop the Thorazine and restart Seroquel.
>What other suggestions besides possibly adding Lithiuim (?) and obviously backing off the Effexor significantly??
Tell me about your experience with the following meds.......
1. Lithium
2. Depakote
3. Tegretol
4. Trileptal
5. Zyprexa
6. AbilifyLove
Ed
Posted by Tomatheus on January 8, 2006, at 10:34:58
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » Tomatheus, posted by ed_uk on January 8, 2006, at 7:54:53
Ed,
See below for my responses...
> Matt lives in the US.
Thanks for the info. It was just a guess, but as I can see, it was an incorrect one.
> Lithium is sometimes (occasionally?) an effective treatment for endogenous rapid cycling. It's not often effective for drug-induced cycling though, but neither is anything else as far as I can tell! There is very little evidence that any drug can prevent medication-induced cycling, although Depakote is a popular choice and it does seem like a reasonable option if withdrawal of the offending AD is not feasible. Combining Lamictal with Depakote is 'tricky' but possible.
Yours is a much better explanation than what I gave. But I do think you're absolutely correct, as always.
> How do you respond to NE-selective ADs such as desipramine?
I'm kind of weary of trying any tricyclics because of their potential to induce rapid cycling by inhibiting the reuptake of both serotonin and norepinephrine (at least to some extent), but at this stage in my treatment, it might be something to consider (however cautiously).
Tomatheus
Posted by ed_uk on January 8, 2006, at 10:47:43
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » ed_uk, posted by Tomatheus on January 8, 2006, at 10:34:58
Hi T
>I'm kind of weary of trying any tricyclics because of their potential to induce rapid cycling by inhibiting the reuptake of both serotonin and norepinephrine (at least to some extent), but at this stage in my treatment, it might be something to consider (however cautiously).
Some TCAs, such as desipramine, are extremely NE selective. That's not to say that they won't induce rapid cycling though. I would imagine that some people cycle in response to 5-HT reuptake inhibitors only, other people cycle in response to NE reuptake inhibitors only, and some people cycle in response to both. LOL, that wasn't very well written but I'm sure you can see what I'm getting at.
Regards
Ed
Posted by Tomatheus on January 8, 2006, at 11:38:26
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » Tomatheus, posted by ed_uk on January 8, 2006, at 10:47:43
> LOL, that wasn't very well written but I'm sure you can see what I'm getting at.
I makes perfect sense to me. :)
Tomatheus
Posted by bigcat on January 8, 2006, at 16:09:40
In reply to Cycling » bigcat, posted by Tomatheus on January 6, 2006, at 20:40:57
Thomaseus:
I needed to write this instant to express my gratitude for the time and care you spent in replying to my posts. I am speechles regarding some of the things you said, things I understood subconsciously, but needed to hear from the outside in order to fully realize and appreciate. We MUST stay in communication, as not only do I have an immense amount of respect and awe for you're insights and writing, but I feel you're words have shed a layer of my feeling isolated and confused. I have a busy night ahead, but I will post a more comprehensive repsonse to you're suggestions and experiences later. I'll need a great deal of time, as you obviosly put a great amount of thought and concern into what you had the compassion and understanding to tell me.I am so glad the MAOI's are the right route for you. From what I have read, it seems like when they work, MAOI's can induce a 100% remission, while other classes seem to have glaring limitations. Perhaps the gretaest failure and oversight of the current psychiatric community is to dismiss the MAOI's as a viable first-line treatment because of dietary resptrictions and possible interactions. Having tried so many MAOI's for so long at such high doses, I have found that the diet fear is drastically overblown, a wholly misconceived hysteria that, clinically speaking, may actually provide a significantly lower risk of occuring than some of the possible side effects of supposedly "clean", more modern meds. With little money to gain off MAOI prescribing or marketing, they are pocketed away as radical, last-resort meds.
My father, a clinical psychopharmacologist for 30 years, Yale-trained, prescribes MAOI's as readily, if not more readily, than the SSRI's, no joke. My current doc pronounced Nardil "Nar-deel", and was looking in a handbook to read up on a med she knew virtually nothing about after I told her how brilliant its effect can be. Anyway, I have a load that I need to say, and we can clearly relate as far as our experiences are concerned, and I was absolutely blown away by you're intelligence and generosity in sharing so much with me. I look forward to writing in more detail when I have read the rest of your and Ed's posts, and have the time to properly respond.
Much Love,
-matt-
Posted by bigcat on January 8, 2006, at 16:20:06
In reply to Re: Cycling...YOU ARE RIGHT!! PLEASE HELP!! » bigcat, posted by ed_uk on January 8, 2006, at 10:33:23
Ed:
Last night was wonderful, and today exceptional as well. I feel very calm, at ease, not anxious or speedy at all. I plan on backing way down off the Effexor, but as you said, a 75mg (or 37.5mg) decrease every few days, not all at once. I am not hypomanic right now. I don't feel such a pressure to socialize or accomplish a billion things. And yet because of this, I AM accomplishing a lot, and making my parents feel good around me, not concerned that I may be "too good" or high, as I have been, and they have seen, in the past. I WILL respond to you're questions and concerns soon, but the awful low I was expecting for today never came, and I have calmed down considerably, especially after a wonderful Thorazine/Ambien sleep. The pain is just gone, and it feels natural. I'm living in the moment, no longer worried that I may be wildly manic (at this moment at least). Yet I fully accept that this *could* be the upside of a swing, but I feel better armed for this possibility with you and Thomaseus having my back. Love you guys:-)-matt-
Posted by Tomatheus on January 8, 2006, at 23:07:27
In reply to Re: Cycling...YESSSS!!!! » Tomatheus, posted by bigcat on January 8, 2006, at 16:09:40
Matt,
Thanks for your kind words. It's great to hear that you found my post helpful and appreciated it as much as you did. I honestly wasn't sure that I would be able to do an adequate job of addressing your questions and statements, but then I happened to get on a roll with my writing, and the words just kept flowing in. It seems to be the case that I can either write nothing due to writer's block or write a book by getting on that "roll" of mine, and I'm glad that I ended up doing the latter in my previous response to you (well, I obviously didn't literally write a book, but I think you get what I mean).
Don't feel too pressured to spend extreme amounts of time replying to my posts, but by all means, if you do want to write a lot in response, don't let me stop you either. Please take your time if you need to, especially if you do slip into a depressive state. I know that it becomes next to impossible to write anything of substance when I'm depressed, so don't worry too much about writing a long response if you don't feel up to it.
Having said that, feel free to reply to me here (at your convenience), or you could either Babblemail me (if you can) or e-mail me at tomatheus50@gmail.com.
Tomatheus
Posted by bigcat on January 9, 2006, at 22:09:04
In reply to Re: Cycling...YESSSS!!!! » bigcat, posted by Tomatheus on January 8, 2006, at 23:07:27
Tomatheus:
I just sent you an email under the address mattlove1@hotmail.comhope to hear from you soon,
-matt-
This is the end of the thread.
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