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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 182 to 206 of 281. Go back in thread:
Posted by floatingbridge on October 31, 2009, at 10:51:32
In reply to Re: Going back to old-school - lithium., posted by SLS on October 31, 2009, at 9:48:14
> Doing better at 900mg of lithium.
>
> I'm afraid to hope...
>
>
> - ScottSo I'm knocking on wood for you today. Thank you for the update.
fb
Posted by SLS on October 31, 2009, at 12:36:42
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on October 31, 2009, at 10:51:32
> > Doing better at 900mg of lithium.
> >
> > I'm afraid to hope...
> >
> >
> > - Scott
>
> So I'm knocking on wood for you today.
Thanks.This is the best I have felt in quite awhile.
- Scott
Posted by ColoradoSnowflake on October 31, 2009, at 13:58:56
In reply to Re: Going back to old-school - lithium., posted by SLS on October 31, 2009, at 9:48:14
Scott, I'm really happy to hear that.
What a wild ride all this mental illness/medication business is!
If people only knew, we'd get some kind of major awards for our bravery, creativity ....and persistence. It sounds like that bucking bronco threw you, you regrouped, and now you're back on!I hope this cocktail/ride lasts for a long time!!!
Good luck and
hugs,Gayle
Posted by Bob on October 31, 2009, at 21:42:23
In reply to Re: Going back to old-school - lithium., posted by ColoradoSnowflake on October 31, 2009, at 13:58:56
> Scott, I'm really happy to hear that.
>
> What a wild ride all this mental illness/medication business is!
> If people only knew, we'd get some kind of major awards for our bravery, creativity ....and persistence. It sounds like that bucking bronco threw you, you regrouped, and now you're back on!
>
> I hope this cocktail/ride lasts for a long time!!!
>
> Good luck and
> hugs,
>
> Gayle
Well said. Unfortunately, there are many unsavory things in life people must endure without any credit or reward.
Posted by HyperFocus on October 31, 2009, at 22:24:14
In reply to Re: Going back to old-school - lithium., posted by SLS on October 31, 2009, at 9:48:14
You're in my thoughts.
Posted by SLS on November 4, 2009, at 7:02:23
In reply to Re: Going back to old-school - lithium. » SLS, posted by HyperFocus on October 31, 2009, at 22:24:14
This is not funny anymore. I am not enjoying this.
I feel improved for a few days to a week after every dose increase of lithium, only to watch that improvement disappear. This pattern is really no different than what I experience with antidepressants. My brain seems to outwit the drugs that are meant to improve its function. The brain thinks it is the normal, healthy state to be depressed. Yeah - real smart. It does a good job of maintaining a dysfunctional homeostasis.
My doctor has had me raise the dosage of lithium to 1200mg. I am not hopeful that the results of doing this will be any different from previous dosage increases.
I think I need to be ready to live like this for several years until a novel treatment comes along. I will stay on a lower dosage of lithium long-term for whatever neuroprotective and neurotrophic properties it may have.
- Scott
Posted by uncouth on November 4, 2009, at 8:45:09
In reply to Re: Going back to old-school - lithium., posted by SLS on November 4, 2009, at 7:02:23
I know people like you (and me) are pretty finely attuned to mood changes and can usually tell the difference between something REALLY working and just thinking its workign (placebo) but your pattern of slight improvement followed by decline seems like a placebo effect, so maybe lithium isn't working at all?
I can't recall your polypharmacy but as long as you can stand the weight issues, it might be worth trying zyprexa again. I can't undercommunicate what a differential response I felt with zyprexa compared to abilify (in the end the weight gain killed me and i'm trying abilify again, but I credit zyprexa with getting me out of the hole).
And have you tried agomelatine? Many of us are seeing great results with it. I'm on 50mg, and I feel so refreshed in the mornings.
Given that your on MAOI, have you tried augmenting with DL-phenylalanine, or PEA?
Agreed that your system seems to be "Stuck" in an equilibrium. THe problem might be that your current slew of meds is simply making that equilibrium more sticky.
I have to say that having been on MAOIs for a year, and parnate for six months, the results I'm getting on high dose (600mg) bupropion, combined with agomelatine, low dose lithium, deplin, and atypical antipsychotic are far superior. My dx is bp2 and parnate, like SS/NRIs, simply put me in a state of 'mind-spinning', ruminative depression. My current mix does not do that nearly as much. I have been free of suicidal ideation for two months, knock on wood.
If your'e still feeling bad despite being on a complex regimin, sometimes its better to start a-new. I for one have never found lamotrigine to be particularly helpful. I tried it as monotherapy and as augmenter. Made me pretty blahhh as both.
Posted by SLS on November 4, 2009, at 9:22:41
In reply to Re: Going back to old-school - lithium., posted by uncouth on November 4, 2009, at 8:45:09
Thanks, Uncouth.
You've given me things to think about. I wish I knew what the right move was. I am currently looking into pursuing employment. I am afraid to discontinue the antidepressants at this time. They do help enough to keep me out of the abyss.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
lithium 1200mg
- Scott
Posted by Phillipa on November 4, 2009, at 18:55:19
In reply to Re: Going back to old-school - lithium., posted by SLS on November 4, 2009, at 9:22:41
Seriously Scott and this isn't meant to be mean I think I posted it once before but at this time of year you consider going to work and then meds seem to fail. Like me could it be a very scarey thing to think of working again and the responsibility of going to a job? Have you ever considered online work? Love Phillipa
Posted by SLS on November 8, 2009, at 7:07:56
In reply to Re: Going back to old-school - lithium., posted by SLS on November 4, 2009, at 9:22:41
A pleasant surprise: I have had two days in a row of feeling significantly improved. It is a true antidepressant effect rather than a limited increase in energy. I have been taking 900mg of lithium steadily since last week. I guess you never know what can happen if you invest the time to fully explore a treatment.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mgIt is probably too early to yell "Woohoo!". I have a hell of a case of optimism, though.
We'll see.
- Scott
Posted by SLS on November 8, 2009, at 7:16:51
In reply to Re: Going back to old-school - lithium. » SLS, posted by Phillipa on November 4, 2009, at 18:55:19
> Seriously Scott and this isn't meant to be mean I think I posted it once before but at this time of year you consider going to work and then meds seem to fail.
I don't recall experiencing anything like that. In a way, I wish I could exercise that kind of control over my state of illness by manipulating my environment - both internal and external. No such luck.
Thanks for the concern.
- Scott
Posted by ColoradoSnowflake on November 8, 2009, at 12:54:36
In reply to Re: Going back to old-school - lithium., posted by SLS on November 8, 2009, at 7:07:56
Scott
That's great!! Can we say "waaahooo" for the moment?!!! I'm so happy you're feeling better and posting again!!!!
One day at a time.
I guess it's too much to celebrate more than today.Today it's beautiful in Colorado!! Fall is gorgeous here, esp in the mountains...aspen turning gold etc.
Hugs to you Scott
Gayle
Posted by floatingbridge on November 10, 2009, at 21:03:48
In reply to Re: Going back to old-school - lithium., posted by SLS on November 8, 2009, at 7:07:56
Very cool, Scott. And I see you are at half the abilify. Maybe the decrease will be helpful in the long run.
You know I wish the best for you--.
healing and good thoughts your way,
fb
Posted by Abby on November 11, 2009, at 7:12:11
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 10, 2009, at 21:03:48
Are you in therapy too? I wouldn't be without my meds, but therapy has helped me a lot to level things out and to work on external triggers.
Posted by SLS on November 11, 2009, at 7:36:08
In reply to Re: Going back to old-school - lithium., posted by Abby on November 11, 2009, at 7:12:11
Hi Abby.
I have been in psychotherapy for quite awhile. It has helped me deal with a childhood of abuse and neglect along with cleaning up the mess created in the wake of a protracted severe depression.
Thanks for asking.
- Scott
Posted by floatingbridge on November 11, 2009, at 15:20:10
In reply to Re: Going back to old-school - lithium. » Abby, posted by SLS on November 11, 2009, at 7:36:08
> Hi Abby.
>
> I have been in psychotherapy for quite awhile. It has helped me deal with a childhood of abuse and neglect along with cleaning up the mess created in the wake of a protracted severe depression.
>
> Thanks for asking.
>
>
> - ScottScott, so you, too? I'm sorry--really. I'm in therapy too.
hugs,
fb
Posted by SLS on November 12, 2009, at 9:27:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 10, 2009, at 21:03:48
> And I see you are at half the abilify.
You are wonderfully observant. Yes. I am trying to reduce a sense of laziness - amotivation - that I believe is due to taking Abilify. My guess is that it is dosage dependent. I wouldn't mind losing a little weight besides.
> Maybe the decrease will be helpful in the long run.
If reducing the dosage of Abilify resolves the amotivation, I will be significantly more functional and more apt to move ahead in life.
- Scott
Posted by SLS on November 20, 2009, at 16:54:55
In reply to Re: Going back to old-school - lithium. » floatingbridge, posted by SLS on November 12, 2009, at 9:27:04
My lithium blood level at a dosage of 900mg/day is 0.60 mmol/L.
I have been progressing gradually over the last week. I really don't care how long it takes to reach remission, as long as I know that I am on the right drugs at the right dosages.
I remain optimistic.
Currently:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 900mg
- Scott
Posted by floatingbridge on November 20, 2009, at 17:24:34
In reply to Re: Going back to old-school - lithium., posted by SLS on November 20, 2009, at 16:54:55
Good news, Scott. I share your optimism and, again, am pausing to knock on wood.
Here's to perseverance!
best wishes,
fb
> My lithium blood level at a dosage of 900mg/day is 0.60 mmol/L.
>
> I have been progressing gradually over the last week. I really don't care how long it takes to reach remission, as long as I know that I am on the right drugs at the right dosages.
>
> I remain optimistic.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 900mg
>
>
> - Scott
Posted by morganator on November 20, 2009, at 23:05:06
In reply to Re: Going back to old-school - lithium., posted by SLS on November 20, 2009, at 16:54:55
Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy? I have read about a few studies on the net.
I want to try abilify as a long term treatment but I am scared by the possibility of damage.
Posted by SLS on November 20, 2009, at 23:48:04
In reply to Re: Going back to old-school - lithium. » SLS, posted by morganator on November 20, 2009, at 23:05:06
Hi.
Thanks for the heads-up. I'll need to review your links more thoroughly.
> Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy?
Well, I'm not terribly happy to be taking a neuroleptic, but brain shrinkage is not one of the things that has concerned me. Believe it or not, I have some concern about developing tardive akathisia with Abilify.
Schizophrenia is a disease that demonstrates a progressive reduction in brain volume as time passes. Neuroleptics might actually reverse this process in certain brain structures. Also, the degree of tissue loss is positively associated with severity of symptoms and resistance to treatment, particularly in the putamen. It is no wonder that neuroleptic dosage is associated with decreased brain volume. These patients are bound to be treated with higher dosages in an effort to effect any kind of improvement.
I guess I should do some more research.
Thanks again.
- Scott
------------------------------------------
Eur Neuropsychopharmacol. 2009 Dec;19(12):835-40. Epub 2009 Aug 29.
Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia.Tomelleri L, Jogia J, Perlini C, Bellani M, Ferro A, Rambaldelli G, Tansella M, Frangou S, Brambilla P; Neuroimaging Network of the ECNP networks initiative.
Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Italy.
Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
----------------------------------------------
Schizophr Res. 2009 Mar;108(1-3):49-56. Epub 2009 Jan 25.
Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia.Takahashi T, Wood SJ, Soulsby B, McGorry PD, Tanino R, Suzuki M, Velakoulis D, Pantelis C.
Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia. tsutomu@med.u-toyama.ac.jp
Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
-----------------------------------------------
Posted by Bob on November 20, 2009, at 23:56:52
In reply to Re: Going back to old-school - lithium. » morganator, posted by SLS on November 20, 2009, at 23:48:04
> Hi.
>
> Thanks for the heads-up. I'll need to review your links more thoroughly.
>
> > Scott, are you at all concerned about the possibility of neuroleptics causing brain damage/atrophy?
>
> Well, I'm not terribly happy to be taking a neuroleptic, but brain shrinkage is not one of the things that has concerned me. Believe it or not, I have some concern about developing tardive akathisia with Abilify.
>
> Schizophrenia is a disease that demonstrates a progressive reduction in brain volume as time passes. Neuroleptics might actually reverse this process in certain brain structures. Also, the degree of tissue loss is positively associated with severity of symptoms and resistance to treatment, particularly in the putamen. It is no wonder that neuroleptic dosage is associated with decreased brain volume. These patients are bound to be treated with higher dosages in an effort to effect any kind of improvement.
>
> I guess I should do some more research.
>
> Thanks again.
>
>
> - Scott
>
>
> ------------------------------------------
>
>
> Eur Neuropsychopharmacol. 2009 Dec;19(12):835-40. Epub 2009 Aug 29.
> Brain structural changes associated with chronicity and antipsychotic treatment in schizophrenia.
>
> Tomelleri L, Jogia J, Perlini C, Bellani M, Ferro A, Rambaldelli G, Tansella M, Frangou S, Brambilla P; Neuroimaging Network of the ECNP networks initiative.
>
> Section of Psychiatry and Clinical Psychology, Department of Medicine and Public Health, University of Verona, Italy.
>
> Accumulating evidence suggest a life-long impact of disease related mechanisms on brain structure in schizophrenia which may be modified by antipsychotic treatment. The aim of the present study was to investigate in a large sample of patients with schizophrenia the effect of illness duration and antipsychotic treatment on brain structure. Seventy-one schizophrenic patients and 79 age and gender matched healthy participants underwent brain magnetic resonance imaging (MRI). All images were processed with voxel based morphometry, using SPM5. Compared to healthy participants, patients showed decrements in gray matter volume in the left medial and left inferior frontal gyrus. In addition, duration of illness was negatively associated with gray matter volume in prefrontal regions bilaterally, in the temporal pole on the left and the caudal superior temporal gyrus on the right. Cumulative exposure to antipsychotics correlated positively with gray matter volumes in the cingulate gyrus for typical agents and in the thalamus for atypical drugs. These findings (a) indicate that structural abnormalities in prefrontal and temporal cortices in schizophrenia are progressive and, (b) suggest that antipsychotic medication has a significant impact on brain morphology.
>
>
> ----------------------------------------------
>
>
> Schizophr Res. 2009 Mar;108(1-3):49-56. Epub 2009 Jan 25.
> Follow-up MRI study of the insular cortex in first-episode psychosis and chronic schizophrenia.
>
> Takahashi T, Wood SJ, Soulsby B, McGorry PD, Tanino R, Suzuki M, Velakoulis D, Pantelis C.
>
> Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Victoria, Australia. tsutomu@med.u-toyama.ac.jp
>
> Morphologic abnormalities of the insular cortex have been described in psychotic disorders such as schizophrenia, but it remains unknown whether these abnormalities develop progressively over the course of the illness. In the current study, longitudinal magnetic resonance imaging data were obtained from 23 patients with first-episode psychosis (FEP), 11 patients with chronic schizophrenia, and 26 healthy controls. The volumes of the short (anterior) and long (posterior) insular cortices were measured on baseline and follow-up (between 1 and 4 years later) scans and were compared across groups. In cross-sectional comparison at baseline, the FEP and chronic schizophrenia patients had significantly smaller short insular cortex than did controls. In longitudinal comparison, the FEP patients showed significant gray matter reduction of the insular cortex over time (-4.3%/2.0 years) compared with controls (0.3%/2.2 years) without significant subregional effects, but there was no difference between chronic schizophrenia patients (-1.7%/2.4 years) and controls. The gray matter loss of the left insular cortex over time in FEP patients was correlated with the severity of positive and negative symptoms at follow-up. These findings indicate that patients with psychotic disorders have smaller gray matter volume of the insular cortex especially for its anterior portion (short insula) at first expression of overt psychosis, but also exhibit a regional progressive pathological process of the insular cortex during the early phase after the onset, which seems to reflect the subsequent symptomatology.
>
>
> -----------------------------------------------
>
>
Amount of brain atrophy has been linked to illness severity and treatment resistance? Wow, that's depressing. Might explain why as time goes on, I have more and more trouble maintaining a response to these drugs. I don't respond like I used to, that's for sure. Where can I read more about this?
Posted by floatingbridge on November 21, 2009, at 11:05:32
In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on November 20, 2009, at 23:56:52
> Amount of brain atrophy has been linked to illness severity and treatment resistance? Wow, that's depressing. Might explain why as time goes on, I have more and more trouble maintaining a response to these drugs. I don't respond like I used to, that's for sure. Where can I read more about this?
My comment is pretty unscientific. My old psyd cbt therapist and my another pdoc (my current) have said that the damage might be less attributable to the medication then to not finding the therapeutic treatment to address the illness. So the faster one gets the 'right' treatment, the more the brain is protected. Not exactly cheerful news for those who are treatment resistant, but a more benign comment on most meds themselves.
I also think there are a few supplements that can help promote brain health--maybe taken in conjunction w/ meds? Like NAC and (I know, I know, everyone's tired of this one) fish oil.
Hey, I'm a luddite w/ a computer. My comments for what they are worth.
Best to you, Bob in healing and remission,
fb
Posted by floatingbridge on November 21, 2009, at 11:12:30
In reply to Re: Going back to old-school - lithium. » morganator, posted by SLS on November 20, 2009, at 23:48:04
Scott,
I thought that signs of tardive akathisia show fairly soon upon treatment. How long have you been on abilify? Are chances are affected by dosage?
(I might be confusing this w/ tardive dyskensesia.)
fb
Posted by desolationrower on November 21, 2009, at 15:49:31
In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on November 21, 2009, at 11:12:30
> Scott,
>
> I thought that signs of tardive akathisia show fairly soon upon treatment. How long have you been on abilify? Are chances are affected by dosage?
>
> (I might be confusing this w/ tardive dyskensesia.)
>
> fbtardive=gradually or delayed appearance, from the latin tardus, or late.
akithisia usually does show up early, and is quite common on aripiprazole (more common than benefit, i think)
-d/r
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