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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by GavinoFelix on October 27, 2013, at 21:52:31
Hey, long time lurker here. Long story short, I just relocated and just started seeing this new doc. Psychiatrist just reduced my clomipramine dose from 150mg to 100mg and I'm feeling pretty bad. Have been stable w/r/t depression for the past 6 months or so. Due to certain side-effects not wearing off (e.g. still unable to exercise aerobically without heart gettin' all worked up, INSANE sweating even when it is 40 degrees F outside) he suggested decreasing dosage.
Previously was going to UPenn for the past year (during which time they, quite heroically, stabilized me) coming in with one of my worst bouts of Depression (225mg venlefaxine and 30mg mirtazapine pooped out entirely) and we tried out tranylcypromine (huge mess), then ran back through the STAR*D thing and eventually landed on the TCA button and they gradually ramped me up on the clomipramine. It's my first TCA and would be willing to try other stuff.
Also, I take 100mg trazodone to help sleep and 3x30mg vyvanse for "severe adhd" according to the formalized testing they administered at UPenn. It was suspected that I was a "rapid metabolizer" of CYP2D6 (and others) at UPenn due to my blood work always coming back as very very low serum levels of clomipramine (in fact, it was only detectable once I got to 150mg). The vyvanse, similarly, is subjectively only functioning for about 2 hours (and yes, all psychiatrists are horrified by this). Adhd-wise, "adderall" really didn't register and years ago I tried atomoxetine.
A week into this decrease in dosing and I feel like the bottom has dropped out on me and I'm completely apathetic. Should I call the psychiatrist this week? I just feel awkward calling this new doctor up right after our 1rst appointment and telling him how I feel like sh*t already. Should I just 'tough it out' until my next appointment in 3 weeks? I'm 27, finally back in school and working part time. Oh, also in a relationship with someone I really love. So I don't really feel up to dealing with 'getting depressed' again or completely re-doing my medication regimen. Thoughts on augmentation? Maybe throw some mirtazapine back in there?
I've always respected many of the posters here. I've scoured plenty of forums, but this is the only one where people are knowledgeable, smart, compassionate and, unfortunately, truly experienced with legitimate MDD.
Thank you
Posted by Christ_empowered on October 27, 2013, at 22:09:44
In reply to One Divine Hammer, posted by GavinoFelix on October 27, 2013, at 21:52:31
Hey. I'm NO EXPERT (sorry for the screaming caps...I just want you to know that I'm just trying to help, not **tell you** what to do), but here's what I was thinking.......switch out the Anafranil for Tofranil-PM. Works well with amphetamines. The PM (pamoate) is more expensive, but its once daily and can be used as a sleeping pill.
...add BuSpar @ 5x3 to calm out the amphetamine and energize the AD. The 15mgs/day dose is low-end; you can go up to 60, I think...or higher (higher doses kinda function like a really cheap, tolerable, low-dose AAP).
Do you have good insurance? A nice doc? If you're having to high-dose amphetamines, a switch to Desoxyn (Rx methamphetamine) might be called for. Lower doses, I think its a 3x daily thing. More potent. Some docs just won't prescribe it, ever, because of the meth issues right now. Others will.
Good luck to you!
Posted by Phillipa on October 27, 2013, at 22:41:34
In reply to One Divine Hammer, posted by GavinoFelix on October 27, 2013, at 21:52:31
Since you were doing well when you saw this new pdoc call him and let him/her know that you are not doing well on his new adjustment. Phillipa
Posted by mogger on October 27, 2013, at 22:54:15
In reply to One Divine Hammer, posted by GavinoFelix on October 27, 2013, at 21:52:31
I encourage you to call asap. Try no to worry about the psychiatrist just focus on yourself. Sorry to hear the bottom has dropped out but you will get back up soon enough. I am the same man my sweating is out of control. Adding mirtazapine has helped and actually neurontin (I was only on it for a short time) helped big time.
Posted by Willful on October 27, 2013, at 23:41:16
In reply to Re: One Divine Hammer » GavinoFelix, posted by Phillipa on October 27, 2013, at 22:41:34
I'm with everyone who's responded-- you should definitely call your new pdoc and let him/her know. First of all, if you were stable before the dosage was changed, you have every right to have that reevaluated at the first opportunity-- not after you've been coping with it for three weeks--. I would hope your new pdoc would expect that the changes might not be for the better and would want to know sooner rather than later that what the negative react was-- so as to reverse it. The longer you let it go-- the harder it may be to get back to where you were-- and you no good pdoc would want that.
I hope your new pdoc is able to fix this and that you can return to your prior state-- which sounds pretty good.
Willful
Posted by GavinoFelix on October 27, 2013, at 23:57:03
In reply to Re: One Divine Hammer, posted by Christ_empowered on October 27, 2013, at 22:09:44
Christ Empowered, Thank you!
I am hesistant about using another med that has strong anti-cholinergic properties (Imipramine), just 'cause those were causing the main long-term SE of sweating. Also, any aerobic activities cause my heart-rate to shoot up high. This hasn't happened with other AD's. Exercise helps my mood/ concentration A LOT and it sucks not really being able to do anything (although I do work on my feet all day, so that must count for something). So if there's a TCA without a strong affinity for the mACH receptor, I'm game.
Buspirone is something I've never used. I'll definitely ask about that. I've never heard of any terrible SE from it.
As far as the 'desoxyn' goes, I tend to not really get too pushy w/ the psychostims. Having gone through a research university's program, I'm pretty used to conservative prescribing measures and tend to let the doctors make the calls with 'stims.
Anxiety: Was terrible in my teens and early 20's (i.e. paralyzing panic attacks almost daily). These days, it's not really too much of an issue. It took 2 intense years with an old school 'psycho-dynamic' psychologist to really get through the anxiety.
Posted by mogger on October 27, 2013, at 23:58:42
In reply to Re: One Divine Hammer, posted by Willful on October 27, 2013, at 23:41:16
Well said Willful. It looks like you have an open minded pdoc from the look of your medication regiment? It looks like/I hope it is an effective combination.
Posted by GavinoFelix on October 28, 2013, at 0:02:54
In reply to Re: One Divine Hammer » GavinoFelix, posted by mogger on October 27, 2013, at 22:54:15
Phillipa, mogger, and WillFul, Thank you for keeping it simple and just telling me to call my doc.
Mogger: what TCA are you taking? The sweating really is terrible, I mean, man, I work in food prep and my manager's always making fun of me. Ugh. I'm glad to hear the mirtazapine helped.
Posted by GavinoFelix on October 28, 2013, at 0:07:58
In reply to Re: One Divine Hammer, posted by Willful on October 27, 2013, at 23:41:16
Willful, how the hell did you get riluzole prescribed? Do you have ALS? Or did you just go through a trial?
Posted by mogger on October 28, 2013, at 0:10:21
In reply to Re: One Divine Hammer, posted by GavinoFelix on October 28, 2013, at 0:02:54
I did catering for years sweating like a maniac. The worst is the leg sweating. I am on an ssri, zoloft, but was on pamelor and had the same issue. I still get so frustrated with the sweating but the flip side is not worth it. I think neurontin helped by blunting the peripheral nervous system so it decreased my sweating profoundly. Mirtazapine does help though. Hang in there.
Posted by mogger on October 28, 2013, at 0:12:57
In reply to Re: One Divine Hammer, posted by GavinoFelix on October 28, 2013, at 0:07:58
I believe it goes generic soon!
Posted by Willful on October 30, 2013, at 21:39:05
In reply to Re: One Divine Hammer, posted by GavinoFelix on October 28, 2013, at 0:07:58
Hi,
I must have been very lucky in my choice of pdocs because he looks into things before they come out and gets very interested in some. In this case, he saw properties in rilutek that he thought might be good for certain types of depression.
I have just benefited from his creative approach.
This combination works extremely well for me. The addition of rilutek was the final element that turned the corner, although I was doing fairly well on the combination before that.
Posted by fiat500 on October 31, 2013, at 23:56:47
In reply to Re: One Divine Hammer--mogger, GF, posted by Willful on October 30, 2013, at 21:39:05
Great to hear! I think that Rilutek should be an option more often. It took a long time to take effect (about 9 weeks) but when it did it was very positive.
This is the end of the thread.
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