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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by AlexCanada on July 20, 2014, at 3:30:39
> > Hi. After over 20+ meds including Parnate, paxil, TCAS (could not tolerate the anx), Ritalin, Dexedrine, modafinil, and dozen+ anti-deps I have had most success with parnate, paxil and especially Ritalin and Dexedrine when it comes to dealing with poor motivation, low emotion, empty dull mindless mood, slow mindedness, poor cognition. Some short term benefits from gabapentin as well especially for emotion.
> >
> > L-dopa mucuna (herbal form of L-dopa) meanwhile has had remarkable effects on positive kind, loving emotions, enhanced empathy, and appreciation of others. So remarkable in fact that it really showed me how negative and tactless I have been under the past decade of melancholic depression + hypothyroid.
> >
> > L-dopa mucuna does not necessarily play well with meds though. I am currently on Cymbalta 30mg + small modafinil, + small Ritalin, + small gabapentin, +magnesium/calcium/d3/zinc combo + 1.5mg valium (trying to withdrawl from it). L-dopa mucuna is supposed to produce dopamine as well as testosterone but the herbal benefits do not last usually and mood eventually may feel sour after few weeks and/or lack of interest.
> >
> > What might be worth a try? Requip? I tried Mirapex many years ago and cannot recall what it did to me aside from me not being pleased with it. Though it might have just been a bad combination with whatever else I was taking.
> >
> > Any other dopamine based options? Supposedly D2 stimulation/production enhancex oxytocin the love molecule. This might be responsible for the greatly enhanced empathy and feelings of Kindness onto others.
> >
> > I miss this priceless feeling. I used to be an immensely loving and very emotional person before Accutane poisoning caused severe melancholic depression in me.
> >
> > I want my emotions back, I want more clear headedness, I want a thirst for life rather than feeling ''nothing'' most of the time.
> >
> >
>
> "poor motivation, low emotion, empty dull mindless mood, slow mindedness, poor cognition"
>
> I would like to add that these symptoms aren't specific to dopamine -- adding despiramine to my combination (which *does* include other dopamine meds) has helped with several of these. Many of the meds you listed, i.e., Parnate, Ritalin, Dexedrine, have strong effects on norepineprhine as well. And these 2 are not the only way to achieve amelioration of these symptoms either -- for example, you could pump someone full of dopamine and norepineprhine but if their serotonin is horribly low they likely won't want to do much still, or enjoy it. But you said you have tried TCAs, okay.
>
> And D2 receptor agonism is not always as pleasurable as it sounds. It can be significantly agitating for some people.
>
> Though I do know what you're talking about with the emotions and clear headedness. I have found Desoxyn to be one of the best meds for these purposes. It has more of an emphasis on dopamine compared to other amphetamines and methylphenidates, and fewer side effects in my case. Speaking of, have you tried Focalin instead of Ritalin?
>
> I have spent much of the past year feeling a lot like you describe, and TMS -- bear in mind I have only had 3 sessions -- is starting to do something that feels dopaminergic.
>
> What are you doing about the thyroid?
>
> Have you tried Lyrica? low-dose amisulpride?
>
> "(pro)dopamine" meds I am taking:
> Marplan 40mg
> Desoxyn 22.5mg
> Deplin 30mg
> Mirapex ER 0.375mg
> Abilify 9mg
>
> One last thing, the Deplin. Yes it's a form of folate, but that shouldn't be underestimated. It is actually a "triamine modulator" in that it increases synthesis of serotonin, norepineprhine, and dopamine. Which in turn causes increased release, and as well Deplin may help replete neurotransmitter stores that are depleted by other meds, e.g. amphetamines, SSRIs. It has helped with my energy too.
>
> Good luck to you.
>
>Thanks for the response. I may have found a source for Agomelatine.
The Deplin is it available via prescription? I'm not sure how to get it. Difficult to find information on it. I really would like to try it.
I got some blood test results back. Turns out my cortisol levels are extremely low. This means low adrenal function. Further testing in few weeks...
Lot of apathy, brain fog, cognitive block, slow thinking, low energy, very poor interest, low emotion. Vyvanse helps to an extent but there is def some stimulation anxiety which accompanies it. It helps for motivation, energy, and somewhat for cognition but the fog is still usually heavy.
Magnesium seems to improve mood, make me more emotionally reactive but sometimes causes more intense headaches than the ones I often have.
edit: I wrote that yesterday. And well I decided to quit the magnesium. It sometimes improves mood a great deal but it causes strong migraines at times and often makes it harder to think! Sometimes it seems to do the opposite though and my mind feels like it is functioning at greater potential. It's so inconsistent.
It may be due to increase in serotonin but inhibition of dopamine. would make sense as sometimes it feels like my vyvanse is doing much less when I am taking magnesium. I sometimes feel extremely cognitively impaired on magnesium yet in a slightly more positive mood (ironically sometimes very negative instead). But the positive moods feel like a positive stupor. Feel like I am severely mentally challenged during those states.
I only took tiny bits of magnesium too. 25-50mg of carbonate and taurate etc. I switch them at times.
Instead I should keep taking calcium, might be linked to some of my mild increase in libido. Royal Jelly might be helping too.
Constant headaches, difficulty thinking, I may need vasoconstriction or dilation or whatever.
Sometimes when these headaches aren't present I have a more positive and more active mind. It feels like the world just opens up more. All that cognitive block dissipates to an extent and I am even able to have some mild interest in things. Sometimes this happens with temporary use of rhodiola. But it never feels the same on the 2nd and 3rd day. Thus only once in a while.
Anyone have any advice for my very low cortisol/adrenal issues? I tend to have extremely slow sluggish thinking, brain fog, much apathy, poor interest, low emotion, and feel like a zombie much of the time. This along with melancholic depression. I do not have the more traditional forms of depression.
I been considering trying caffine again. Has some benefit to interest and thought process perhaps due to vasoconstriction aside from the Dopamine and Serotonin. But it sometimes causes some anxiety.
Posted by Phillipa on July 20, 2014, at 9:46:16
In reply to Update on my status. Very Low Cortisol/adrenals!, posted by AlexCanada on July 20, 2014, at 3:30:39
Medically you tested for low cortisol levels. Has your doctor mentioned Addison's Disease a medical condition? Maybe you problem isn't in your head but in your endocrine system of your body? Phillipa
Posted by Phillipa on July 20, 2014, at 12:12:26
In reply to Re: Update on my status. Very Low Cortisol/adrenals! » AlexCanada, posted by Phillipa on July 20, 2014, at 9:46:16
http://www.livestrong.com/article/24059-effects-low-cortisol-levels/
Posted by babbler20 on July 20, 2014, at 23:39:09
In reply to Update on my status. Very Low Cortisol/adrenals!, posted by AlexCanada on July 20, 2014, at 3:30:39
This may come across as harsh, but I will save you years of speculation about what's wrong with you. Alternative medicine doctors tell everyone they have low adrenals. In reality, your adrenals are fine or you have Addison's Disease or Cushing's Syndrome. In reality, your adrenals are fine and you are just depressed and probably don't sleep well. You may not know you don't sleep well because you may have been sleeping insufficiently your whole life. I guarantee you that if you start getting at least 7 hours of sleep a night, you will feel much better. Try getting that amount of sleep without relying on a benzo. Benzo's often don't allow you to get restful sleep. Try Trazodone or Remeron for sleep. Trust me, your adrenals are fine.
Posted by AlexCanada on July 21, 2014, at 5:53:49
In reply to Re: Update on my status. Very Low Cortisol/adrenals!, posted by babbler20 on July 20, 2014, at 23:39:09
> This may come across as harsh, but I will save you years of speculation about what's wrong with you. Alternative medicine doctors tell everyone they have low adrenals. In reality, your adrenals are fine or you have Addison's Disease or Cushing's Syndrome. In reality, your adrenals are fine and you are just depressed and probably don't sleep well. You may not know you don't sleep well because you may have been sleeping insufficiently your whole life. I guarantee you that if you start getting at least 7 hours of sleep a night, you will feel much better. Try getting that amount of sleep without relying on a benzo. Benzo's often don't allow you to get restful sleep. Try Trazodone or Remeron for sleep. Trust me, your adrenals are fine.
Wow that's nonsense. I have been suffering for over a decade due to damage caused by Accutane. What it did I never fully understood but the damage has been long lasting.
I don't need some alternative doctor to tell me about low adrenals because I have not even seen one. I have only dealt with typical clowns who have no modern day knowledge about endocrine issues. To pretend that there is no such thing as adrenal issues is like pretending no one truly suffers from depression or low serotonin/dopamine etc.
The blood tests show it. As much as these clowns have tried to tell me that my thyroid is normal even though 5.1 TSH is outside range in almost every country except Canada. There is not one person in the world with a TSH of 5 whom will tell you they are reasonably healthy. But unless I am bleeding out of my ears and have my eyebrows falling out most of these terrible doctors won't listen and just tell me to take more anti deps.
Well all my problems may not be from the extremely low cortisol levels but likely at the very least a very large part of it. Likely I do have dopamine and serotonin issues as well as evidenced by the significant but temporary mood boost from certain serotonin substances such as Lyrica, Korean Ginseng among others.
Also some of most promising medications I have ever tried in my life have unknown to me actually had effect on adrenals. Ritalin/Dexedrine, Licorice Root, Vyvanse, Rhodiola etc.
I have gone through stages where I have slept 7-10 hours a day and my mood was no better. I have gone through hypo and hyperthyroid states. Often with immense tiredness, dreadfully poor energy, extremely low emotional capacity and overall sense of apathy. Hyper states involved immense irrational anxiety, dark thoughts and so forth.
Additionally I can only deduct that what I went through 2-3 months ago was a severe adrenal crisis when I stopped Licorice root and other substances were not playing well.
I tried Remeron before btw. Helped very minorly if I recall. Low dose and high dose. higher dose was less sedating. Still lousy days. Only these adrenal meds/herbs have had singnificant effect on my ability to think and usually overall mood.
If I could get off the benzos without intense dysphoric withdrawl I would but I am on only 1.5mg Valium. That is a pretty low dose. Unfortunately I may remain on it for a long time because withdrawl is too long and too intense. I can quit any medication, even paxil cold turkey and just tough it out for few weeks but... you cannot ''tough'' out crippling valium withdrawl which could last for months. It alters the gaba receptor. Benzos are absolute poison.
If I could get agomelatine (sleep + cortisol + Serotonin/D) then I would.
I may try emailing my doctor again. See if he will write me online script to order.
Over 2 dozen meds for depression with very minor relief. Paxil was one of the better ones, as was Parnate, but they lost their effect.
Also my testosterone is pretty low but not incredibly low like my cortisol.
Sorry I'm bit irritable this morning.
Posted by AlexCanada on July 21, 2014, at 5:56:24
In reply to Re: Update on my status. Very Low Cortisol/adrenals! » AlexCanada, posted by Phillipa on July 20, 2014, at 9:46:16
> Medically you tested for low cortisol levels. Has your doctor mentioned Addison's Disease a medical condition? Maybe you problem isn't in your head but in your endocrine system of your body? Phillipa
It was a broad range of blood tests. He was very surprised to learn about low adrenals. I was expecting more severe thyroid issue honestly but adrenal fatigue or something relating to it was one of my other theories.
Too bad it took so many years to figure out one piece of this puzzle.
He didn't give me any new medication yet. More tests. Some insulin stress test next week for pituitary gland.
Posted by Tomatheus on July 21, 2014, at 12:13:57
In reply to More detailed status of my situation » babbler20, posted by AlexCanada on July 21, 2014, at 5:53:49
> Additionally I can only deduct that what I went through 2-3 months ago was a severe adrenal crisis when I stopped Licorice root and other substances were not playing well.
Alex,
Why did you stop taking licorice root? What do you think would happen if you were to try it again?
Have you ever tried an adrenal glandular supplement?
It sounds like both of us have found many treatments that temporarily relieve our symptoms, but nothing that seems to provide long-term relief. I can only hope that testing low for cortisol will guide you toward an effective long-term treatment. If I ever find a treatment for my chronic fatigue that has lasting benefits, I'll let you know.
Tomatheus
Posted by Phillipa on July 21, 2014, at 21:02:28
In reply to Next week test for pituitary gland » Phillipa, posted by AlexCanada on July 21, 2014, at 5:56:24
I remember was years ago and the accutane. Isn't it now known for causing a lot of problemes and females of birthing age have to be on birth control or something. Have you seen an endocrinologist? I have one see every six months. I also have a miroadenoma on pituitary gland per MRI. Hasn't been retested in years. Here it's not hard to get on thyroid meds at all. Google Mary Shoman. She also has a facebook page on thyroid. Lots of interesting stuff. And remeron did not thing for sleep for me. Benzos did. Take less now but it's been 44 years. Doubt will be able to get off them. Phillipa
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