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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 54. Go back in thread:
Posted by Phillipa on April 25, 2012, at 17:07:19
In reply to i cant even smile., posted by b2chica on April 25, 2012, at 14:50:32
Add back the perphenazine was working wasn't it? Phillipa
Posted by Alexei on April 25, 2012, at 17:34:17
In reply to Re: i cant even smile. » SLS, posted by SLS on April 25, 2012, at 16:13:45
Of course, we now see how amphetamines can actually have a calming effect for some people.
> - Scott
Agree 100%. I could take my vyvanse at bedtime and fall out immediately.
"Treating MDD with a combination of Parnate + desipramine can crack even the worst cases of depression"I've heard of this. Have you tried it? Suddenly it seems a waste of time to try anything else. IIRC, stims can be taken with MAOI if closely monitored.
Posted by SLS on April 25, 2012, at 17:50:23
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 25, 2012, at 17:34:17
> Of course, we now see how amphetamines can actually have a calming effect for some people.
>
> > - Scott
>
> Agree 100%. I could take my vyvanse at bedtime and fall out immediately.
>
>
> "Treating MDD with a combination of Parnate + desipramine can crack even the worst cases of depression"
>
> I've heard of this. Have you tried it? Suddenly it seems a waste of time to try anything else. IIRC, stims can be taken with MAOI if closely monitored.
The same is true of combining Parnate and desipramine. Traditionally, one either begins taking both drugs at the same time or establishes the desipramine first. Personlly, I have added desipramine to ongoing Parnate therapy without adverse effect. There is some indication that for TRD cases, the combination of Parnate and desipramine is more effective than either one alone. Because Parnate alone is capable of precipitating spontaneous hypertensive reactions, it is prudent to monitor blood pressure for the first few days when desipramine is added.http://apt.rcpsych.org/content/4/6/320.full.pdf
"Combining TCAs and MAOIs
The combination of TCAs and MAOIs has been in
use since the 1960s when the efficacy of this
regime was first strongly advocated. Although the
combination of MAOIs and TCAs is reported to be
hazardous, the risks of significant interaction can
be minimised if reasonable precautions are
taken. These include avoiding imipramine and
APT(1998),vol.4,p.324 Coiveti
clomipramine, and starting the drugs together at low
dose or adding the MAOI cautiously to established
TCA treatment (see Chalmers &Cowen, 1990).
In patients not selected for treatment resistance
the combination of MAOIs and TCAs does not
appear to confer additional therapeutic benefit over
either drug used alone. However, Sethna (1974)
carried out an open study of MAOI-TCA treatment
in 12 patients with depression who had failed to
respond to either TCAs or MAOIs given separately
(or electroconvulsive therapy (ECT) in 10 cases). At
follow-up periods of 7-24 months, nine subjects
were reported to be without significant depressive
symptomatology. Most of these subjects had chronic
non-melancholic depression with prominent
anxiety symptoms.
In addition to these series, case reports continue
to appear where it seems well documented that a
patient has failed to respond to either a TCA or an
MAOI given alone, but achieves a good clinical
response when both drugs are used together (Tyrer
& Murphy, 1990). Therefore, although controlled
evidence is lacking, it seems likely that individual
patients with refractory depression are helped by
MAOI-TCA combinations. Generally, the adverse
effects of the combination are no worse than with
either drug alone, although weight gain and
postural hypotension may be more troublesome.
Conversely, if an MAOI is given with a TCA such as
amitriptyline or trimipramine, MAOI-induced
insomnia may be prevented.
There is less information about the combination
of other antidepressants with MAOIs. However,
trazodone in doses of 50-150 mg is fairly commonly
used to treat MAOI-induced insomnia and is
generally well-tolerated (Nierenberg &Keck, 1989)."
- Scott
Posted by papillon2 on April 25, 2012, at 22:56:36
In reply to Re:sdf » SLS, posted by b2chica on April 25, 2012, at 15:55:59
> i came back to this site cuz i feel like i keep asking for help then not doing anything about it or pdoc ends up going in different direction. sorry i keep asking.
Nope, ask away. We like helping and troubleshooting. :-)
> also cant talk to my pdoc right now. i know he'll want to up zyprexa. and i want to wait till after menses ends to see if mood changes. normally i'm worse after it ends.but we see.
If increasing your Zyprexa dose is a non-negotiable, tell him. Practise what you'll say, being assertive and using "I statements".
Unless you're sectioned under a mental health act, you do NOT have to have a treatment you do not want. And unwillingness to tolerate side effects like excessive, non-relenting weight gain IS a valid reason. Just because other people are willing to put up with it doesn't mean you have to or even should.
There are pretty much always work arounds. Just remember that you may not get weight gain from a med even if it is common in most people. Example: I gain weight on Remeron, but not Nortriptyline, even though Nortriptyline supposedly has a higher weight burden than Remeron. Beats me. I also gain weight on Zyprexa.
Hang in there. xoxoxoxox
Posted by zazenducke on April 26, 2012, at 7:51:46
In reply to Re: i cant even smile. » b2chica, posted by SLS on April 25, 2012, at 15:37:54
>Treating MDD with a combination of Parnate + desipramine can crack even the worst cases of depression, and won't put a single pound on you. S
There is a huge difference between CAN and WILL.
Buying a 2 dollar lottery ticket CAN win you 300 million dollars.How do you define the worst case of depression? I think many people assume it must be theirs :)
Are you aware that weight gain is a side effect of desipramine?
Just posting in the interest of accuracy. Nothing personal Scott.
Posted by SLS on April 26, 2012, at 8:24:52
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 7:51:46
> > Treating MDD with a combination of Parnate + desipramine can crack even the worst cases of depression, and won't put a single pound on you. S
> There is a huge difference between CAN and WILL.
So, my choice of the word "can" was inappropriate?
> How do you define the worst case of depression?
I meant TRD.
> I think many people assume it must be theirs :)
Thanks for the insight. It never occurred to me.
> Are you aware that weight gain is a side effect of desipramine?According to whom? Did you just look it up? IRL?
> Just posting in the interest of accuracy. Nothing personal Scott.
Yeah.
- Scott
Posted by zazenducke on April 26, 2012, at 8:40:35
In reply to Re: i cant even smile. » zazenducke, posted by SLS on April 26, 2012, at 8:24:52
> > > Treating MDD with a combination of Parnate + desipramine can crack even the worst cases of depression, and won't put a single pound on you. S
>
> > There is a huge difference between CAN and WILL.
>
> So, my choice of the word "can" was inappropriate?
No. I was just adding clarity. Can't have too much of that.>
> > How do you define the worst case of depression?
>
> I meant TRD.
>
> > I think many people assume it must be theirs :)
>
> Thanks for the insight. It never occurred to me.
>
> > Are you aware that weight gain is a side effect of desipramine?
>
> According to whom? Did you just look it up? IRL?
>http://www.medicinenet.com/desipramine/page2.htm
It lists a reference as FDA prescribing information. Do you not trust this source? Why?
Posted by SLS on April 26, 2012, at 8:43:06
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 7:51:46
> > Are you aware that weight gain is a side effect of desipramine?
Okay. You are right. As listed in the PI, weight gain is listed as a possible side effect. So, too, is weight loss listed as a possible side effect.
Now, what?
Accuracy.
- Scott
Posted by SLS on April 26, 2012, at 8:45:58
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 8:40:35
> It lists a reference as FDA prescribing information. Do you not trust this source? Why?
You really ought to read the literature that you cite.
- Scott
Posted by zazenducke on April 26, 2012, at 8:54:35
In reply to Re: i cant even smile. » zazenducke, posted by SLS on April 26, 2012, at 8:45:58
> > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
>
>
> You really ought to read the literature that you cite.
>
>
> - ScottI did read what I cited. I didn't read what I cited listed as reference :)
Posted by SLS on April 26, 2012, at 9:15:20
In reply to Re: i cant even smile., posted by zazenducke on April 26, 2012, at 8:54:35
> > > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
> > You really ought to read the literature that you cite.
I read the literature that you provided the following link to as a citation.
http://www.medicinenet.com/desipramine/page2.htm
> I did read what I cited. I didn't read what I cited listed as reference :)
Apparently, not closely enough.
"SIDE EFFECTS: The most commonly encountered side effects associated with desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss..."
Nothing personal. Just trying to be accurate.
Do you think that I am a bully?
- Scott
Posted by SLS on April 26, 2012, at 9:16:31
In reply to Re: i cant even smile., posted by zazenducke on April 26, 2012, at 8:54:35
Have a nice day.
:-)
- Scott
Posted by zazenducke on April 26, 2012, at 9:33:21
In reply to Re: i cant even smile. » zazenducke, posted by SLS on April 26, 2012, at 9:15:20
> > > > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
>
> > > You really ought to read the literature that you cite.
>
> I read the literature that you provided the following link to as a citation.
>
> http://www.medicinenet.com/desipramine/page2.htm
>
> > I did read what I cited. I didn't read what I cited listed as reference :)
>
> Apparently, not closely enough.
>
> "SIDE EFFECTS: The most commonly encountered side effects associated with desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss..."
>
> Nothing personal. Just trying to be accurate.
>
> Do you think that I am a bully?
>
>
> - ScottScott I don't understand what point you are trying to make. Do YOU think you are a bully? I have no opinion. You know yourself much better than I do. I am just pointing out that
desipramine can cause weight gain which is what the quote you produced says.
Posted by ron1953 on April 26, 2012, at 11:41:48
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 9:33:21
It's sad enough having professionals who play doctor and prescribe medications (often with dubious results) in a trial-and-error fashion, but sadder still that there are folks on the internet who are so delusional and/or arrogant as to think they have expertise in the same foggy area. If someone on this site doesn't trust their doctor, perhaps they should question the entire paradigm instead of taking advice from a stranger in the cloud.
Posted by Willful on April 26, 2012, at 12:04:56
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 25, 2012, at 17:34:17
I also agree 100% that some activating drugs-- parnate, amphetamines, ritalin, emsam, rilutek etc-- can have a calming effect.
It may seem contradictory, but they seem to increase ability to concentrate, andto reduce agitation.
Maybe not for everyone, and maybe not at every phase of the drugs, but in general, especially if you;re acclimated to them, and don't get a high or a low phase.
Posted by Willful on April 26, 2012, at 12:15:25
In reply to Re: i cant even smile., posted by ron1953 on April 26, 2012, at 11:41:48
why should we question the paradigm of trying to treat illness with the best available treatments?
Do you prefer that we ourselves remain completely in the dark? do you think we're incapable of reading and drawing inferences. Doctors do their best. And I don't feel that least bit foggy about the knowledge that I"ve acquired in this area. I don't know as much as a doctor-- especially a good one-- but so? I shouldn't have an opinion if I"ve read the literature?
I don't really get your point. We question the paradigm. Then what? It's not the paradigm that matters anyway, it's whether the treatments are helping people. And how to improve their helpfulness. And in case you haven't noticed, researchers are trying.
shall we sit here helplessly insisting nirvana descend? Predicting doom for anyone who dares try a less-then-guaranteed treatment? feel sorry for ourselves because it isn't different? curse our parents physiology and our own? what?
Posted by b2chica on April 26, 2012, at 12:21:22
In reply to Re:sdf, posted by papillon2 on April 25, 2012, at 22:56:36
thank you pappillon2.
i cant believe your post made me cry.
i feel like i'm acting like a baby cuz i'm not doing what i should. but ps. i cried at walgreens last night picking up my adderall rx...not even sure why.
ive decided to up zyprexa tonight.i dont even want to talk to pdoc so i txt'd him to tell him im upping dose after 5 weeks of crap.
i came in to work today to see 300 emails all saying FO. apparently someone stole my email address and using it as a reply for a spam. i'm tired of getting told to f#ck off, and what a terrible person i am. i know they arent really talking to me. but i'm feeling it today. just not what i needed.
so fyi to everyone. if you get a bank scam email. dont bother replying.its doubtful its their email for return.:`(
Posted by b2chica on April 26, 2012, at 12:24:25
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 9:33:21
Posted by sleepygirl2 on April 26, 2012, at 12:32:46
In reply to please dont fight. i'm sorry i started this thread (nm), posted by b2chica on April 26, 2012, at 12:24:25
It's not your fault b2chica, that others are in conflict. No reason to feel sorry, just had to say...
Take care,
sleepy
Posted by ron1953 on April 26, 2012, at 12:55:09
In reply to Re: i cant even smile., posted by Willful on April 26, 2012, at 12:15:25
I'm sorry if my post upset you, and do feel free to ignore my opinions - it's not personal.
If the "best treatment out there" doesn't work, some may choose to stop beating a dead horse. If it works, great; but if it doesn't, doesn't there come a time to stop and reassess the situation?
Some of us weren't born with the "happy gene", and we endure a lifelong struggle trying to be like the ones who were, perhaps never accepting the fact that it'll never happen.
If drug treatment makes the difference between being functional and non-functional, then it would seem "successful" in my opinion, but if it's about being "happy", and has been a multi-year pursuit, then maybe it's time to consider both acceptance of the "condition" and to seek other forms of "therapy", whether it be meditation, exercise, religion, peer support, hobbies, diet, etc., etc., etc..
Maybe there is no there there.
Posted by Alexei on April 26, 2012, at 13:50:32
In reply to Re: i cant even smile. » Alexei, posted by SLS on April 25, 2012, at 17:50:23
> The same is true of combining Parnate and desipramine. Traditionally, one either begins taking both drugs at the same time or establishes the desipramine first. Personlly, I have added desipramine to ongoing Parnate therapy without adverse effect. There is some indication that for TRD cases, the combination of Parnate and desipramine is more effective than either one alone. Because Parnate alone is capable of precipitating spontaneous hypertensive reactions, it is prudent to monitor blood pressure for the first few days when desipramine is added.
>
> http://apt.rcpsych.org/content/4/6/320.full.pdf
>
> "Combining TCAs and MAOIs
> The combination of TCAs and MAOIs has been in
> use since the 1960s when the efficacy of this
> regime was first strongly advocated. Although the
> combination of MAOIs and TCAs is reported to be
> hazardous, the risks of significant interaction can
> be minimised if reasonable precautions are
> taken. These include avoiding imipramine and
> APT(1998),vol.4,p.324 Coiveti
> clomipramine, and starting the drugs together at low
> dose or adding the MAOI cautiously to established
> TCA treatment (see Chalmers &Cowen, 1990).
> In patients not selected for treatment resistance
> the combination of MAOIs and TCAs does not
> appear to confer additional therapeutic benefit over
> either drug used alone. However, Sethna (1974)
> carried out an open study of MAOI-TCA treatment
> in 12 patients with depression who had failed to
> respond to either TCAs or MAOIs given separately
> (or electroconvulsive therapy (ECT) in 10 cases). At
> follow-up periods of 7-24 months, nine subjects
> were reported to be without significant depressive
> symptomatology. Most of these subjects had chronic
> non-melancholic depression with prominent
> anxiety symptoms.
> In addition to these series, case reports continue
> to appear where it seems well documented that a
> patient has failed to respond to either a TCA or an
> MAOI given alone, but achieves a good clinical
> response when both drugs are used together (Tyrer
> & Murphy, 1990). Therefore, although controlled
> evidence is lacking, it seems likely that individual
> patients with refractory depression are helped by
> MAOI-TCA combinations. Generally, the adverse
> effects of the combination are no worse than with
> either drug alone, although weight gain and
> postural hypotension may be more troublesome.
> Conversely, if an MAOI is given with a TCA such as
> amitriptyline or trimipramine, MAOI-induced
> insomnia may be prevented.
> There is less information about the combination
> of other antidepressants with MAOIs. However,
> trazodone in doses of 50-150 mg is fairly commonly
> used to treat MAOI-induced insomnia and is
> generally well-tolerated (Nierenberg &Keck, 1989)."
>
>
> - ScottThank you for this. The only concern would be postural hypotension.... since both drugs can cause it. Would it be possible to remain on vyvanse?
What would make desipramine the preferred TCA? I know it is one of the most potent NRI's. Could low dose seroquel be used for insomnia?
You can probably notice I'm getting weary of trying to find an ssri/snri that works, lolz. Haven't tried pristiq, though.
Thank you...
Posted by Alexei on April 26, 2012, at 14:02:47
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 26, 2012, at 13:50:32
P.S.... I want to apologize for my last post. I did not realize the topic had changed...
I did not read entire thread...
Posted by SLS on April 26, 2012, at 14:37:54
In reply to please dont fight. i'm sorry i started this thread (nm), posted by b2chica on April 26, 2012, at 12:24:25
Dear B2C,
Any altercations that have occurred along this thread have nothing to do with you or your plight. That is the shame of it. I'm sorry. Perhaps I should have asked to start a separate thread. I don't think I would want to, though. I don't have very much motivation to argue with people just for the sake of argument.
Don't worry. You will smile again. In the meantime, I will do the smiling for you. :-)
Keep posting. Please?
- Scott
Posted by Zyprexa on April 26, 2012, at 18:14:18
In reply to i cant even smile., posted by b2chica on April 25, 2012, at 14:50:32
I suggest going up on perphenazine. Back on it and up the dose. 4-8mg /2-3 times a day. I think it may help with weight. Becuase it makes you tired and you sleep off the weight. It does also help with anxiety. I'm pretty sure of that now.
Why did you go off the perphenazine?
Posted by SLS on April 27, 2012, at 7:05:44
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 26, 2012, at 13:50:32
> Thank you for this. The only concern would be postural hypotension.... since both drugs can cause it.
It helps to hydrate with a fluid that contains electrolytes like Gatorade. For me, the hypotension was worst at the beginning of treatment and mitigated over time. It was well worth the wait.
> Would it be possible to remain on vyvanse?
I don't know about Vyvanse, but I have tried Dexedrine along with Parnate and desipramine. There were no adverse effects.
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
"Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression"
http://www.ncbi.nlm.nih.gov/pubmed/3997787
I wish I could find the full text.
http://www.dr-bob.org/tips/split/TCAs-+-MAOIs.html
> What would make desipramine the preferred TCA?I was making reference to using desipramine when weight-gain is a concern. For me, nortriptyline produces a better antidepressant response than desipramine. However, the first time I entered a period of extended remission, it was the result of treatment using a Parnate + desipramine combination.
> I know it is one of the most potent NRI's. Could low dose seroquel be used for insomnia?
I can't think of any reason why not.
http://www.theannals.com/content/40/3/567.full
Interestingly, high dosages of Seroquel result in a certain amount of NE reuptake inhibition via an active metabolite.
- Scott
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Dr. Bob is Robert Hsiung, MD,
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