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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 52. This is the beginning of the thread.
Posted by paulbwell on May 27, 2010, at 21:43:10
Hi PBs
I havn't been here for a while because i'v been well.
I went through the multi SSRI trial you all have, and they all made things worse.
Fluoxetine and i go back 16 years and is the 'gold standard' AD AFAIK.
40mgs Fluox alone kept my mood at 50%.
You don't have to live life at a 50% functional level. I have been seeing a new PCP and we work together with equal input.
You all know about long term SSRI-blahs!! right?
well thats where a dopamine booster comes in, in my case brand name Ciba Ritalin SR20 tabs-40mgs 3x a day comes in, and i have forgotten what it feels like to be 'depressed'.40mgs Fluox and a Doc who was willing to work with me and a dose of Ritalin which is 2x the max recommended PDR dose of 60mg daily--2, 20mg Ritalin SR20s 3x a day produced 95% remission.
The 2 meds act as a catalyst for each other and return ME to a state of how i felt as a young person.
Folks, my point is this, i tried 6 standard SSRI, TCA meds which made me worse (Citalopram, Paroxetine made me suicidal) Fluox made me well in the mid 1990's but combined with the "mild stimulant" Ritalin-which was indicated for use as an AD until the 1970 CSA scheduling of meds put it into Sch ll, when amphetamine type stimulants (ATS), use dropped by 80-90%.
Good luck in your journey, and NEVER EVER give up-OK?
Posted by Phillipa on May 27, 2010, at 21:59:41
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
Hi stranger add meds made you well? Well write. Love Phillipa
Posted by Laney on May 28, 2010, at 0:37:31
In reply to Re: Depression? whats that? i can't remember » paulbwell, posted by Phillipa on May 27, 2010, at 21:59:41
Paulbwell,
Thanks for the input! So happy you found an answer for you. Keep in touch! It give us hope.
Laney
Posted by hopefullynow on May 28, 2010, at 2:18:54
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
Hy Paul,
I'm very glad for you, and I thank you that you post your success here, on PB!I think we all, that are here, need success stories like yours, we read too many horror stories and failed treatments.
Be well :)!
Posted by Jeroen on May 28, 2010, at 3:52:12
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
i'm glad its helping and not causing psychosis
Posted by Laney on May 28, 2010, at 9:26:35
In reply to Re: Depression? whats that? i can't remember, posted by Jeroen on May 28, 2010, at 3:52:12
Why would it cause psychosis?
Laney
Posted by Jeroen on May 28, 2010, at 9:28:53
In reply to Re: Depression? whats that? i can't remember, posted by Laney on May 28, 2010, at 9:26:35
my previous doctor tells ritalin CAN cause psychosis in 1% of the people that it takes its rare but it can happen like amantadine or so it rarely causes psychosis in people
Posted by Phillipa on May 28, 2010, at 13:29:33
In reply to psychosis from ritalin, posted by Jeroen on May 28, 2010, at 9:28:53
I'd think it would only be if you were on the med and you didn't need it and would be fine when stop taking it? Phillipa
Posted by linkadge on May 28, 2010, at 14:27:37
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
I agree. I have dysthymia / depression and have been on the SSRI merry-go-round as well as TCAs. The methylphendiate is about the only thing that keeps me well. Currently on 10mg amitriptyline, 5mg of citalopram and 30mg of methylphenidate.
Linkadge
Posted by Bob on May 28, 2010, at 16:37:57
In reply to Re: Depression? whats that? i can't remember » paulbwell, posted by hopefullynow on May 28, 2010, at 2:18:54
I tried stimulants back in the nineties, and they worked wonderfully for about for a few days/weeks, and then they turned nasty. Wasn't getting the beneficial effects any longer and started developing physical side-effects. I think I tried both ritalin and dexedrine. I've also taken Provigil, which didn't ever do much good either.
In any case, I'm glad you found something to help you out. It must be such a relief.
Posted by Bob on May 28, 2010, at 16:43:43
In reply to Re: Depression? whats that? i can't remember, posted by linkadge on May 28, 2010, at 14:27:37
> I agree. I have dysthymia / depression and have been on the SSRI merry-go-round as well as TCAs. The methylphendiate is about the only thing that keeps me well. Currently on 10mg amitriptyline, 5mg of citalopram and 30mg of methylphenidate.
>
> Linkadge
>
Linkadge -What is your rationale for having that 5mg of citalopram in there? You just feel you need an extra dose of SRI and you don't want to raise the amitriptyline because of the side-effects?
Bob
Posted by Bob on May 28, 2010, at 16:47:48
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
I always thought that long term stimulant use didn't work well. I mean, why aren't psychiatrists everywhere trying this? What is the drawback?
Posted by linkadge on May 28, 2010, at 19:44:53
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Bob on May 28, 2010, at 16:43:43
Sorry, that should read 5mg of escitalopram. I feel that even at 5mg its potent.
Linkadge
Posted by linkadge on May 28, 2010, at 19:46:28
In reply to Re: Depression? whats that? i can't remember, posted by Bob on May 28, 2010, at 16:47:48
It probably doesn't work for everybody (just like everything). I would imagine the main hesitation is due to the abuse potential of stimulants and the fear that the user will completely adapt to the effects requiring dosage escalation.
Linkadge
Posted by Bob on May 28, 2010, at 20:23:34
In reply to Re: Depression? whats that? i can't remember, posted by linkadge on May 28, 2010, at 19:46:28
> It probably doesn't work for everybody (just like everything). I would imagine the main hesitation is due to the abuse potential of stimulants and the fear that the user will completely adapt to the effects requiring dosage escalation.
>
> Linkadge
Well in any case, that combo you've arrived at is quite unique and interesting to me.I tried to get on 10mg of Amitriptyline a few weeks back and by the 3rd day I was sedated, confused and irritably depressed. I then stopped it.
Bob
Posted by linkadge on May 28, 2010, at 20:43:04
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Bob on May 28, 2010, at 20:23:34
Yeah, I am thinking about ditching the amitriptyline too. It just causes too many side effects and leaves me too out of it.
It would be a nice if I was doing some hard time in prison and needed an "escape drug", but to take amitriptyline and cary out my daily routine is prety hard.
Linkadge
Posted by linkadge on May 28, 2010, at 20:43:34
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Bob on May 28, 2010, at 20:23:34
It also just feels so bloody toxic.
Linkadge
Posted by Conundrum on May 30, 2010, at 10:16:18
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
Great story! I tried ritalin, but after reading what you wrote I may have been under dosed. This story truely gives hope to those struggling here.
Posted by Conundrum on May 30, 2010, at 10:20:05
In reply to Re: Depression? whats that? i can't remember, posted by linkadge on May 28, 2010, at 19:46:28
I get the impression that dose escalation is less common with methylphenidate than amphetamines.
Jeez my doses seemed so low now. I was told to take 5mg 2x a day and felt nothing just some energy/increased heart rate at first. Maybe you really need like 10mg 3x a day or more. Do you notice something right away or does it take a few days?
Posted by chujoe on May 30, 2010, at 10:58:44
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Conundrum on May 30, 2010, at 10:20:05
I started out last month on 5 mg of Ritalin three times a day & felt quite a buzz of energy the first couple of days, but then just a bit of increased focus. I asked my NP if I could go up to 5 mg four times a day and that has seemed to work pretty well. Since I'm usually pretty good in the morning, I don't take my first 5 mg until around 10 or 10:30, then space them out over the rest of the day about 3.5 to 4 hours apart. If I'm just going to kick back or go to bed early I might skip the last dose.
I think pdocs & NPs are paranoid of prescribing larger doses because of the perceived potential for abuse, which is mostly a result of the culture of fear surrounding illegal meth use / addiction. That is, I think their reluctance is social rather than medical.
Posted by linkadge on May 30, 2010, at 14:38:24
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Conundrum on May 30, 2010, at 10:20:05
Well, at first the medication seems to act more like a "stimulant", there is a feeling of being "high" with increased energy etc. In a few days this wears off and I just start to feel more "normal".
I can think clearly, the dark moods are gone and my mood is transparent (i.e. I don't think about how I feel, its just me and the world).
I think its efficacy really depends on what your underlying issue is.
Linkadge
Posted by linkadge on May 30, 2010, at 14:41:10
In reply to Re: Depression? whats that? i can't remember » Conundrum, posted by chujoe on May 30, 2010, at 10:58:44
There is a book I was reading in which methylphenidate was studied in depression via pet scans. Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead". They did before and after scans and after the MPH the cerebral blood flow had improved substantially.
They refered to it as a "PET activator".Linkadge
Posted by SLS on May 30, 2010, at 14:51:25
In reply to Re: Depression? whats that? i can't remember, posted by linkadge on May 30, 2010, at 14:41:10
> Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead".
Yes. The brain does look dead in severe depression. My cerebral cortex showed up as mostly blue on a FDG PET scan. It should have been yellow and orange.
- Scott
Posted by Bob on May 30, 2010, at 15:01:51
In reply to Re: Depression? whats that? i can't remember, posted by SLS on May 30, 2010, at 14:51:25
> > Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead".
>
> Yes. The brain does look dead in severe depression. My cerebral cortex showed up as mostly blue on a FDG PET scan. It should have been yellow and orange.
>
>
> - ScottWell, mine certainly feels like it's dead sometimes, so I guess that makes sense.
Bob
Posted by Conundrum on May 30, 2010, at 15:09:33
In reply to Re: Depression? whats that? i can't remember » SLS, posted by Bob on May 30, 2010, at 15:01:51
Same here. :-/ I guess I could try an experiment with my left over ritalin. I think tricyclics work similarly to, they increase norepinephrine via reuptaked blockade and dopamine release and block reuptake in some places.
Interesting about the scans. It would be neat if they could find meds that worked in certain areas and prescribe them first rather than make everyone go on the drug medi-go-round.
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