![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by simcha on August 18, 2010, at 16:06:44
Folks, I'm coming to you again after having a few good years with my MDD with recurrence. Currently I'm on the following regimen:
Morning:
60mg CymbaltaEvening:
450mg BuproprionXL
.5-1mg of Klonopin for restless legs
25mg Trazodone for insomniaI used to be on 300mg BuproprionXL until 2 weeks ago when my pdoc increased the dosage to 450mg because I was very depressed. I've started to feel better but I'm not all the way back to remission yet. I'm still having a "why bother" attitude. I have a lack of motivation. I have a hard time focusing. And I'm still down in mood more often than not.
My pdoc mentioned he might max out the Cymbalta dose next to 90 or even 120mg? The thing is that I sweat so much and I think that the Cymbalta makes that worse. And I have Ectopic Atrial Tachycardia and I suspect that they Cymbalta may be contributing to raising my pulse rate sometimes.
He mentioned that he could try to start changing my meds. He reasoned that since I'm on so many meds that he's not sure what does what. I have this feeling I'm still benefiting from the BuproprionXL since in increase of 150mg for the past two weeks has helped somewhat.
He said that I should investigate the following meds:
Remeron
Lamictal
AbilifyMy brother is on Remeron. He used to be quite thin. He isn't anymore. The medication makes mornings groggy for him. I'm not a morning person. I'm not a thin guy. I'm already a big guy. Anything that makes you gain weight is not going to work for me.
Abilify scares the crud out of me. I already have borderline high cholesterol and this drug increases serum cholesterol. Beyond that it can encourage diabetes. Also there is a significant risk of Akathisia. I already have restless legs, so I don't want that.
Lamictal sounds more benign but is it really all that effective for depression? Also there is the chance of getting a rash. I've had allergic reactions to some medications in the past and they are not fun.
In the past I've already tried EffexorXR (effective but major impotence and intensely horrific withdrawal).
I was on Neurontin for the longest time, gained weight and it didn't really seem to do much of anything.
Celexa was also in my mix. It pooped out.
I have no clue what to tell him. I don't know what would be best. Should I get off of the Cymbalta and have it replaced by Remeron, Abilify, or Lamictal eventually? Anyone have any suggestions or experiences to offer. I'd appreciate it.
Posted by simcha on August 18, 2010, at 18:51:28
In reply to Depressed Again. Haven't been here in years., posted by simcha on August 18, 2010, at 16:06:44
OK, so it seems that my pdoc is going to start me on Lamictal and keep everything the same for the moment. He says that if I notice an improvement from the Lamictal, I could possibly drop the Cymbalta. I'm not sure the Cymbalta has been the best drug for me. It makes me sweat uncontrollably and it messes up my sex life. And it has a reputation for increasing heart rate and since I have Ectopic Atrial Tachycardia, I've wondered whether or not it has been the best drug for me to take for a while.
Anyone currently using Lamictal as a booster for an anti-depressant? Anything I should expect to see if it's working? Anything I should watch out for? Am I making a good decision by following this suggestion?
Posted by bleauberry on August 19, 2010, at 18:15:40
In reply to Depressed Again. Haven't been here in years., posted by simcha on August 18, 2010, at 16:06:44
> Folks, I'm coming to you again after having a few good years with my MDD with recurrence. Currently I'm on the following regimen:
>
> Morning:
> 60mg Cymbalta
>
> Evening:
> 450mg BuproprionXL
> .5-1mg of Klonopin for restless legs
> 25mg Trazodone for insomnia
>
>
> He said that I should investigate the following meds:
>
> Remeron
> Lamictal
> Abilify
>
> My brother is on Remeron. He used to be quite thin. He isn't anymore. The medication makes mornings groggy for him. I'm not a morning person. I'm not a thin guy. I'm already a big guy. Anything that makes you gain weight is not going to work for me.
>
> Abilify scares the crud out of me. I already have borderline high cholesterol and this drug increases serum cholesterol. Beyond that it can encourage diabetes. Also there is a significant risk of Akathisia. I already have restless legs, so I don't want that.
>
> Lamictal sounds more benign but is it really all that effective for depression? Also there is the chance of getting a rash. I've had allergic reactions to some medications in the past and they are not fun.
>
> In the past I've already tried EffexorXR (effective but major impotence and intensely horrific withdrawal).
>
> I was on Neurontin for the longest time, gained weight and it didn't really seem to do much of anything.
>
> Celexa was also in my mix. It pooped out.
>
> I have no clue what to tell him. I don't know what would be best. Should I get off of the Cymbalta and have it replaced by Remeron, Abilify, or Lamictal eventually? Anyone have any suggestions or experiences to offer. I'd appreciate it.Of everything you said above, one thing jumped out at me...celexa was in the mix but pooped out.
That would have been the perfect time to add nortriptyline, not some other new age drug. SSRI+TCA is hard to beat. Why they go for the exotic drugs instead, I have no clue. My own theory is that when an ssri poops out, it is because the body can longer keep up the struggle to elevate norepinephrine to match the artificially high serotonin. That's where the TCA comes in.
You doctor is a doctor, and I am not. Regardless, I would shun all three meds he suggested, for all the reasons you mentioned plus some of my own. Better choices IMO would include LDN, Nortriptyline, Ritalin, and the natural supplement DLPA.
Of the 3 meds he suggested, I personally might consider a short trial of abilify at no higher than 1mg to start with, and a ceiling of 5mg. Go from there depending on what happens. The other meds, forget it. Just my opinion though.
Posted by simcha on August 19, 2010, at 20:43:12
In reply to Re: Depressed Again. Haven't been here in years., posted by bleauberry on August 19, 2010, at 18:15:40
Thanks Bleauberry, I responded to you about why I can't take the Ritalin in the other thread titled "Monotherapy vs. Polytherapy." (electrical heart issues)
Perhaps I could try the DLPA. I could ask my pdoc about using it to see if it reacts with anything I'm taking now.
I'm not sure what LDN is or what it does. Can you explain this please?
Also, I don't know about TCAs. I may be able to take Nortriptyline if it doesn't interfere with my heart medicine, Sotalol, or my heart rate. I know TCAs are good medications for some people with treatment resistant depression. Perhaps that's what I'll try next if Lamictal doesn't help.
Posted by bleauberry on August 20, 2010, at 15:29:39
In reply to Re: Depressed Again. Haven't been here in years. » bleauberry, posted by simcha on August 19, 2010, at 20:43:12
I don't know, you kind of have to do whatever your doc wants.
The best way to learn about LDN is to do a google search on it. That will bring you to the LDN (low dose naltrexone) home page and other good sources of info as well.
With heart problems, TCAs might be off limits except in small doses. But combined with SSRI, they don't need to be any more than small doses anyway. I don't like the idea of lamictal, but I'm not the doctor.
If you do try DLPA, ignore the instructions on the web or the bottle. Instead, make custom size doses starting at 60mg (divide the powder into 8 roughly equal size piles), and do just one pile in the morning between meals. Then gradually build up. You can stir it in water, juice, or make your own custom capsules from empty size OO gel caps.
The clinical trials on DLPA were back in the 1970's and 1980's. They were small and probably not as controlled as trials today. In those trials response was very good, as good or better than drugs. Their doses were 75mg to 200mg per day. The internet folks are pushing for 1500mg a day or more. I am sensitive and so stay low on dosing, and I trust those trials more than I trust someone selling DLPA.
If your doc is from the old school or has an expanded knowledge base outside of his formal training, he'll know about DLPA and its potential. If he doesn't, he will shun it simply because he doesn't know about. They can tend to be critical of things they know nothing about, whether that thing is a miracle or not doesn't matter.
> Thanks Bleauberry, I responded to you about why I can't take the Ritalin in the other thread titled "Monotherapy vs. Polytherapy." (electrical heart issues)
>
> Perhaps I could try the DLPA. I could ask my pdoc about using it to see if it reacts with anything I'm taking now.
>
> I'm not sure what LDN is or what it does. Can you explain this please?
>
> Also, I don't know about TCAs. I may be able to take Nortriptyline if it doesn't interfere with my heart medicine, Sotalol, or my heart rate. I know TCAs are good medications for some people with treatment resistant depression. Perhaps that's what I'll try next if Lamictal doesn't help.
Posted by simcha on August 21, 2010, at 20:08:56
In reply to Re: Depressed Again. Haven't been here in years. » simcha, posted by bleauberry on August 20, 2010, at 15:29:39
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.