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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by doxogenic boy on August 15, 2009, at 9:08:10
Hello to all of you.
I have treatment-resistant depression, obsessive-compulsive disorder, generalized anxiety disorder and social phobia, which I have had most of my life. A problem that is part of this, did I mention in the newbie group (things take long time for me to do because it has to be so circumstantial).
My current combination is:
quetiapine 600 mg (200 + 100 + 100 + 200 mg)
liothyronine sodium 20 mcg (20 mcg in the morning)
escitalopram 40 mg (40 mg in the morning)
tianeptine 150 mg (4 tablets 12,5 mg three times a day)
clonazepam 1 mg (1 mg at bedtime)
trimipramine 100 mg (100 mg in the evening)Friday 8/7/09 hydromorphone immediate release 3,9 mg (1,3 mg three times a day) was added and Thursday 08/13/09 I started with 4 mg sustained release capsules, Friday 08/14/09 4 mg twice a day.
I think all of the medicines contribute to the antidepressant effect, and most of them also to the anxiolytic effect, because I experienced an improvement when each of them was added, but it was the hydromorphone that gave it the finishing touch.
This is the 9th day with the hydromorphone combination. I have not felt any euphoria, but I feel calm and a little more confident. My worries are there, but they just pass away without scaring me. Usually, I am insecure and anxious.
What I would like to get advice about, is what I can do if I experience tolerance for, or loss of effect of the hydromorphone. It has been nasty when I have had a hope to a medication to get me into remission, when it stops working.
And I wonder how the SSRI/SSRE combination works, as they theoretically should cancel each other out? What about hydromorphone/tianeptine, could there be a synergetic anxiolytic effect?
(I get all of the medication on prescription, and I ask my psychiatrist if I will change anything).
I want to write much more about this, but I think it is time to post, to get started. :)
doxogenic
Posted by SLS on August 15, 2009, at 9:30:53
In reply to hydromorphone in combination with six other meds, posted by doxogenic boy on August 15, 2009, at 9:08:10
Hi.
The addition of memantine (Namenda) can help prevent the development of tolerance to the analgesic effects of opioids. Hopefully, it would also work this way for the psychotropic effects of these drugs. However, data is lacking.
Does the trimipramine make for a good sleep aid? What about anxiety?
- Scott
Posted by Phillipa on August 15, 2009, at 10:37:42
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by SLS on August 15, 2009, at 9:30:53
Hi that's great that you have a combo that's working. I'd take it day by day. I don't think there are any guarantees on any meds that they work forever. I also found opiods lessened anxiety when given for pain. Best of luck to you and welcome. Phillipa
Posted by bulldog2 on August 15, 2009, at 13:04:56
In reply to hydromorphone in combination with six other meds, posted by doxogenic boy on August 15, 2009, at 9:08:10
> Hello to all of you.
>
> I have treatment-resistant depression, obsessive-compulsive disorder, generalized anxiety disorder and social phobia, which I have had most of my life. A problem that is part of this, did I mention in the newbie group (things take long time for me to do because it has to be so circumstantial).
>
> My current combination is:
>
> quetiapine 600 mg (200 + 100 + 100 + 200 mg)
> liothyronine sodium 20 mcg (20 mcg in the morning)
> escitalopram 40 mg (40 mg in the morning)
> tianeptine 150 mg (4 tablets 12,5 mg three times a day)
> clonazepam 1 mg (1 mg at bedtime)
> trimipramine 100 mg (100 mg in the evening)
>
> Friday 8/7/09 hydromorphone immediate release 3,9 mg (1,3 mg three times a day) was added and Thursday 08/13/09 I started with 4 mg sustained release capsules, Friday 08/14/09 4 mg twice a day.
>
> I think all of the medicines contribute to the antidepressant effect, and most of them also to the anxiolytic effect, because I experienced an improvement when each of them was added, but it was the hydromorphone that gave it the finishing touch.
>
> This is the 9th day with the hydromorphone combination. I have not felt any euphoria, but I feel calm and a little more confident. My worries are there, but they just pass away without scaring me. Usually, I am insecure and anxious.
>
> What I would like to get advice about, is what I can do if I experience tolerance for, or loss of effect of the hydromorphone. It has been nasty when I have had a hope to a medication to get me into remission, when it stops working.
>
> And I wonder how the SSRI/SSRE combination works, as they theoretically should cancel each other out? What about hydromorphone/tianeptine, could there be a synergetic anxiolytic effect?
>
> (I get all of the medication on prescription, and I ask my psychiatrist if I will change anything).
>
> I want to write much more about this, but I think it is time to post, to get started. :)
>
> doxogenicI take neurontin 1200 mg twice a day and percocet 10 mg 4-6 times a day. This is for hip pain that has to be replaced.
Very good combo for anxiety and is a potent antidepressant.
Try a drug holiday now and than to maintain med potency.
Afer surgery will be transferred to self administered pump morphine and than put back on percocet.Eventually have to wean off.
They will let me stay on neurontin. I was thinking of going to parnate and nortriptyline.
So again to you, drug holidays now and than.or use other drugs in place of yours now and than.
I find shifting meds around maintain potency.
Posted by doxogenic boy on August 15, 2009, at 15:59:40
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by SLS on August 15, 2009, at 9:30:53
> Hi.
>
> The addition of memantine (Namenda) can help
> prevent the development of tolerance to the
> analgesic effects of opioids.Thank you, I will take this with me to my psychiatrist.
Ultralow doses of naltrexone has been considered for me, but it will probably be both expensive and difficult to obtain, my psychiatrist said. I wonder how those who have tried naltrexone in about 0,5 mcg (microgram) doses, have got it? I asked the pharmacy at the local hospital if they could thin 50 mg naltrexone tablets to 0,5 mcg, but they said they did not have the equipment for this, or that it was "impossible" to thin naltrexone 100 000 times.
About naltrexone:
http://www.ncbi.nlm.nih.gov/pubmed/16681181Excerpt from url:
"Concomitant administration of minute doses (about 0.5 mcg) of the opioid antagonist naltrexone with each dose of codeine was found in both cases to obviate the expected opioid withdrawal syndrome, resulting in asymptomatic and uneventful transitions from physical opioid dependency states to exogenous opioid-free metabolism.
[...]
It was found that coadministration of naltrexone with codeine phosphate obviated the development of both tolerance and physical dependency over several months of four daily oral doses of 200 mg, allowing abrupt ("cold turkey"), asymptomatic and uneventful withdrawal."> Hopefully, it
> would also work this way for the psychotropic > effects of these drugs. However, data is
> lacking.Yes, I find it strange that the amazing effects of opioids on serverly treatment-resistant depression in some cases in the scientific literature haven't been followed with enthusiastic research for how to stop tolerance buildup against the antidepressant effect of opioids.
There are no promising antidepressants in the pipeline the nearest years, so what can we do in the meantime?
> Does the trimipramine make for a good sleep
> aid? What about anxiety?Trimipramine make me extremely sedated the first night, and I can sleep for up to twenty hours (not continuosly, though) but this effect fade away more or less after a short time.
I have always had problems with sleep (insomnia and periodic limb movements during sleep), but this combination of medicines actually have made it easy to fall asleep and stay asleep both for an after-dinner nap and during the night. I manage to sleep in the night even though I have slept two hours in the afternoon.
I suppose this is because of trimipramine, quetiapine, clonazepam and now also hydromorphone. But too much sleep is said to be depressogenic...
Clonazepam and hydromorphone probably works against the periodic limb movements during sleep.
Lots of psychotropics worsen that sleep disorder.The reason why I asked for trimipramine, was its anxiolytic properties and to suppress anxiety from escitalopram. I can't say for sure if it actually had that effect, but I haven't dared to try without if it could cause the anxiety and insomnia to come back.
doxogenic
Posted by Sigismund on August 15, 2009, at 16:22:41
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by SLS on August 15, 2009, at 9:30:53
Why not just take the hydromorphone, Namenda, and get rid of or reduce the others as you see fit?
Posted by doxogenic boy on August 15, 2009, at 16:28:29
In reply to Re: hydromorphone in combination with six other meds, posted by Phillipa on August 15, 2009, at 10:37:42
> Hi that's great that you have a combo that's
> working. I'd take it day by day.That is a good reminder; if the effect fades away, I can feel good in the meantime. My brain searches constantly for signs of anxiety and that makes me very vulnerable for even the smallest frustrations.
> I don't
> think there are any guarantees on any meds that > they work forever.Of those medications I have tried, only a few have worked, and all of them have stopped working.
> I also found opiods lessened
> anxiety when given for pain.I have been told that a combination drug, morphine-scopolamine was in use in psychiatry before, against extreme anxiety. It is now still used - as premedication injection before anesthesia.
> Best of luck to you and welcome. Phillipa
Thank you, I am happy that I finally managed to post here.
doxogenic
Posted by doxogenic boy on August 15, 2009, at 16:43:34
In reply to Re: hydromorphone in combination with six other meds, posted by Sigismund on August 15, 2009, at 16:22:41
> Why not just take the hydromorphone, Namenda,
> and get rid of or reduce the others as you see fit?I am afraid that they will not work again if I have to go back to them, if hydromorphone stops working and the terrible anxiety returns. Before the hydromorphone, the escitalopram/tianeptine combination gave some relief from anxiety, and quetiapine too. About one hour after each of the 50 mg tianeptine doses, I feel more calm. But before the hydromorphone, I had serious mood swings every day.
doxogenic
Posted by Phillipa on August 15, 2009, at 21:03:59
In reply to Re: hydromorphone in combination with six other meds, posted by doxogenic boy on August 15, 2009, at 16:43:34
I'm also glad that you decided to post here now don't be a stranger. Best of luck to you!!!!Periodic updates? Love Phillipa
Posted by doxogenic boy on August 16, 2009, at 14:20:11
In reply to Re: hydromorphone in combination with six other meds, posted by bulldog2 on August 15, 2009, at 13:04:56
> So again to you, drug holidays now and than.or
> use other drugs in place of yours now and than.
> I find shifting meds around maintain potency.Do you experience withdrawal if you take drug holidays from opioids, for example, a week?
doxogenic
Posted by doxogenic boy on August 16, 2009, at 14:49:38
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by Phillipa on August 15, 2009, at 21:03:59
> I'm also glad that you decided to post here now
> don't be a stranger. Best of luck to
> you!!!!Thank you! :)
I am a bit insecure if I post something with references to scientific articles, and time shows that the users of this board knew all of it from before. Is it best to read what users have written before to avoid such embarrassing situations?
> Periodic updates? Love Phillipa
This evening I have had some anxiety again, but not so bad as before. Maybe I need to increase the hydromorphone. One 4 mg sustained release capsule every 12 hours is a low dose. But it gives me some kind of depersonalization, more than before I started with hydromorphone. My attention is worse, too. I am willing to live with that if only it keeps depression and anxiety away.
doxogenic
Posted by Phillipa on August 16, 2009, at 20:16:22
In reply to Re: hydromorphone in combination with six other meds, posted by doxogenic boy on August 16, 2009, at 14:49:38
I don't feel that posting medical journal articles are not beneficial although some know astounding amounts about meds not all do. So do you have permission from doc to raise dose? What is the long range goal? Top dose allowed? Phillipa
Posted by doxogenic boy on August 17, 2009, at 14:57:04
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by Phillipa on August 16, 2009, at 20:16:22
> So do you have permission from doc to raise
> dose? What is the long range goal? Top dose
> allowed?I talked to him today, and he didn't recommend a higher dose now. We haven't discussed long range goal or top dose of hydromorphone yet. Today I tried a glass of grape fruit juice, and it gave me more of the side effects, I am not sure if it had positive effects.
doxogenic
Posted by Phillipa on August 17, 2009, at 21:02:37
In reply to Re: hydromorphone in combination with six other meds, posted by doxogenic boy on August 17, 2009, at 14:57:04
Grapefruit juice is contraindicated with a lot of meds is opiods Included? Love Philllpa
Posted by doxogenic boy on August 19, 2009, at 15:21:33
In reply to Re: hydromorphone in combination with six other meds » doxogenic boy, posted by Phillipa on August 17, 2009, at 21:02:37
> Grapefruit juice is contraindicated with a lot of meds is opiods Included? Love Philllpa
I thought grapefruit juice could increase the effect of hydromorphone but I haven't found anything.
http://en.wikipedia.org/wiki/List_of_drugs_affected_by_grapefruit#Affected_drugs
http://en.wikipedia.org/wiki/Grape_fruit#Drug_interactions
Another thing:
Here is an article about opioids and tolerance:
http://bja.oxfordjournals.org/cgi/reprint/81/1/58.pdfExcerpt from the article:
"The indications are that blocking of opioid tolerance by
NMDA antagonists is not a general phenomenon but appears
selective for tolerance induced by morphine."
doxogenic
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