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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by GoddamnElectric on May 15, 2012, at 0:06:54
Long time lurker here! I'll try and introduce myself and my predicament...
I'm a 28 year old male from Australia.
I was prescribed high dose SSRI's from the age of about 11 onwards for anxiety and panic attacks. (It was moreso very high amounts of anxiety that lingered for months at a time.) *Note, I have never been off medication until now*
I have been on practically every SSRI medication available, and unfortunately during all these years I never really received help to understand what I was feeling and/or why, until I was old enough to fend for myself... this has been a slow process through attained wisdom (from therapists and collective understanding from online information - wikipedia FTW) and self-insight.
I have been on:
Paroxetine 40mg
Fluvoxamine 150-300mg
Escitalopram 20mg
Zoloft 50-200mg
Mirtazapine - 45mg
Tricyc drug - Clomipramine- ?? can't remember dose
Effexor - 75mg starting dose.... now here's where things went crazy for me, I will get to this towards the bottom of this wall of text... (not in a bad way)
I felt for many years, no matter how much I tried to get well rested... I never felt like I'd slept, as to say even more tired than when I went to bed on a daily basis. I am in a normal BMI range, being 86kg's or so at 6'ft tall, ectomorph body type.Only in the last 6 months, after seeing several different sleep doctors, normal GP's, psychiatrists, sleeping pills you name it for the last 4 years, I went to my doctor and said "I demand a sleep study, I've asked you and many other doctors for the same thing, they all tell me it's in my head, but I know how I feel... I don't care if I have to pay for a sleep study, I'm unhappy with how I'm feeling". He thankfully agreed and put it through... I asked for this for YEARS from a range of doctors, including sleep specialists. I was told my sleep concerns were all in my head and I just had anxiety/depression. I find it hard to get a doctor to listen to you if they see you've had a history of anxiety and what not, like they jump straight onto mental problems and stop listening.
I had the sleep study done, and BAM... SEVERE SLEEP APNEA. Over 45 combined apneas/hypopneas per hour, lots of breath holding. Now this is unusual for someone like myself, I've had myself checked out by an ENT and all seems fine... perhaps a thick tounge, narrow pathways in my neck but that's just run of the mill imperfect human design, really.
When I review all the medications I've been on in my time, I realised all of them gave me apathy/lack of motivation/carelessness and tiredness... except for when I tried an SNRI. Whether or not I've had sleep apnea for many years is anyones' guess, but it's taken care of now with a CPAP machine and my life has improved for the better.
My concern is I still don't feel like I have energy in my brain, no drive or desire or motivation... even though I have many great things I want to do with my life, I just can't seem to get a fire lit under my butt.So this leads to something amazing which happened for me when I tried Effexor... my mind felt like it had energy, drive, motivation, desire... literally a fire lit under my buttocks! And this was when I was still suffering with terrible yet to be diagnosed severe sleep apnea.
I responded so well to the starting dose of 75mg, and it made me feel amazing within days, perhaps great improvement within the first day. The problem I had with it over months was increased muscle tension, and so pain... it became quite intense over several months and so I simply had to quit. I tried again a few more times, being told that was an unusual side effect, but the same thing happened.
Now with several months of cpap therapy... trying to make something of myself (I tried studying and my brain just felt so slow and foggy, so I'm just working an average job) and doing a lot of reading... I really believe some sort of stimulant medication would work wonders for me. Whether I start with an NRI or a workable amphetamine based drug with less of a tendency to cause increased anxiety, is hard to say. I have got over 95% of all my anxiety related issues, the the general low mood I had with being so incredibly unrested all the time just by getting a good nights sleep, who woulda' thought?! No medication for the last few months and I feel like I've finally found a path to fixing my poor brain/body which has been holding me back from all I wish to achieve.
After much thought and investigation, I believe I either have Inattentive ADD (no hyperactivity aspect) and/or my brain chemistry has truly been rooted from being on SSRI's for so long through my young life/terrible sleep apnea/who the funk knows what EXACTLY... but I can say the NRI aspect of Effexor clearly worked for me, even at the dose which 'supposedly' doesn't work much on NE at that dose. I know it's very possible just with the way my brain is wired, and my body chemistry... that it works very well, perhaps it worked by repumping some dopamine as NE is very closely related.
So, for those who managed to read through my long winded post (which I think was necessary), what would be my best starting point in terms of NE/DA Reuptake/Release effect?
My guess is to start out with an NRI, before I even think about a dual NE/DA medication and see how I go.
For those out there much more intelligent than I, what would you speculate is the reason the NRI portion of a medication worked so well for me at such a preliminary dose? What would you recommend to me on this basis?
Reboxetine?
Sorry for the wall of text, but I am always a student to learning more about how this crazy world works, medications, life in general and I'd like to think those of you here could help salvage the life of someone who really wants to be as well as he can possibly be.
Thanks for reading!
Posted by rjlockhart04-08 on May 16, 2012, at 1:35:43
In reply to Helpful advice on NE and/or NE/DA medication?, posted by GoddamnElectric on May 15, 2012, at 0:06:54
I am not the high minded posters of babble but I can relate to your post and your struggle with slow thoughts, same thing right here..now a NRI may be some benefit to you, but its not going to release the feeling as stimulants do. Amphetamine type stimulants are activating, they stimulate behavior and repetative tasks. Methyphenidate is less activating, but it does provide long periods of focus, and increases motivation due to the increase of dopamine in the synapse..it doesnt release it. Amphetamine type stimuants tend to leave people tired and washed out after they were off.
See....I take Nuvigil and of course its suppost to be working right now but I am suffering with something in my digestive track that is preventing it from being absorbed, its vary frustrating...like wanting to kick a car for not using the gasoline or the oil, seriously it makes so mad. But, to get back to the point...Provigil with Wellbutrin will simulate a psychostimulant effect to mild degree....you could also try strattera or roboxetrine with provigil...but you have to sit down with a doctor and have to explain whats going on, some doctors will give you b*llsh*t medications and vary difficult to work with, and they can be a waste of time if your condition is getting worse. They will sit there an argue and even try to confuse you when you telling them facts, come up with their own false conclusion and will not treat the condition. How do I know this? because my doctor is one of these doctors, arrogant, corrupt in their own mind, their fruit is a good as a rotten apple to the core, full of deciet and trickery. But anyways, back to what your saying, I personally think that a stimulant would help you in this situation but ... Norephrinerine medications can increase anxiety...it just depends on the person, if they low levels of it then it may be beneficial and bring them back to normal....have you ever heard of vivactil?
really you should ask about it but still until then we need to think of medication that is easy to be prescibed, usally in the first visit...or any visit that you can be switched to another medication quickly, wellbutrin, prozac, effexor to a high dose, pristiq, celexa...these medications are usally written on a presciption within mintues of discussing about depression. You going to have to be smart with your doctor, know how they think, and their likes and dislikes. After the first class of medications are used then they should move to something else...like Vivactil and then after that maybe Parnate but that has alot of side effects, but it works well and stimulanting...oh!! I forgot to mention....Selegine, keep that in mind and bring it up when you thinks its time to do it with your doc. Until then, theres a supplement called L-tyrosine....it will increase your dopamine levels for a period of time and It should help with sluggish thoughts, it made feel sharp, but its not a stimulant.
Best luck to you really...i really can relate to your posts.
rj
Posted by creepy on May 16, 2012, at 9:48:06
In reply to Helpful advice on NE and/or NE/DA medication?, posted by GoddamnElectric on May 15, 2012, at 0:06:54
Wonder if the effexor pushed you into a hypomanic state? It can happen to anyone if theyre susceptible.
I wouldnt chase the antidepressant properties of amphetamines.. they inevitably induce tolerance and you have to raise the dose to get the same response. Im not sure if motivation and energy would work the same or not, my guess is yes.
If you have a history of anxiety, any of the stimulant type meds will probably make it worse.
I liked desipramine when I was on it. Its cheap too.
any SSRI can cause apathy. wellbutrin is usually prescribed for that. Problem is it makes a lot of folks anxious and irritable.
Posted by GoddamnElectric on May 16, 2012, at 17:32:34
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by creepy on May 16, 2012, at 9:48:06
> Wonder if the effexor pushed you into a hypomanic state? It can happen to anyone if theyre susceptible.
> I wouldnt chase the antidepressant properties of amphetamines.. they inevitably induce tolerance and you have to raise the dose to get the same response. Im not sure if motivation and energy would work the same or not, my guess is yes.
> If you have a history of anxiety, any of the stimulant type meds will probably make it worse.
> I liked desipramine when I was on it. Its cheap too.
> any SSRI can cause apathy. wellbutrin is usually prescribed for that. Problem is it makes a lot of folks anxious and irritable.I looked up the symptoms of hypomania, to be honest I couldn't give you an exact answer. To me it honestly just felt like my mind was clear, I could think straight, focus on things properly and wanted to get things done. I wasn't in a state of racing thoughts, agitation, anxiety or anything like that... though it did affect my sleep quite badly for a while.
Wellbutrin is not considered a very useful medication overall, here in Australia. It is prescribed 99% of the time for those who want to quit smoking. After doing a bit of research on it, I'm led to believe there are better medications available.
In terms of stimulant tolerance, that seems to be easily solved by doing a slow taper and supplementing with l-tyrosine or similar precursor amino acids for building dopamine/norepinephrine stores. The process seems pretty straight forward, though I can easily see where people have got stuck... especially with fast acting, quick duration stimulant medications.
Vyvanse seems to be a good medication with slow onset and long duration, though I will try out an NRI medication first and see how I go.
I was hoping someone here could give me their experience on a norepinephrine type medication?
Posted by rjlockhart04-08 on May 16, 2012, at 19:58:17
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by GoddamnElectric on May 16, 2012, at 17:32:34
NRI's usally give more vigilent type feelings, more alertness, but it does not provide a stimulant feeling completly but it does increase alterness. Increase in the ability to pay attention....longer periods. Have you tried strattera yet?
Posted by GoddamnElectric on May 17, 2012, at 0:49:27
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by rjlockhart04-08 on May 16, 2012, at 19:58:17
> NRI's usally give more vigilent type feelings, more alertness, but it does not provide a stimulant feeling completly but it does increase alterness. Increase in the ability to pay attention....longer periods. Have you tried strattera yet?
While I have not tried strattera, it might be something worthwhile. It is a black box medication, so that in concerning but I have been on a few other black box medications... so I'm happy to give it a go.
From what I understand, Reboxetine would probably work just as well.
Posted by psychobot5000 on May 29, 2012, at 2:24:50
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by GoddamnElectric on May 17, 2012, at 0:49:27
>
> From what I understand, Reboxetine would probably work just as well.
>
>
Straterra and reboxetine are, in my experience, very, very different medications, despite the fact that they act in (roughly) the same way. These ways we think about medications--what neurotransmitter they affect, what transporter they occupy--are really very crude. We have to think about other things, things largely unknown: what brain regions are affected by a given drug, what concentrations make it to the striatum as opposed to the nucleus accumbens, what down-the-line alterations in brain structure or chemistry occur. Even that is a pretty rough way to look at the intricacy of the central nervous system. ...And, in any case, every person's brain chemistry is different. Everyone reacts differently to a given drug. Which is a long way of saying: this theorizing only goes so far; you can only find out what works FOR YOU through some drug trials.Bottom line: if effexor worked for you in a way that SSRIs didn't, then great! If you can't find a way to keep taking it (could you ask them to add a muscle-relaxant? I don't know...), then you may well get mileage by trying medications that affect noradrenaline (there's no reason to go immediately to dopaminergics--many aren't very good [or are illegal], and effexor has no direct effect on dopamine, anyway). In my experience, desipramine is a good NA medication, but I don't believe you have that in Australia. Nortriptyline is another good one. Reboxetine could be a good choice, but maybe not straterra for your purposes--it doesn't have a great reputation... Any tricyclic antidepressant, with the possible exception of clomipramine--which you seem to have already tried anyway (and if that one didn't work, you may wish to avoid imipramine as well)-- is probably worth trying. Wellbutrin has its flaws, but I think may also be worth your time. Milnaciprin, if you have it down there, is pretty similar to effexor, so that might be a place to go first, if they have it down there. That might be where I would go first.
Keep in mind that, if you end up going for drugs that affect dopamine as well, they can be difficult to get. Still, if you have ADD-like symptoms (if you have depression, then -technically- you don't have ADD also, at least according to official psychiatry. Mental illness classification is weird, that way. But, seriously, depression can cause the same symptoms, and what you call a thing doesn't matter), it may be a possibility.
Hope that's useful in some way.
Posted by creepy on May 30, 2012, at 7:32:21
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by GoddamnElectric on May 16, 2012, at 17:32:34
I was on desipramine for awhile. The TCAs get used for pain quite a bit. It also gave me some energy and attention which I lack with chronic fatigue.
I had some headaches at first, thats about it.
One thing I noted was that like a lot of drugs that raise NE, my sinuses cleared up and my sense of smell came back for a bit.
I cant recall if it messed with CYP1A2.. but it made caffeine more potent.
Posted by psychobot5000 on May 30, 2012, at 14:03:11
In reply to Re: Helpful advice on NE and/or NE/DA medication?, posted by psychobot5000 on May 29, 2012, at 2:24:50
cymbalta/duloxetine is another one to try--similarish to effexor.
> >
> > From what I understand, Reboxetine would probably work just as well.
> >
> >
> Straterra and reboxetine are, in my experience, very, very different medications, despite the fact that they act in (roughly) the same way. These ways we think about medications--what neurotransmitter they affect, what transporter they occupy--are really very crude. We have to think about other things, things largely unknown: what brain regions are affected by a given drug, what concentrations make it to the striatum as opposed to the nucleus accumbens, what down-the-line alterations in brain structure or chemistry occur. Even that is a pretty rough way to look at the intricacy of the central nervous system. ...And, in any case, every person's brain chemistry is different. Everyone reacts differently to a given drug. Which is a long way of saying: this theorizing only goes so far; you can only find out what works FOR YOU through some drug trials.
>
> Bottom line: if effexor worked for you in a way that SSRIs didn't, then great! If you can't find a way to keep taking it (could you ask them to add a muscle-relaxant? I don't know...), then you may well get mileage by trying medications that affect noradrenaline (there's no reason to go immediately to dopaminergics--many aren't very good [or are illegal], and effexor has no direct effect on dopamine, anyway). In my experience, desipramine is a good NA medication, but I don't believe you have that in Australia. Nortriptyline is another good one. Reboxetine could be a good choice, but maybe not straterra for your purposes--it doesn't have a great reputation... Any tricyclic antidepressant, with the possible exception of clomipramine--which you seem to have already tried anyway (and if that one didn't work, you may wish to avoid imipramine as well)-- is probably worth trying. Wellbutrin has its flaws, but I think may also be worth your time. Milnaciprin, if you have it down there, is pretty similar to effexor, so that might be a place to go first, if they have it down there. That might be where I would go first.
>
> Keep in mind that, if you end up going for drugs that affect dopamine as well, they can be difficult to get. Still, if you have ADD-like symptoms (if you have depression, then -technically- you don't have ADD also, at least according to official psychiatry. Mental illness classification is weird, that way. But, seriously, depression can cause the same symptoms, and what you call a thing doesn't matter), it may be a possibility.
>
>
> Hope that's useful in some way.
>
This is the end of the thread.
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