![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 42. Go back in thread:
Posted by SLS on August 4, 2006, at 22:04:55
In reply to Re: What stage of treatment-resistance are you? » SLS, posted by fuchsia on August 4, 2006, at 19:56:19
> If one has a hypomanic response is that classed as'failure'?
I guess such a response would be considered a failure if it could not be converted into a stable hypomania or a euthymic remission. My doctor and I would consider a stable hypomania to be a success in my case. A transient response of any sort would be a treatment failure, I should think.
I don't know how a persistent manic switch would be viewed. Ideally, such a switch could be treated without removing the antidepressant.
- Scott
Posted by Maxime on August 4, 2006, at 23:28:15
In reply to What stage of treatment-resistance are you?, posted by SLS on August 4, 2006, at 8:48:06
Stage 4 ... and I will never get to stage 5 to find out.
Maxime
What stage of treatment-resistance are you?
>
>
> * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
>
> * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
>
> * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
>
> * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
>
> * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
>
>
> - Scott
Posted by SLS on August 5, 2006, at 1:48:28
In reply to Re: What stage of treatment-resistance are you? » SLS, posted by Maxime on August 4, 2006, at 23:28:15
> Stage 4 ... and I will never get to stage 5 to find out.
Would you consider repetitive transcranial magnetic stimulation (rTMS)?There is such a thing as magnetic seizure therapy (MST). It is still in its infancy. It applies a transcranial magnetic flux sufficient to induce a seizure. It is hoped that it will produce antidepressant efficacy comparable to ECT while sparing the patient the cognitive side effects of ECT.
I'm stage 5 by the way.
- Scott
Posted by cecilia on August 5, 2006, at 3:09:33
In reply to What stage of treatment-resistance are you?, posted by SLS on August 4, 2006, at 8:48:06
I guess I'm stage 4 and a half. I've tried rTMS but not ECT. I'm with Racer, I just can't see doing ECT, the long term risks seem to outweigh any possible short term benefits. But how exactly is an adequate trial defined? At least 6 weeks at a dose the PDR considers in a therapeutic range? Or the incredibly high doses some people here seem able to tolerate? If it's the latter I may have never had an adequate trial! If it's the former, I've had adequate trials on Trazodone, Wellbutrin (combined with Celexa), Celexa, Serzone, Zoloft, Paxil, Nortriptyline, Lamictal (combined with Celexa and Trazodone), Moclobemide, Tianeptine, Milnacipran, Marplan, Remeron, Gabapentin, Buspar (combined with Celexa), 5-HTP and St. John's Wort. Plus almost adequate (38 and 37 days) on Nardil and Emsam. Inadequate trials from one day to one month (due to unbearable side effects) on Desipramine, Doxepin, Imipramine, Prozac, Effexor, Clomipramine, Lithium, Methylphenidate, Dexedrine, Olanzapine, Parnate, Reboxetine, Luvox, Adrafinil, Cymbalta, and SAM-e. Cecilia
Posted by linkadge on August 5, 2006, at 3:48:34
In reply to Re: What stage of treatment-resistance are you?, posted by cecilia on August 5, 2006, at 3:09:33
Somewhere at stage 4. I didn't fail and MAOI, I just couldn't take it for long enough. Had a spontainious hypertensive crisis, and have since been refused a subsequent trial.
Parnate was kindof scarry though. (Intense), I don't know if Nardil is any lighter.
Linkadge
Posted by SLS on August 5, 2006, at 7:01:50
In reply to Re: What stage of treatment-resistance are you?, posted by linkadge on August 5, 2006, at 3:48:34
> Somewhere at stage 4. I didn't fail and MAOI, I just couldn't take it for long enough. Had a spontainious hypertensive crisis, and have since been refused a subsequent trial.
>
> Parnate was kindof scarry though. (Intense), I don't know if Nardil is any lighter.In some ways, Nardil is a lighter, more pleasant experience. Marplan is even more so, but is often thought of as a less effective drug. I guess that depends upon who you ask. If you really want to force the issue, I would try Nardil first, and then decide between Emsam and Marplan. Use Emsam is low energy is a major component of your illness. Marplan might be a better "mood-brightener", as is Nardil.
You *appear* to be doing better now than you had been in years previous. I know you have abstained from major antidipressants over this recent period. Perhaps reuptake inhibitors are not the way to go for you.
MAOIs are in some ways cleaner than reuptake inhibitors. Perhaps neurons are not forced to depolarize when no signal is to be propagated with these drugs. There is less noise. They might act more as amplifiers. Who knows? (Not me). If there comes a time when you wish to revisit antidepressant medication, and nothing new has captured your interest, you might want to go with one of the other MAOIs.
Maybe it will be a cannabinoid that gets us both well...
I wish you nothing but the best.
- Scott
Posted by Jost on August 5, 2006, at 12:32:47
In reply to Re: What stage of treatment-resistance are you?, posted by nickguy on August 4, 2006, at 15:58:36
SSRI: prozac, zoloft too sick to go more than three weeks and that was a huge effort):
SNRI: effexor also made me sick
Remeron (1 night) out cold in about three minutes, and slept for about 16 hours, felt awful, pdoc didn't want to try higher dose
Trazadone also sick
SNRI: cymbalta worked a little, but could only take v. low dose every other day, because more made me sick (serotonin syndrome), so somewhat better than nothing--had to stop about three months, because of other adverse reaction
MAOI : Parnate, worked somewhat, but made me feel so tired that, in retrospect, I' was functioning at a very low level, both mentally and physically. Couple of Ts I saw thought I had possible brain malfunction (?) and suggested neuropsych work-up. When the second one saw me after I stopped Parnate, said it must have been Parnate, because I seemed totally different.
Stopped doing a lot of things, because I was sleeping all day, and 10 hours a night, waking up and needing hours more sleep- but I guess just helped me feel less bad-- but again had adverse reaction eventually and had to stop
Welbutrin worked a little, not enough to be adequate AD effect, but also somewhat better than nothing
TCA never tried, my pdoc doesn't like them, and didn't think I would do well on them, after other reactions
now on Emsam.
So, SSRI, SNRI, Trazadone, Remeron--didn't work (or didn't work much)
MAOI (Parnate) not sure if it worked, or I was so wiped out, I didn't have energy to remember how I felt-- wouldn't do it again
If Emsam doesn't work, I'd probably try Welbutrin, and see if I could keep my head somewhat above water until something else comes out, if it does; or I might try combination of adderal and benzo--not sure
Won't ever do ECT, probably won't ever do TCA, unless new ones come out with fewer SE, and less effect on serotonin
My problem--possibly toxic reaction to anything that boosts serotonin too much, or out of proportion to other neurotransmitters.
Don't know how you would stage that.
Jost
Posted by Bob on August 5, 2006, at 16:54:21
In reply to Re: What stage of treatment-resistance are you?, posted by Jost on August 5, 2006, at 12:32:47
I'd classifiy myself as a stage 5+. I've failed countless trials of SSRIs, and all kinds of augmenting strategies with them. I took Anafranil, which was a quite unpleasant experience, and have also taken Depakote, Lamictal, along with many other anticonvulsants, including Topomax - which almost killed me. I've also tried ECT, which turned out to be an unmitigated disaster. The only thing from the "stages" I haven't tried is an MAOI, but not for lack of wanting. I don't think I could get through the washout period, and if the med turned out to be no good (an excellent chance) I don't think I could make it through the second washout. Coming on and off meds as become so difficult for me that it is almost impossible.
Posted by Maxime on August 5, 2006, at 17:29:07
In reply to Re: What stage of treatment-resistance are you? » Maxime, posted by SLS on August 5, 2006, at 1:48:28
rTMS doesn't work for most people. I don't even know if it's option in Canada. I would have DBS (deep brain stimulation) though.
Maxime
> > Stage 4 ... and I will never get to stage 5 to find out.
>
>
> Would you consider repetitive transcranial magnetic stimulation (rTMS)?
>
> There is such a thing as magnetic seizure therapy (MST). It is still in its infancy. It applies a transcranial magnetic flux sufficient to induce a seizure. It is hoped that it will produce antidepressant efficacy comparable to ECT while sparing the patient the cognitive side effects of ECT.
>
> I'm stage 5 by the way.
>
>
> - Scott
Posted by linkadge on August 5, 2006, at 21:21:13
In reply to Re: What stage of treatment-resistance are you? » linkadge, posted by SLS on August 5, 2006, at 7:01:50
I'm not doing to bad. I have had some suicidal feelings, but they seem to pass. I am pretty much the same on drugs or off drugs. I'm not really in any state of remission, but in order to go anywhere I'd need a doctor who was intent on things.
I have been intermittantly using turmeric, probably the strongest herbal MAOI, at doses that should theoretically inhibit MAO-A about 50%.
Turmeric inhibits MAO-A stronger than MAO-B, about 2-1. I read somewhere that Nardil too is stronger an inhibitor of MAO-A than MAO-B, but parnate has the slightly higher on MAO-B.
See the second table on this link.
http://www.bdbiosciences.com/discovery_labware/gentest/products/pdf/Fluor_A&B-ISSX02.pdf
Linkadge
Posted by exquilter on August 5, 2006, at 21:23:13
In reply to Re: What stage of treatment-resistance are you? » SLS, posted by Maxime on August 5, 2006, at 17:29:07
Stage 5+ for me, Scott.
Posted by linkadge on August 5, 2006, at 21:31:26
In reply to Re: What stage of treatment-resistance are you?, posted by linkadge on August 5, 2006, at 21:21:13
I would have to say that parnate "definately" had more umph to it than most of the ferry SSRI's. Even in the short time I used it, there seemed to be a very strong will to live that was emerging.
SSRI's never really made me want to live, they just stopped me from killing myself I guess.Parnate did some weird things to me though.
In hindsight some of the events that were passing may have been the precursors to a deeper response I don't know. (That may just be crazytalk) I felt the very strong urge (that I had to) clear my conscience, like I needed to tell people about all the things I had done wrong in my life, or perhaps all the lies I had told.
In hindsight, it may have been and induction of placiticity in the part of the brain that generates feelings of guilt.
Linkadge
Posted by JahL on August 7, 2006, at 20:22:45
In reply to What stage of treatment-resistance are you?, posted by SLS on August 4, 2006, at 8:48:06
> What stage of treatment-resistance are you?.
>.....
> * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
Stage 6: not a f@cking hope.
J.
Posted by SLS on August 7, 2006, at 20:40:09
In reply to Re: What stage of treatment-resistance are you?, posted by JahL on August 7, 2006, at 20:22:45
> > What stage of treatment-resistance are you?.
>
> >.....
>
> > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)Stage 6: Stage 5 plus failure of a 6 month course of aerobic exercise.
Stage 7: Failure to recognize that Stage 6 would be a waste of time.
- Scott
Posted by JahL on August 7, 2006, at 20:47:48
In reply to Re: What stage of treatment-resistance are you?, posted by SLS on August 7, 2006, at 20:40:09
> > > What stage of treatment-resistance are you?.
> >
> > >.....
> >
> > > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
>
> Stage 6: Stage 5 plus failure of a 6 month course of aerobic exercise.
>
> Stage 7: Failure to recognize that Stage 6 would be a waste of time.Is there a stage 8 then Scott?
I exercise regularly and would recommend that anyone physically capable does likewise, but I don't think it has any real lasting effect as regards Bipolar etc.
What's the final stage?
Ta,
J.
Posted by SLS on August 7, 2006, at 21:11:12
In reply to Re: What stage of treatment-resistance are you? » SLS, posted by JahL on August 7, 2006, at 20:47:48
> > > > What stage of treatment-resistance are you?.
> > >
> > > >.....
> > >
> > > > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
> >
> > Stage 6: Stage 5 plus failure of a 6 month course of aerobic exercise.
> >
> > Stage 7: Failure to recognize that Stage 6 would be a waste of time.
>
> Is there a stage 8 then Scott?Stage 8: Failure to recognize that acknowledging Stage 7 would irritate a sizeable number of people.
> I exercise regularly and would recommend that anyone physically capable does likewise, but I don't think it has any real lasting effect as regards Bipolar etc.
I wouldn't argue with someone who reports that exercise changed their life for the better. Each person's depression will respond uniquely to a varying array of biological and psychological treatments. Not everyone responds to Prozac. Not everyone responds to exercise. However, I can't help but to think that exercise is currently granted hyperbole given what I have experienced personally and seen of people diagnosed with MDD and BP in clinical settings.
> What's the final stage?The rationalization that there must be none.
- Scott
Posted by Ame-Sans-Vie on August 9, 2006, at 9:49:56
In reply to What stage of treatment-resistance are you?, posted by SLS on August 4, 2006, at 8:48:06
> What stage of treatment-resistance are you?
Hmm, I found this a bit interesting, as I'd long wondered if there were subdivisions of treatment-resistant depression, such as this. Guess I'll go through it one stage at a time:
> * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
Well, for this first "stage", let's just say that I've definitively failed more-than-adequate trials of all the following primarily serotonergic medications:
~~SSRIs -- Paxil, Prozac, Zoloft, Luvox, Celexa, Lexapro
~~SNRIs -- Effexor, Cymbalta
~~Atypical SRIs/TCAs -- Anafranil
~~NaSSAs -- Remeron
~~SARIs -- Serzone, Desyrel> * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
Well, all that I listed in Stage 1 alone technically allows me to "pass" this stage, but for good measure, neither the NDRI Wellbutrin nor the NRIs Strattera and Edronax have helped me.
> * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)Well I guess this is where I tack on the TCAs, which have never helped me (save the little relief I achieved while having tremendous fibromyalgia pain). I've tried Elavil, Sinequan, Prothiaden, Surmontil, Tofranil, Tofranil-PM, Norpramin, Pamelor, Vivactil, Ludiomil, Asendin, Flexeril... and possibly others I can't recall at the moment.
> * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
Had several very adequate trials of MAOIs. First was Nardil (this was before the new formulation began causing an uproar on the boards here a while back... lucky I didn't try that stuff). I was aggressively pushed to 120mg Nardil daily, and toughed out the inability to have an orgasm for six months in hopes it'd kick in. Needless to say, it never did. Not in the least.
Parnate was tried for about six months last year... I believe the dose was 60mg. Never helped with my depression, except at first, but I may have been confusing the initial stimulation from Parnate (due to metabolism to amphetamines?) with actual relief of symptoms.
Now giving Emsam a try.
> * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
Okay, ya got me there, lol. Haven't had to do anything so drastic... yet.
For the record, I also failed the following when prescribed them to treat my depression. Some, primarily the opioids and psychostimulants, worked wonderfully for a while... but for various reasons didn't work out:
~~OPIOIDS -- Ultram, Hycodan, Avinza, Duragesic
~~STIMS -- Concerta / Ritalin, Focalin, Adderall, Dexedrine / DextroStat, Desoxyn, Cylert, Provigil, Adipex-P, Bontril, Tenuate, Sanorex, others...
~~MOOD STABILIZERS -- Lamictal, Gabitril, Topamax, Neurontin, Keppra, Tegretol, Trileptal, Depakote (again I know I'm leaving some out...)
~~DA AGONISTS/RELEASERS -- Symmetrel, Mirapex, Requip, Parlodel
~~ANTIPSYCHOTICS -- Risperdal, Zyprexa, Geodon, Abilify, Seroquel, Mellaril, Stelazine, Thorazine
~~AUGMENTORS -- BuSpar, Visken, Cytomel, lithium carbonate, othersBut then there's Xanax, which I'm still taking and which does have a pronounced antidepressant -- even somewhat hedonic -- effect on me.
That's basically the tip of the iceberg as far as what I've tried, but I'd say it places me far into the Stage 4 categorization.
Cheers,
Michael
Posted by Bob on August 9, 2006, at 13:21:15
In reply to Re: What stage of treatment-resistance are you?, posted by Ame-Sans-Vie on August 9, 2006, at 9:49:56
> > What stage of treatment-resistance are you?
>
> Hmm, I found this a bit interesting, as I'd long wondered if there were subdivisions of treatment-resistant depression, such as this. Guess I'll go through it one stage at a time:
>
> > * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
>
> Well, for this first "stage", let's just say that I've definitively failed more-than-adequate trials of all the following primarily serotonergic medications:
>
> ~~SSRIs -- Paxil, Prozac, Zoloft, Luvox, Celexa, Lexapro
> ~~SNRIs -- Effexor, Cymbalta
> ~~Atypical SRIs/TCAs -- Anafranil
> ~~NaSSAs -- Remeron
> ~~SARIs -- Serzone, Desyrel
>
> > * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
>
> Well, all that I listed in Stage 1 alone technically allows me to "pass" this stage, but for good measure, neither the NDRI Wellbutrin nor the NRIs Strattera and Edronax have helped me.
>
> > * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
>
> Well I guess this is where I tack on the TCAs, which have never helped me (save the little relief I achieved while having tremendous fibromyalgia pain). I've tried Elavil, Sinequan, Prothiaden, Surmontil, Tofranil, Tofranil-PM, Norpramin, Pamelor, Vivactil, Ludiomil, Asendin, Flexeril... and possibly others I can't recall at the moment.
>
> > * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
>
> Had several very adequate trials of MAOIs. First was Nardil (this was before the new formulation began causing an uproar on the boards here a while back... lucky I didn't try that stuff). I was aggressively pushed to 120mg Nardil daily, and toughed out the inability to have an orgasm for six months in hopes it'd kick in. Needless to say, it never did. Not in the least.
>
> Parnate was tried for about six months last year... I believe the dose was 60mg. Never helped with my depression, except at first, but I may have been confusing the initial stimulation from Parnate (due to metabolism to amphetamines?) with actual relief of symptoms.
>
> Now giving Emsam a try.
>
> > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
>
> Okay, ya got me there, lol. Haven't had to do anything so drastic... yet.
>
> For the record, I also failed the following when prescribed them to treat my depression. Some, primarily the opioids and psychostimulants, worked wonderfully for a while... but for various reasons didn't work out:
>
> ~~OPIOIDS -- Ultram, Hycodan, Avinza, Duragesic
> ~~STIMS -- Concerta / Ritalin, Focalin, Adderall, Dexedrine / DextroStat, Desoxyn, Cylert, Provigil, Adipex-P, Bontril, Tenuate, Sanorex, others...
> ~~MOOD STABILIZERS -- Lamictal, Gabitril, Topamax, Neurontin, Keppra, Tegretol, Trileptal, Depakote (again I know I'm leaving some out...)
> ~~DA AGONISTS/RELEASERS -- Symmetrel, Mirapex, Requip, Parlodel
> ~~ANTIPSYCHOTICS -- Risperdal, Zyprexa, Geodon, Abilify, Seroquel, Mellaril, Stelazine, Thorazine
> ~~AUGMENTORS -- BuSpar, Visken, Cytomel, lithium carbonate, others
>
> But then there's Xanax, which I'm still taking and which does have a pronounced antidepressant -- even somewhat hedonic -- effect on me.
>
> That's basically the tip of the iceberg as far as what I've tried, but I'd say it places me far into the Stage 4 categorization.
>
> Cheers,
> MichaelJust the tip of the iceberg?
Posted by Ame-Sans-Vie on August 10, 2006, at 23:22:31
In reply to Re: What stage of treatment-resistance are you? » Ame-Sans-Vie, posted by Bob on August 9, 2006, at 13:21:15
Well, I've utilized a great number of "natural" and nutritional remedies, to varying degrees of success. Then of course there's proper diet and exercise. I left out quite a few meds that I've tried, actually. For example, Stablon, Survector, Inderal, etc... And I've also tried various hypnosis-based therapies, CBT, acupuncture... the list goes on and on.
Posted by Paulbwell on August 11, 2006, at 3:02:28
In reply to Re: What stage of treatment-resistance are you? » Bob, posted by Ame-Sans-Vie on August 10, 2006, at 23:22:31
hOWS THE:
-60mgs Dex Spans going?
-40mgs Desoxyn
-40mgs Prozac
-16mgs Xanax
-8mgs Clonaz
-Seconal-TuinalGoing?
Cheers
Posted by Ame-Sans-Vie on August 11, 2006, at 6:30:21
In reply to AME SANS VIE » Ame-Sans-Vie, posted by Paulbwell on August 11, 2006, at 3:02:28
Hi Paul, good to see you again!
Actually, I haven't been on that combination in a good while. More recently I was on Concerta, Xanax, Klonopin, and the occasional barbs for sleep. But then I developed thrombocytopenic purpura and erythema multiforme because of methylphenidate hypersensitivity, immediately stopped the Concerta and started giving the amphetamines a try again. They didn't quite work out as well as they had the previous times, so I stopped Desoxyn last month and have now been on Emsam for 14 days.
I also have been working on cutting back the benzos... well, that's a bit of an understatement. I now only take 2mg Xanax. No clonazepam. Now that I'm down to such a low dose, my tolerance seems to have reset quite dramatically -- I've been able to cut out the barbs entirely, and now just use Dalmane 60-90mg as needed for sleep.
So to sum it up, my current regimen is:
Emsam 20mg qd
alprazolam 1mg SL bid
flurazepam 60-90mg hs prn
Avapro 150mg qd (I may be able to stop this now that I no longer take stims, but I'll wait to get with my GP on that issue)All in all, I'm feeling great. Not a panic attack in sight, no social anxiety problems, and no real depression to speak of. I'm taking the Emsam more for energy and motivation, which it [thusfar] is helping with quite a bit (though I know two weeks is probably far too early to really judge).
I'm in therapy for a newfound diagnosis - Asperger Syndrome. High-functioning autism. Receiving that diagnosis has seriously changed my life; I finally understand the issue that underlies the vast majority of my psych problems! And of course I also still watch my diet carefully, avoid caffeine, and exercise every day. Things are looking wayyyy up. :-)
So how have things been for you lately?
Cheers,
Michael
Posted by Paulbwell on August 11, 2006, at 7:51:05
In reply to Re: AME SANS VIE » Paulbwell, posted by Ame-Sans-Vie on August 11, 2006, at 6:30:21
> Hi Paul, good to see you again!
>
> Actually, I haven't been on that combination in a good while. More recently I was on Concerta, Xanax, Klonopin, and the occasional barbs for sleep. But then I developed thrombocytopenic purpura and erythema multiforme because of methylphenidate hypersensitivity, immediately stopped the Concerta and started giving the amphetamines a try again. They didn't quite work out as well as they had the previous times, so I stopped Desoxyn last month and have now been on Emsam for 14 days.
>
> I also have been working on cutting back the benzos... well, that's a bit of an understatement. I now only take 2mg Xanax. No clonazepam. Now that I'm down to such a low dose, my tolerance seems to have reset quite dramatically -- I've been able to cut out the barbs entirely, and now just use Dalmane 60-90mg as needed for sleep.
>
> So to sum it up, my current regimen is:
>
> Emsam 20mg qd
> alprazolam 1mg SL bid
> flurazepam 60-90mg hs prn
> Avapro 150mg qd (I may be able to stop this now that I no longer take stims, but I'll wait to get with my GP on that issue)
>
> All in all, I'm feeling great. Not a panic attack in sight, no social anxiety problems, and no real depression to speak of. I'm taking the Emsam more for energy and motivation, which it [thusfar] is helping with quite a bit (though I know two weeks is probably far too early to really judge).
>
> I'm in therapy for a newfound diagnosis - Asperger Syndrome. High-functioning autism. Receiving that diagnosis has seriously changed my life; I finally understand the issue that underlies the vast majority of my psych problems! And of course I also still watch my diet carefully, avoid caffeine, and exercise every day. Things are looking wayyyy up. :-)
>
> So how have things been for you lately?
>
> Cheers,
> Michael
>Hi Ya!
I THOUGHT YOU HATED METHYLPHENIDATE!!??
(OMG i think i'm on more psychotropics than you ATM)!!-i remember your extreme reguime a few months ago-Meth/amphetamines, High Xanax, Klon, SEconal/Tuinal-it was quite something.
I have been in hospital (2 weeks) due to alcohol overuse, my PsyDoc came to my house when i was drunk-:( and he sent me to hospital.
Anyway he put me back on 2mgs Clonazepam~3x day+5mg Valium at night, after a quick booze, detox of 40mgs Valium+2 7.5mg Zopliclones for 2 days, (Hospital sucks!!)
He asked me what i would require to control my GAD, without booze, so i quickly, somehow said 3mgs Xanax, which he gave me!! (rare downunder) (this not being USA-this is a rarely used med, i may inquire about 2mgs 2x daily xnt week) with 6mgs Clonaz+5mgs Valium@2 Zoplicones-(i'm benzo tolerant-3,5 years).
I have 300 Ritalins in my closet, from last month. He (Consultant Psychiatrist) said of Ritalin, "it's pro psychotic, and anxiolytic".
Trouble is i get too depressed and slow, so i may mention Dex (I do have a medical diagnosis of ADHD@GAD)so if i can convince him i need an ADHD med, and he hopefully goes along with it, it will help with motivation@mood-I think i remember you saying Dex+Clonaz was the social anxiety treatment, de jour?
You have tried all the stims@ seem to find 80yo Dex the most satisfactory?, even more satisfactory than the rarely scripted Desoxyn. I was scripted 80mgs gen Rit daily.
Man how did you get a Doc to script 2 Seconal or Tuinal daily?, i would love to try a Barb.
Cheers Michael-good health
Posted by Ame-Sans-Vie on August 11, 2006, at 8:13:06
In reply to Re: AME SANS VIE » Ame-Sans-Vie, posted by Paulbwell on August 11, 2006, at 7:51:05
> I THOUGHT YOU HATED METHYLPHENIDATE!!??
lol, I did when I tried it years back -- it made me feel extremely tense and nauseated. But I was on a much higher dose of benzos this time around. And I think the formulation in Concerta feels quite a bit gentler than the immediate-release formulations.
> (OMG i think i'm on more psychotropics than you ATM)!!-i remember your extreme reguime a few months ago-Meth/amphetamines, High Xanax, Klon, SEconal/Tuinal-it was quite something.Ha, yes, it was *quite* something, to say the least. Glad to not be dealing with 25+ pills a day anymore, lol!!
> I have been in hospital (2 weeks) due to alcohol overuse, my PsyDoc came to my house when i was drunk-:( and he sent me to hospital.
>
> Anyway he put me back on 2mgs Clonazepam~3x day+5mg Valium at night, after a quick booze, detox of 40mgs Valium+2 7.5mg Zopliclones for 2 days, (Hospital sucks!!)Ugh, tell me about it. :-/ I've been lucky enough to remain unhospitalized for a couple years now. ::knock on wood::
> He asked me what i would require to control my GAD, without booze, so i quickly, somehow said 3mgs Xanax, which he gave me!! (rare downunder) (this not being USA-this is a rarely used med, i may inquire about 2mgs 2x daily xnt week) with 6mgs Clonaz+5mgs Valium@2 Zoplicones-(i'm benzo tolerant-3,5 years).Yeah, I've heard from many people in Australia and the UK that prescription of alprazolam is generally frowned upon there. Lucky you!
> I have 300 Ritalins in my closet, from last month. He (Consultant Psychiatrist) said of Ritalin, "it's pro psychotic, and anxiolytic".
>
> Trouble is i get too depressed and slow, so i may mention Dex (I do have a medical diagnosis of ADHD@GAD)so if i can convince him i need an ADHD med, and he hopefully goes along with it, it will help with motivation@mood-I think i remember you saying Dex+Clonaz was the social anxiety treatment, de jour?Amphetamines and clonazepam worked wonders for a very long time in my case. Unfortunately, after many months on the uppers I began to sort of withdraw myself from the world... would spend hours and hours on end inanely browsing the net, just hyper-focused on what I was doing. Lower doses didn't provide any relief, so it was all or nothing for me after the initial "honeymoon period". Also, I began to develop a problem with skin-picking due to the amphetamines' potential to induce stereotypical behavior... that was the final straw for me. But barring all that, it was a sublime combination.
> You have tried all the stims@ seem to find 80yo Dex the most satisfactory?, even more satisfactory than the rarely scripted Desoxyn. I was scripted 80mgs gen Rit daily.
Actually, I prefer Desoxyn, but I would've required a much higher dose than Medicaid would pay for to keep my symptoms at bay; hence the Dex/Des combo.
> Man how did you get a Doc to script 2 Seconal or Tuinal daily?, i would love to try a Barb.
Eh, my history of unresponsiveness to hypnotics has been *very* well documented over the years. The most convincing evidence of this came from my various hospital stays, when my complete lack of sedative response to anything but short-acting barbiturates pretty much perplexed the staff. My pdoc thus had no problem giving me what had worked for me in the past.
> Cheers Michael-good health
And to you as well!
Posted by jerrympls on August 12, 2006, at 3:04:57
In reply to What stage of treatment-resistance are you?, posted by SLS on August 4, 2006, at 8:48:06
> What stage of treatment-resistance are you?
>
>
> * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
>
> * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
>
> * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
>
> * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
>
> * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
>
>
> - ScottStage Six: All of the above plus the VNS Implant.
Posted by Paulbwell on August 12, 2006, at 4:10:28
In reply to Re: What stage of treatment-resistance are you?, posted by jerrympls on August 12, 2006, at 3:04:57
> > What stage of treatment-resistance are you?
> >
> >
> > * Stage 1: Failure of an adequate trial of 1 class of major antidepressant
> >
> > * Stage 2: Failure of adequate trials of 2 distinctly different classes of antidepressant
> >
> > * Stage 3: Stage 2 plus failure of a third class of antidepressant, including a tricyclic antidepressant (TCA)
> >
> > * Stage 4: Stage 3 plus failure of an adequate trial of a monoamine oxidase inhibitor (MAOI)
> >
> > * Stage 5: Stage 4 plus failure of an adequate course of electroconvulsive therapy (ECT)
> >
> >
> > - Scott
>
> Stage Six: All of the above plus the VNS Implant.Come on Jerry-stop feeling so damn sorry for yrself-you gots your Hydro-maybe another Narcotic, or Gog forbid brain cautarisition-aka modern lobertomery-you done ECT?
Time heals
Cheers
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