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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 g_g_g_unit on July 29, 2010, at 8:45:00
I've just recently moved countries and saw a psychiatrist who was of no use to me. I've since managed to track down a psychologist I'm very happy with and who has tentatively diagnosed me as suffering from: Atypical Depression, Inattentive ADD (lifelong), Pure "O" OCD (emerging amidst the stress of college), PTSD (from dealing with the OCD). I've been chronically depersonalized since the OCD crescendoed and capitulated me into major depression, and have been suffering from persistent cognitive problems.
Unfortunately, it's *incredibly* hard to tease out what is causing what. I know that Depersonalization/PTSD, Depression, and inattentive ADD *all* have their own associated cognitive difficulties. If I'm not actively dissociating, then I'm prey to a sluggish ADD tempo, or trying to battle the onslaught of OCD.
Logically, I imagine a prescriber would suggest an SSRI for the depression, depersonalization and OCD, but if this makes the inattentive ADD worse, then I'm guessing it would just enhance my fogginess and feelings of detachment. They've also never done wonders for my mood. Stimulants (well caffeine anyway) make me feel more present, less anhedonic, and more attached to my thoughts for a couple of days before 'pooping out'.
Is the logical answer an SSRI + stimulant? My psychologist has suggested Effexor.
Should I consider giving an MAOI another shot? I'm a little wary of going down that path though because sleep deprivation just seems to exacerbate things.
Thanks for any advice.
Posted by Christ_empowered on July 29, 2010, at 11:25:42
In reply to how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 29, 2010, at 8:45:00
Sorry you're going through such a rough patch. Using an antidepressant with a stimulant has its pros and cons. The stimulant boosts the antidepressant, and the antidepressant can help mellow out the stimulant a little bit--I personally found that a reuptake inhibitor of some sort mixed with a stimulant made the stimulant less harsh and also made the time in between doses a good bit more tolerable.
I would think Cymbalta or Effexor would be good with a stimulant. I used to take Tofranil-PM with Adderall with good results. Cymbalta is kind of like Tofranil (I think...) in that it has balanced dual reuptake inhibition, whereas Effexor is an SSRI at lower doses and then you get dual action at higher doses and (I think) some dopamine reuptake inhibition at much higher doses. The cool thing about Cymbalta is that, unlike effexor, dosing is easy; 60mgs is the ideal dose, based on the data available. You don't have to go up and down like you would with some other medications.
Do keep in mind that mixing a stimulant and an antidepressant can sometimes lead to serotonin syndrome.
There are now non-stimulant options for ADD. You have Tenex (original, generic, and a new form specifically for ADD--I think its an XR or something), Straterra, or high doses of more activating antidepressants (Wellbutrin, Cymbalta, Effexor, etc.) w/o a stimulant.
You could use a non-stimulant, especially something like Tenex, along with a stimulant and other CNS drugs.
Good luck.
Posted by Christ_empowered on July 29, 2010, at 11:37:15
In reply to how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 29, 2010, at 8:45:00
I just thought, since I'm currently a vitamin junkie, that I'd also mention deplin. It is an Rx only vitamin product that apparently boosts antidepressants. If you opt to take an antidepressant, you might get better results if you take deplin with the antidepressant.
www.deplin.com
Posted by Phillipa on July 29, 2010, at 12:51:40
In reply to Deplin!?!, posted by Christ_empowered on July 29, 2010, at 11:37:15
Don't you have to watch B 12 levels with Deplin? I did try it once. Didn't notice a thing. Phillipa
Posted by manic666 on July 29, 2010, at 13:05:01
In reply to how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 29, 2010, at 8:45:00
1f you want a simple answer to a ssri,PROZAC it cured my depression an killed o.c.d dead.Also ssri,s are a lot better to tapper on an off, Effexor an snri is a nightmare to get off
Posted by g_g_g_unit on July 30, 2010, at 5:58:33
In reply to Re: how to 'treat' this awful conglomerate of issues?, posted by Christ_empowered on July 29, 2010, at 11:25:42
Thanks for your reply. I've read some criticisms about using a stimulant in conjunction with an SSRI - things along the lines of the combo inducing a sorta zombie-ish state of focus, wherein it becomes easy to just zone out on whatever happens to be in front you.
Unfortunately, like I say, the OCD and depression are relatively severe, so I'm not left with too many options. Do you think Cymbalta would be at all effective for OCD, or would the greater NE action disturb any anti-obsessional benefits?
I'm also not terrible sure how effective the non-stimulants like Tenex would be for inattentive ADD (characterized my mental sluggishness, motivational difficulties, etc.). My general impression was that the compounds were better suited to hyperactivity.
I guess I should try to get the depression and OCD under control first and then see if I could tolerate a stimulant. I'll keep your suggestion of Cymbalta in mind. I'm a little scared of the Effexor withdrawals ...
> Sorry you're going through such a rough patch. Using an antidepressant with a stimulant has its pros and cons. The stimulant boosts the antidepressant, and the antidepressant can help mellow out the stimulant a little bit--I personally found that a reuptake inhibitor of some sort mixed with a stimulant made the stimulant less harsh and also made the time in between doses a good bit more tolerable.
>
> I would think Cymbalta or Effexor would be good with a stimulant. I used to take Tofranil-PM with Adderall with good results. Cymbalta is kind of like Tofranil (I think...) in that it has balanced dual reuptake inhibition, whereas Effexor is an SSRI at lower doses and then you get dual action at higher doses and (I think) some dopamine reuptake inhibition at much higher doses. The cool thing about Cymbalta is that, unlike effexor, dosing is easy; 60mgs is the ideal dose, based on the data available. You don't have to go up and down like you would with some other medications.
>
> Do keep in mind that mixing a stimulant and an antidepressant can sometimes lead to serotonin syndrome.
>
> There are now non-stimulant options for ADD. You have Tenex (original, generic, and a new form specifically for ADD--I think its an XR or something), Straterra, or high doses of more activating antidepressants (Wellbutrin, Cymbalta, Effexor, etc.) w/o a stimulant.
>
> You could use a non-stimulant, especially something like Tenex, along with a stimulant and other CNS drugs.
>
> Good luck.
>
>
Posted by g_g_g_unit on July 30, 2010, at 5:59:30
In reply to Re: how to 'treat' this awful conglomerate of issues?, posted by manic666 on July 29, 2010, at 13:05:01
> 1f you want a simple answer to a ssri,PROZAC it cured my depression an killed o.c.d dead.Also ssri,s are a lot better to tapper on an off, Effexor an snri is a nightmare to get off
Thanks for the suggestion. I've tried Prozac twice though and each time it's produced insomnia at doses above 20mg.
Posted by Christ_empowered on July 30, 2010, at 7:41:09
In reply to Re: how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 30, 2010, at 5:59:30
I'm not a doctor or anything--just a patient who's been around the block a few times re: meds. I suggested Cymbalta b/c its kind of like a cleaned-up TCA (so is effexor), so you might get more of an anti-depressant effect. TCA drugs are considered by some to be more effective for more severe cases of depression, even though they don't out-perform SSRI drugs for moderate depression.
The zombie state is possible, I've experienced it, but it is also possible with stimulants alone. Stimulants can leave you in a hyper-focused but utterly unproductive state; I've personally found that this is a result of an excessively high dose, but I imagine that for some people, a stimulant really isn't the way to go at any dose. Unfortunately, you may just have to try it out and see.
Stimulants are sometimes used for OCD. Dexedrine in particular seems to be pretty popular; I don't know if that is because Dexedrine has unique characteristics that make it awesome for some cases of OCD, or if its just b/c Dexedrine pre-dates Adderall by a good 30+ years as a psych drug (Adderall, BTW, was originally a diet pill, not a psych drug).
You're right about the Tenex (and I would imagine clonidine) being better for the restless kind of attention problems; Tenex and clonidine can, however, help with stimulant-induced side effects and sleep, so if those problems pop up during treatment, it might be something to consider (although that would be a lot of medication to take).
I wish you the best of luck with what you're going through. Hopefully, you'll find medication(s) that get you to point where you can function better and enjoy life more.
Posted by manic666 on July 30, 2010, at 13:06:25
In reply to Re: how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 30, 2010, at 5:59:30
Of the things you listed ,Insomnia is not a bad trade off for getting rid of depression an ocd. there are lots of ways to induce sleep.I only sleep 4 hours a night ,an so does my wife an she has no mental illness. 20mg of prozac was all i took for 2 years an i never felt better. It was a long time ago before generic. It pooped out on me when the NHS only aloud generic, which in a word is grap.Did you try the real prozac or its,poor subsitute
Posted by g_g_g_unit on July 30, 2010, at 23:37:29
In reply to treatment options..., posted by Christ_empowered on July 30, 2010, at 7:41:09
Have you tried Cymbalta yourself? If so, did you find it less numbing than the SSRI's?
Dexedrine has less peripheral stimulation than Adderall, which is probably why it's more suited to OCD.
Thanks again for your suggestions. When I first saw your user-handle, I was fearing a zealous anti-medication spiel :)
> I'm not a doctor or anything--just a patient who's been around the block a few times re: meds. I suggested Cymbalta b/c its kind of like a cleaned-up TCA (so is effexor), so you might get more of an anti-depressant effect. TCA drugs are considered by some to be more effective for more severe cases of depression, even though they don't out-perform SSRI drugs for moderate depression.
>
> The zombie state is possible, I've experienced it, but it is also possible with stimulants alone. Stimulants can leave you in a hyper-focused but utterly unproductive state; I've personally found that this is a result of an excessively high dose, but I imagine that for some people, a stimulant really isn't the way to go at any dose. Unfortunately, you may just have to try it out and see.
>
> Stimulants are sometimes used for OCD. Dexedrine in particular seems to be pretty popular; I don't know if that is because Dexedrine has unique characteristics that make it awesome for some cases of OCD, or if its just b/c Dexedrine pre-dates Adderall by a good 30+ years as a psych drug (Adderall, BTW, was originally a diet pill, not a psych drug).
>
> You're right about the Tenex (and I would imagine clonidine) being better for the restless kind of attention problems; Tenex and clonidine can, however, help with stimulant-induced side effects and sleep, so if those problems pop up during treatment, it might be something to consider (although that would be a lot of medication to take).
>
> I wish you the best of luck with what you're going through. Hopefully, you'll find medication(s) that get you to point where you can function better and enjoy life more.
>
>
Posted by manic666 on July 31, 2010, at 3:54:50
In reply to Re: treatment options... » Christ_empowered, posted by g_g_g_unit on July 30, 2010, at 23:37:29
No the haddle is only for impact,not many dare use the devil sign 666, that,s just my kick in the face to illness. Cybalta yes i have been on it, It was good for aches an pains it was like a 10,000 shot of ibrufin ,but for depression no good anxierty worse, Effexor is satan,s child to me made me loose body an head hair.The hair has grown back on my head ,but to this day i could win a loverly legs compertision the aint no hairs still on my legs.
Posted by chujoe on July 31, 2010, at 5:54:22
In reply to Re: treatment options..., posted by manic666 on July 31, 2010, at 3:54:50
I just mentioned this is another thread, but I take 60 mg of Cymbalta & 30 mg of Ritalin for a cluster of symptoms very close to yours. It works a treat. I feel better than I have in years.
Posted by manic666 on July 31, 2010, at 7:10:57
In reply to Re: treatment options..., posted by chujoe on July 31, 2010, at 5:54:22
maybe, but it dont do it for me i was on 6 months.I dont even no what ritalin is.I live in England we dont get things like add ons.Just shut the door on your way out. But we do no worse on 1 med as you do on combo,s. We just aim for 2 targets depression an anxierty, an are given 1 med that attacks both.A benzo if your 2 minutes from death, brit docs are reluctant an are told not to give benzo,s.All the other thinks like not sleeping ,costipation ,ace,s an pains , migranes,ECT ECT we dont look for stimulants we just get on with it,There is no one to write us presciptions For the types of meds you talk about,plus are shrinks would not no what the are unless the in the NHS bible
Posted by Christ_empowered on July 31, 2010, at 8:46:46
In reply to Re: treatment options... » Christ_empowered, posted by g_g_g_unit on July 30, 2010, at 23:37:29
hey. yeah, I've been on cymbalta @ 60-90mgs/day. The 60mgs/day was reasonably effective; it kept the worst of the depression at bay, but it didn't really touch my anxiety. The 90mgs/day was an Rx from a not-so-great doc; it made my stomach hurt and caused pretty intense anxiety. There's usually no reason to go above 60mgs/day...the Cymbalta people tested higher doses and settled on 60mgs as the best doses for the vast majority of people.
It did numb me up some. Taking it with Adderall kind of helped with that. I think the dual reuptake inhibition helped prevent full-blown SSRI style apathy and lethargy, but, still...its not as if Cymbatla is some sort of amazing breakthrough drug. It just may be slightly better, for some people, than other options.Good luck.
Posted by chujoe on July 31, 2010, at 13:43:30
In reply to Re: treatment options..., posted by manic666 on July 31, 2010, at 7:10:57
Ritalin is just speed, Manic. Methelphenedate. (sp?)
Posted by manic666 on July 31, 2010, at 13:45:29
In reply to Re: treatment options..., posted by chujoe on July 31, 2010, at 13:43:30
Posted by bleauberry on August 3, 2010, at 18:30:12
In reply to how to 'treat' this awful conglomerate of issues?, posted by g_g_g_unit on July 29, 2010, at 8:45:00
Try an antibiotic like Doxycycline or Flagyl.
Anytiime brain fog is an issue, IMO antibiotics have to be on the radar screen. Add in a long history of psychciatric issues not responding well to psych drugs, and it is takes on even more suspicion.
You don't wait for a test or try to figure it out. You just get an antibiotic and take it and see what happens. The same as you would with any of 50 potent drugs in the psychiatric toolbox. Except the antibiotic actually makes sense.
This is the end of the thread.
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