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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 uncouth on November 28, 2008, at 11:42:42
What do you think? I keep piling things on, and I haven't gotten a response:
80mg parnate
5mg abilify
37.5 tianeptine (for it's unique neurotrophic effects)
5mg memantine (for cognitive improvement, just added this last week, hoping to go up to 20mg)
1700mg metformin for weight control
100mcg thyroxine
300mg lithium at night
50mg seroquel for sleep
200mg modafinil on occasion
For those of you expert in psychopharmacology, what would you drop, and what would you focus on increasing given that i'm only seeing a partial response. (Took me out of deep depression, but left me in my dysthymia that has been impossible to lick for years). Have been on the tianeptine for only two weeks, and i have a total of about 6-7 weeks supply, so i'm hoping to stay on it just for that length of time and hope the repair work it does stays permanent even when I go off of it.
Posted by uncouth on November 28, 2008, at 11:43:51
In reply to Overmedicated?, posted by uncouth on November 28, 2008, at 11:42:42
Oh, and I forgot:
3g of Omega-3
2000mg of L-Tryptophan
1800mg of NAC
B-100 ComplexAnd thinking about trying SAM-e
Posted by Phillipa on November 28, 2008, at 12:35:37
In reply to Re: Overmedicated?, posted by uncouth on November 28, 2008, at 11:43:51
Certainly not being an expert but a few things stand out to novice me. Lithium with thyroid meds. Lithium can mess up the thyroid is that why the thyroxine? Seems like quite a few antipsychotics. Diagnosis and are you meds being prescribed by a doc? Since metformin is used in diabetes do you also have that? Diagnosis? love Phillipa
Posted by Phillipa on November 28, 2008, at 12:38:28
In reply to Re: Overmedicated? » uncouth, posted by Phillipa on November 28, 2008, at 12:35:37
Could you get serotonin syndrome with samee too? Phillipa
Posted by Sigismund on November 28, 2008, at 13:35:15
In reply to Re: Overmedicated?, posted by uncouth on November 28, 2008, at 11:43:51
It's all very unpredictable. SAMe and Parnate didn't work out well for me.
When I was on the standard tianeptine dose I took just 1 Parnate and spent that day in bed.
But it must be OK for you.
There may be people who have done it, but I seriously wonder whether dysthymia can be treated by our available drugs, mainly due to issues of toxicity.
Posted by desolationrower on November 28, 2008, at 14:02:06
In reply to Overmedicated?, posted by uncouth on November 28, 2008, at 11:42:42
Hm I think I would try to find a different sleep drug than quetiapine. I think it might be making you drowsy in the day and thus needing the modafinil (and also, making weight problems worse and needing the metformin).
-d/r
Posted by Jakeo29 on November 29, 2008, at 9:52:44
In reply to Overmedicated?, posted by uncouth on November 28, 2008, at 11:42:42
Maybe give EMSAM (selegiline) a try. It's a much better MOAI type stimulant that focuses on Dopamine that may boost energy levels and releave those symtoms. Watch the caffeine and constipation though for possible Serotonin Syndome. Not sure about emsam and your other meds.
Posted by Jakeo29 on November 29, 2008, at 9:54:21
In reply to Re: Overmedicated?, posted by Jakeo29 on November 29, 2008, at 9:52:44
One other thing= maybe change the Lithium to Lamictal.
Posted by rjlockhart04-08 on November 29, 2008, at 13:51:58
In reply to Re: Overmedicated?, posted by Jakeo29 on November 29, 2008, at 9:54:21
Hi.....i do not believe we have met, but that is alot of medications, that's just "wow"
Can i just....what do suffer with, and dont let that offend you.
I'll tell you straight up, i have severe mood swings which i think i'm a diffrent persona, depression, anger, and severe ability to just keep on tasks.
2 weeks ago, i was just driving and i thought, there's "self-awareness" so, there must be a "brain self-awareness" , can actually self-upregulation of the mind. I thought of it, my self....no web site, no nothin, it's just where the mind is aware of every aspect of what's thinking, and over time the brain can help itself. But....that's just a new new theroy i thought of myself.
I hate disorders, i reliazied they started to manifest when i was 12, by the time i was 17 they where "blown", today i'm in 20's. And i just believe, god, will deliever and heal just like a psychical disorder, faith.
rj
Posted by uncouth on November 29, 2008, at 14:47:41
In reply to Re: Overmedicated?, posted by rjlockhart04-08 on November 29, 2008, at 13:51:58
I am BP2 but only had hypomania from effexor, never on its own. Largely my depression has been constant, and at some points very deep (double depression). I am feeling merely dysthymic right now, which I consider my baseline. The challenge has been once the meds get me out of this pits of darkness, how I can fight the dysthymia.
I should note i added SAM-e to my cocktail and will stop taking memantine. I am considering swapping out Parnate and Seroquel for Agomelatine, which I have on order (do not ask me for sources as I cannot supply). Agomelatine seems to have great effectiveness for TRD cases and can help with sleep, so that will help knock out two medicines.
Additionally, I am considering replacing lithium with lamictal, as my doctor has suggested that before. THe problem is that at 200mg of lamictal I get cognitive slowness and fuzzyness over time. But who knows how i'll feel with Agomelatine. Right now Agomelatine is my last great hope before I swap out Parnate and go back to Effexor (this time trying Pristiq, which is supposed to be more stimulating). I've never been on effexor plus abilify, and I'm hoping that will prevent the hypomania I felt when on 300mg of Effexor.
It wasn't a good hypomania, as it contained severe ADHD components and an exacerbation of compulsions, like internet use, porn, eating, and smoking. Which is why I ditched it even though it worked for Parnate.
Tried emsam but it gave me terrible anxiety and caused me to sweat, but never tried ti with abilify which again could potentially help with that. May try Emsam again, but right now Agomelatine is where I think my solution is at. I'm hoping. Will know more next week.
Posted by desolationrower on November 30, 2008, at 1:59:30
In reply to Re: Overmedicated?, posted by uncouth on November 29, 2008, at 14:47:41
Hm, memantine is rather experimental but it seems odd to ditch it so soon before giving it a while in your system. While i hate venlafaxine, and like maois, i think since you had some response with it before, the mood stabilizer, neuroleptic, and effexor combo does sound like a good idea. It sounds like you have some good options for things.
-d/r
Posted by Racer on November 30, 2008, at 8:52:32
In reply to Re: Overmedicated?, posted by uncouth on November 29, 2008, at 14:47:41
>
> I should note i added SAM-e to my cocktailMy doctor started me on MetanX when he "prescribed" SAMe to me. He says that SAMe can mess with homocysteine levels, and the MetanX counters that.
>I am considering swapping out Parnate and Seroquel for Agomelatine, which I have on order (do not ask me for sources as I cannot supply).
Well, you know I'm not going to ask for your sources -- I am going to ask, though, something related:
Does your doctor know about all the different medications you're currently taking? And that you self-prescribe and order online?
It seems to me that those are very relevant facts for your psychopharmacologist to be aware of. He's much more likely to catch potential interactions if he actually knows that you're taking another medication. What's more, he may know more about certain medications than you do -- for instance, he may be aware that something occasionally causes increased depression in some people, or that mixing these three medications can cause a volcanic response. I think it would be good to let him know, if he isn't already aware of it.
Best luck.
Posted by uncouth on November 30, 2008, at 11:48:56
In reply to Re: Overmedicated? » uncouth, posted by Racer on November 30, 2008, at 8:52:32
Yeah,I'm going to call him regarding my ago trial (haven't started yet) although sometimes I do test things without him knowing. I've asked him about tianeptine before but obviously, he doesn't know much about it since it's not prescribable in this country.
The only reason for the short term trial of memantine is to focus on the ago trial first. I've tried amantadine before and it just made me more depressed so I'm not as optimistic about memantine, but figured i'd try it anyway (at some point).
Posted by yxibow on December 1, 2008, at 19:34:21
In reply to Re: Overmedicated?, posted by uncouth on November 30, 2008, at 11:48:56
Mainly metformin is used for diabetes-2 patients, if that is a diagnosis. Weight loss is one claim but not a definite.
-- Jay
People do have very complicated lists if they're on polypharmacy and I would only have one if I were in the hands of a psychopharmacologist (basically a psychiatrist with more residency and specialty) or at least a psychiatrist who has taken extended courses.
Your combination is probably the only one in the world, just as mine is, and just as anyone who has polypharmacy on this board, so its hard to say "what to remove".
A better way of being sure of things if you are really concerned is getting a second consultation/opinion (not a second doctor) to go over your symptoms and list (your doctor would probably fax over some small list of things tried and various things about your history to whatever extent necessary).
-- Jay
Posted by Tony P on December 1, 2008, at 22:00:59
In reply to Re: Overmedicated?, posted by uncouth on November 30, 2008, at 11:48:56
Your list is different from mine, which is at least as long, but includes some of the same meds, & some I have taken previously. I've been wondering too if I'm overmedicated -- I have episodes of sleeping anywhere from 15-30 hrs. at a stretch.
I just saw a new pdoc to re-evaluate, & I'll share with you her observations that are relevant to what you're taking:
- Seroquel has a moderately long half-life (I get a considerable hangover from 50mg), so the modafinil (which I'm also taking) is probably compensating for the seroquel hangover (I know it is for me). Maybe less Seroquel or switch to something shorter acting, & you could cut back on the modafinil.
- Tianeptine I've found is very mild and free from side-effects, so I wouldn't worry about that one if it's working for you.
- Seroquel can increase seizure risk, and increase heart/stroke risk (which I didn't know), so if you have any risk factors for these (e.g. overweight, family history of high BP / heart attack / stroke, previous seizures), you likely should review that with your dr.
Tony
Posted by JadeKelly on December 2, 2008, at 17:12:31
In reply to Re: Overmedicated?, posted by uncouth on November 29, 2008, at 14:47:41
> I am BP2 but only had hypomania from effexor, never on its own. Largely my depression has been constant, and at some points very deep (double depression). I am feeling merely dysthymic right now, which I consider my baseline. The challenge has been once the meds get me out of this pits of darkness, how I can fight the dysthymia.
>
> I should note i added SAM-e to my cocktail and will stop taking memantine. I am considering swapping out Parnate and Seroquel for Agomelatine, which I have on order (do not ask me for sources as I cannot supply). Agomelatine seems to have great effectiveness for TRD cases and can help with sleep, so that will help knock out two medicines.
>
> Additionally, I am considering replacing lithium with lamictal, as my doctor has suggested that before. THe problem is that at 200mg of lamictal I get cognitive slowness and fuzzyness over time. But who knows how i'll feel with Agomelatine. Right now Agomelatine is my last great hope before I swap out Parnate and go back to Effexor (this time trying Pristiq, which is supposed to be more stimulating). I've never been on effexor plus abilify, and I'm hoping that will prevent the hypomania I felt when on 300mg of Effexor.
>
> It wasn't a good hypomania, as it contained severe ADHD components and an exacerbation of compulsions, like internet use, porn, eating, and smoking. Which is why I ditched it even though it worked for Parnate.
>
> Tried emsam but it gave me terrible anxiety and caused me to sweat, but never tried ti with abilify which again could potentially help with that. May try Emsam again, but right now Agomelatine is where I think my solution is at. I'm hoping. Will know more next week.Hi Uncouth,
Just a few thoughts. Wonder how long on Parnate? I'm on it, and have the feeling I'm headed for good/great results. If Parnate is what took you out of "double depression" (its the only thing thats touched my depression) I really doubt Agomelatine is going to fill its shoes.
However, if you think your safely out of the danger zone I've heard that Ago is good for dysthmia and mild depressions. My son has epilepsy and is on 300mg seroquel. So I wouldn't worry about siezures.
Hope you get to run your final list by a good psychpharmacologist as you dont want to be taking meds that are just a "wash", or accidentally take a dangerous combo.
Good luck to you!
~Jade
Posted by neal on December 4, 2008, at 1:32:19
In reply to Overmedicated?, posted by uncouth on November 28, 2008, at 11:42:42
you don't say how long you've been where you are now. Yes, AD's build really good floors, but sometimes not the whole house. you might check some of my other posts this month for other possible directions.
This is the end of the thread.
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