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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 brynb on January 1, 2013, at 7:25:58
I had a brief phone conversation w/ my pdoc this weekend regarding how bad my depression is again and the need for a new med approach. I also brought up that when I see him next (either this week or next), I'd like to discuss disability. He seemed bent on the idea that he wasn't sure if I have bipolar or MDD w/ GAD, and that he needs to make a definitive diagnosis before I seek disability. Can't he just put one Dx in for disability so it doesn't slow my application process down? (I'd just like to insist he make a diagnosis for the disability as we continue to seek the right med combo.)
I'd also like to present some combos to him based on positive or neutral experiences I had in the past, or try something new. Refactory depression, melancholia, lack of motivation, anhedonia, fatigue, irritability, mood swings and anxiety are my worst symptoms.
I'm currently on Lexapro and Librium (stopped lithium 2 weeks ago). Lexapro doesn't prevent depressive episodes, but does help my symptoms on a daily basis (to a degree). I don't do too well w/ TCAs but there are many I haven't tried. I'm VERY concerned with weight gain as I'm petite and many psych meds make me blow up.
I would love some feedback on these combos based upon my situation:
Past positive-ish combos:
Lex w/ Trileptal + benzo
Lex w/ Tegretol + benzo
Lex w/ Invega + benzoNew ideas:
Viibryd + ? + benzo
TCA + ? + benzo
Nardil + benzo
???Any suggestions? Thanks in advance and happy new year to everyone.
-Bryn
Posted by SLS on January 1, 2013, at 8:24:09
In reply to Med Combos, posted by brynb on January 1, 2013, at 7:25:58
Racing thoughts?
Rapid cyclicity?
High energy despite depressive symptoms?
Pressured or loud speech?
Impulsiveness?
Rage attacks?
Loose associations (derailment)?
Flight of ideas?
Expansive thoughts?
Starting many tasks, finishing none?
Distractibility?
Ideas of reference?
Delusions of grandeur?
Reduced need for sleep?
- Scott
Posted by Phillipa on January 1, 2013, at 9:34:10
In reply to Med Combos, posted by brynb on January 1, 2013, at 7:25:58
Happy New Year Bryn seems like you have been on a lot of combos I have. I was assured I wasn't bipolar and when on trileptal and SSRI & benzo was given to "boost" effects of antidepressants. I think if going for Disability with regulations as strict as they are your pdoc wants to be sure of dx as if the Disability docs evaluate you also as is done with some his reputation of being accurate is at stake. As for the meds will leave that to the others. Phillipa
Posted by brynb on January 1, 2013, at 10:31:37
In reply to Re: Med Combos » brynb, posted by SLS on January 1, 2013, at 8:24:09
> Racing thoughts? Yes
> Rapid cyclicity? Yes
>
> High energy despite depressive symptoms? Sometimes
>
> Pressured or loud speech? YES!
>
> Impulsiveness? YES!
>
> Rage attacks? Yes
>
> Loose associations (derailment)? Yes
>
> Flight of ideas? Yes
>
> Expansive thoughts? Sometimes
>
> Starting many tasks, finishing none? YES!
>
> Distractibility? Somewhat
>
> Ideas of reference? Yes
>
> Delusions of grandeur? No
>
> Reduced need for sleep? Yes
>
>
> - Scott
>Scott,
I identify with A LOT of these! This is kinda bipolar, huh?
-b
Posted by brynb on January 1, 2013, at 10:35:48
In reply to Re: Med Combos » brynb, posted by Phillipa on January 1, 2013, at 9:34:10
> Happy New Year Bryn seems like you have been on a lot of combos I have. I was assured I wasn't bipolar and when on trileptal and SSRI & benzo was given to "boost" effects of antidepressants. I think if going for Disability with regulations as strict as they are your pdoc wants to be sure of dx as if the Disability docs evaluate you also as is done with some his reputation of being accurate is at stake. As for the meds will leave that to the others. Phillipa
Happy New Year to you too, P! That's an excellent thought; it didn't even occur to me. Makes total sense. Thank you...
-b
Posted by SLS on January 1, 2013, at 14:08:31
In reply to Re: Med Combos » SLS, posted by brynb on January 1, 2013, at 10:31:37
You just passed the abbreviated SLS test for bipolar disorder. You might want to discuss these things with your doctor. It might help him make a more definitive diagnosis. If he concludes that you do not have bipolar disorder, I would be curious to know why.
- Scott
> > Racing thoughts? Yes
>
> > Rapid cyclicity? Yes
> >
> > High energy despite depressive symptoms? Sometimes
> >
> > Pressured or loud speech? YES!
> >
> > Impulsiveness? YES!
> >
> > Rage attacks? Yes
> >
> > Loose associations (derailment)? Yes
> >
> > Flight of ideas? Yes
> >
> > Expansive thoughts? Sometimes
> >
> > Starting many tasks, finishing none? YES!
> >
> > Distractibility? Somewhat
> >
> > Ideas of reference? Yes
> >
> > Delusions of grandeur? No
> >
> > Reduced need for sleep? Yes
> Scott,
>
> I identify with A LOT of these! This is kinda bipolar, huh?
>
> -b
Posted by jono_in_adelaide on January 1, 2013, at 16:53:23
In reply to Med Combos, posted by brynb on January 1, 2013, at 7:25:58
If you need a robust combo with no weight gain, have you considered an SSRI or Vibryd with Wellbutrin or desipramine with a benzo?
Posted by jono_in_adelaide on January 1, 2013, at 17:10:06
In reply to Re: Med Combos, posted by jono_in_adelaide on January 1, 2013, at 16:53:23
I know you said that yiou havent done well with TCA's in the past, but desipramine has a very good side effect profile compared to the others, and I think would be well worth a try.
An MAOI would also be well worth considering
Posted by jono_in_adelaide on January 1, 2013, at 17:32:14
In reply to Re: Med Combos, posted by jono_in_adelaide on January 1, 2013, at 17:10:06
Effexor in highish dose + Remeron would also be worth considering if you ould dela with some minor weight gain, you have a very serious illness and it would be worth gaining a few pounts to lick it
To summerise my thoughs
- SSRI or Viibryd plus either Welbutrin or desipramine and a benzo
- MAOI plus a benzo
- High dose Effexor with Remeron with or without a benzo
There are many other combos that also might be your magic bullet - just remember, you have a very serious illness, and it might be worth dealing withsome weight gain and mild side effectsto get it under control
Posted by brynb on January 1, 2013, at 18:27:03
In reply to Re: Med Combos » brynb, posted by SLS on January 1, 2013, at 14:08:31
Scott,
Thanks. Broken down that way, it really makes sense.
I feel like I've done ok with Trileptal added in the mix; does it address many of the issues I responded "yes" to?I'm definitely bringing this up to my pdoc. I'm curious to hear his thoughts. Thank you again for your insight! Hope you're doing well!
-b
Posted by brynb on January 1, 2013, at 20:01:03
In reply to Re: Med Combos, posted by jono_in_adelaide on January 1, 2013, at 17:32:14
Thanks, Jono. All good and reasonable meds, but I can't take Wellbutrin--it makes me too anxious. I havent tried desipramine; what, if any other TCA, is it like?
Perhaps an MAOI w/ a benzo would be good. I'll be discussing all of my options w/ my pdoc. He seems to be leaning towards adding a mood stabilizer, too. I'd prefer one w/o weight gain as a big side effect. I understand my condition is serious, but it depresses me more when I worry about how some side effects are too hard to deal with...
Again, many thanks,
-b
Posted by jono_in_adelaide on January 1, 2013, at 21:56:59
In reply to Re: Med Combos » jono_in_adelaide, posted by brynb on January 1, 2013, at 20:01:03
Desipramine is unlike any of the other TCA's, in that sedation, weight gain and anticholinergic effects are quite rare. In your case I'd say it would be well worth a try with Lexapro (given that thats been of some use in the past)
Start of at 25mg/day and increse over a week or two to 150mg/day
Posted by brynb on January 2, 2013, at 10:34:44
In reply to Re: Med Combos, posted by jono_in_adelaide on January 1, 2013, at 21:56:59
> Desipramine is unlike any of the other TCA's, in that sedation, weight gain and anticholinergic effects are quite rare. In your case I'd say it would be well worth a try with Lexapro (given that thats been of some use in the past)
>
> Start of at 25mg/day and increse over a week or two to 150mg/day
>
>
Thanks, Jono. Sounds a little too good to be true...I'll ask my pdoc. I might need to add a stabilizer in, though. I'm weary of this. I just don't like stabilizers & APs in general.Thanks again. I really appreciate it!
Posted by brynb on January 2, 2013, at 10:37:06
In reply to Med Combos, posted by brynb on January 1, 2013, at 7:25:58
Would either of these be a good addition? I remember responding well to both in the past. Doesn't seem like many babblers are on either of these meds, though...
Posted by jono_in_adelaide on January 2, 2013, at 17:11:18
In reply to Re: Med Combos » jono_in_adelaide, posted by brynb on January 2, 2013, at 10:34:44
Yes, i'd think that a mood stabaliser would be essential given the answers you gave to some of Scots questions.
Posted by jono_in_adelaide on January 2, 2013, at 17:27:50
In reply to Re: Trileptal or Tegretol, posted by brynb on January 2, 2013, at 10:37:06
I beleive that both are good at preventing/controling mania, not so sure they are much help in depression (though if you were on Lexapro and desipramine that probably wouldnt matter)
My dads wift took tegretol for years for trigeminal neuralgia (sp?), and found it was easy to take and tolorate
Posted by brynb on January 2, 2013, at 23:25:55
In reply to Re: Trileptal or Tegretol, posted by jono_in_adelaide on January 2, 2013, at 17:27:50
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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