Psycho-Babble Medication Thread 1062167

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

Phidippus.

Posted by SLS on March 10, 2014, at 8:13:49

All I wanted to say is thank you for being here.


- Scott

 

Re: Phidippus. » SLS

Posted by phidippus on March 10, 2014, at 10:08:03

In reply to Phidippus., posted by SLS on March 10, 2014, at 8:13:49

No, thank you.

Eric

 

Re: Phidippus. » phidippus

Posted by SLS on March 10, 2014, at 11:03:59

In reply to Re: Phidippus. » SLS, posted by phidippus on March 10, 2014, at 10:08:03

> > All I wanted to say is thank you for being here.
> >
> > - Scott

> No, thank you.
>
> Eric

That is an interesting reaction, indeed.

My statement is unambiguous. I am somewhat confused by your statement, though. Perhaps you can clarify your remark. Of course, you can always decline doing so.

Maybe you don't like me?


- Scott

 

Re: Phidippus. » SLS

Posted by phidippus on March 10, 2014, at 11:07:26

In reply to Re: Phidippus. » phidippus, posted by SLS on March 10, 2014, at 11:03:59

NO, thank YOU for being here.

I like you just fine :)

Eric

 

Re: Phidippus. - I see. My apologies. » phidippus

Posted by SLS on March 10, 2014, at 12:46:57

In reply to Re: Phidippus. » SLS, posted by phidippus on March 10, 2014, at 11:07:26

> NO, thank YOU for being here.
>
> I like you just fine :)
>
> Eric

OH!!!

I am so sorry.

Thank YOU for thanking ME!

I would have been disappointed otherwise.

Chalk that one up to the vestiges of my defensive self.


- Scott

 

Re: Phidippus. - I see. My apologies. » SLS

Posted by phidippus on March 10, 2014, at 14:53:11

In reply to Re: Phidippus. - I see. My apologies. » phidippus, posted by SLS on March 10, 2014, at 12:46:57

>Chalk that one up to the vestiges of my defensive self.

Tell me about your childhood.

And tell me about your medicine regimen.

Eric

 

Re: Phidippus. - I see. My apologies. » phidippus

Posted by SLS on March 10, 2014, at 23:54:55

In reply to Re: Phidippus. - I see. My apologies. » SLS, posted by phidippus on March 10, 2014, at 14:53:11

> >Chalk that one up to the vestiges of my defensive self.
>
> Tell me about your childhood.
>
> And tell me about your medicine regimen.
>
> Eric

My childhood sucked. It was full of parental physical and emotional abuse - that is, when I wasn't being totally neglected. At school, I was teased and bullied. There may be an element of PTSD (developmental PTSD) involved. I have been depressed since age 10. The most severe depression began at age 17, and has been chronic ever since - with the exception of a 2 year period during which I was an ultra-rapid cycler (11 day cycle). Bipolar disorder was diagnosed at the NIH. Severe, psychotic mania have occurred in association with antidepressant administration. The symptomatology of my depression is most similar to bipolar depression. Anergia, psychomotor retardation, hyperphagia, hypersomnia, early morning and late night improvement, unreactive, little or no rejection sensitivity, some melancholia and depressed mood, social anxiety, lack of interest, amotivation, poor concentration and memory.

Currently:

Parnate 100 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 450 mg/day
prazosin 25 mg/day
minocycline 200 mg/day
Abilify 10 mg/day

This regime is tweaked in that each drug has demonstrated its value by attempting its discontinuation. Dosages have been optimized by careful titration. Dosages have been pushed and reduced as necessary.

I have tried most antidepressants. The notable exceptions are Fetzima, Brintellix, nefazodone, and doxepin. All AAPs except for Clozaril. Most all mood stabilizers. Augmentation with bromocriptine, amphetamine, methylphenidate, thyroid, memantine, Deplin, and other stuff.

MAOI + TCA has produced the best results, including one 6-month period of remission in 1987 using Parnate + desipramine. The doctor had me discontinue treatment as he said, "mission accomplished". Upon relapse, he refused to restart both drugs for fear of mania. I was never to respond robustly to treatment again.


- Scott

 

Re: Phidippus. » phidippus

Posted by SLS on March 11, 2014, at 0:45:11

In reply to Re: Phidippus. » SLS, posted by phidippus on March 10, 2014, at 10:08:03

By the way, it was suggested to me that the nausea produced by certain serotonergic antidepressants can be treated with doxepin rather than ondansetron. If you ever want to revisit Brintellix, you might want to look into this.

Histamine H2 antagonism in the chemoreceptor trigger zone (CTZ)? This would explain the lack of effect of ondansetron.


- Scott

 

Re: Phidippus. - I see. My apologies.

Posted by phidippus on March 11, 2014, at 11:49:05

In reply to Re: Phidippus. - I see. My apologies. » phidippus, posted by SLS on March 10, 2014, at 23:54:55

Scott,

> My childhood sucked. It was full of parental physical and emotional abuse - that is, when I wasn't being totally neglected.

Has borderline personality disorder ever been discussed as a possible diagnosis for you?

My childhood sucked because of peer abuse and neglect. I had trouble socially well into highschool

>I have been depressed since age 10.

I had mood and behavior issues beginning as early as age 5. In my teens I struggled with depression and impulsive behavior.

>The most severe depression began at age 17

My most severe depressive episode occured in 1999 when I had my first mixed bipolar episode. The depression was acute, had psychotic features, including cotard syndrome (I thought I was dead). On top of the bipolar symptoms I had severe OCD symptoms-persistent thoughts of harming others.

What was your depression like at age 17?

>The symptomatology of my depression is most similar to bipolar depression.

What's strange is that I get my mania, ADHD and OCD under control and all I'm left with is a gnawing depression, which I am only now trying to treat. I feel sad and empty. I feel hopeless. I feel this anxiety like everyrthing is wrong. I feel guilty that I haven't become more successful. I lose interest in things that usually bring me joy. I have difficulty concentrating. I sleep too much or too little. I eat less. I have thoughts of hurting myself.

> Parnate 100 mg/day

I wonder if the Parnate is adequate.

> nortriptyline 150 mg/day

I wonder if you'd have a more robust response to Atomoxetine, which also happens to be an NMDA antagonist.

> Lamictal 200 mg/day
> lithium 450 mg/day

What's the point of 450 mg of Lithium? You're probably reaping more side effects than benefits. Why not double the Lamictal and drop the Lithium or vice versa?

> prazosin 25 mg/day

(in theory) raises dopamine (DA) levels in the synaptic cleft in the prefrontal cortex and inhibiting extracellular DA concentrations in the nucleus accumbens

How is this helpful to you?

> minocycline 200 mg/day

What does this do?

> Abilify 10 mg/day

Why not Geodon instead? Geodon has a far more sophisticated mechanism of action.

> This regime is tweaked in that each drug has demonstrated its value by attempting its discontinuation.

How odd. I take medication based on whether it makes me feel better or not, not because I feel worse because I stop taking it.

> Dosages have been optimized by careful titration. Dosages have been pushed and reduced as necessary.

I push my medications to the highest dose then reduce to taste.

Have you tried Rilutek?

>I was never to respond robustly to treatment again.

I think you're on too many drugs. There's gotta be a way to simplify your regimen. I find if I take too many meds, sh*t just gets muddy upstairs.

Why not try Parnate and Desipramine again?

Eric

 

Re: Phidippus. - Med Regimen

Posted by LouisianaSportsman on March 11, 2014, at 23:59:06

In reply to Phidippus., posted by SLS on March 10, 2014, at 8:13:49

Eric, since you gave such helpful advice to Scott, what would you do with my med regimen?:

Adderall IR (amphetamine salts) 60mg.;
Aplenzin (bupropion hydrobromide) 522mg.;
Brintellix (vortioxetine) 10mg.;
Lamictal (lamotrigine) 200mg.;
Latuda (lurasidone) 80mg.;
Nuvigil (armodafinil) 250mg.;
Neurontin (gabapentin) 1,200mg.;
Trokendi XR (topiramate extended-release) 100mg.

I'm planning on increasing Brintellex to 20mg. next month, and Lamictal to 300mg., Neurontin to 1,600mg and Trokendi XR to 200mg. at some point.

I'm considering returning to Dexedrine for blood pressure purposes; amphetamine salts has more of a "boost" that I prefer, however.

I feel vortioxetine may cause mood destabilization; therefore, I might need my mood stabilization dosages increased.

The topiramate at the current 100mg. sub-therapeutic was working just fine because we have lamotrigine on board, and there are studies that suggest that you can use lower doses of the mood stabilizer you're augmenting to another mood stabilizer.

I feel like it is time to increase dosages; especially, I have been on these doses for so long, particularly lamotrigine at 200mg. for years; topiramate (indicated for weight-loss) for months.

I would love to trial Oxtellar XR (oxcarbazepine extended-release tablets) in place of my lamotrigine.

Lurasidone dosages above 80mg. don't seem to be any more efficacious. If conditions call for it, however, I would trial 120mg.

A gabapentin escalation would help with my anxiety and other factors.

What would you suggest, Eric? Replace and augment? Remove? Change? Edit? Etc.

Anyone other opinions?

 

Re: Phidippus. - Med Regimen » LouisianaSportsman

Posted by phidippus on March 12, 2014, at 17:16:54

In reply to Re: Phidippus. - Med Regimen, posted by LouisianaSportsman on March 11, 2014, at 23:59:06

> Adderall IR (amphetamine salts) 60mg.;

I'm a big fan of amphetamines. They help with executive function, mood and even some anxiety disorders (OCD). If anytyhing, I'd recommend 70 mg of Vyvanse, which just lasts longer.

> Aplenzin (bupropion hydrobromide) 522mg.;

Odd number there. With the amphetamines on board it gets difficult to recommend bupropion, but there's no denying it can help with mood. I'd do a quick check and go off it for a bit to see if it really makes a difference.

> Brintellix (vortioxetine) 10mg.;

I made it to 20 mg before I started puking all over the place. This is an awesome drug for anxiety - 5ht1d antagonism, 5ht3a antagonism, 5ht1b agonism, 5ht1a agonism, 5ht7 antagonism. I had an amelioration of my OCD about 4 weeks into the drug. However, it didn't seem to impact my mood in 6 weeks. Maybe if I'd stayed on it longer...

> Latuda (lurasidone) 80mg.;

I like Geodon more-it has a lot of the same mechanisms of action as Brintellix and is an SNRI to boot. BUT, Latuda gets the job done and helps with anxiety at higher doses (120-160 mg).

> Nuvigil (armodafinil) 250mg.;

Fun, fun. What do you need this for?

> Lamictal (lamotrigine) 200mg.;
> Neurontin (gabapentin) 1,200mg.;
> Trokendi XR (topiramate extended-release) 100mg.

That's a lot of anticonvulsant and I'd be worried about what depressive effects the some total is having. Topamax is probably only contributing side effects at that dose (and maybe preventing migraines).

If your looking for more mood stabilization because you're taking more antidepressant, I would first look at increasing your antipsychotic. That will reduce mania and OCD symptoms.

Otherwise, I'd go for 400 mg on the Lamictal-the higher you go with lamictal the better the mood stabilization. Something to do with the potentials of sodium channels...I had a cool pdf around her somewhere...

Neurontin will provide some mood stabilization and some relief from anxiety-as a glutamate antagonist it will also reduce your OCD. Can you tolerate it at 2400 mg?

> I'm planning on increasing Brintellex to 20mg.

good

>Lamictal to 300mg.

try 400, unless your moving that way slowly.

>Neurontin to 1,600mg

The difference between 1200 and 1600 mg is nil. You really need to double it to feel results.

>and Trokendi XR to 200mg. at some point.

I'd just drop the Tokendi XR

>there are studies that suggest that you can use lower doses of the mood stabilizer you're augmenting to another mood stabilizer.

This is true, but we're talking about Dopomax here.

> I would love to trial Oxtellar XR (oxcarbazepine extended-release tablets) in place of my lamotrigine.

Trileptal just doesn't have the 'zing' of Lamictal.

Eric

 

Re: Phidippus. - I see. My apologies. » phidippus

Posted by SLS on March 12, 2014, at 20:59:14

In reply to Re: Phidippus. - I see. My apologies., posted by phidippus on March 11, 2014, at 11:49:05

Thank you for your consideration of my situation. You ask all the right questions. Your ideas are great.

> > My childhood sucked. It was full of parental physical and emotional abuse - that is, when I wasn't being totally neglected.

> Has borderline personality disorder ever been discussed as a possible diagnosis for you?

It was never offered as a diagnosis. I am sure that it was screened for, as I have had several psychometric evaluations, including the MMPI at the NIH (National Institutes of Health). The NIH was quite rigorous in their examinations.

> My childhood sucked because of peer abuse and neglect. I had trouble socially well into highschool

Perhaps prazosin would help you as it does me.

> My most severe depressive episode occured in 1999 when I had my first mixed bipolar episode.

That sucks.

> The depression was acute, had psychotic features, including cotard syndrome (I thought I was dead). On top of the bipolar symptoms I had severe OCD symptoms-persistent thoughts of harming others.

That really sucks.

> What was your depression like at age 17?

Gray and melancholic. Anergic. Moderate GAD. Severe social anxiety. Irritable. Somewhat paranoid. Moderate loss of interest and motivation. Moderately impaired reading and memory. Anhedonia (I get no pleasure out of saying that).

> What's strange is that I get my mania, ADHD and OCD under control and all I'm left with is a gnawing depression, which I am only now trying to treat.

I'm sure you'll figure it out.

> I feel sad and empty. I feel hopeless. I feel this anxiety like everyrthing is wrong. I feel guilty that I haven't become more successful. I lose interest in things that usually bring me joy. I have difficulty concentrating. I sleep too much or too little. I eat less. I have thoughts of hurting myself.

I have been plagued by most of those things at different times.

> > Parnate 100 mg/day

> I wonder if the Parnate is adequate.

I tried 120 mg/day recently and 150 mg/day a number of years ago, both times in conjunction with TCA. Neither trial produced robust improvements.

> I wonder if you'd have a more robust response to Atomoxetine, which also happens to be an NMDA antagonist.

I tried atomoxetine, but had no luck with it.

> What's the point of 450 mg of Lithium?

It helps with depression and might act as a prophylactic against contracting Alzheimer's Dementia.

> You're probably reaping more side effects than benefits.

No side effects at all. (Maybe a little electrical discharge from time to time).

> Why not double the Lamictal and drop the Lithium or vice versa?

At 400 mg/day of Lamictal, I can't remember my own name. When I go above 450 mg/day of lithium, I experience amotivation and apathy along with having diarrhea.

> > prazosin 25 mg/day

> (in theory) raises dopamine (DA) levels in the synaptic cleft in the prefrontal cortex and inhibiting extracellular DA concentrations in the nucleus accumbens

That's interesting. How does that work?

> How is this helpful to you?

It feels like a very clean antidepressant. My doctor thought of this in response to my descriptions of childhood.

> > minocycline 200 mg/day

> What does this do?

Biologically, a whole bunch of things.

http://www.dr-bob.org/babble/20120803/msgs/1023257.html

Clinically, it feels like an antidepressant.

> > Abilify 10 mg/day

> Why not Geodon instead? Geodon has a far more sophisticated mechanism of action.

Perhaps, but:

1. Parnate plus serotonin reuptake inhibition will likely precipitate serotonin syndrome.

2. It might be the DA D2/D3 receptor partial agonism that is important with my response to Abilify. It also antagonizes 5-HT7 receptors, but not to the same extent as Latuda.

3. I tried Geodon at 40 - 80 mg/day. I experienced a profound cognitive dulling (brain-fog) along with some derealization.

> > This regime is tweaked in that each drug has demonstrated its value by attempting its discontinuation.

> How odd. I take medication based on whether it makes me feel better or not, not because I feel worse because I stop taking it.

If I have been on a particular drug for a long time, especially after other agents have been introduced, I will sometimes back off the dosage of that drug to see whether it is still contributing to my improvement, and what dosage is optimal in a new treatment structure.

> > Dosages have been optimized by careful titration. Dosages have been pushed and reduced as necessary.

> I push my medications to the highest dose then reduce to taste.

> Have you tried Rilutek?

For me, it was an expensive placebo. Memantine was without effect, but I only went up to 20 mg/day.

> > I was never to respond robustly to treatment again.

> I think you're on too many drugs.

One is one too many.

> There's gotta be a way to simplify your regimen.

That's why I will try to discontinue a specific drug from time to time. I might try d/c the prazosin so that I can recover my sex-drive. I am hoping that the subsequent addition of minocycline will allow for this. I doubt it, though.

> Why not try Parnate and Desipramine again?

I originally responded to Parnate 60 mg/day + desipramine 150 mg/day. The combination never worked again. I have tried Parnate 60 - 150 mg/day + desipramine 200 - 300 mg/day.

Now that really, REALLY sucks.


- Scott

 

Re: Phidippus. - I see. My apologies. » SLS

Posted by phidippus on March 12, 2014, at 22:08:32

In reply to Re: Phidippus. - I see. My apologies. » phidippus, posted by SLS on March 12, 2014, at 20:59:14

> Perhaps prazosin would help you as it does me.

I like Prazosin. It does help with nightmares and left me feeling calm, but it did not affect my anxiety or mood enough to warrant taking it.


>Anhedonia (I get no pleasure out of saying that).

Ha. I want to buy you a beer.

> > > Parnate 100 mg/day
>
> > I wonder if the Parnate is adequate.
>
> I tried 120 mg/day recently and 150 mg/day a number of years ago, both times in conjunction with TCA. Neither trial produced robust improvements.

What of a different MAOI? Nardil? I really think you need to rethink your main antidepressant if you feel you still struggle with feeling good.

>might act as a prophylactic against contracting Alzheimer's Dementia.

Do you have a fear of becoming senile?

> At 400 mg/day of Lamictal, I can't remember my own name.

Lightweight.

> That's interesting. How does that work?

tonically activated alpha 1-adrenoceptors stimulate dopamine release in the caudate putamen as well as in the nucleus accumbens.

> Biologically, a whole bunch of things.

Its a wonder you haven't responded to other NMDA or glutamatergic drugs.

> 3. I tried Geodon at 40 - 80 mg/day. I experienced a profound cognitive dulling (brain-fog) along with some derealization.

Those side effects go away at the higher doses.

> Memantine was without effect, but I only went up to 20 mg/day.

I hit 60 mg before I felt any effect from this drug.

> > I think you're on too many drugs.
>
> One is one too many.

I disagree. I think everyone could benefit from some "augmentation".

> I am hoping that the subsequent addition of minocycline will allow for this. I doubt it, though.

Would you say you suffer from treatment resistant depression...Maybe a little mania would do you some good...

Eric


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