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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by uncouth on May 3, 2009, at 12:31:39
is there any theoretical reason/mechanism why taking riluzole and/or memantine, which are both anti-glutamate drugs, would WORSEN depression, instead of helping? please advise....i thought i'd feel SOMETHING on both these meds, but i just feel WORSE in fact...very much into planning my death if I can't beat this illness soon. been too long like this.
Posted by Phillipa on May 3, 2009, at 12:41:48
In reply to rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 12:31:39
Uncouth can you list all your meds so the experts can see? I'm seriously routing for you. You will make it. Love seriously Phillipa
Posted by uncouth on May 3, 2009, at 13:25:23
In reply to Re: rilutek / namenda harm? » uncouth, posted by Phillipa on May 3, 2009, at 12:41:48
Here's what I'm on:
Ixel 100mg (milnacipran)
Rilutek 100mg (riluzole)
Nortriptyline 200mg
Agomelatine 50mg
Lithobid 600mg
Lunesta 3mg
Geodon 120mg
Selegiline 4mg
Namenda 40mg (memantine)
Deplin 7.5mg
Adderall 10mg
Posted by uncouth on May 3, 2009, at 13:58:27
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 13:25:23
also, forgot to add, 1 grain Armour Thyroid daily
Posted by Jeroen on May 3, 2009, at 14:45:15
In reply to rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 12:31:39
hi, im too suffering for long time, no social life anymore
memantine can either make you feel good i heared or worse, or even in 1% induced a psychosis or other things
Posted by jms600 on May 3, 2009, at 14:56:25
In reply to rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 12:31:39
Memantine really helped my anxiety. It seemed to have a calming effect on me - which in turn helped my depression as, with me, my depression appears to be somewhat linked to my anxiety issues.
Have you considered Parnate / Nardil? I know you're already taking selegiline; however, many posters on here seem to have a high regard for these two where treatment resistant depression is concerned.
Posted by SLS on May 3, 2009, at 16:27:20
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 13:25:23
> Here's what I'm on:
>
> Ixel 100mg (milnacipran)
> Rilutek 100mg (riluzole)
> Nortriptyline 200mg
> Agomelatine 50mg
> Lithobid 600mg
> Lunesta 3mg
> Geodon 120mg
> Selegiline 4mg
> Namenda 40mg (memantine)
> Deplin 7.5mg
> Adderall 10mg
Holy crap!That's one heck of a drug cocktail you are on.
I think you are taking too much nortriptyline. It might be that you are above its therapeutic window. Who knows how this might be effecting everything else? I would drop it to 100mg and see what happens. Either that, or get a blood test to determine whether or not you exceeded the therapeutic window.
As for everything else is concerned, if you throw enough crap against the wall, some of it is bound to stick. I think it may be time to start weeding out drugs that are not helping at this juncture. Finish your riluzole treatment first. I would get rid of the Ixel and Agomelatine in preperation for trying an MAOI. Geodon is too high for treating depression. 40-80mg is the range that most clinicians are finding effective. Too much Deplin might be hurting you. If you are experiencing vivid dreams with violent content, I would at least cut the dosage in half. Drop the selegiline Leave the Namenda and Adderall. Try Parnate.
I haven't given this a whole lot of thought. It was just off the top of my head. However, it will give you a few things to think about. You seem to be fully capable of putting things together for yourself.
Good luck.
- Scott
Posted by uncouth on May 3, 2009, at 16:55:03
In reply to Re: rilutek / namenda harm?, posted by SLS on May 3, 2009, at 16:27:20
Thanks scott, respect your opinion. Already been through a trial of Nardil and Parnate, even at high doses. Was up to 90mg parnate. Decided I needed to attack my ADHD component and doctor wasn't about to rx adderall with an MAOI, so I switched from Parnate to Effexor....in hindsight, that was probably the switch that launched me into my current depressive episode.
Only been one week on 200mg of Nortryptiline, and have a Dr appointment this week when I assume he will direct me to get my blood level checked. On Namenda because im' also in the middle of a course of ECT treatment. Agomelatine i'm on to help with sleep and becuase it's supposed to be the greatest thing since sliced bread, but since i'm still feeling like sh*t, i will probably not reorder when I'm out of this batch. And Ixel, well on that for just 2 weeks now too, so haven't given it a full trial yet.
You know, I guess if you do the math, there are gonna be some unlucky souls who just are part of that small % of people who are resistant to every treatment known. And who knows why...perhaps I'm resistant because for some sick reason I WANT to stay depressed. You never know, deep down, unconsciously, despite all my attempts to fight it....who knows.
All I know is that I'm in a state of misery that seems to get worse every day, and sooner or later, I'm going to just decide to get outta here. So it's a race against the clock I feel like, trying to find that combo that will work, before my time is up.
Posted by SLS on May 3, 2009, at 20:03:16
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 16:55:03
> All I know is that I'm in a state of misery that seems to get worse every day, and sooner or later, I'm going to just decide to get outta here. So it's a race against the clock I feel like, trying to find that combo that will work, before my time is up.
There is quite a bit of uncertainty as to what, if anything, awaits us on the other side. One of the things that helped me stay on this side is that I don't believe that there is a hereafter. I'm not sure, of course. However, I am sure about the moment. It seems to me that you only get one chance to go around in this universe as you. I would rather bet that there is no hereafter and make decisions based upon that supposition. It is logical. However, I believe that there are situations where it is logical to execute an act of autoeuthanasia. There were times when I thought it was INEVITABLE that I would take my own life. This was an act of logic. This is not the same as being in suicidal state, where the feelings of suicidality become dominant over all others.
I have had certain psychotropic drugs put me in suicidal states that were not the product of situational depression. I believe there is a neuropsychobiological state that can cause someone to commit suicide without reason. This is usually accompanied by either anxiety or anger. It is an act of impulse rather than deliberation. It feels like it is your thoughts that are producing feelings of suicide, but it is really the opposite way around. Suicidal feelings evolve thoughts of ending one's life for reasons that seem rational. Again, I do believe in a rational suicide (autoeuthanasia). However, the depressive state itself colors ones thoughts and feelings black. So, how do you determine whether your judgment is affected by the illness? It is a paradox of sorts. I would not try to convince you that such things are in your future. However, it is a gamble that you might one day find a treatment that hits your unique target and allows you to emerge out of the blackness to a bright new world in which you function with great ease.
I waited 27 years for a treatment to produce a stable improvement. I am not in remission at the moment. However, I believe I am close enough such that I am trying to add augmenting drugs one by one to a core treatment regime. I must break through a wall that a plateau in response has placed before me.
I fully identify with your current thoughts and feelings. I have been there for long stretches of time. However, what better choice do I have but to continue searching for effective treatment? This issue really deserves many more paragraphs to address properly. I would suggest to you that you learn to be able to recognize the thoughts that are the voice of the depression. This is probably best accomplished by recognizing suicidal feelings. When the feelings produce the thoughts, you are in trouble. When the thoughts produce the feelings, you are probably closer to exercising good judgment.
You would not be a coward to want to give up. Learned helplessness is a bitch. Every man has his breaking point. You may have reached this point a long time ago, in which case you probably feel passive such that you tend to let things happen to you without offering resistance. I must say, though, that your aggressive pursuit of health shows that you still have quite a bit of fight left in you. Despite your feelings that your current path will lead you to autoeuthanasia, you are still fighting. You are still being positive and constructive. You can decide to kill yourself anytime. There is no reason to place an arbitrary deadline on attaining your mental health. Keep working. You are probably tired and fatigued, from fighting so hard against what has thus far been an unrelenting depression. It is so hard. You don't deserve this.
I can't guarantee that you will ever get well. However, I can say that you will never get well if you take your life. I think you deserve the opportunity to live without depression. It would make all the suffering worth it.
Take a deep breath. You deserve it.
It is selfish of me to want you to remain in the world. I hope you can forgive me.
:-)
- Scott
Posted by uncouth on May 3, 2009, at 21:38:32
In reply to Re: rilutek / namenda harm? **S Trigger** » uncouth, posted by SLS on May 3, 2009, at 20:03:16
Scott,
Once again, a beautiful post from one of the few people I am in connection with online or offline who has even close to a sense of what this is like for me. Thank you, just knowing there are other people on this earth who are looking at the world through a similiar set of eyes, walking with a similar stutter to their step, and thinking with similar errors of logic, well....well i know why its a cliche to find comfort in the idea that "I am not alone." but it truly is helpful.
I will read and reread your post again and again. Thank you for writing it. Bless you.
-AV
Posted by desolationrower on May 3, 2009, at 23:30:46
In reply to Re: rilutek / namenda harm? **S Trigger**, posted by uncouth on May 3, 2009, at 21:38:32
if nothing else, and you can't get opioid from a doc, i'd try tramadol (unscheduled) with namenda to slow tolerance. you might end up with an addiction problem, but thats better than a farm-buying problem
-d/r
Posted by uncouth on May 4, 2009, at 12:31:24
In reply to Re: rilutek / namenda harm? **S Trigger** » uncouth, posted by desolationrower on May 3, 2009, at 23:30:46
i don't get it...why would tramadol help? what?
Posted by jms600 on May 4, 2009, at 16:14:36
In reply to rilutek / namenda harm?, posted by uncouth on May 3, 2009, at 12:31:39
Just a thought, but what about tianeptine?? It's not licensed in Britain or the US so you would have to buy it in from Europe.
Posted by uncouth on May 4, 2009, at 16:38:02
In reply to Re: rilutek / namenda harm? » uncouth, posted by jms600 on May 4, 2009, at 16:14:36
i have tried tianeptine and would be interested in trying again, but i don't feel comfortable taking it alongside any other medicine that acts to increase neurotransmitters. I feel like they'd cancel each other out. So i'd try tianeptine, but only by itself, and i dont think i could augment it with an MAOI or TCA or SSRI.
I'm leaning towards augmenting the 200 nortriptyline with parnate at this point.
Posted by SLS on May 4, 2009, at 17:01:35
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 4, 2009, at 16:38:02
> i have tried tianeptine and would be interested in trying again, but i don't feel comfortable taking it alongside any other medicine that acts to increase neurotransmitters. I feel like they'd cancel each other out. So i'd try tianeptine, but only by itself, and i dont think i could augment it with an MAOI or TCA or SSRI.
>
> I'm leaning towards augmenting the 200 nortriptyline with parnate at this point.
Get that nortriptyline blood test!The therapeutic range for nortriptyline is 50-150ng/ml.
IF YOU GO ABOVE THIS RANGE, YOU LOSE THE ANTIDEPRESSANT RESPONSE. What's more, I am suspicious that it might even confound the activity of the other drugs you are taking.
You really need to explore this before making any further changes.
- Scott
Posted by jms600 on May 5, 2009, at 7:08:06
In reply to Re: rilutek / namenda harm? » uncouth, posted by SLS on May 4, 2009, at 17:01:35
If all else fails there's always tryptophan - a hospital only treatment though.
Posted by Nadezda on May 5, 2009, at 16:35:54
In reply to Re: rilutek / namenda harm?, posted by jms600 on May 5, 2009, at 7:08:06
I'm perplexed about exactly what combination of meds you're taking.
Now you say you aren't taking tianeptine, but you wrote this a few days ago, which, as I understand it, says that you're taking it now.:
"Posted by uncouth on April 15, 2009, at 19:05:31
In reply to Re: Riluzole - Any and ALL experiences please!, posted by desolationrower on April 14, 2009, at 20:16:48
correction:
Nortriptyline, Tianeptine (just getting through a 20 day supply I have left), Agomelatine, Namenda (during and for a few weeks after the ECT), Lithium, Effexor (tapering down to 0 now that i'm on Nortriptyline), Magnesium Glycinate, SAMe, Geodon, Seroquel for sleep, Dessicated Thyroid 1grain......and have riluzole, milnacipran on order.Lord Jesus I better get well with all of this. "
I don't get it. Are you on tianeptine or not?
Also, I'm confused about whether you're taking riluzole or only have it on order. I thought you had said you were taking it now.Nadezda
Posted by pixel8 on May 5, 2009, at 17:57:29
In reply to Re: rilutek / namenda harm?, posted by jms600 on May 5, 2009, at 7:08:06
> If all else fails there's always tryptophan - a hospital only treatment though.
Not sure why you say tryptophan is "hospital only" as it's now available at least in some places. It was taken off the market in the 80s, right when prozac was approved (probably not a coincidence) because of some faulty batches that caused less harm than recent e coli in food incidents.
Posted by Larry Hoover on May 5, 2009, at 18:11:06
In reply to Re: rilutek / namenda harm? » jms600, posted by pixel8 on May 5, 2009, at 17:57:29
Prozac was licensed in 1987. Tryptophan was banned in 1991. There is no connection between the two events.
Lar
Posted by pixel8 on May 5, 2009, at 19:16:35
In reply to Re: rilutek / namenda harm? » pixel8, posted by Larry Hoover on May 5, 2009, at 18:11:06
> Prozac was licensed in 1987. Tryptophan was banned in 1991. There is no connection between the two events.
>
> LarHi Lar, I'm no conspiracy theorist but there are many who identify this as more than coincidence:
"The fact that the FDA ban of L-Tryptophan and the Newsweek Prozac cover story occurred within four days of each other.... Yet, to those who understand the effective properties of L- Tryptophan and Prozac, the concurrence seems 'unbelievably coincidental.' The link here is the brain neurotransmitter serotonin---a biochemical nerve signal conductor. The action of Prozac and L-Tryptophan are both involved with serotonin..."
(From http://www.lef.org/fda/fdaban95.html )
Although this seems like beating a dead horse at this point, and for whatever reason the FDA banned tryptophan, it's now legal and easy to get, which was my point.
- Barb
Posted by uncouth on May 5, 2009, at 20:23:37
In reply to Re: rilutek / namenda harm?, posted by Nadezda on May 5, 2009, at 16:35:54
you are right to be confused becuase that is what i am myself -- extremely confused. i am in the process of massively simplifying. the past few weeks of ect has caused some drug and supplament seeking behavior, combined with the memory loss of ect, means i am doing some very stupid and counterproductive things with med trials and the like.
today's ect has hopefully 'shocked' some sense back into me. i have put away half the supplament/vitamin/med bottles on my bathroom countertop....so no, not taking tianeptine. did about a 1 week trial of riluzole, mood got very bad last weekend (of course, with everything else i'm doing i can't say for sure it was the riluzole) but realized i should probably not be experimenting on myself during ect especially with such a medication.
i have come to the conclusion that i am currently in a downward spiral of obsessive-compulsive behavior such that my depression has become my primary hobby and it has crowded out everything else, and my obsessional research, psychobabble postings, med/supplament trials, etc. is completely counterproductive and dangerous and if i continue along this path i will only end up in the ground by my own hands. i am currently in a situation where i honestly don't think I would recognize or accept "wellness" if it was sent to me by express mail. i just don't think i'd recognize it, and i think me staying depressed is the easy way out for some strange reason.
this post probalby doesn't make much sense but that should be further evidence that i'm in a bad but hopefully eye-opening state right now. half the problem is my time spent on PB and doing research, trying to "save" me. when really my depression has become my hobby, my excuse, my time sink, my girlfriend, my everything.
<sigh>
-uncouth
Posted by Phillipa on May 6, 2009, at 0:26:02
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 5, 2009, at 20:23:37
Uncouth that does make sense. Are you living alone? If so is there someone who could stay with you through the ECT and memory loss? To me you're doing an awesome job and your thinking sounds so much more rational now. Love Phillipa
Posted by uncouth on May 6, 2009, at 12:15:08
In reply to Re: rilutek / namenda harm? » uncouth, posted by Phillipa on May 6, 2009, at 0:26:02
Thanks Phillipa, living at home with family right now during ECT....maybe thinking sounds more rational but still in deep pain and feel like i'm so so so close to the "EDGE".
Posted by Jeroen on May 6, 2009, at 12:39:19
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 6, 2009, at 12:15:08
hi, im in pain aswell buddy, youre not alone :|
Posted by Sigismund on May 6, 2009, at 17:38:30
In reply to Re: rilutek / namenda harm?, posted by uncouth on May 5, 2009, at 20:23:37
Alex, I just want to say to begin that it is obvious that you are in terrible pain.
A decent health system would, IMO, put you in hospital on low dose morphine and withdraw you from every psychiatric treatment and drug and have a long think about what to do next.
So, that's my 2 bob's worth.I was very reassured to hear you say this.....
>i have come to the conclusion that i am currently in a downward spiral of obsessive-compulsive behavior such that my depression has become my primary hobby and it has crowded out everything else, and my obsessional research, psychobabble postings, med/supplament trials, etc. is completely counterproductive and dangerous and if i continue along this path i will only end up in the ground by my own hands. i am currently in a situation where i honestly don't think I would recognize or accept "wellness" if it was sent to me by express mail. i just don't think i'd recognize it, and i think me staying depressed is the easy way out for some strange reason.
I'm stunned by how difficult this must be for you, and how painful and special that insight is.
Someone put this in a post on the psych board. It touches on what you mention and I really liked it.>Finally I realized that wanting to get rid of the "bad" parts of me was itself the problem. I had to hear what they were saying and stop thinking of them as "bad." This led to a new level of self-love. Paradoxically, I think a lot of the change in therapy is realizing you don't need to--or that you're going to--change that much. And that in itself is a huge change.
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