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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by francineus on January 13, 2008, at 12:14:20
I'm depressed, always have been, bad brain chemistry I guess. Tried almost everything except
pill Maos and Lithium...SSRi's poop out or make me feel emotionless and sexless. Did wellbutrin (hyper/anxious), serzone, effexor...no real help. Starting to think NO pills Will. Did Thyroid, buspar, Cytomel as augmenters.
Tried, Nortryp, lamictil, Emsam (really bad reaction)Now on 60mg Remeron...feels like a sugar
pill. And klonopin .25 prn for anxiety.
Only thing that helps a little is Ritalin or Adderall, which takes some of the suid. thoughts away and makes me productive, alert (and irritable )but at least I don't want to die as much when I take it. I just want to kill others!Think I may have dopamine sensitiv. bc/ fish oil made me agitated and EMSAM drove me through the roof.. Now doc wants to try Lithium.
And I'm curious about Maos. and any other novel ideas. Would my horrible reaction to Emsam just be replicated with Nardil or Parnate or do they differ? Sorry for the long post. I feel like I'm running out of options. I have two young kids and so much to live for yet I just don't want to stick around if I have to feel like this forever.
Posted by Phillipa on January 13, 2008, at 12:41:41
In reply to Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 12:14:20
Is he thinking bipolar? You did say you had been on lithium before though. I know the feeling of being this way forever. Phillipa
Posted by Racer on January 13, 2008, at 12:54:21
In reply to Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 12:14:20
Welcome to PsychoBabble! I've found a lot of good information here, and an awful lot of support. I hope it's as good for you as it has been for me.
What sort of reaction did you have to EMSAM, and how long were you on it? The answers to those questions may help predict your response to a traditional MAOI. Lithium has some good history with unipolar depression, although my doctors have usually offered it as an adjunct to other anti-depressants, rather than a sole agent. It's certainly worth trying.
How long have you been taking Remeron? One thing about Remeron is that its nature changes with dose -- lower doses are more sedating, higher doses less so, and it may be that a lower dose will address your symptoms more effectively. Regardless, it's always better to give any antidepressant an adequate time to show whether it will be helpful or not. The rule was always six weeks at an adequate dose, but the STAR*D study showed that many time the response was at or after eight weeks, so maybe a longer trial is worthwhile.
Speaking of symptoms, depression is a complex disorder, and there are a lot of different symptoms that can come along with it. Which symptoms you have show which sub-type you have, and the different subtypes often respond to different medications. If you give an idea of what sorts of symptoms you have, and which are most bothersome, that might also help in suggesting possible medications for you.
It does sound as though you've been on the Medication Go Round for a while. Not fun. There is hope, though -- speaking as someone with chronic treatment resistant depression, I can say that there's hope for more helpful treatments.
Good luck.
Posted by Phoenix1 on January 13, 2008, at 14:32:06
In reply to Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 12:14:20
> I'm depressed, always have been, bad brain chemistry I guess. Tried almost everything except
> pill Maos and Lithium...
>
> SSRi's poop out or make me feel emotionless and sexless. Did wellbutrin (hyper/anxious), serzone, effexor...no real help. Starting to think NO pills Will. Did Thyroid, buspar, Cytomel as augmenters.
> Tried, Nortryp, lamictil, Emsam (really bad reaction)
>
> Now on 60mg Remeron...feels like a sugar
> pill. And klonopin .25 prn for anxiety.
> Only thing that helps a little is Ritalin or Adderall, which takes some of the suid. thoughts away and makes me productive, alert (and irritable )but at least I don't want to die as much when I take it. I just want to kill others!
>
> Think I may have dopamine sensitiv. bc/ fish oil made me agitated and EMSAM drove me through the roof.. Now doc wants to try Lithium.
>
> And I'm curious about Maos. and any other novel ideas. Would my horrible reaction to Emsam just be replicated with Nardil or Parnate or do they differ? Sorry for the long post. I feel like I'm running out of options. I have two young kids and so much to live for yet I just don't want to stick around if I have to feel like this forever.In my mind, a bad reaction does not rule out trying the old MAOIs. ALL the MAOIs are different. Many people have a bad response with one, but a great response to another. I also cycled through every med possible and many combos, and Nardil was a last resort, but it seems to be working. Don't rule out the MAOIs until you've tried them. BTW, lithium could be a good augmenter for your current AD, and also could augment an MAOI. Not a bad idea to try if nothing else is working. "This", as you describe it, isn't necessarily forever. You still have avenues you haven't exhausted, more things to try. Keep up the good fight!
Phoenix1
Posted by francineus on January 13, 2008, at 15:14:13
In reply to Re: Tried it all... MAO's and Lithium as sole AD ? » francineus, posted by Phillipa on January 13, 2008, at 12:41:41
Thank you so much Philipa, Phoenix and Racer! Your responses made me cry (tears of gratefulness for not being alone, and knowing that people care and are willing to take time out to respond etc). And I don't feel like quite the freak I felt before reading your posts!The doc doesn't think I'm bipolar. I'm just treatment resistant dysthymia and now I can diagnose myself as just a big pain in his butt! All of my calls to him start out "Sorry to bother you again...."
But my moods ARE up and down so I may have some bipolar sx and may benefit from a mood stabilizer. Perhaps I may be more in the cyclothymic range.
( I'm a social worker LCSW , 41 y/o (in semi retirement-due to my depression and to stay at home with my kids) so luckily I am pretty familiar with the terminology/meds and dx stuff. But that works against me at times bc/ sometimes I think I have everything....my worst fear being that I have BPD. I don't think I do, but still, we all have sx of that don't we? Who really is good at being rejected?
Yes, I've read about the Remeron dosage differences. Interesting how it's used..
I tried it at 15, 30 and now 60 and the only difference seems to be that now I have trouble sleeping (leg restlessness)...but that could be the ritalin. The remeron has had no bad side effects,just no real response.The news on the MAO's being different IS hopeful. My doc seemed to imply that if Emsam didn't work that Nardil would probably offer me the same response. Perhaps the Emsam was a fluke and nardil will help. I'll mention trying that and perhaps the lithium too. The Emsam just made me very agitated and I couldn't stop crying. And I had red marks on my skin.
But, your notes were uplifting in and of themselves. Thank you thank you thank you!
Posted by Phoenix1 on January 13, 2008, at 18:20:38
In reply to Re: Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 15:14:13
>
> Thank you so much Philipa, Phoenix and Racer! Your responses made me cry (tears of gratefulness for not being alone, and knowing that people care and are willing to take time out to respond etc). And I don't feel like quite the freak I felt before reading your posts!
>
> The doc doesn't think I'm bipolar. I'm just treatment resistant dysthymia and now I can diagnose myself as just a big pain in his butt! All of my calls to him start out "Sorry to bother you again...."
>
> But my moods ARE up and down so I may have some bipolar sx and may benefit from a mood stabilizer. Perhaps I may be more in the cyclothymic range.
>
> ( I'm a social worker LCSW , 41 y/o (in semi retirement-due to my depression and to stay at home with my kids) so luckily I am pretty familiar with the terminology/meds and dx stuff. But that works against me at times bc/ sometimes I think I have everything....my worst fear being that I have BPD. I don't think I do, but still, we all have sx of that don't we? Who really is good at being rejected?
>
> Yes, I've read about the Remeron dosage differences. Interesting how it's used..
> I tried it at 15, 30 and now 60 and the only difference seems to be that now I have trouble sleeping (leg restlessness)...but that could be the ritalin. The remeron has had no bad side effects,just no real response.
>
> The news on the MAO's being different IS hopeful. My doc seemed to imply that if Emsam didn't work that Nardil would probably offer me the same response. Perhaps the Emsam was a fluke and nardil will help. I'll mention trying that and perhaps the lithium too. The Emsam just made me very agitated and I couldn't stop crying. And I had red marks on my skin.
>
> But, your notes were uplifting in and of themselves. Thank you thank you thank you!I'm glad that you feel a sense of community here. You aren't alone, and you certainly aren't a freak. I was in your boat just 2 or 3 months ago. Thought I'd tried everything and should just give up. Now on Nardil, I'm feeling (almost) like my old self. Actually, it's been so long that I wouldn't recognize my old self so I'll just say I feel like a new person. And my side-effects are so minor, gastrointestinal distress and insomnia (which I had before treatment anyways). The biggest MAOI drawback is the diet, which may or may not have come into play when you tried EMSAM. There are lots of food to avoid while on Nardil/Parnate.
What's your worry with personality disorders about? They're just a diagnosis on paper, and your depression outweighs any PD a hundred fold in terms of deserving adequate treatment. I seriously think after reading DSMIV criteris for the PD's that a large portion of society meet enough criteria for a dx...
OK, so MAOI's. They are all very different. I can only speak for Nardil because it's the only one I've tried. I can guarantee you that failure on EMSAM doesn't mean DEFINITE failure on Nardil. They are SO different. Only the very basic mechanism of action is supposedly the same, and we (science) don't even understand those mechanisms fully.
I've found Nardil to reduce agitation and anxiety quickly, strongly, and powerfully. Everyones mileage varies though. If you are cyclothymic or have bipolar tendencies, MAOIs have less potential of causing manic swings than other AD's from what I've read.
Anyways, don't give up, you still have lot's of things to try. I would start by asking for a trial of another MAOI. Nardil, Parnate, Marplan... If agitation/anxiety is an issue, Nardil seems to be the preferred choice among prescribers.
Feel free to ask any and all questions here.
Phoenix1
Posted by francineus on January 13, 2008, at 18:47:47
In reply to Re: Tried it all... MAO's and Lithium as sole AD ?, posted by Phoenix1 on January 13, 2008, at 18:20:38
Thank you so much Phoenix for your support and thoughtful note. It's so nice to know I'm not alone. And I agree that most people would fit into SOME dx in the DSMIV. The hard thing I think about depression and mental illness in general is that the treatment is so random, and mental illness is still so misunderstood. I liken some of the AD's and pills we take to chemo. The treatment is worse than the disease. And the stigma associated is pretty hard to endure--- even for someone like me who is a social worker. I'm so glad that you are feeling better on Nardil and I will definitely give it a go!
Posted by polarbear206 on January 14, 2008, at 7:46:02
In reply to Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 12:14:20
> I'm depressed, always have been, bad brain chemistry I guess. Tried almost everything except
> pill Maos and Lithium...
>
> SSRi's poop out or make me feel emotionless and sexless. Did wellbutrin (hyper/anxious), serzone, effexor...no real help. Starting to think NO pills Will. Did Thyroid, buspar, Cytomel as augmenters.
> Tried, Nortryp, lamictil, Emsam (really bad reaction)
>
> Now on 60mg Remeron...feels like a sugar
> pill. And klonopin .25 prn for anxiety.
> Only thing that helps a little is Ritalin or Adderall, which takes some of the suid. thoughts away and makes me productive, alert (and irritable )but at least I don't want to die as much when I take it. I just want to kill others!
>
> Think I may have dopamine sensitiv. bc/ fish oil made me agitated and EMSAM drove me through the roof.. Now doc wants to try Lithium.
>
> And I'm curious about Maos. and any other novel ideas. Would my horrible reaction to Emsam just be replicated with Nardil or Parnate or do they differ? Sorry for the long post. I feel like I'm running out of options. I have two young kids and so much to live for yet I just don't want to stick around if I have to feel like this forever.
Chances are you will do better with Nardil since you had a bad experience with Emsam. Nardil helps more with anxiety as compared to Parnate and Emsam. MAOI's are excellent drugs and work well too with Lithium and other mood stabilizers.PB
Posted by FrequentFryer on January 15, 2008, at 23:35:59
In reply to Tried it all... MAO's and Lithium as sole AD ?, posted by francineus on January 13, 2008, at 12:14:20
> I'm depressed, always have been, bad brain chemistry I guess. Tried almost everything except
> pill Maos and Lithium...
>
> SSRi's poop out or make me feel emotionless and sexless. Did wellbutrin (hyper/anxious), serzone, effexor...no real help. Starting to think NO pills Will. Did Thyroid, buspar, Cytomel as augmenters.
> Tried, Nortryp, lamictil, Emsam (really bad reaction)
>
> Now on 60mg Remeron...feels like a sugar
> pill. And klonopin .25 prn for anxiety.
> Only thing that helps a little is Ritalin or Adderall, which takes some of the suid. thoughts away and makes me productive, alert (and irritable )but at least I don't want to die as much when I take it. I just want to kill others!
>
> Think I may have dopamine sensitiv. bc/ fish oil made me agitated and EMSAM drove me through the roof.. Now doc wants to try Lithium.
>
> And I'm curious about Maos. and any other novel ideas. Would my horrible reaction to Emsam just be replicated with Nardil or Parnate or do they differ? Sorry for the long post. I feel like I'm running out of options. I have two young kids and so much to live for yet I just don't want to stick around if I have to feel like this forever.You have had all the same reactions as me (cept Nardil is working for me at the moment.
I would consider Nardil plus Bupropion if u havn't tried it and it dosn't raise your Blood preasure (and you can get it scripted) }, theoredically it could give a strong dopamine reaction with a little 5ht / Na boost.
People here People here have taken 90mg of Nardil with max dose of Bupropion without a bad interaction, so maybe a small dose of Bupropion so it dosn't make you anxious and stuffs up your sleep.
Or add a small dose of a primary NA tricyclic, that will give you a good sleep (if thats a problem and again should nicely increase your 5ht levels a bit) just keep an eye on your BP.
NA = Noradrenalin / 5ht = serotonin / BP = Blood preassure.Freq
Posted by francineus on January 16, 2008, at 17:37:39
In reply to Re: Tried it all... MAO's and Lithium as sole AD ? » francineus, posted by FrequentFryer on January 15, 2008, at 23:35:59
I am going to ask my doc to Rx Nardil tomorrow. After the weeks I'll need to wait before Remeron leaves my system, will I have to stop taking the ritalin and klonopin also? They both have been helping to keep my head above water and I'm nervous
to give those up but read that MAOS and amphetamines don't mix. Does anyone know the scoop about this?
Much thanks
Posted by FrequentFryer on January 17, 2008, at 2:46:38
In reply to Nardil and Ritalin....can the be combined?, posted by francineus on January 16, 2008, at 17:37:39
> I am going to ask my doc to Rx Nardil tomorrow. After the weeks I'll need to wait before Remeron leaves my system, will I have to stop taking the ritalin and klonopin also? They both have been helping to keep my head above water and I'm nervous
> to give those up but read that MAOS and amphetamines don't mix. Does anyone know the scoop about this?
> Much thanksYep definatly gotta quit the ritalin for now.
Your supposed to wait 14 days with the remeron you could try 7.5 or 15mg of Nardil after 7 days and if it dosnt raise your blood preasure to much you could go for 15 - 30mg then rince and repeat.
Ages ago they used to treat ppl with MAOI / stimulant but I have tried it and had a hypertensive crisis, (I immediatly took Pindolol I think it was which lowers blood preasure so it wasn't to bad) but MAOI + Amphetamine = possibly the most dangerous contradiction known to man.
You might wanna ask your doc for something to lower your blood prasure just incase & if you get a migrain & high temperature take em.Freq
Posted by Phoenix1 on January 17, 2008, at 8:27:12
In reply to Re: Nardil and Ritalin....can the be combined? » francineus, posted by FrequentFryer on January 17, 2008, at 2:46:38
> > I am going to ask my doc to Rx Nardil tomorrow. After the weeks I'll need to wait before Remeron leaves my system, will I have to stop taking the ritalin and klonopin also? They both have been helping to keep my head above water and I'm nervous
> > to give those up but read that MAOS and amphetamines don't mix. Does anyone know the scoop about this?
> > Much thanks
>
> Yep definatly gotta quit the ritalin for now.
> Your supposed to wait 14 days with the remeron you could try 7.5 or 15mg of Nardil after 7 days and if it dosnt raise your blood preasure to much you could go for 15 - 30mg then rince and repeat.
> Ages ago they used to treat ppl with MAOI / stimulant but I have tried it and had a hypertensive crisis, (I immediatly took Pindolol I think it was which lowers blood preasure so it wasn't to bad) but MAOI + Amphetamine = possibly the most dangerous contradiction known to man.
> You might wanna ask your doc for something to lower your blood prasure just incase & if you get a migrain & high temperature take em.
>
> Freq
>
>FrequentFryer is right Ritalin and Nardil are strictly contraindicated. You'll have to stop both the Remeron and the Ritalin 14 days before you start Nardil. Then, there will be no more need for the Remeron. BUT, some doctors are OK trying to add Ritalin to Nardil at very low dosages with close blood pressure monitoring. It may be hard to find a pdoc willing to try this combo though, as it has more risks than standard Nardil therapy.
Phoenix1
Posted by francineus on January 17, 2008, at 13:24:14
In reply to Re: Nardil and Ritalin....can the be combined?, posted by Phoenix1 on January 17, 2008, at 8:27:12
gulp....scary...the ritalin was helping me motivate in the am...should be a fun 14 days. thanks for all the input!
Posted by SoulSickness on January 27, 2008, at 18:34:50
In reply to Re: Nardil and Ritalin....can the be combined?, posted by Phoenix1 on January 17, 2008, at 8:27:12
I've combined almost every contradicted medication with nardil because i've come to realize nothing is written in stone in the practice of psychiatry, and drastic pharmacological measures are required, indicated, and perfectly o.k. in order to fight hard to treat mental disorders. Just use common sense by starting low and going slow with dosages and have an anti-hypertensive on hand. I did myself a great disservice and suffered for a long time by not aggressively treating my symptoms out of fear of side effects, ignorance of medications, and fear of adverse reactions that only some people have experienced.
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