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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by europerep on July 17, 2010, at 11:49:16
hey there..
I recently returned home to my parents, and spontaneously decided to see my old pdoc and ask him what he'd suggest for my situation (treatment-resistant depression) which I outlined in my previous thread ("where to go from here?"). I'm opening this new one because right here it's just all about the thread title:he prescribed me methylphenidate (he STILL believes it would be for ADS, which I definitely do not suffer from.. I can sit in the library and study for hours, so attention is not the issue here). also, he said that I could take it with my high dose of venlafaxine, since methylphenidate is not serotonergic. but, both venlafaxine and methyphenidate might have cardiovascular side effects, no? am I safe starting with a tiny dose (5mg), and possibly lowering venlafaxine later?
but, I am still scared of stimulants.. I think on wiki there is a statement by a professor who is warning of "tardive parkinson" as a side effect of methylphenidate when continuously given to adolescents, and although I am 24, I wonder whether messing with dopamine is really such a good idea in the long term? basically, I am looking for a medication I can take throughout my whole life, because I do not expect my depression to ever get any better.. from eight years ago until now, it has ONLY worsened, and it has become really really severe.. currently, the question is not so much if but rather when I will have lost my last bit of will to live.. it's still a question of years, and of different meds I'd have to try until then, but still.. life could be so beautiful, but I'm just not getting there. and so, since I am not sure whether it is really a dopamine issue that causes my depression or not something else, and in case methylphenidate does help me, I'd still be in a dilemma.. but I guess that's not a question for now, so the actual question is what's up with venlafaxine plus methylphenidate? the literature mentions some cases of it, but not too many.
thanks in advance!
eR
P.S.: sorry to those who posted in my recent thread and to who I didn't answer, especially violette who wrote such a long post.. it's just that I am really down right now... sorry for that!
Posted by Phillipa on July 17, 2010, at 12:07:44
In reply to venlafaxine 600mg + methylphenidate?, posted by europerep on July 17, 2010, at 11:49:16
I'm quite sure I understand. High dose effexor and stimulant is that the main question? Phillipa
Posted by europerep on July 17, 2010, at 12:09:25
In reply to Re: venlafaxine 600mg + methylphenidate? » europerep, posted by Phillipa on July 17, 2010, at 12:07:44
> I'm quite sure I understand. High dose effexor and stimulant is that the main question? Phillipa
yup, exactly...
Posted by ed_uk2010 on July 17, 2010, at 13:16:08
In reply to venlafaxine 600mg + methylphenidate?, posted by europerep on July 17, 2010, at 11:49:16
I think you have some difficult decisions ahead. Since your depression has been very long lasting, you obviously need a medication which will not 'poop out' after a few weeks. Before antidepressants even existed, stimulants were often prescribed for depression. The main problem was that the benefits were often transient and some patients got addicted. Many patients note that stimulants reduce their fatigue and apathy without actually elevating mood. This suggests that stimulants are not 'true' antidepressants.
If you do decide to try methylphenidate, the benefits should appear quickly. If there is no response after a couple of weeks at a low/moderate dose, you should probably discontinue treatment. Also, if tolerance starts to develop after several weeks or months, I think it would be best to taper off rather than increasing the dose. Increasing the dose could cause you to become dependent on a medication which will not provide a long term improvement.
If venlafaxine is not providing adequate relief, perhaps it would be better to switch to a different antidepressant instead. What do you think? Clomipramine (Anafranil) is regarded by some as the most potent antidepressant ever made. Have you tried it?
Posted by europerep on July 17, 2010, at 14:53:35
In reply to Re: venlafaxine 600mg + methylphenidate? » europerep, posted by ed_uk2010 on July 17, 2010, at 13:16:08
hi ed_uk..
I too read of individual cases of methylphenidate improving some symptoms of depression, but that feelings remained flat. I fear this very much, because it might bring me closer to where I want to be, and I might hesitate to switch to something totally different..
so far, I have only tried one TCA, the first antidepressant that I took, which was amitriptyline, up to 300mg... at lower doses, I had nortriptyline added to it, but didn't feel anything. it is true that I have read a few studies and case reports of clomipramine being effective even after several ineffective interventions against TRD. and it is very potent both on 5HT and NE, which is good. I think it would indeed be a good idea to consider this next, if methylphenidate fails.. I hesitate when it comes to going off of venlafaxine, but there would then be no way around it I guess.
I'd of course still have the MAOI option, but that would definitely mean hospitalization, probably for quite a long time, and that scares me.. not so much the hospital aspect of it, but losing another year of my studies, etc... well, I'll have to see about that then.
thx for answering!
Posted by ed_uk2010 on July 17, 2010, at 15:09:00
In reply to Re: venlafaxine 600mg + methylphenidate? » ed_uk2010, posted by europerep on July 17, 2010, at 14:53:35
>I'd of course still have the MAOI option, but that would definitely mean hospitalization......
Why would it definitely mean hospitalisation? It's quite possible to start MAOIs in outpatients. In fact, this is the norm. You would, of course, have to have been completely off venlafaxine for at least two weeks before starting the MAOI.
Posted by Christ_empowered on July 17, 2010, at 16:23:13
In reply to Re: venlafaxine 600mg + methylphenidate? » ed_uk2010, posted by europerep on July 17, 2010, at 14:53:35
Ritalin in particular has always been used for "anergic depression." Back when it first hit the market, they used it as a "psychic energizer" and for those pesky kids who wouldn't sit still and watch "Leave it to Beaver".
What exactly are you looking for from your drugs? There's really only so much "antidepressants" and other substances can do. They can perk you up, mellow you out, etc., but the help they offer is limited. Lots of times, psych drugs don't even beat placebo.
I don't say that to make you angry or anything, I'm just saying that you should maybe lower your expectations of the meds and focus on non-medical ways of coping with your problems. Obviously, there's therapy. There's also alternative help, like orthomolecular psychiatry.
Have you read "Man's Search for Meaning" ?
Posted by europerep on July 18, 2010, at 10:57:46
In reply to Re: venlafaxine 600mg + methylphenidate?, posted by ed_uk2010 on July 17, 2010, at 15:09:00
hm, well, I'm not sure if I'm so comfortable with being two weeks entirely without meds, that would surely be very very difficult... because even if I lower the current dose of venlafaxine only by 75 or 150mg, I notice a strong worsening of symptoms, I am no longer able to get up before noon or even later, etc.. but I will of course not refrain from trying MAOIs at the point where it is necessary, I just hoped to be able to go without them.
I now also "re-discovered" why I was hesitant about clomipramine the last time I considered it. apparently, it has been shown to be mutagenic in drosophila flies. of course that's just these tiny flies, but it scared me, especially in terms of "reproduction", since I am still relatively young. I am at a different point now though, and maybe I will just have to hope it works differently in humans. of course, clomipramine has been in use for a long time, but I could imagine that it is very difficult to trace back possible genetic changes, if they are ever discovered, to a certain medication, since there are so many factors in the environment that might have similar effects. hm, it's all difficult.
Posted by ed_uk2010 on July 18, 2010, at 12:06:34
In reply to Re: venlafaxine 600mg + methylphenidate? » ed_uk2010, posted by europerep on July 18, 2010, at 10:57:46
>I now also "re-discovered" why I was hesitant about clomipramine the last time I considered it. apparently, it has been shown to be mutagenic in drosophila flies.
You're right that it's difficult. Clomipramine (chlorimipramine) has also shown anti-cancer properties...
http://www.ncbi.nlm.nih.gov/pubmed/15694394
Posted by Justherself54 on July 18, 2010, at 12:18:02
In reply to Re: venlafaxine 600mg + methylphenidate?, posted by ed_uk2010 on July 18, 2010, at 12:06:34
Clomiprine is working for me. Three other TCA's had side effects I couldn't handle..so I'm still amazed that I could tolerate it. Huge bonus for me..pain relief.
Might be worth a try for you before the MAOI's.
Posted by bulldog2 on July 18, 2010, at 18:16:28
In reply to maybe stimulants are the next step..., posted by Christ_empowered on July 17, 2010, at 16:23:13
> Ritalin in particular has always been used for "anergic depression." Back when it first hit the market, they used it as a "psychic energizer" and for those pesky kids who wouldn't sit still and watch "Leave it to Beaver".
>
> What exactly are you looking for from your drugs? There's really only so much "antidepressants" and other substances can do. They can perk you up, mellow you out, etc., but the help they offer is limited. Lots of times, psych drugs don't even beat placebo.
>
> I don't say that to make you angry or anything, I'm just saying that you should maybe lower your expectations of the meds and focus on non-medical ways of coping with your problems. Obviously, there's therapy. There's also alternative help, like orthomolecular psychiatry.
>
> Have you read "Man's Search for Meaning" ?I will do my best to be civil though I will certainly be blocked as you seem untouchable. I do not feel you are being civil to people.
You really need to stop lecturing people on what they need to do. When a question is asked I thought the rules stated that you answer the question. What a person asks is what should be answered. You are lecturing people when you don't know what their mindset is. How do you know what their expectations are from drugs?
After what you did when you came back to babble
you really need people teaching and helping you with some of your emotional problems. You seem to have a need to have power over people and be in a role of leadership.
You were irrepsonsible when you basically told people the path to getting better was get rid of your meds and follow Christ. Don't you realize the naive may have followed you advice and had disasterous results because they followed you.Than you reenter babble and go woops I made a mistake. I will need the drugs at times.
1. So you will now define when we need drugs and when it is acceptable to take them based on your experiences.
2. Wow you just can't stop. You have no right to lecture and assume a leadership role when your own life appears to be in chaos. You just give yourself a pass everytime you can't follow your edicts and redefine the book of Christ Emp.
3. You appear to be the one that needs a leader not vice versa...
4. When you came back into babble and did the woops I made a mistake everyone was so kind and understanding. Maybe you need people holding you responsible for your actions.
But you Mr. Christ need to start looking inside of yourself and when you have attained perfection you can start lecturing. It appears you have learned nothing from your previous mistakes.
Posted by Dr. Bob on July 19, 2010, at 14:10:53
In reply to Re: maybe stimulants are the next step... » Christ_empowered, posted by bulldog2 on July 18, 2010, at 18:16:28
> I will do my best to be civil though I will certainly be blocked
If you don't think your best will be enough, you might consider asking another poster to be your "civility buddy" and to preview your posts before you submit them.
> When a question is asked I thought the rules stated that you answer the question.
There's no rule that people have to answer questions. People don't even have to reply if they'd rather not.
> I do not feel you are being civil to people.
>
> You really need to stop lecturing people on what they need to do.
>
> You seem to have a need to have power over people
>
> You were irrepsonsible
>
> 2. Wow you just can't stop. ... You just give yourself a pass everytime you can't follow your edicts
>
> It appears you have learned nothing from your previous mistakes.Please don't post anything that could lead others to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
I do hope that you choose to remain a member of this community and that members of this community help you, if needed, to avoid future blocks.
It's up to you to decide whom you interact with. Sometimes interacting with others may be frustrating, staying civil may be a challenge, and new skills may be required. If you're open to developing new skills (which I realize may not be why you came in the first place), that's another way in which you may be supported by other posters.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceChrist_empowered, I'm also sorry if you felt hurt.
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
PS: According to the formula:
duration of previous block: 3 weeks
period of time since previous block: 1 week
severity: 2 (default) + 1 (uncivil toward particular individual) = 3
block length = 8.75 rounded = 9 weeks
Posted by jade k on July 19, 2010, at 17:19:04
In reply to maybe stimulants are the next step..., posted by Christ_empowered on July 17, 2010, at 16:23:13
Back when it first hit the market, they used it as a "psychic energizer" and for those pesky kids who wouldn't sit still and watch "Leave it to Beaver".
C emp,
I find this remark to be particularly offensive. Many of "Those pesky kids" had/have parents who have had to make extremely difficult decisions in terms of what is best for their children, not just while they watch TV. These decisions effect education, learning to socialize appropriatly with other children, and how to interact with the world at large. This is not easy for parent or child. I feel it should not be mocked in this way.
~Jade
Posted by emmanuel98 on July 19, 2010, at 20:30:14
In reply to Re: maybe stimulants, maybe not..... » Christ_empowered, posted by jade k on July 19, 2010, at 17:19:04
I was at a dinner party once and a woman was talking about how kids are overmedicated, etc. After all, she asked, what did they do before ritalin. I said, before ritalin, they had corporal punishment. And worse.
Posted by Dr. Bob on July 20, 2010, at 14:00:54
In reply to Re: maybe stimulants, maybe not..... » Christ_empowered, posted by jade k on July 19, 2010, at 17:19:04
> I find this remark to be particularly offensive.
Would anyone be willing to try to show jade how she might rephrase the above or to encourage her to apologize? You may have the power to help her avoid being blocked again. Thanks,
Bob
Posted by fayeroe on July 20, 2010, at 17:30:08
In reply to Re: being blocked again, posted by Dr. Bob on July 20, 2010, at 14:00:54
Jade, you could say "OMG, I had no idea how offended I could feel just by reading a post that said blah, blah, blah". You will have to fill in the blah, blah, blahs.
"I am really concerned for people who may take the med or have a loved one who takes it."
And I think you could then finish it off with something that is poetic and sweet.
Posted by jade k on July 20, 2010, at 18:42:24
In reply to Re: being blocked again...is she blocked yet? » Dr. Bob, posted by fayeroe on July 20, 2010, at 17:30:08
Mr. Empowered
"OMG, I had no idea how offended I could feel just by reading your post.
>
> "I am really concerned for people who may, or may not, take the med or have a loved one who takes it or may take it or may not take it."
>
"I was shocked at my outburst as I have so thoroughly enjoyed all your other posts!~Jade
Posted by Phillipa on July 20, 2010, at 20:40:49
In reply to Re: Attention Mr. Empowered., posted by jade k on July 20, 2010, at 18:42:24
Good response only in my opinion of course as I felt your pain. Phillipa
Posted by Dr. Bob on July 20, 2010, at 21:35:21
In reply to Re: Attention Mr. Empowered., posted by jade k on July 20, 2010, at 18:42:24
Posted by Dr. Bob on July 22, 2010, at 16:45:57
In reply to Re: blocked for 9 weeks » bulldog2, posted by Dr. Bob on July 19, 2010, at 14:10:53
> Follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Here's a link:
http://www.dr-bob.org/babble/admin/20100714/msgs/955458.html
Thanks,
Bob
This is the end of the thread.
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