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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Jimmyboy on December 18, 2006, at 11:08:45
Hey Tometheus,
I read your post on the above nootropics thread and your symptoms are exactly the same as mine. If ou don't mind could you tell me what medication has been the most helpful for these symptoms? I have tried alot of things and basically gotten no long term relief.
Thanks
Posted by Tomatheus on December 25, 2006, at 2:01:17
In reply to Tometheus, posted by Jimmyboy on December 18, 2006, at 11:08:45
Jimmyboy,
Thanks for your post and for your interest in what I've written. I apologize for neglecting to acknowledge your post until now.
Like you, I have had great difficult getting long-term relief from most of the meds and medication cocktails that I've tried. Quite often, I get what I sometimes call an "antidepressant tease" from certain meds: a nice response (even though it's not usually quite full remission) that lasts approximately 2-4 days, and then an abrupt return to my "normal" severely depressed and lethargic state or perhaps a faintly detectable but barely noticeable residual AD effect. More often than not, that's the best kind of response that I can get out of a med. There are some meds that I haven't benefited from at all and still others that make me feel worse instead of better, but it's my impression that most treatment-resistant psychiatric patients end up going through at least a few meds that produce those types of responses (either not much of a response, or a worsening of symptoms) at some point or another. So, I'm not saying that there's anything unusual about that.
Basically, I experienced sustained partial (but rather inadequate) relief once for about a year and a half on a combination of Wellbutrin and lithium. Unfortunately, this relief came at a price. Even though I felt energized enough on most days to complete the assignments that I needed to complete as a university student (which I was at the time) and to fulfill my responsibilities as a student worker, I still usually just had barely enough energy to get through the day. And oftentimes, the energy boost that I received from the Wellbutrin and the lithium wasn't enough to get me up and moving, but I usually ended up doing whatever I felt was necessary (e.g., taking excessive amounts of supplements, drinking caffeinated beverages, etc. -- nothing illegal, though) so I could get to class and be able to think coherently enough to complete my assignments. The lithium that I was taking produced a rather severe hand tremor, some moderate akathisia, and some cognitive dulling that wasn't too unbearable when I was taking it in combination with Wellbutrin, but I didn't so much care what my meds and all of the supplements and caffeine were doing to me in the long run because just completing all of my assignments felt like a monumental struggle. Even though I completed my assignments, I ended up turning in a lot of my papers late because it just took me too damned long to write them with the way that I was feeling. But that didn't matter. I was getting by and accomplishing things, which was a lot more than I was ever able to say when I wasn't taking any meds.
After about a year and a half on my Wellbutrin-lithium combo, I discontinued the Wellbutrin basically because I couldn't afford it at the time and just tried taking lithium as monotherapy. At first, I didn't notice much of a difference between the way I had felt on my Wellbutrin-lithium combo and the way that I was feeling on lithium monotherapy, which is somewhat surprising considering that I had been at 400 mg/day of the SR version of Wellbutrin before stopping it "cold turkey." Slowly but surely, however, what little motivating energy I had felt on the Wellbutrin-lithium combo faded away, and the akathisia and other lithium-induced extrapyramidal side effects (tremor, dystonia, and muscle rigidity) started to get worse. These symptoms and a massive sense of confusion that was even worse than it had been before I started taking any meds did not go away after I discontinued the lithium. More than a year and a half later, the symptoms still linger to an extent, and I think that this has clearly complicated my already difficult-to-treat condition.
Earlier this year, I actually achieved what was pretty much complete remission on 75 mg/day of a partially homemade enteric version of the Australian Nardil (I was taking it with 25 mg of doxylamine succinate at night). Unfortunately, I noticed an abrupt onset of extreme urinary retention and excessive sweating shortly after I received a bottle of Nardil without any silica gel inside of it and started taking the tablets from that bottle using my usual enteric-preparation method. A few days later, I lost the antidepressant response completely and could not regain it for as long as I continued to take the Australian Nardil. I eventually tried applying the enteric-preparation approach to the U.S. Nardil and felt a consistent-but-only partial response for about two months. Still, that was far better than nothing and superior to the rather weak response that I had with my Wellbutrin-lithium combo. I ultimately stopped taking Nardil, though, after I started taking what was probably a "bad lot" of the medication and abruptly started feeling extremely irritable and experiencing severe panic attacks.
Right now, I'm trying out a combination of the Goldshield Parnate and SAM-e, and I've actually been having some success with it. Unfortunately, it's too early to tell whether or not I'll be able to get any kind of lasting response out of the combo. I recently described my trial with the combo so far here:
http://www.dr-bob.org/babble/20061224/msgs/716247.html
I have some reason to believe that I may ultimately benefit from the right balance of MAO-inhibition (preferably mostly MAO-A inhibition) and increased methylation from SAM-e supplementation. Basically, to put things as simply as possible, if your psychiatric and physical symptoms match up somewhat closely with both the "high copper" and "high histamine" depressive sybtypes that the late Dr. Pfeiffer and his colleagues have described, then I think that there's a good chance that you too might theoretically benefit from finding the right balance between MAO inhibition and SAM-e supplementation. Then again, what makes sense in theory doesn't always work out in practice. I am still a long way from knowing whether or not I'll get a long-term response out of my Goldshield Parnate-SAM-e combo, but if you'd like, I'll keep you updated on my response as it progresses.
I hope this helps, at least a little. Please let me know if you have any questions, and have a happy holidays!
Tomatheus
> Hey Tometheus,
>
> I read your post on the above nootropics thread and your symptoms are exactly the same as mine. If ou don't mind could you tell me what medication has been the most helpful for these symptoms? I have tried alot of things and basically gotten no long term relief.
>
> Thanks
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