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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by TylerJ on January 27, 2006, at 17:32:39
I suffer from Treatment resistant depression and social phobia. For the past 24 yrs. I've tried everything from TCA's, SSRI's, MAOI's, and lots of augmentation agents-and oh yea, even ECT. Some things worked for awhile but nothing has lasted very long. My best response was from Parnate 9 yrs. ago, but it only lasted for 2 mos. The only thing that has kept me afloat has been Ativan, and I don't think it's helping that much anymore even at 6-8 mgs a day. I'm thinking of switching to klonopin, I appreciate anyones advice on this. Also in about 2 wks we'll be trying Parnate again but I must be honest I'm very concerned about poop-out again. Any suggestions, augmentation strategies etc. will be greatly appreciated. Thanks.
TylerJ
Posted by linkadge on January 27, 2006, at 18:05:48
In reply to Are there any AD's that don't poop-out?, posted by TylerJ on January 27, 2006, at 17:32:39
I think the best approach is to use the AD that has proven most effective for you, and then to augment it as best you can.
Don't load down on supplements, but there are some that have proven efficacy in aiding antidepressant treatment.
Zinc, Folic acid, b12, and Omega 3, and vitamin D are the first things that come to mind. Bright light therapy may also be usefull if depression worsens in winter months.
Add exercise to this if possable.Linkadge
Posted by TylerJ on January 27, 2006, at 19:01:22
In reply to Re: Are there any AD's that don't poop-out?, posted by linkadge on January 27, 2006, at 18:05:48
Thanks for the info. What do you consider to be the best augmentation agents for Parnate. I appreciate your input.
Posted by gardenergirl on January 27, 2006, at 19:57:22
In reply to Re: Are there any AD's that don't poop-out?, posted by TylerJ on January 27, 2006, at 19:01:22
Hi Tyler,
I take Nardil, not Parnate. I've had good luck augmenting it with Lamictal.Good luck.
gg
Posted by Phillipa on January 27, 2006, at 21:03:04
In reply to Re: Are there any AD's that don't poop-out? » TylerJ, posted by gardenergirl on January 27, 2006, at 19:57:22
Wow you've had some pretty bad luck sure hope you get a combo to work again. Fondly, Phillipa
Posted by blueberry on January 28, 2006, at 13:10:02
In reply to Are there any AD's that don't poop-out?, posted by TylerJ on January 27, 2006, at 17:32:39
Just viewing posts here over the years, it seems like every med poops out sooner or later.
There are two meds however that some people seem to be able to get benefits from for many years. One is klonopin. I've seen people report using it many years at a constant dose with no poopout. The other is prozac. For me I got 5 years out of it. I've heard of others getting 8 or 10 years out of it. But as usual, everyone's mileage will vary.
Posted by TylerJ on January 28, 2006, at 16:47:16
In reply to Re: Are there any AD's that don't poop-out?, posted by blueberry on January 28, 2006, at 13:10:02
Blueberry,
I've been taking Ativan for about 20 years. My current dose is about 6-8mg a day. I really don't think it's helping much anymore. My question is, is it possible to switch to another benzo (Klonopin) and have better results with it? My pdoc says a benzo is a benzo, if you are immuned to one you're immuned to all. What do you think?
Posted by krybrahaha78 on January 28, 2006, at 17:56:38
In reply to Re: Are there any AD's that don't poop-out?, posted by TylerJ on January 28, 2006, at 16:47:16
has anyone used klonopin to augment their ad?
Posted by TylerJ on January 28, 2006, at 19:15:23
In reply to Re: Are there any AD's that don't poop-out?, posted by krybrahaha78 on January 28, 2006, at 17:56:38
No, but Ativan has helped somewhat. But after taking it for 20 years I don't think it's helping much anymore. My pdoc says that if you have built up resistance to one benzo-you basically have built resistance to all benzos. Do you think this is true? Because I would like to try switching to Klonopin.
Posted by blueberry on January 29, 2006, at 6:58:54
In reply to Re: Are there any AD's that don't poop-out?, posted by TylerJ on January 28, 2006, at 16:47:16
Hi Tyler,
I'm no expert at all and this is purely my opinion based primarily on observing the posts here over the years. But I do not believe a benzo is a benzo. People who have tried several of them give clear descriptions of how they feel different. They are totally different molecules. Though they all work in similar ways, there are enough subtle molecular and cellular differences to make each one unique.An emergency room physician once told me that all benzos are the same except for their half-lives. I was polite, but when I left I got a chuckle out of that one.
I don't go by textbooks or doctor concensus. I go by what real world people at psychobabble have to say about their real experiences.
Some people who have been on benzos for decades have reported that they have a cross-tolerance to other benzos. But being that each benzo is a different molecule, I always think it is worth a try.
Posted by TylerJ on January 29, 2006, at 9:26:45
In reply to Re: Are there any AD's that don't poop-out? » TylerJ, posted by blueberry on January 29, 2006, at 6:58:54
Thank you...I think you're right and I think I'm going to ask my pdoc if I can switch to Klonopin. I appreciate your opinion. Take care.
Posted by Racer on January 29, 2006, at 17:23:06
In reply to Re: Are there any AD's that don't poop-out?, posted by TylerJ on January 28, 2006, at 19:15:23
> No, but Ativan has helped somewhat. But after taking it for 20 years I don't think it's helping much anymore. My pdoc says that if you have built up resistance to one benzo-you basically have built resistance to all benzos. Do you think this is true? Because I would like to try switching to Klonopin.
Personally, I reacted differently to ALL the benzos I've tried. If you develop tolerance to one, you are not necessarily going to be tolerant of another. Yes, the mechanism of action is basically the same, but the molecular structures are different, and your reaction can be very different, too. It's probably worth trying klonopin, in your case.
As for ADs without poop-out, I have heard that MAOIs don't poop-out the way the newer drugs do. And I haven't heard too many complaints here about TCAs pooping out. The SSRIs, though, *do* poop out, as do the SNRIs.
Hope that helps.
Posted by TylerJ on January 29, 2006, at 18:31:15
In reply to Nope, I haven't found that to be true » TylerJ, posted by Racer on January 29, 2006, at 17:23:06
It does help, and I appreciate your imput very much. I'm going to ask my doc if I can switch to Klonopin. Thanks and take care.
Posted by cindy lou on January 30, 2006, at 13:35:00
In reply to Are there any AD's that don't poop-out?, posted by TylerJ on January 27, 2006, at 17:32:39
Hi Tyler,
I feel for you -- I have also been on about every medication I can think of, and they either cause too severe side effects, or they work for a short while, then poop-out.The longest-lasting combo I have been on is Lexapro (10 mg) + Dexedrine + Klonapin.
I take Klonapin (0.5 - 1 mg) at night for anxiety and sleep, and a smaller dose during the day if I feel especially agitated during the day (rarely).
The Dexedrine (5-10 mg. a few times a day) seems to help boost the Lexapro's effect. Have you tried any stimulants? I tried several, and most resulted in huge "crashes" after a few days or a week, but I have found Dex to be the most manageable.
This combo has worked for up to a year -- then I had to switch because it pooped out -- and I have been back on it for about 8 months now. Again, I am suffering a "relapse" and I am considering adding a bit of Prozac instead of stopping this combo completely.
Best to you -- keep us posted.
cindy
> I suffer from Treatment resistant depression and social phobia. For the past 24 yrs. I've tried everything from TCA's, SSRI's, MAOI's, and lots of augmentation agents-and oh yea, even ECT. Some things worked for awhile but nothing has lasted very long. My best response was from Parnate 9 yrs. ago, but it only lasted for 2 mos. The only thing that has kept me afloat has been Ativan, and I don't think it's helping that much anymore even at 6-8 mgs a day. I'm thinking of switching to klonopin, I appreciate anyones advice on this. Also in about 2 wks we'll be trying Parnate again but I must be honest I'm very concerned about poop-out again. Any suggestions, augmentation strategies etc. will be greatly appreciated. Thanks.
>
> TylerJ
Posted by TylerJ on January 30, 2006, at 14:41:56
In reply to Re: Are there any AD's that don't poop-out? » TylerJ, posted by cindy lou on January 30, 2006, at 13:35:00
Cindy, thanks for your interest. My pdoc will not prescribe stimulants, which kind of frustrates me-but if they don't last it's just as well...he will prescribe benzos and MAOI's thank God! I think I'm going to try Parnate again and as my doc said "augment the hell out of it." I'm also thinking of trying Klonopin as I don't think Ativan is helping much anymore. Isn't this a lovely disease?! :( You take care and keep in touch please w/any ideas,etc.
TylerJ
Posted by Sarah T. on February 1, 2006, at 0:14:33
In reply to Re: Are there any AD's that don't poop-out? » TylerJ, posted by cindy lou on January 30, 2006, at 13:35:00
Hi Cindy Lou,
What did you take when you took a break from your current combo?
Have you ever taken Celexa?
Sarah
Posted by cindy lou on February 1, 2006, at 6:50:29
In reply to Re: Are there any AD's that don't poop-out? » cindy lou, posted by Sarah T. on February 1, 2006, at 0:14:33
Hi Sarah,
Last year I switched to Prozac + Lithium. This was not a good combo for me!We chose Prozac because it has worked like a charm for me several times over the past 15 years -- but it ALWAYS poops out in about 2 months. My doc added Lithium to see if it would keep the Prozac from pooping out. But the Lithium made me very volatile, agitated, almost paranoid.
I think I stayed on it for about 6-8 months or so ... then i stopped completely because I had Mono and felt so horrible I didn't know what was causing what. Of course, I ended up severely depressed with no meds at all.
About a month later I started back up on the Lexapro again. Even though it doesn't help the depression completely, it is like a "safety net" for me, keeping me from hitting rock bottom.
Last night I added 5 mg. of Prozac to the mix ... just to see if it could augment the Lexapro and help me out of this relapse I am in.
I have tried Celexa but I couldn't tolerate the side effects -- I am very sensitive to medications.
take care,
cindy.
> Hi Cindy Lou,
>
> What did you take when you took a break from your current combo?
>
> Have you ever taken Celexa?
>
> Sarah
Posted by TylerJ on February 1, 2006, at 10:06:51
In reply to Re: Are there any AD's that don't poop-out? » Sarah T., posted by cindy lou on February 1, 2006, at 6:50:29
Have you guys ever tried Remeron. Remeron worked well for me for about 2 yrs then fizzled out. It definitely helped my depression but the side effects sucked-I gained about 25 lbs on it that I have thankfully since lost. They can fly a man to the Moon...why can't they make a really good antidepressant without all the side effects?! best wishes. Ty
Posted by cindy lou on February 1, 2006, at 13:50:16
In reply to Re: Are there any AD's that don't poop-out?, posted by TylerJ on February 1, 2006, at 10:06:51
Hi Tyler,
Yes, I tried Remeron a long time ago. I don't remember much except I couldn't tolerate the side effetcts -- usually the negative side effects I get from SSRIs and SNRIs are severe fatigue and brain fog (that don't go away in time).The other meds (APs, mood stabilizers), give me other weird side effects.
Cymbalta REALLY did a number on me!! I think that's an SNRI? I was so disoriented and exhausted I felt like I was on some LSD trip -- not to that extent, obviously, but I was definitely reacting STRONGLY to it. I got lost in the mall parking lot (a mall where I go often), I spent way too much money because my judgment was so off, and then I had to sleep for almost two days straight. After about 3 days of that I quit and got back on the Lexapro.
This is why I am sticking to things I know I can tolerate right now.
It is very helpful to read posts from others who have had a hard time tolerating meds -- it helps me feel that I am not alone. The pdocs I have seen in this town act like they have never heard of anyone like me. I used to live in Detroit where the doctors seemed much more understanding and less judgmental ...
But I am rambling now ...
Thanks, cindy
> Have you guys ever tried Remeron. Remeron worked well for me for about 2 yrs then fizzled out. It definitely helped my depression but the side effects sucked-I gained about 25 lbs on it that I have thankfully since lost. They can fly a man to the Moon...why can't they make a really good antidepressant without all the side effects?! best wishes. Ty
Posted by TylerJ on February 1, 2006, at 15:35:00
In reply to Re: Are there any AD's that don't poop-out? » TylerJ, posted by cindy lou on February 1, 2006, at 13:50:16
Cindy, don't worry about rambleing on...I care and find it helpful and interesting to hear other peoples stories. Wow,that must of been scarey on the Cymbalta-yes it is a snri, so maybe it was the norepinepherine that caused the reaction you had. The scariest thing I've ever tried was ECT. In 1997 I went thru a very severe depression was hospitalized for 2 mos. and had 24 ECT treatments and they were freaky...I hated them, and they really didn't help me that much. They really did a number on my short term memory-I still don't remember much about that year. One time shortly after I got home I was driving by myself and could not remember where my house was...talk about scary!! I'm just the opposite w/meds they usually just don't have any effect on me at all. But Parnate does, the problem is keeping it working...it has a tendency to "poop-Out" on me after a couple of mos. Well, sorry for rambleing myself..take care and I wish you all the best.
Tyler
Posted by Sarah T. on February 2, 2006, at 0:33:08
In reply to Re: Are there any AD's that don't poop-out? » Sarah T., posted by cindy lou on February 1, 2006, at 6:50:29
Hi Cindy Lou,
Thanks for your reply. I think it's good that you're staying on a combo that's "tried and true" even if it's not perfect.
I had asked you about Celexa because I'm always interested to hear from people who've taken both Lexapro and Celexa but have chosen one over the other. I'm interested to hear why one is chosen rather than the other. Can you tell what intolerable side effects you had on Celexa? I also had great difficulty with Celexa, but I have difficulty with most meds. Even worse than that, I am unable to tolerate most med combos even though it's clear that I need a combination.
Is it too soon to tell how the addition of Prozac is affecting you? I hope that goes well.
Sarah
Posted by cindy lou on February 2, 2006, at 7:31:32
In reply to Re: Are there any AD's that don't poop-out? » cindy lou, posted by Sarah T. on February 2, 2006, at 0:33:08
Hi Sarah,
It's hard to recall exactly since it's been so long since I tried Celexa, but I think the side effects were the same as other SSRIs out there -- severe fatigue, "brain fog", so tired and out of it I could barely function.We tried Lexapro because I believe it is a form of Celexa, but you don't need as much of it for effectiveness (??) Not sure about this, but that's what I recall.
I started out on 1/4 of a 10 mg. tablet of the Lexapro and SLOWLY worked my way up to 10 mg. The highest I have been able to go is 15 mg. When I get up to 20 mg. I become too fatigued. It is frustrating, because I know I need the higher dose for my depression, but I just can't get up there!
I just tried the Prozac for one night (only 5 mg.) It is probably too soon to tell if it is helping -- I felt a little better yesterday, but I think that might have been coincidence.
I am sorry to hear how hard it is for you to tolerate meds as well. It is such a long road. I have found that starting out ridiculously low and working my way up slowly really seems to help. I don't even bother telling my pdocs anymore, since they don't really get it. They prescribe 10 mg., and I start out with 2.5 on my own.
Thanks so much for your concern and support!
Take care,
cindyP.S. Are you on any meds now? How are you doing?
> Hi Cindy Lou,
>
> Thanks for your reply. I think it's good that you're staying on a combo that's "tried and true" even if it's not perfect.
>
> I had asked you about Celexa because I'm always interested to hear from people who've taken both Lexapro and Celexa but have chosen one over the other. I'm interested to hear why one is chosen rather than the other. Can you tell what intolerable side effects you had on Celexa? I also had great difficulty with Celexa, but I have difficulty with most meds. Even worse than that, I am unable to tolerate most med combos even though it's clear that I need a combination.
>
> Is it too soon to tell how the addition of Prozac is affecting you? I hope that goes well.
>
> Sarah
Posted by Sarah T. on February 3, 2006, at 1:14:18
In reply to Re: Are there any AD's that don't poop-out? » Sarah T., posted by cindy lou on February 2, 2006, at 7:31:32
Hi Cindy Lou,
Do you take Lexapro at night or in the morning? Do you take it all at once? It looks as if you take Prozac at night.
When I was on Celexa, I couldn't function at all if I took it during the day, but when I took it at night, I always woke up in the middle of the night at the exact same time, and I'd remain awake for two hours, no matter what I did to try to fall back to sleep. I just had to wait out those two hours, which meant I had to sleep two hours later in the morning in order to get enough sleep.
Another problem I had on Celexa was that when I was awake in the middle of the night during those two hours, I would feel ravenous, but it didn't feel like the healthy, true hunger that I have after swimming or other exercise. On Celexa, I had a most unpleasant kind of gnawing, edgy "hunger" that no particular food and no amount of food could satisfy. It was most unpleasant. I would also sweat profusely during that time. I guess the blood levels of the drug were peaking then. Whatever was happening, it never got better, so I finally stopped it.
Posted by cindy lou on February 3, 2006, at 11:18:23
In reply to Re: Are there any AD's that don't poop-out? » cindy lou, posted by Sarah T. on February 3, 2006, at 1:14:18
Hi Sarah,
I take everything at night since all of the AD's tend to make me sleepy. They still cause me fatigue during the day, so that's why we added Dexedrine to the mix, to help offset the fatigue.I seem to react the opposite to most meds than what the "reported" side effects are. My old pdoc and I used to laugh about it -- he'd say, "well, Dexedrine usually supresses the appetite, but with you it will probably make you hungry!" (Actually it does suppress my appetite, so there are a few ways that I react "typically" to these meds...just not many.)
That's interesting about how the Celexa would wake you up at night for 2 hours. I used to have that happen to me, but I can't recall what I was taking -- I didn't attribute it to a med at the time, but I'm sure it could have been. Now that I have 2 kids who wake me up anyway, and now that I am taking Klonapin at night, I don't usually have that 2-hour stretch. I used to get up, eat cereal, and watch the news.
Also interesting about your hunger ... I know exactly what you are talking about. However, I get that feeling when I am off meds altogether. It is the worst feeling -- that feeling of NEEDING to eat, of some kind of gnawing hunger but not true hunger -- people would try to tell me it was emotional, but I knew it was something physical.
Are you taking anything now? I am glad you got off the Celexa.
Take care,
cindy> Hi Cindy Lou,
>
> Do you take Lexapro at night or in the morning? Do you take it all at once? It looks as if you take Prozac at night.
>
> When I was on Celexa, I couldn't function at all if I took it during the day, but when I took it at night, I always woke up in the middle of the night at the exact same time, and I'd remain awake for two hours, no matter what I did to try to fall back to sleep. I just had to wait out those two hours, which meant I had to sleep two hours later in the morning in order to get enough sleep.
>
> Another problem I had on Celexa was that when I was awake in the middle of the night during those two hours, I would feel ravenous, but it didn't feel like the healthy, true hunger that I have after swimming or other exercise. On Celexa, I had a most unpleasant kind of gnawing, edgy "hunger" that no particular food and no amount of food could satisfy. It was most unpleasant. I would also sweat profusely during that time. I guess the blood levels of the drug were peaking then. Whatever was happening, it never got better, so I finally stopped it.
Posted by Sarah T. on February 7, 2006, at 3:34:41
In reply to Re: Are there any AD's that don't poop-out? » Sarah T., posted by cindy lou on February 3, 2006, at 11:18:23
> > I seem to react the opposite to most meds than what the "reported" side effects are. My old pdoc and I used to laugh about it -- he'd say, "well, Dexedrine usually supresses the appetite, but with you it will probably make you hungry!"
Hi Cindy Lou,
Thanks for your reply. I apologize for not answering sooner. My computer has been having major problems that are still not resolved, but I HAD to log onto PB!I tend to have a lot of paradoxical reactions to medications also. It took a while to find a doctor who understood that paradoxical reactions do occur. I got so sick of doctors who'd say, "You can't sleep on Trazodone? I've never heard of that before!"
> Also interesting about your hunger ... I know exactly what you are talking about. However, I get that feeling when I am off meds altogether. It is the worst feeling -- that feeling of NEEDING to eat, of some kind of gnawing hunger but not true hunger -- people would try to tell me it was emotional, but I knew it was something physical. >>
Yes, that Celexa-induced gnawing "hunger" was always accompanied by an edgy feeling and drenching night sweats. It was horrible. And then I'd get the chills.
I am currently still trying to find a tolerable drug combo, but I'm so sensitive to meds and med combinations that I'm having the difficulties I always have. I'm feeling very discouraged these days, but I continue to hope for something that might work.
Again, thanks so much for your help.
Sarah
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