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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Squiggles on May 7, 2007, at 7:35:15
In reply to Following posts too tiresome for me...New doc Tues, posted by stargazer on May 6, 2007, at 22:21:35
Hi Stargazer,
I think that people who post here are by
definition people searching or wanting to
share questions regarding medication *problems*.
So, yes, it does seem frustrating to anyone,
even those who have hit on a successful drug
or combination.To me, you sound depressed and maybe burned out
from either bad luck or long-term frustration
with psychiatric drugs. I am sure you are not
the only one.I hope that things look up for you with your
new doctor soon.Take care-- i will check the board for your
posts.Squiggles
Posted by Intrepid on May 7, 2007, at 10:06:28
In reply to Following posts too tiresome for me...New doc Tues, posted by stargazer on May 6, 2007, at 22:21:35
> Unfortunately, I want to read so many posts but I am unable to lately. I am truly amazed at how so many of you have the focus, energy and interest to do this over and over in articulate and interesting ways.
>My belief is this board is more for folks seeking, needing to vent and, to some degree, wanting a platform for agendas - none of which I believe to be bad when looked at in the correct context. It is very easy to get discouraged, at times, if one spents too much time here reading and trying to be discerning regarding the info, personal stories and the frustrations folks voice.
I am someone who is doing well on meds, although I know they are not the answer for everyone. They were not the whole of the answer for me but they have been a great adjunct.
I think opinions about meds will always be a dicey subject because of the very nature of being usually based on subjective findings. So individual, so much about the very human feelings, emotions and behaviors that make up *us*.
I wish you luck in your quest. There are various paths to getting better. I highly recommend attempting to develop our own convictions which are true for us. That is not an easy task when we are struggling but can be good first step to advocating for our own wellbeing.
Posted by stargazer on May 7, 2007, at 10:24:52
In reply to Re: Following posts too tiresome for me...New doc, posted by Squiggles on May 7, 2007, at 7:35:15
Thanks for taking the time to write me back. I do find that I have little interest in anything. Right now I feel very uncertain about everything...life, depression, future plans, etc. and I vacillate between depression and feeling "blah" not sure if it's depression, even though I have been battling "it" for some 20+ years on and off, more on lately.
The worse part is not knowing when enough is enough, sometimes the deepest depression almost feels better(not) but at least when I'm in that state I can understand it is an illness that will pass. The feeling I have right now is somewhere between how I think most people feel but with an undercurrent of not knowing what to do about it, whether a medication is the answer, a major life change to stir things up, although I think that is what has lead me to many of my poor choices and bailouts in the past to "escape" the pain and uncertainty.
I'm hoping this new doc can do something although starting with a new pdoc is very scarey since they know nothing about you but might be the best one to see your situation from a fresh perspective, since the pdoc I've had for 17 years "knows" me but can't help me other than to try med after med with mixed results.
I guess I still want to think I can feel better and regain some of my life back before it is too late, but at age 50, it seems like half of my life was wasted with the wrong meds and poor choices from a lifetime of depression, ADD and whatever else I have which has changed year to year. It just doesn't get any easier the more you know and think you can understand what needs to be done next. I feel like I am losing my way lately.
I am willing to give it another try but wish I had more faith in finding a cure at least for a few years. I had two or three brief remissions with Nardil, Marplan and a combo of Celexa/Wellbutrin/Adderall and most of the other 20 or 30 meds I've tried were just time spent going through the motions and never really getting to a place where I could forget I was depressed.
I is getting pretty scarey to think there may be no answer for me in the short time that I may have left.
You are kind to be there to at least offer a word or two of your insight with me. I will keep you posted of the new pdoc's insight and treatment plan for my situation. He is a specialist in TRD so at least he comes highly recommended and if he can't help me at least I know I tried my best to figure this out. The last thing I wanted to do was give up not knowing if someone else might be able to get to the bottom of my poor responses to meds and give it the best chance for another person to figure it out. I'm hoping he will know what to do next since I have almost given up trying anymore meds. I really think the treatment of depression is archaic, preying on the vulnerability of those who can't help themsselves and it seems so many "professionals" can't help us either. It is a real crapshoot to find the right medication despite my sticking it out and trying everything except the last resort of VNS or ECT. I hope he can prove me wrong and come up with a new game plan given my history and past experiences with meds...
Sorry so long and boring, it took alot of effort to put this into words, if you have read this whole thing I admire your patience and effort...Stargazer
Posted by Squiggles on May 7, 2007, at 10:56:53
In reply to Re: Following posts too tiresome for me/Squiggles, posted by stargazer on May 7, 2007, at 10:24:52
Anyone here like Dr. Bob's students know about
the algorithms for drug choices? I take it that
your dx is depression, Stargazer? I was wondering if perhaps skipping to another class of meds (e.g. Alzheimer's or Parkinson's meds, or even pain killers) might not be a good option before going to the esoteric treatments like ECT and Vagus Nerve Stimulation. I posted about that before.I sincerely believe that getting the right drug(s) is the answer. And, getting a nice check-up (bloods) in case something else is wrong-- the brain is part of the body. They interact. That's just my layman's opinion.
Good luck
Squiggles
Posted by Phillipa on May 7, 2007, at 11:08:06
In reply to Re: Following posts too tiresome for me/Squiggles, posted by stargazer on May 7, 2007, at 10:24:52
Stargazer I know that feeling of getting older as I'm older than you and the limited amount of time to find something that works but at about your age my hormones were going through a lot of changes too. Could they maybe contributing? Love Phillipa
Posted by Squiggles on May 7, 2007, at 12:13:52
In reply to Re: Following posts too tiresome for me/Squiggles » stargazer, posted by Phillipa on May 7, 2007, at 11:08:06
Guidelines for Treating Major Depressive Disorder:
TMA PHYSICIAN PROCEDURAL MANUAL:
Trivedi, Shon, Crimson and Key.http://www.dshs.state.tx.us/mhprograms/timaMDDman.pdf
----------------------------
----------------------------
Medical guides: they don't make they like they used to.:-) Oh well, maybe this will help.Squiggles
Posted by Quintal on May 7, 2007, at 13:44:49
In reply to Following posts too tiresome for me...New doc Tues, posted by stargazer on May 6, 2007, at 22:21:35
I agree with Squiggles re: trying another class of med. Codeine is really the main drug keeping me in remission, and this is in small doses of ~20-40mg. My energy levels seem to be a lot lower than other people's too, but opiates help a great deal with resilience. There may be various treatment protocols, algorithms etc that some pdocs use, but the most anyone can say is that some drug 'might' help you. It's impossible to say with certainty that any treatment will definitely work, anyone who tries to tell you so is probably lying or exaggerating.
I find conflict invigorating, maybe it gives me a sense of purpose? I think that's where some of the most interesting debates come from but as you say, when you're feeling low your instinct is to crave peace and harmony. "Chicken soup for the nurse's soul"?
Q
Posted by Squiggles on May 7, 2007, at 16:50:23
In reply to TEXAS IMPLEMENTATION OF MED ALGORITHMS (TIMA), posted by Squiggles on May 7, 2007, at 12:13:52
There are other such "algorithms" for
the procedural treatment of medication,
and I have not looked at all countries.
Hopefully, there is no major disparity
between one and the other. It would be
very interesting if there were.Here is a link with some at the bottom from
the APA, Canadian Mental Health, etc.http://www.mentalhealth.com/dis/p20-md01.html
Squiggles
Posted by stargazer on May 7, 2007, at 17:23:27
In reply to Re: TEXAS IMPLEMENTATION OF MED ALGORITHMS (TIMA), posted by Squiggles on May 7, 2007, at 16:50:23
I want someone to help me figure this out, that algoritm has 91 pages, I can't print that out to read, I'll lose what little mind I have left.
I can sometimes help myself but lately I want an expert to help me, is this too much to ask? If we can't rely on these experts who study this stuff, it is really sad and paints a dismal picture of psychiatry. The average, depressed person cannot read and understand any of this algorthm and I do not have the ability to focus and know what to read, not read to get any idea of what may help ME!
Many here have backgounds in medicine, pharmacueticals and that is a blessing for them and for many of us that can benefit from their knowledge but I want someone who can give me the benefit of their training and and research to be able to know what can help my situation. I'm very tired of it all, it is too much to try and figure out, along with trying to just get through an average day in my world. My comphrehension is next to nothing, I don't read anymore, I can't read the paper or even watch TV anymore. I have no memory left, I used to be rather intelligent but 30 years of depression has ruined my confidence from so many failures, that I don't trust my instincts anymore. I don't think I can do alot of this on my own, for the simple reason is that I don't trust me abilities anymore. I seem to be failing fast.
That is why I've called in the Big Guns to help me, if they can't, I may just give up the fight. That is how i'm starting to feel and I haven't felt like this for a long time.
I may want to try Nardil again but I want this so called expert to point me in the right direction so I can feel hopeful that new or better options exist for me. It is all I have left to try, short of treating myself with online meds and that seems too reckless to me. But I wouldn't rule it out completely.
I may see if this expert can work with my pdoc together so they can use eachother consultively and do with me what they like, I don't even care what they want to try as long as it has a shot at working.
Stargazer
Posted by Racer on May 7, 2007, at 17:30:42
In reply to Appreciate the information but. 90 pages is crazy., posted by stargazer on May 7, 2007, at 17:23:27
I just took a look at it, using the table of contents, and it was easy enough to see just the parts that applied to me. I don't know that I'd even suggest printing all of that out.
Maybe look at the Critical Decisions section for your sort of depression, and the basic algorithm for your type of depression. That's only a few pages.
Good luck.
Posted by Squiggles on May 7, 2007, at 17:31:43
In reply to Appreciate the information but. 90 pages is crazy., posted by stargazer on May 7, 2007, at 17:23:27
I understand your point. It is long.
They are all long because they are guides
for physicians.You may have noticed that the TAMI one has
a part of psychotic and non-psychotic depression.
Also, there are many short monographs for the
drugs used, and other details near the end.For your interest, it may help to look at the
index in the front and go to the page that
interests you.If you like you can ask me a question. But I am
not responsible for taking on a doctor's or
nurses' role, just for reading the stuff.
Chances are most psychiatrists follow these guides too, but I don't know if non-psychiatrists do.Squiggles
Posted by stargazer on May 7, 2007, at 21:17:09
In reply to Re: Appreciate the information but. 90 pages is cr, posted by Squiggles on May 7, 2007, at 17:31:43
Thanks for all your help. Perhaps in a few days I will be able to read the info. Today is just not the time to even look at this since I believe alot of my uncertainty and anxiety is from seeing this new doc tomorrow and not knowing what to expect although I am expecting alot. I really hope he can offer me some encouragement and hope for the future. I do appreciate all of the info you have graciously offered me. It is just too much for me to digest online. I have to print it out in order to read it and the 90 pages scared me away. Perhaps I can just print a section or two(?) for another time and place.
Stargazer
Posted by Phillipa on May 7, 2007, at 22:13:26
In reply to Lots of help out there just really feel alone toda, posted by stargazer on May 7, 2007, at 21:17:09
Stargazer good luck will be thinking of you tomorrow.No way could I not. Love Jan
Posted by UgottaHaveHope on May 8, 2007, at 1:01:40
In reply to Following posts too tiresome for me...New doc Tues, posted by stargazer on May 6, 2007, at 22:21:35
I may not always be right with my opinions, but they are my perspectives, right or wrong.
I will always be here because my Godly gift is being an Encourager. And ppl on this board (myself included) need lots of encouragement.
I love Dr. Bob!!!!!!!!!!!!!!!!!!!!!!
Posted by Squiggles on May 8, 2007, at 8:21:57
In reply to Lots of help out there just really feel alone toda, posted by stargazer on May 7, 2007, at 21:17:09
I hope your new doc helps you. This mental
health business is very high-maintenance stuff.
That can be hard on the patient as well as the
practitioner. Don't give up.Squiggles
Posted by stargazer on May 8, 2007, at 18:44:14
In reply to Re: Lots of help out there just really feel alone, posted by Squiggles on May 8, 2007, at 8:21:57
Briefly, saw him, he listened to my abbreviated story and asked alot of questions that I really had to think about. He took the time, copied my notes and gave me an article about Fentanyl being used for depression, which I will read.
Bottom line:
He wants to meet with me again, good news.
He was very understanding and thoughtful, good.
He thinks my memory is WNL, good.
My concentration is another story, NSG (not so good)I cried and talked and cried and talked but feel at least he was listening to me between sobs.
He thinks my pdoc has been doing a good job based on his review of my 3 page typed summary of all the meds I've tried and their side effects and results of the past 20 years. Good job but not improvement in my condition.
He said I could switch Emsam for Nardil and stay on the Abilify, but the amphetamine I take would probably have to go, if I decided to switch to Nardil. He said the MOAI's have less mood destabalization than the SSRI's and tricyclics. We touched on the idea of me having bipolar tendencies.
He mentioned some of the research he is involved in but hesitated to make any suggestions for my next steps until he met with me again. So that was good and I liked his approach and manner so next time will help sort things out better.
Stargazer
Posted by Quintal on May 8, 2007, at 19:00:43
In reply to Saw the research doc, like him, no suggestions yet, posted by stargazer on May 8, 2007, at 18:44:14
Great news SG! I'm surprised (but encouraged) to hear about the Fentanyl. I thought it was rarely prescribed to outpatients unless they already had a high tolerance to other opiates? Something about its very high potency being a high risk factor for accidental overdose. I'd go with it if he's willing to prescribe though - opiates being the one avenue you haven't been down before?
Anyway, sounds as if there's much more hope with this new pdoc. Congratulations!
Q
Posted by Squiggles on May 8, 2007, at 19:32:08
In reply to Saw the research doc, like him, no suggestions yet, posted by stargazer on May 8, 2007, at 18:44:14
Gee what's his name? :-)
Fentanyl, amazing. Its only
use I have come across was when
our dog had surgery. We were
advised not to touch it- must
be powerful stuff.Squiggles
Posted by Phillipa on May 8, 2007, at 21:10:46
In reply to Re: Saw the research doc, like him, no suggestions, posted by Squiggles on May 8, 2007, at 19:32:08
It is my older neighbor across the street wears a fentanyl patch as she needs knee replacement surgery . She has to flush the patch down the toilet as others can use the discarded patch for a high. Her Daughter abuses or did opiods. So has to be tightly controlled in her house. But never throw them away as someone else can use them. Love Phillipa
Posted by Squiggles on May 9, 2007, at 8:09:16
In reply to Re: Saw the research doc, like him, no suggestions » Squiggles, posted by Phillipa on May 8, 2007, at 21:10:46
For anyone receiving or giving treatment, i
found an interesting article about the relative
efficacy of pharmacological versus psychotherapeutic treatments for various degrees of depression:
Posted by stargazer on May 9, 2007, at 16:40:20
In reply to Saw the research doc, like him, no suggestions yet, posted by stargazer on May 8, 2007, at 18:44:14
It is ketamine that is being used in resrach for relief of depression... The article is titled, "Antidepressant Effects of ketamine in depressed Patients".
Ketamine is a NMDA receptor antagonist, for those of you science/pharmaceutical wiz kids.
Sorry for any confusion I may have caused... The other med used in research is Riluzole, the article is titled "Riluzole Augmentation for Treatment- Resistant Depression". Riluzole is a ALS drug and is a putative antilutamatergic agent.
Stargazer
Posted by Quintal on May 9, 2007, at 17:05:14
In reply to Sorry, KETAMINE not Fentanyl, my mistake...., posted by stargazer on May 9, 2007, at 16:40:20
He has taken Ketamine and found small doses very helpful in keeping his depression and social anxiety in remission. He's also just completed a trial of Riluzole and found that very effective too. Hope he drops by to lend us his insight. I'll email him.
Q
Posted by stargazer on May 10, 2007, at 8:27:32
In reply to You need to speak to rovers95..................... » stargazer, posted by Quintal on May 9, 2007, at 17:05:14
Rovers95... welcoming your feedback and experiences on these two drugs. All I know is that Ketamine is given intravenously as a one time dose and it acts to "reboot" the brain and reset the neurons to be more receptive to medications which might work more effectively once the Ketamine does its thing. Also, the action is short lived so a one time dose may only last for a week or so until the other meds can pickup the slack.
I know that Riluzole is an adjunctive medication with good results when added to the baseline meds you are on. Its original indication is for ALS (Lou Gehrig's disease, I belive, a neuromuscular condition).
What did you find and are you taking either right now? side effects? baseline meds?
Stargazer
Posted by rovers95 on May 22, 2007, at 21:09:18
In reply to You need to speak to rovers95..................... » stargazer, posted by Quintal on May 9, 2007, at 17:05:14
> He has taken Ketamine and found small doses very helpful in keeping his depression and social anxiety in remission. He's also just completed a trial of Riluzole and found that very effective too. Hope he drops by to lend us his insight. I'll email him.
>
> Q
Im here!!! Ok the ket is doing good for me and i dont seem to be ebuilding up a tolerance - i think this is due to the fact i seem to be suffering some sort of intractable magnesium deficiency.Anyway now i am working all the time and the last few weeks i played cricket with my mates, these are MASSIVE steps for me!!!!! However, i dont think the ket will work 2 the max again until the riluzole has worn off, it seems to still have dampened the NMDA receptors (still no noise sensitivity etc. like i used to have)
At the time, the riluzole didnt get give me that "flash" of happiness i was lookin 4 - prob due to its lack of effiacy at the HPA axis, but i wasnt "sad" anymore so to speak!!! Kinda wish i hadnt tried the riluzole in one way (has made the ket slightly less effective - think its cos its dose dependent), but in another i still have 39 tablets and i no if i ever go seriously downhill and/or run out of ket it will pull me out of that dark place!!!
In the meantime im gettin sum mirapex for my libido and praying the docs r inventing new NMDA antagonists for depression...........r they???!!!
rovers95
Posted by rovers95 on May 22, 2007, at 21:16:46
In reply to Calling rovers95 to come over for Ketamine/Riluzol, posted by stargazer on May 10, 2007, at 8:27:32
> Rovers95... welcoming your feedback and experiences on these two drugs. All I know is that Ketamine is given intravenously as a one time dose and it acts to "reboot" the brain and reset the neurons to be more receptive to medications which might work more effectively once the Ketamine does its thing. Also, the action is short lived so a one time dose may only last for a week or so until the other meds can pickup the slack.
>
> I know that Riluzole is an adjunctive medication with good results when added to the baseline meds you are on. Its original indication is for ALS (Lou Gehrig's disease, I belive, a neuromuscular condition).
>
> What did you find and are you taking either right now? side effects? baseline meds?
>
> Stargazer
Should add that i take lamotrigine 4 ket s/e's and also magnolia rhodila complex - a combo of relora, rhodiloa and l - theanine........the l-theanine and relora are definetly effective!!hav come clean 2 my GP about my internet buying (hes a nice guy - so i felt bad!!!) and hes sending me bk 2 the pdoc ASAP so wel c, occasionally use klonopin instead of alcohol on nights out (which i can now participate in!!)
This is the end of the thread.
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