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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by michael on May 8, 2008, at 13:12:59
Hey Scott,
It's been a while since we've corresponded... don't know if you'll recall exactly who I am... (an old-timer who rarely stops by PB these days) Nonetheless, I hope all is well with you - at least relatively speaking.
I was just wondering... I went to take a look at your Psychiatric & Associated Drugs chart, and wasn't able to get there. Is it still available?
Fwiw, I'm taking 450 mg welbutrin xl, 60 mg dexedrine spasules, and sulpiride - still experimenting a bit w/doseage, but I think I'll wind up somewhere around 150 mg - 200 mg. ...doing relatively well, though there's always room for improvement...
Oh, and thanks again, for all the feedback & advice you've offered, at various times, over the years!
I hope things are going better in your world...? Anything exciting or promising on your end these days? ... and let me know about the Psych & Assoc. Drugs chart.
Thanks again,
Michael
Posted by SLS on May 8, 2008, at 15:41:01
In reply to SLS - Scott, question for you..., posted by michael on May 8, 2008, at 13:12:59
Hi Michael.
Thanks for the kind words.
Yes, the URL for my drug page has changed. You can find it at:
http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
I have been a bit neglectful about adding new drugs to the list. Maybe I'll work on that over the weekend.
What is your diagnosis?
How does it manifest?
How are you doing with your treatment?
How would you compare yourself to when you were not responding to anything?I have had some success with having added Deplin to my treatment regime. I am currently taking:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.50mg
If you don't feel like you are continuing to improve, you might consider taking Abilify. It is an activating antipsychotic that is sometimes touted as being a "dopamine system stabilizer" (DSS).Have you tried Lamictal? Wellbutrin + Lamictal can make for a useful combination.
- Scott
Posted by michael on May 8, 2008, at 17:17:11
In reply to Re: SLS - Scott, question for you..., posted by SLS on May 8, 2008, at 15:41:01
Hi Scott,
Thanks for getting back to me so quickly. I put my answers to you questions directly below each question... hope that makes sense.
> Hi Michael.
>
> Thanks for the kind words.
>
> Yes, the URL for my drug page has changed. You can find it at:
>
> http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
>
> I have been a bit neglectful about adding new drugs to the list. Maybe I'll work on that over the weekend.
>
> What is your diagnosis?
Dysthymia
> How does it manifest?
Largely fatigue, lack of energy, lethargy, sleeping a lot, lack of motivation or ambition or interest in doing anything generally, somtimes cognitive difficulties (focus & concentration - maintaining a train of thought, or memory issues). General difficulty getting things done, and even just getting things started (even simple tasks - like laundry for example), Etc.Without any meds, in addition to feeling run down (both physically and mentally), I also feel somewhat "flu-ish" - or generally ill, or a general malaise... Between the fatigue and the malaise, it often feels like it's something physical, rather than something mood-related - but they can't find anything wrong physically, and insist that it's dysthymia.
> How are you doing with your treatment?
Fairly well, I guess... over the last few years, I tried a number of different meds (duloxetine, parnate, a TCA - seems like there were others, but perhaps not? In any case, they're not coming to mind at the moment). They generally did the opposite of help...Now I'm back to wellbutrin, which seems to be the best base med for me (parnate was also helpful) and it also keeps me from smoking. It helps with the feeling ill. The dexedrine helps w/energy, motivation, ambition, thinking, and amount of sleep - though I can still easily take a nap, even just after taking it. The sulpiride is subtle, but seems to help lift my mood a touch - it makes the whole thing a little bit lighter, or brighter - if that makes any sense.
> How would you compare yourself to when you were not responding to anything?
While I wouldn't say that I feel great, with this combo, I feel like I'm largely functional - at least I think so... I'm not working at the moment, (I'm looking) so that'll be a better test of just how well I can "function" these days. For a while there, I felt like I might not be able to function well enough to support myself (i.e. not able to work) - kind of a helpless, and depressing feeling. But things seem to be getting better again with this combo... time will tell.
>
> I have had some success with having added Deplin to my treatment regime. I am currently taking:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> Deplin 7.50mg
>
>
I'm glad to hear that you've had at least some success to report, in your quest! I hope things will improve even more in the future.I'm not familiar with Deplin... I've been out of the PB loop for a long time. I'll have to do a little research, and take a look at it.
> If you don't feel like you are continuing to improve, you might consider taking Abilify. It is an activating antipsychotic that is sometimes touted as being a "dopamine system stabilizer" (DSS).
>
Abilify is one of the meds that I forgot in my list above - oh, yeah, also mirapex, and another antipsychotic that I can't think of just now - maybe seroquel?In any case, you had recommended that I try abilify a while ago, and I did. I liked the activation, but had difficulty sleeping, or getting on a regular sleep schedule. I believe it synergizes with welbutrin, so I started out with just 2.5 mg per day. When I went up to 5 mg, it was like someone flipped a switch, and rather than being stimulating, it became VERY sedating - and it stayed sedating even when I went back down to 2.5 mg again. It really knocked me out, so I moved on at that point. Have you heard of that kind of reaction to abilify?
I may experiment a bit with abilify again, down the road a bit. If I could substitute that for the dexedrine, that might be an appealing mix - particularly since the dexedrine has such a short, fixed window during which it works. It'd be nice if abilify could give me enough stimulation around the clock, without giving me too much stimulation & messing with my sleep... Ironically, I found abilify to be much more stimulating than dexedrine - until it flipped and knocked me out.
> Have you tried Lamictal? Wellbutrin + Lamictal can make for a useful combination.
>
I tried adding lamictal to wellbutrin a number of years ago - didn't seem to have any noticeable effect at all, for me... Just my luck.Thanks, as always, for your thoughts and suggestions. I always value your feedback.
I hope all of this is coherent... let me know if I missed anything, or if anything was unclear, or if you have any further questions, etc.
Michael
p.s. thanks for the link to your chart!
>
> - Scott
>
>
Posted by undopaminergic on May 9, 2008, at 16:50:41
In reply to Re: SLS - Scott, question for you..., posted by michael on May 8, 2008, at 17:17:11
>
> Now I'm back to wellbutrin, which seems to be the best base med for me (parnate was also helpful) and it also keeps me from smoking. It helps with the feeling ill. The dexedrine helps w/energy, motivation, ambition, thinking, and amount of sleep - though I can still easily take a nap, even just after taking it. The sulpiride is subtle, but seems to help lift my mood a touch - it makes the whole thing a little bit lighter, or brighter - if that makes any sense.
>
> I may experiment a bit with abilify again, down the road a bit. If I could substitute that for the dexedrine, that might be an appealing mix - particularly since the dexedrine has such a short, fixed window during which it works. It'd be nice if abilify could give me enough stimulation around the clock, without giving me too much stimulation & messing with my sleep... Ironically, I found abilify to be much more stimulating than dexedrine - until it flipped and knocked me out.
>I have largely the same symptoms as you (I consider it chronic anergic-apathetic depression/dysthymia and ADD).
I found sulpiride (at low doses) to be more stimulating than methylphenidate (=MPH; at high doses), especially with regard to motivation. However, in the long run, MPH has been more useful because tolerance to it can be addressed with dose escalation so that limited efficacy is maintained up to two months or more.
Several people have found memantine to be effective against stimulant tolerance, and also to have antidepressant and stimulant effects of its own. I'm currently experimenting with it, and it looks promising. I had temporary excellent results with amantantadine (memantine without the two methyl-groups) also.
You may also wish to experiment with smart drugs/nootropics, although I personally haven't had much luck with them so far. Galanthamine, an acetylcholinesterase inhibitor with nicotinic agonist properties, may be particularly interesting from the point of view of smoking reduction/cessation.
Selegiline and rasagiline have some potential as mood brigtheners on their own and to augment stimulants. Their combination with phenylalanine or phenylethylamine (PEA), however, is particularly powerful. On the other hand, long-term use of high doses of PEA or amphetamine (AMPH) can produce long-lasting tolerance - or a withdrawal syndrome upon cessation; in the the case of AMPH, there is furthermore strong evidence of deleterious neuroadaptive or neurotoxic changes affecting the dopaminergic system in particular. For those reasons and others, I've personally abandoned amphetamine-type stimulants in favour of other solutions.
Posted by michael on May 12, 2008, at 15:39:34
In reply to Re: SLS - Scott, question for you..., posted by undopaminergic on May 9, 2008, at 16:50:41
> >
> > Now I'm back to wellbutrin, which seems to be the best base med for me (parnate was also helpful) and it also keeps me from smoking. It helps with the feeling ill. The dexedrine helps w/energy, motivation, ambition, thinking, and amount of sleep - though I can still easily take a nap, even just after taking it. The sulpiride is subtle, but seems to help lift my mood a touch - it makes the whole thing a little bit lighter, or brighter - if that makes any sense.
> >
> > I may experiment a bit with abilify again, down the road a bit. If I could substitute that for the dexedrine, that might be an appealing mix - particularly since the dexedrine has such a short, fixed window during which it works. It'd be nice if abilify could give me enough stimulation around the clock, without giving me too much stimulation & messing with my sleep... Ironically, I found abilify to be much more stimulating than dexedrine - until it flipped and knocked me out.
> >
>
> I have largely the same symptoms as you (I consider it chronic anergic-apathetic depression/dysthymia and ADD).
>That sounds like a pretty accurate description of me too.
> I found sulpiride (at low doses) to be more stimulating than methylphenidate (=MPH; at high doses), especially with regard to motivation. However, in the long run, MPH has been more useful because tolerance to it can be addressed with dose escalation so that limited efficacy is maintained up to two months or more.
>What doses of sulpiride and MPH were you using/comparing?
Why has the MPH been more useful for you? (...you indicate that the sulpiride was more stimulating - which would seem to indicate that sulpiride was more useful...?)
> Several people have found memantine to be effective against stimulant tolerance, and also to have antidepressant and stimulant effects of its own. I'm currently experimenting with it, and it looks promising. I had temporary excellent results with amantantadine (memantine without the two methyl-groups) also.
>I'd be interested in hearing how your experiments with memantine go... And I am curious regarding what kind of excellent results you experienced with the amantadine... and what doseages of amantadine were you using?
> You may also wish to experiment with smart drugs/nootropics, although I personally haven't had much luck with them so far. Galanthamine, an acetylcholinesterase inhibitor with nicotinic agonist properties, may be particularly interesting from the point of view of smoking reduction/cessation.
>
> Selegiline and rasagiline have some potential as mood brigtheners on their own and to augment stimulants. Their combination with phenylalanine or phenylethylamine (PEA), however, is particularly powerful. On the other hand, long-term use of high doses of PEA or amphetamine (AMPH) can produce long-lasting tolerance - or a withdrawal syndrome upon cessation; in the the case of AMPH, there is furthermore strong evidence of deleterious neuroadaptive or neurotoxic changes affecting the dopaminergic system in particular. For those reasons and others, I've personally abandoned amphetamine-type stimulants in favour of other solutions.
>I tried low dose seligilene a long time ago, but was actually considering giving it another shot... something like adding 10 mg seligilene to my 450 mg wellbutrin xl, and perhaps 100 - 150 mg sulpiride.
Have you looked into abilify? I found that to be rather stimulating - even at just 2.5 mg per day. In fact, too much so - couldn't sleep much. That is another one I was thinking about trying again with the wellbutrin & sulpiride... maybe trying just 1.25 mg/day (1/4 of a 5 mg tablet) this time. [wellbutrin & abilify are metabolized by the same pathway - I think that's the right way to say it - so small doses of abilify affect me as if they were larger doses]
In any case, thanks for your feedback - you've given me a couple of things to think about.
Michael
Posted by undopaminergic on May 15, 2008, at 19:31:33
In reply to Re: SLS - Scott, question for you... » undopaminergic, posted by michael on May 12, 2008, at 15:39:34
>
> > I found sulpiride (at low doses) to be more stimulating than methylphenidate (=MPH; at high doses), especially with regard to motivation. However, in the long run, MPH has been more useful because tolerance to it can be addressed with dose escalation so that limited efficacy is maintained up to two months or more.
> >
>
> What doses of sulpiride and MPH were you using/comparing?
>Sulpiride from about 100 up to 600 mg a day, generally divided into three doses, and methylphenidate from 36 to 108 mg a day (or slightly more) in the form of extended release tablets roughly corresponding to three repeated doses of immediate release MPH.
> Why has the MPH been more useful for you? (...you indicate that the sulpiride was more stimulating - which would seem to indicate that sulpiride was more useful...?)
>Tolerance develops to both drugs; with MPH, dose increases are useful to retain effectiveness for longer periods of time; this is in contrast to sulpiride, which is most stimulating at low doses, and less so at higher doses - above 600 mg or so - where the postsynaptic dopamine D2-recpeptor blockade will begin to predominate over the enhanced DA release resulting from blockade of presynaptic D2-autoreceptors. In other words, MPH has been more useful in the long term, although sulpiride was more stimulating at its best - before tolerance set in.
> > Several people have found memantine to be effective against stimulant tolerance, and also to have antidepressant and stimulant effects of its own. I'm currently experimenting with it, and it looks promising. I had temporary excellent results with amantadine (memantine without the two methyl-groups) also.
> >
>
> I'd be interested in hearing how your experiments with memantine go...
>So far so good - my experience is still limited, especially since I was using a SSRI during much of my period of memantine use, and this affects the results: SSRIs dampen the dopaminergic effects of other drugs. To this point, memantine has been particularly useful for attention, insomuch that I'm more in tune with my sensory input and surroundings - I normally experience low grade depersonalisation and derealisation, and tend to "live inside my head". I've also noticed that I perceive challenges and obstacles as smaller and less discouraging while on memantine.
> And I am curious regarding what kind of excellent results you experienced with the amantadine... and what doseages of amantadine were you using?
>I've tested amantadine on a number of occasions, and at various doses, but only one of the trials has been successful. The peak response was intense, featuring a hypomanic-like flight of ideas - not quite euphoria, but pleasant, yet at the same time overwhelming. I calmed myself with a dose of 5-hydroxytryptophan (5-HTP), and remained in "remission" for a week or two, slowly returning to baseline. During remission, motivation, initiative, cognition, insight, confidence and several other qualities were excellent. My successful trial of amantadine generally involved the use of doses of 50 mg at a time, two to three times daily.
> Have you looked into abilify?
>Not seriously, but it's one of many drugs that I may look into, if needed, at some future point.
>
> In any case, thanks for your feedback - you've given me a couple of things to think about.
>I'm glad to hear it was well received, and thank you for your interest.
This is the end of the thread.
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