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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 Phillipa on January 5, 2008, at 20:29:02
May seem like a silly question but I really don't understand poopout other than a med that works no longer does for the person length of time seems to vary a lot. If a med works and then poops out then another med right? And this can continue correct or not? If so what happens that the med no longer works or does this mean that you will continually have to find another med. And can you run out of things. I wish I did have one that worked right now I'm just me depending on my strength of will power to continue. And isn't it said that a bout of depression only last a period of time as I've been depressed according to others for many years and did take meds long enough to finish trials. One time luvox worked at 250mg for about two weeks. First ad was l0mg of paxil and xanax and it was working till the doc took me off it for a med trial. So if he hadn't might I still be working and feeling fine as I was then or is this a fallacy. That eventually they all stop working. Thanks for you time to answer. Phillipa ps been depressed without a break for ll years. Benzos have been a savior for sleep.
Posted by bleauberry on January 5, 2008, at 21:00:49
In reply to Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 20:29:02
I don't know, Phillipa. I guess if someone knew the answer to poopout they could become a millionaire overnight. We know that with a SSRI, serotonin receptors will decrease in numbers over time to compensate genetically for the artifically increased serotonin. The receptors change responsiveness based on the new serotonin. We have no idea what instructions our genes have in various situations. Some drugs eventually effect thyroid function, such as prozac or paxil, due to their fluoride content.
Memantine, an NMDA antagonist, supposedly prevents tolerance to opiates, stimulants, and cannabis, so maybe somehow the whole glutamate/potassium/calcium circuit is somehow involved. Feedback mechanisms might be slow to kick in but eventually get the idea there is too much serotonin and just shut things down. There has been theory that tryptophan conversion into serotonin is altered in a negative way by antidepressants. Don't know. Complicated stuff.I've heard of people happy with prozac for 10 years, and others it poops out in a month. Same with zoloft. I don't know why. Individual genetics.
Does that mean that every so often we will have to stop a drug that has pooped out, return to it later, or start a new one, or augment it with something new? Don't know.
I do know one thing. You are ready for a change. I see absolutely zero sense in continuing with luvox. Your genetics have well figured that drug out and got it beat. If Paxil worked once, maybe again.
While researching SNRIs at pubmed it became apparent that SSRIs generally work better for younger people but not older people, while SNRIs work better for older people but not younger people. You might limit your sights to norepinephrine type drugs...nortriptyline maybe. Paxil by the way has fairly strong norepinephrine action compared to others. Maybe there's a hint in there, why you did well with paxil. Anything but luvox. Please. It's time.
> May seem like a silly question but I really don't understand poopout other than a med that works no longer does for the person length of time seems to vary a lot. If a med works and then poops out then another med right? And this can continue correct or not? If so what happens that the med no longer works or does this mean that you will continually have to find another med. And can you run out of things. I wish I did have one that worked right now I'm just me depending on my strength of will power to continue. And isn't it said that a bout of depression only last a period of time as I've been depressed according to others for many years and did take meds long enough to finish trials. One time luvox worked at 250mg for about two weeks. First ad was l0mg of paxil and xanax and it was working till the doc took me off it for a med trial. So if he hadn't might I still be working and feeling fine as I was then or is this a fallacy. That eventually they all stop working. Thanks for you time to answer. Phillipa ps been depressed without a break for ll years. Benzos have been a savior for sleep.
Posted by Justherself54 on January 5, 2008, at 21:11:40
In reply to Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 20:29:02
> May seem like a silly question but I really don't understand poopout other than a med that works no longer does for the person length of time seems to vary a lot. If a med works and then poops out then another med right? And this can continue correct or not? If so what happens that the med no longer works or does this mean that you will continually have to find another med. And can you run out of things. I wish I did have one that worked right now I'm just me depending on my strength of will power to continue. And isn't it said that a bout of depression only last a period of time as I've been depressed according to others for many years and did take meds long enough to finish trials. One time luvox worked at 250mg for about two weeks. First ad was l0mg of paxil and xanax and it was working till the doc took me off it for a med trial. So if he hadn't might I still be working and feeling fine as I was then or is this a fallacy. That eventually they all stop working. Thanks for you time to answer. Phillipa ps been depressed without a break for ll years. Benzos have been a savior for sleep.
I know of people who've had success with long term usage of an Ad, however, in my case you're correct..every AD that I've been able to tolerate has pooped out on me within a year..so on to the next one..and the next one..they all have stopped working..even when I retry one after a long time it doesn't work again..that's why I'm on Nardil..I'm hoping it's history of longevity will help me..I've tried 3 time to return to work with no success..I still have trouble accepting the fact that I'm too ill to work..
I don't know why it happens..I'm sure there are posters on babble who will have that answer..
Zoloft and Lexapro were great while they lasted..if Nardil poops out on me I don't know what we'll do, other than my pdoc says we'll have to get really creative..scares me to even think of another trial of meds..but I'll do it if I have too..I keep on keeping on..
After my first full blown mania, we haven't been able to get my depression under control..it has to be really hard for you..11 years with no relief..you are a trouper Phillipa! Keep on trying different meds..hopefully you'll find one that you can tolerate..
Posted by bleauberry on January 5, 2008, at 21:19:05
In reply to Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 20:29:02
Phillipa I am concerned about you. To put it bluntly...please get a doctor. Any doctor. Someone different. I have known a lot of doctors, and witnessed stories of many good ones and bad ones right here at babble, and it is hard to fathom why any of them would keep a patient on luvox that was getting them nowhere except stuck in a dark hole. Just about any psychiatrist would have changed course with your meds in about 6 weeks. It is way way way past 6 weeks.
I was looking at cymbalta, effexor, milnacipran...all serotonin/norepinephrine drugs. There are studies at pubmed that looked at gender and age differences in response to various meds. Basically the general trend found was, with a cutoff point of age 49, younger did better with SSRIs, older did better with SNRIs or tricyclics.
Sleep is an issue with you. Anxiety is an issue with you. According to the above mentioned trend, norepinephrine might be an issue. Your fatigue hints to hypo-norepinephrine function. Cymbalta did nothing for you. Ok. Don't know if you tried effexor. Milnacipran is popular in 40 countries but I don't know if you would go the non-FDA mailorder route that some of us are comfortable with. Considering the trend and your symptoms, nortriptlyine makes sense to me. Actually, anything except luvox makes sense to me.
But you need a doctor who is willing to try stuff! How can a doctor be so complacent to leave you in a dark hole for so long and do little piddly adjustments instead of meaningful changes? Gee whiz man, come on, let's get the show on the road! A new doctor, a second opinion, a fresh start, and major med changes. God says he will restore all the years lost to the locusts. But we have to be willing to help ourselves overcome.
Posted by SLS on January 5, 2008, at 21:24:25
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by bleauberry on January 5, 2008, at 21:00:49
Hi.
> I do know one thing. You are ready for a change. I see absolutely zero sense in continuing with luvox.
I agree with you BB.
> Your genetics have well figured that drug out and got it beat.
:-)
Damned exons. Maybe those introns have something to say afterall?
My dear Phillipa:Stop drinking grapefruit juice and let that Luvox drain out of your system.
Nardil + Klonopin?
Go for it already!
It is frustrating to watch you suffer so much and do so little.
Trust more and fear less. Move. Moving in any other direction will begin a path away from failure. This is all I can promise you.
Nardil + Klonopin. It seems like as good a direction as any to begin the rest of your life...
- Scott
Posted by SLS on January 5, 2008, at 21:28:57
In reply to Re: Anyone Know why a Med will Poop out for some? » Phillipa, posted by bleauberry on January 5, 2008, at 21:19:05
> God says he will restore all the years lost to the locusts. But we have to be willing to help ourselves overcome.
I really like you, Bleuberry.
You do good work here. I learn from your every post.
- Scott
Posted by Phillipa on January 5, 2008, at 23:41:30
In reply to Re: Anyone Know why a Med will Poop out for some? » bleauberry, posted by SLS on January 5, 2008, at 21:28:57
You are all so kind to me. Yes luvox has no side effects for me. Wierdly though another pdoc this summer took me off luvox gave me high doses of xanax long acting got name brand too and then he gave me ativan 8mg. Only took 6mg. But the strangest thing happened. I didn't sleep at all without the 50mg of luvox. Ended up in the ER . Very nice ER doc called the big hospital downtown with a psych dept came back and was scratching his head and said obviously consulting with the head pdoc luvox does something for you so I went back to the original dose of 50mg luvox and 20mg of valium. yes I tried cymbalta and felt nothing at all. Seems like in the last few years my metabolism or something has changed as now benzos tire me and what used to flip me out the ad's don't do anything I can see. Either I'm depressed or saddened at getting older not being able to nurse. May be not a great job for a lot of folks no glory or high dollars but I received true happiness doing something I loved. I worked all the floors and much positive feedback not blowing my horn but I was a great nurse as I cared about all the patients. Never worked overtime as I did things quickly and efficiently still took time to read all my patients charts and go back and talk with each one. For some reason I pick or get the wrong docs. I had an appointment for this week at the psch unit head doc downtown and he cancelled til March his patients. I'd already waited three months. Can't go to the other practice as once you see one of the docs can't switch. Some know about this situation. That's the way it is. Did find out why. The docs are competitive amongst themselves and jelousy happens if one doc is more popular so the patients suffer. I have medicaire a and b but don't think that's causing a problem. Someone here found me one that does do nardil but he's in that practice. Yes I am in a hard place. And age is a factor. One I have now says I thought maybe you could have a few years. Well now that makes you feel real good. Do need surgery in Feb. end of month. Female stuff. So what to do. I'm trying the therapist stuff at the moment and even picked her wrong. So what to do don't know. keep riding my bike for one thing. But I refuse to quit. And its so demeaning not to work when your identity came from working right or wrong. Love Phillipa to you all.
Posted by Glydin on January 6, 2008, at 8:02:02
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by SLS on January 5, 2008, at 21:24:25
> Trust more and fear less. Move. Moving in any other direction will begin a path away from failure. This is all I can promise you.
>
~~~ Excellent advice.If one continues to do the same thing, one can reasonabilly expect the same results.
I also believe you are in need of big changes to your treatment plan. I suggest making an effort to be heard. Print out the posts that convey your level of distress and its longstanding... your posts tell your story well. There comes a time when we need to begin advocating for ourselves, stop the excuses and rationales, stop being victims and demand decent treatment. We also need to be willing to accept treatment.
My wish is to see you open your life up to living in the present and adapting appropriately to the changes life brings to all of us.
Posted by tecknohed on January 6, 2008, at 10:42:44
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 23:41:30
I have no idea why they poop out.
Can you explain why you cant see another doctor untill March when you see your new pdoc? Cant you see a General Practitioner for a script of something new to try, at least until March?
What bleauberry said makes sense. You haven't tried all the tricyclics have you? Imipramine is one of the strongest & most reliable ADs around. Its one of the oldest yet is equally effective (usually moreso) than most other ADs. Even gives those opiate receptors a tweak! Its a good anti-panic med so should be good for anxiety. You just need to be able to tolerate it - however, without meaning to sound rude, older people usually need lower doses of ADs anyway.
SSRI + NRI (carefull which ones as some can increase levels of the other 10-20 fold, especially if the NRI is a tricyclic).
NRIs will give you more energy (desipramine is the best one for mood as it has a weak SRI effect too). & you have your benzos to help prevent any anxiety.
I know its been a long time (too long) but you have to remain proactive in your search for a better med(s). If I'm not satisfied with results I'm strait on to the next.
What alternatives have you tried? St. Johns Wort? Something like that might be worth a try until March. Different brands can be very different. I've always gone for Kira SJW myself with good AD effects, being more activating that sedating.
Korean Ginseng will strengthen the whole system, mental & physical, especially in older people.Best of luck!
teck ;)
Posted by Justherself54 on January 6, 2008, at 10:43:56
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by Glydin on January 6, 2008, at 8:02:02
Have you asked your current pdoc about Nardil? Mine told me the only hesitation he has in prescribing it to a patient is if he feels the patient might not be compliant, or be able to be compliant, with taking the food and drug interactions seriously..with your background and education, seems to me he shouldn't hesitate to let you give it a try..
I don't understand the US health care system, so I can't comment..other than I don't get why you can't pick your own pdoc, if they are taking new patients, or change pdocs, if you feel you aren't getting results from your current one..can your GP help you with a referral to another one?
Posted by Phillipa on January 6, 2008, at 11:58:39
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by Justherself54 on January 6, 2008, at 10:43:56
I'm not sure what country you're in but it is rare at least where I am for a pdoc to use an MAOI. These are not excuses my facts of what happened to me. I thought moving to a larger city would open up possibilites to much better health care as I was at the beach. Just recently learned there is not even a pdoc in that area quite large anymore at least there was l when I was there. Found the largest practice in this new area two docs were taking patients. One in particular I thought would be good unfortunately he wasn't taking new patients. So that left me two one you needed a referral for figured must be the best one of the two. Now there are about 20 docs in this practice. Run the psych ward in the biggest psych dept of the hospital here. Well I messed up and picked one that immediately both my husband and I knew was not the right choice. Please no offense intended here but his specialty was eating disorders. I don't have one. He spent as my husband timed it 20minutes first visit and was quite obviously wanting to get the appointment done running behind he said take 30mg cymbalta first week, 60mg second week, 90mg third week, and l20mg. I said I thought the company doesn't recommend over 60mg he said I like high doses better. And it was out of there for a month. Filled the prescription and at that point was so afraid of him I think the reason I couldn't tolerate even the 30mg was lack of trust and inability to call him as they have a fancy answering system where you never talk to a doc always a machine. I say this as back at the beach I took 60mg of cymbalta and felt nothing. This time felt like my head would explode I wanted to cry and couldn't it was horrible thinking of it now. So after l0 days went off it he knew and gave me luvox again. No MAOI's are used by my current pdoc she once when I asked said oh yeah I think I still have one patient on one. Well I wanted to try EMSAM and she did give me two sample boxes. Then she said it would be too activating for me said don't take it. Just up your luvox again. Got to l50mg and didn't feel any different with the 20mg of valium. Meanwhile I had stopped seeing the lets call him scarey pdoc. Oh he also wanted to give me 120mg of geodon to start I said no. And glad I did. A wonderful babbler found me a pdoc that still uses MAOI's up here and he's in that first practice. He went to a lot of trouble for me. But still can't see the one that does use them. As far as GP's go the two I've seen refer you to a specialist for anything but things like flu and colds. I mentioned an ad he said oh I don't do them.Now I'm trying therphy. But I can't cold turkey valium and have to see the poc (old one seeing now) for refills. Now that's an 8 hour drive turn around and back home. She will use conventional meds meaning the SSRI's, trileptal, lamictal, benzos but she says my tiredness and symtoms are high anxiety. So I would love to call Dr. Phil and be sent away by him. But Id be afraid to go. And I was such a non afraid person before. It's the bad painful mental experiences with pdocs that have caused this fear and a horrible fear of dying. This is me and my story. And for the person who is not working I was ( know this sounds horrible) but relieved to know I'm not the only one and wish you the best success possible. I was doing much better til each time I saw a regular doctor they found something wrong with me scarey as I don't want to die. Thanks for listening and I know I got off track but I tried. Love Phillipa may you all have a wonderful day.
Posted by Justherself54 on January 6, 2008, at 16:45:33
In reply to Re: Anyone Know why a Med will Poop out for some? » Justherself54, posted by Phillipa on January 6, 2008, at 11:58:39
I'm so sorry you are having such a hard time finding a pdoc you can trust..the only thing I can suggest is getting very very assertive with your pdoc..tell him you have done a lot of research and what drug you want to try..maybe the scary one will tell you he won't see you and you can at least try to find another one who's more inclined to listen to you..sometimes the squeaky wheel gets the oil..this is your mental health and 11 years is too long to be feeling like this..IMO no one should have to stay with any doctor they don't trust and feel comfortable with..
I know it's hard to be assertive when you are full of anxiety..but standing up for yourself may make you feel like your are taking back part of your old self..if that makes any sense!
Posted by bleauberry on January 6, 2008, at 18:31:58
In reply to Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 20:29:02
I agree with SLS. Nardil and Klonopin. Others in my mind that might fit the bill are zyprexa or TCAs.
For TCAs there is a test you can do to help pinpoint which one you would respond to. Not completely accurate, nothing is, but it stacks the odds greatly in your favor. It is called the Methylphenidate challenge. You take up to 20mg Ritalin during a day. If Ritalin perks up your mood noticeably, that is predictive of a response to Desipramine. If Ritalin does not do much for mood, that is predictive of a response to Nortriptyline. If you need more sedation, then Imipramine instead of Desipramine, or Amitriptyline instead of Nortriptyline. All of them are real workhorses on depression and anxiety.
You have a narrow field to choose from, which is good. No overwhelming choices and confusion. Nardil, Klonopin, Zyprexa, Nortriptyline, Desipramine.
I know insomnia off Luvox is a problem. That is to be expected. Expect it. Do not use that as a reason to start taking it again. It will take in my best guess 3 to 5 weeks for that to resolve partially on its own, and maybe 3 months to fully resolve. Your biochemistry is so accustomed to that molecule it is going to take some time.
Just do something. Get on the phone and call around. Have a friend or a relative do it for you. Find a doctor who will see you quickly and who is not afraid of MAOIs or TCAs.
The only other option is to choose to keep suffering and waste time. That is something that is chosen, not something that is forced upon you.
Posted by Phillipa on January 6, 2008, at 18:48:01
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by bleauberry on January 5, 2008, at 21:00:49
Blueberry know she will let me try that as she did at one time give me a sample bottle of it. Unfortunately I flushed it down the toilet fighting with husband. I tend to do things that hurt me not physically when mad like I need to be punished. The best combo ever was believe it or not l2.5mg of luvox and 5mg of paxil. That might do the trick of why my brain likes luvox? What do you think? See her thursday. Find getting out of here and doing something relaxing helps me the most. Phillipa ps was in the hospital at the time and that pdoc took away the paxil and I did notice a difference not a good one . That was when lymes was active getting antibiotics through pic line. Also xanax at the time. Never higher than 2mg and then it was l0cc of chloral hydrate for sleep. Also was on synthroid then too.
Posted by SteelyDan on January 6, 2008, at 19:09:47
In reply to Anyone Know why a Med will Poop out for some?, posted by Phillipa on January 5, 2008, at 20:29:02
I don't really think the drugs "poop out", i think our bodies just develop resistance to them. Just my opinion.
Posted by Phillipa on January 6, 2008, at 19:19:25
In reply to Re: Anyone Know why a Med will Poop out for some?, posted by Justherself54 on January 6, 2008, at 16:45:33
Makes a lot of sense to me. No to the doc here as I cringe when going by their street. More to that story. Practice is supposed to be one with psych testing given to your pdoc to help with finding a med. And theraphy also that is supposed to make up the treatment team. Had the psych testing all the tester did and my husband was in so he can attest to it was criticize the benzos that were working very well at the time. It was like brain washing . Kept saying they are bad no good. And no none of the info was ever given or discussed with the pdoc as I asked more than once. The therapist would talk no suggestions though and again when asked a month later still the pdoc didn't know what we were talking about or any treatment plan. Very disorganized practice for me.
Hence the reason I go back to the old one so far away I do trust her and know she wouldn't hurt me. And she does listen to my suggestions hence why she was going to let me try Emsam. But it was new then and she had one lady rash that was so bad that she had to discontinue no cortisone cream didn't help. Hence she said no not to take it and also since last vistit patients were having bad anxiety and that has always been number l problem for me. So I will ask for some paxil to add to the luvox. See what happens take it from there. Also she knows my Son, Daughter in law and Grand kids and treats them if needed. So family history is known in great detail to her. If I had a choice it would be my first pdoc was med free with him and no drinking either. And he referred me to a school chum when I moved to Virginia and he was very good too. Worked in the same hospital with him and he got me a part-time job at the jail where he also worked. They both wouldn't believe what has happened to me. They both knew me as I am not very assertive but also compliant and non demanding and intelligent. Phillipa
Posted by Phillipa on January 6, 2008, at 19:23:54
In reply to Re: Anyone Know why a Med will Poop out for some? » Phillipa, posted by SteelyDan on January 6, 2008, at 19:09:47
Like so many antibiotics do also. Not all of course but some. Hence the vancomyacin resistant staph. Or the little kids with ear aches that their antibiotics no longer work for them and another is tried. Phillipa makes sense to me.
This is the end of the thread.
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