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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 vic80 on June 14, 2010, at 17:23:39
okay - the 5th week:
After an almost maddening 3rd week with severe panic and suicidal ideation, I had upped the dosage to 25mg 2x daily from 25mg 1x. It did help bring down the despair and darkness - but in the days to follow I would experience this total drugged feeling - like as though I have eaten a pound of nutmeg - the hot flushes - tingling in the limbs - a sort of weird discomfort in the lower body - muscle weakness - and a general feeling of 'hotness'.... and it'd make me feel zombiefied - unable to react to the pressing issues I am dealing with - sent me to the zero zone - where one feels existing over actually living.
Plus I had to take the horrible propranolol to deal with the tachycardia caused - which further caused me to feel exhausted and tired and dysphoric.The saving grace all along has been my lorazepam 0.5mg which I take a half hour before my Milnacipran.
Since past 2 days I upped the dose back to 50mg in 25mg 2x installments - and the horrible flu like symptoms are back - the burning of the limbs - the giddy dizzy feeling - the feeling cut off from the world - the drugged without the drug-euphoria discomfort feeling - and worse - the horrible flu like symptoms - sneezings and a sore throat - this one particularly irks me the most coz it adds to discomfort.
I think MIL has caused major physical side effects - starting with tachycardia, dyspnea, upper respiratory tract infections, muscle weakness, hot flushes, malaise, headaches and general feeling of being ill and worse of all apathy especially with the morning dose.
I HAVE NO SEX DRIVE, erectile dysfunction, premature ejaculation. I feel as though I am not even interested in looking at women. As though there is some basic chemical dysfunction which completely inhibits any sense of infatuation/attraction or interest - even on non-sexual levels.
Now I am deciding to go back to the 25mg daily once dose. I really wonder how I can start life afresh with something always making me feel so passive and complacent and apathetic....
I have felt that it is also making me feel sleepy - which is not good at all - the lorazepam with the 15mg 2x dose somehow makes me feel drowsy nstead of just providing the calm and clarity it has been giving me all along.
Wonder if the short 8 hour half-life is too difficult to put up with.
When can I expect the drug to have a stable peak plasma concentration and actually start to make me feel motivated and energetic the way it is supposed to act on me.
I can actually feel the mood-brightening effect of this drug a few hours after taking it - which is sort of eerie given it does not cross the blood-brain barrier like the benzos etc. This could perhaps just be my own imagination.
Am i getting more Norepinephrine that I need?
I am particularly uncomfortable with the flu-like symptoms, the maialse, drugginess, and detachment that I get on this med.How would a switch to Tianeptine be?
Milnacipran seems to have done very little for me - perhaps it has stopped me from dwindling down the dark spiral - but I am running out of patience with this drug.
Posted by Phillipa on June 14, 2010, at 18:35:05
In reply to Milnacipran 5th wk: no sex drive, physical side fx, posted by vic80 on June 14, 2010, at 17:23:39
Five weeks I'd think you would feel something positive. So those are blips of feeling the med kick in but it leaves? What's you doc say about the difficulty you're experiencing. Phillipa
Posted by Sendow on June 14, 2010, at 19:09:11
In reply to Milnacipran 5th wk: no sex drive, physical side fx, posted by vic80 on June 14, 2010, at 17:23:39
-Am i getting more Norepinephrine that I need?
yeah i think so... i had this experience with norepinephrine's reputakers. I think norepinephrine is the most overrated neurotransmitter.
Posted by bleauberry on June 15, 2010, at 15:38:48
In reply to Milnacipran 5th wk: no sex drive, physical side fx, posted by vic80 on June 14, 2010, at 17:23:39
The mood brightening effect you feel a few hours after dosing would continue if you took multiple doses. I don't mean 25mg three times a day. I mean, 25mg divided into 3 or 4 doses throughout the day. You are having too many peaks and valleys including the flu-like withdrawal symptoms.
Just opinion, but yeah, I think you are getting too much of this drug. More does not universally mean better. More can be worse. What is normal for one person can be way too much for another. You've probably heard the saying "less is more".
I know I sound like a broken record, and I apologize if my opinions are not taken well, but I still feel this entire trial has been poorly managed. No wonder all the problems.
Much less of a dose, divided into multiple doses. That's what you need to do before throwing in the towel on this thing.
Posted by vic80 on June 15, 2010, at 18:07:03
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid, posted by bleauberry on June 15, 2010, at 15:38:48
Hi Bleauberry,
Thanks for your reply. I value your suggestions given that your posts on Milnacipran inspired me to talk to my pdoc and get my prescription.
I did try the 25mg split thing - where I stay i could not find a chemist who could divide the capsule dose - so I ended up splitting open the capsule myself and taking 12.5mg twice daily. This hardly seemed to have much effect on me. Infact I started feeling darker and more panicked. SO a call to the pdoc - and I was asked to start 25mg twice daily - this definitely improved the depressive state - but as I explained in my post brought along a bevy of other problems - mainly a dazed feeling which makes me have feelings of disorientation, deja-vu, and weird body sensations.
I really am wondering if the norepinephrine is too much for me to handle.- I have figured that I dont have much of the somatic signs of depression - I mainly have a low mood now which is accompanied with dysphoria in the morning - I cannot recall any particular increase or decrease in my energy levels. Its been the same.
I basically not feel I can function well when my mood if elevated - which is also scary for me coz of the increased cravings for alcohol and cannabis - intoxicants I have not used since a few years now. I have even experienced a craving for smoking - yet another habit I came out of 8 years ago.
I would not blame MIL for all this - my social situation too has changed - I no longer live with a 9 YO partner, plus my previous job is gone. So such stressors too contribute to my condition - even though these 2 were the reasons for it to appear in the first place.
I have an appointment with my pdoc on friday - I woukld have completed 5 weeks of MIL by then - I am really unsure of what to make out of my current situation whilst being on MIL. I have clearly felt a dumbing and numbing down of my brain - apathy and amotivation, and the sharpness of mind I once possessed. This could well be the lorazepam 0.5 mg I have been on for 2 months now.
All I can say is that the heightened emotionality I experienced at the beginning of MIL treatment was a welcome thing - it helped me feel the pain and live it rather coop it up and have panic attacks like I did previously. I had crying bouts - something which never happened in almost 6 years. All this felt nice - the escitalopram induced mental-numbing and derealization too had lifted. But that all could just be the dopamine rebound after stopping Lexapro.
A drug that would constantly give me the flu and make me sexually dead, make me feel disoriented, give me panic induced suicidal ideation et al - does not seem to somehow fit the bill of what I am looking forward to in terms of a helpful therapy.
I need something which is light - doesnt interfere with the acetylcholine, screw my sleep, or cause physical symptoms like the ones I have mentioned - more importantly I want to have full emotional range - no anxiety - I seem to be asking too much I guess!
What are your views if any on tianeptine
?DO you feel I should still stick with MIL, how would a change to clomipramine be?
> The mood brightening effect you feel a few hours after dosing would continue if you took multiple doses. I don't mean 25mg three times a day. I mean, 25mg divided into 3 or 4 doses throughout the day. You are having too many peaks and valleys including the flu-like withdrawal symptoms.
>
> Just opinion, but yeah, I think you are getting too much of this drug. More does not universally mean better. More can be worse. What is normal for one person can be way too much for another. You've probably heard the saying "less is more".
>
> I know I sound like a broken record, and I apologize if my opinions are not taken well, but I still feel this entire trial has been poorly managed. No wonder all the problems.
>
> Much less of a dose, divided into multiple doses. That's what you need to do before throwing in the towel on this thing.
Posted by former poster on June 15, 2010, at 18:57:43
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » bleauberry, posted by vic80 on June 15, 2010, at 18:07:03
"A drug that would constantly give me the flu and make me sexually dead, make me feel disoriented, give me panic induced suicidal ideation et al - does not seem to somehow fit the bill of what I am looking forward to in terms of a helpful therapy".
I gave Manalcipran a try. You are going through exactly the same side effects I had. All the literature on this med says its the least likely to cause sexual disfunction. Nothing could be further from the truth! It takes about a week for the ED to kick in and if you stop Minalcipran suddenly, you have to wait almost a month to get normal function again. I had the same wonderful relief from depression you described about a week after starting it, somewhere around the 50-75mg range. Another good effect I got, (you didnt seem to get this) was I had the most natural, deepest and refreshing sleep. The best sleep I have had in decades.
It's Amazing that you mentioned trying Tiameptine next. That was exactly what I did. I tried Stablon right away. I discontinued Stablon (tianeptine), because I was terrified to sleep. Every night I got a horrific nightmare. Any other questions you might have about the 2 medications mentioned meds let me know. Good luck!
Posted by bleauberry on June 16, 2010, at 20:06:29
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » bleauberry, posted by vic80 on June 15, 2010, at 18:07:03
I understand your situation. Your last question was whether I thought you should stay with milnacipran. Honestly, if it were me, no, I would be done with it. But then, it hasn't been long enough for adaptive changes to happen. You are still feeling it in the early stages and nothing has kicked in yet. So it's a tough call. I guess if someone had the will of iron they could stick it out. Me, I couldn't do that. So while I can't give you advice on whether to stay with it or not, I personally wouldn't. If it's that darn troublesome, no way.
Posted by Conundrum on June 16, 2010, at 21:33:08
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » bleauberry, posted by vic80 on June 15, 2010, at 18:07:03
How was your response to SSRIs? Just curious have you taken nefazodone before?
Posted by vic80 on June 16, 2010, at 22:14:06
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid, posted by Conundrum on June 16, 2010, at 21:33:08
> How was your response to SSRIs? Just curious have you taken nefazodone before?
I was on escitalopram which was the cause of Depersonalization, made me feel unreal, emotionally dead, killed my REM sleep.. Have me severe fatigue and caused Anhedonia and apathy. I guess the drug did more damage than it did any good. I was unfortunately too fixated with its side effects to actually make any life changes... It has been 7 months of the current depressive spell. Which was mainly anxiety to begin with. The Melancholic depression started with stopping escitalopram and starting Milnacipran. I am considering going off all meds... Or atleast try and get my pdoc to prescribe me a stimulant. Were the side effects ignorable i would have just stay put. I would discuss nefadazone with my pdoc.I guess my way out is more of psychotherapy.
Posted by Conundrum on June 16, 2010, at 22:24:25
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » Conundrum, posted by vic80 on June 16, 2010, at 22:14:06
> I was on escitalopram which was the cause of Depersonalization, made me feel unreal, emotionally dead, killed my REM sleep.. Have me severe fatigue and caused Anhedonia and apathy. I guess the drug did more damage than it did any good.Did the damage continue after you stopped the drug?
<I was unfortunately too fixated with its side effects to actually make any life changes... It has been 7 months of the current depressive spell. Which was mainly anxiety to begin with. The Melancholic depression started with stopping escitalopram and starting Milnacipran. I am considering going off all meds... Or atleast try and get my pdoc to prescribe me a stimulant. Were the side effects ignorable i would have just stay put. I would discuss nefadazone with my pdoc.
>
> I guess my way out is more of psychotherapy.I wasn't suggesting nefazodone. I was just wondering if you had tried that as well as SSRIs if you didn't do well with SSRIs, nefazodone, or milnacipran, I would be surprised if clompiramine. You seem to be on the right track in two ways.
1. If meds make you feel this bad you might be better off without them. I would try to do without them if you can. If you can return to only an anxious state you could just take benzos. They're addictive but don't seem to cause all these weird brain changes SSRIs cause. Beware benzos can make people feel flat as well.
2. If you were to take an AD again you would probably need something more stimulating like you suggested. Less serotonergic more adrenergic or dopaminergic.If all you have is anxiety and benzos have helped I would recommend staying on them only as needed.
Someone in my family has a good book on handling anxiety and panic attacks. I'll have to find the title for you. It has to do with watching the anxiety as it happens and the more you observe it the less power it has over your life.I'd hate to see someone dealing with meds, side effects, poop outs if they don't really need them. I hope you make the best choice. Only you know what you need.
Posted by former poster on June 16, 2010, at 23:55:10
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid, posted by Conundrum on June 16, 2010, at 21:33:08
My response to SSRI's? I tried most of them. Luvox worked the best. The only one I didnt try was Paxil. All of them caused ejaculation delay, and erectile dysfunction. At the time it was a welcome side effect. Later it was not.
I tried Serzone, (Nefazadone) around 1999. I was frustrated with the sexual side effects of Nardil and my Dr. put me on Serzone. I noticed anxiety symptoms improved. I was in college at the time and it seemed like I couldn't retain anything I learned. I gave up on it after 2 weeks and went back on Nardil.
Posted by Conundrum on June 17, 2010, at 0:25:54
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid, posted by former poster on June 16, 2010, at 23:55:10
I've heard nefazodone can cause memory problems. There are plenty accounts of this on askapatient.com. I'm curious about the mechanism that causes this, but I'll save that for another day and thread.
I was actually asking vic80, since he was considering clomipramine. Seems like he doesn't do too well on drugs that increase serotonin. Not saying clompiramine wouldn't help, it has some actions that SNRIs don't, but it might not be the best next step since he has tried a number of serotonergic drugs and not done very well with them.
Posted by former poster on June 18, 2010, at 0:26:51
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » former poster, posted by Conundrum on June 17, 2010, at 0:25:54
Yeah it really sucks when you have to sacrifice your drive/performance. It can make you feel even more insecure, depressed. I have asked and searched everywhere for a med that works as good as a SSRI for depression / anxiety without the sexual side effects. Remeron actually can improve sex drive, but it is HORRIBLE! Sedation is so bad it will make you want to sleep for 3 days. It seems the only choice we have is Bupropion and Sam-E. Which have really mild effects. I'm trying Emsam and it seems to mess around with errection and libido too. Maybe not quite as bad as Minalcipran. But I can't be sure until I give it more time. Let me know if you find anything??
Posted by former poster on June 18, 2010, at 0:34:13
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » former poster, posted by Conundrum on June 17, 2010, at 0:25:54
Yeah it really sucks when you have to sacrifice your drive/performance. It can make you feel even more insecure, depressed. I have asked and searched everywhere for a med that works as good as a SSRI for depression / anxiety without the sexual side effects. Remeron actually can improve sex drive, but it is HORRIBLE! Sedation is so bad it will make you want to sleep for 3 days. It seems the only choice we have is Bupropion and Sam-E. Which have really mild effects. I'm trying Emsam and it seems to mess around with errection and libido too. Maybe not quite as bad as Minalcipran. But I can't be sure until I give it more time. Let me know if you find anything??
Oh I forgot there is hope... Mirapex! It's been documented that it is an effective antidepressant and libido enhancer too!! Getting a Dr. to prescribe it can be difficult since I heard you need 4mg a day and all they will give you is less than 1mg a day for RLS. Do you ride the bus? Mirapex can make you fall asleep anywhere anytime. Also causes nausea.
Posted by vic80 on June 20, 2010, at 16:06:01
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid, posted by former poster on June 15, 2010, at 18:57:43
> I gave Manalcipran a try. You are going through exactly the same side effects I had. All the literature on this med says its the least likely to cause sexual disfunction. Nothing could be further from the truth! It takes about a week for the ED to kick in and if you stop Minalcipran suddenly, you have to wait almost a month to get normal function again. I had the same wonderful relief from depression you described about a week after starting it, somewhere around the 50-75mg range. Another good effect I got, (you didnt seem to get this) was I had the most natural, deepest and refreshing sleep. The best sleep I have had in decades.
> It's Amazing that you mentioned trying Tiameptine next. That was exactly what I did. I tried Stablon right away. I discontinued Stablon (tianeptine), because I was terrified to sleep. Every night I got a horrific nightmare. Any other questions you might have about the 2 medications mentioned meds let me know. Good luck!
I should have mentioned sleep - yes the sleep quality is really good - but since the past one week - I have experienced excessive sleepiness - a good 8 hours of sleep does not seem enough - I have almost 3-4 hours of naps after I wake up and feel sleepy through the day. This is strange given that it occured during the 5th week.
Also I have developed shortness of breath in the past 2-3 days.
It appears that your experience on Tianeptine is not a good one. Would you totally NOT recommend it to anyone?
Posted by former poster on June 20, 2010, at 16:36:54
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » former poster, posted by vic80 on June 20, 2010, at 16:06:01
Would I recommend Tianeptine? I don't think I would recommend it to my brother or my son. If you feel you must try it, start at a very low dose titrating up very slowly. It only comes in one tablet strength.
I was really amazed at the depth of realistic emotions the bad dreams stirred up in me. A Pdoc once told me that nightmares are a sign that you are having a robust response from the AD.I'm trying Emsam 6mg patch now.
Posted by Conundrum on June 20, 2010, at 20:49:26
In reply to Re: Milnacipran 5th wk: no sex drive, physical sid » vic80, posted by former poster on June 20, 2010, at 16:36:54
> Would I recommend Tianeptine? I don't think I would recommend it to my brother or my son. If you feel you must try it, start at a very low dose titrating up very slowly. It only comes in one tablet strength.
>
> I was really amazed at the depth of realistic emotions the bad dreams stirred up in me. A Pdoc once told me that nightmares are a sign that you are having a robust response from the AD.
>
> I'm trying Emsam 6mg patch now.Interesting, I feel my emotions often have no depth. I wonder if this drug could help at least for a short time.
This is the end of the thread.
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