![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 63 to 87 of 90. Go back in thread:
Posted by johnLA on August 14, 2014, at 20:57:06
In reply to Re: day 7 deep tms » johnLA, posted by Chris O on August 12, 2014, at 16:50:33
> That was a very insightful and moving self analysis. I don't have time to reply to it now, but I can relate to much of it, in one way or another. Good to know today was a bit better for the deep TMS.
>
> This sentence struck me as particularly humorous:
>
> "...showered now 3 days in a row. good gawd..."
>
> Man, I'm totally there. Sometimes I even sit around in my underwear all day.
>
> Christhanks chris! appreciate you following my progress. and, making me laugh too. cheers.
john
Posted by johnLA on August 14, 2014, at 21:08:31
In reply to Re: ***possible trigger***, posted by Beckett on August 12, 2014, at 22:15:35
> >god I wish john lennon or bob marley were still alive
>
> I miss John Lennon.
>
> During my first hospitalization, the doctor said once someone 'tastes this kind of anxiety and depression', that experiences changes them. I've come to realize, for myself, that I will experience ups and downs. I try not to be frightened or dismayed by the downward turns.
>
> Thanks for posting your progress.thanks beckett.
i loved john lennon so much. deep down i think he knew depression. how wonderful it must have been to deal with it thru his art.
funny/sad; my anhedonia is so severe that not only do i not listen to music that much, but lennon's amazing yearning voice sounds different to me. when i told this to the doc down at uc san diego his eyes went-up. he said let me get my camera. he was a teaching psych as well. this was an intake interview for a ketamine infusion. i think he may have thought that showing this to his students would give them an idea of how a person can change while in depression.
i identified with john lennon because he had many early childhood losses. but, he was a much better fighter than me.
i wrote that bit about lennon and marley because i think there really needs to be a change in mental health. i look at the civil rights movement and i see that the arts and sports were maybe some of the catalyst for change.
maybe robin williams will be more of a start in that direction hopefully.
and! for the record; paul mccartney is my 4th favorite beatle. lol
thanks again beckett for your post.
john
Posted by johnLA on August 14, 2014, at 21:13:57
In reply to Re: deep tms days 8 and 9 » johnLA, posted by Phillipa on August 14, 2014, at 20:47:39
> One shower a day is pleanty. I admire you eating fish and meat without smell taste as it kind of makes me sick so I don't. I would love a salad each night but get depressed when can't taste it. So it's chicken, green beans, 1/2 baked potatoe prepared by husband. And in my defense I hadn't cooked since I began working back in 85 since ate at work.
>
> Congrats sounds to me like you are accomplishing a whole lot. Phillipathanks for the reminder as usual dear phillipa.
yeah, i need to look at the overall picture and realize this is a game of inches. there has been improvement. but; 'i want candy!' now. doesn't work that way with this mental crap.
i did just shower! i'm thinking 1 a day is plenty too. he-he.
going-out to dinner soon...i think i will order what your husband cooks-up every night. tell him thanks. :)
john
Posted by Chris O on August 14, 2014, at 23:48:02
In reply to deep tms days 8 and 9 » johnLA, posted by johnLA on August 14, 2014, at 20:33:54
Three cheers for John!
Awesome and thoughtful post again. No need to reply. Let's hope that even if the deep TMS is not miraculous, it's at least just less of miraculous. I know that's what I hope for every time I take a new med.
Chris
Posted by SLS on August 15, 2014, at 8:12:53
In reply to deep tms days 8 and 9 » johnLA, posted by johnLA on August 14, 2014, at 20:33:54
Hi John.
Thanks for your generous postings. I find them invaluable.
I don't think you could ask for a more optimistic scenario for your response pattern to TMS treatment. Your doctors' description of the order in which the features of depression improve mirrors that seen with a good-prognosis response to drug treatment in more severe cases. My best and longest-lasting remission developed most gradually over the course of two months rather than two weeks. Unfortunately, the doctor elected to discontinue treatment after nine months. I never responded to that same treatment again.
- Scott
Posted by johnLA on August 20, 2014, at 2:03:53
In reply to going for deep tms..., posted by johnLA on August 3, 2014, at 10:56:55
friday marked day 10 of my deep tms treatment.
this also marked the hallway point of the 'acute' phase of my treatment protocol. again, it is 20 treatments over 4 weeks, with a taper of 2 or 3 per week over 2 to 12 weeks or longer.
friday's treatment also included a halfway depression assessment. not sure how i feel about these questionnaires. i am pretty sure i scored probably the same as the first one i took at the beginning of treatment. but, i do know that i have experienced relative improvement over the past 2 weeks. hmmm...
friday night was a very special night. a old/new friend came back into my life after many years. we talked for hours. thanks slim. ;)
i crashed again though over the weekend. pretty bad actually. i ran out of the little klonopin i was on and really felt it by monday. just 3 days w/out the stuff and i was hurting a bit. i really want off that stuff. sigh. i also went almost 2 days without really eating. dumb and lame.
i actually missed monday's treatment. i just couldn't get out of bed. argh. hadn't slept really at all for a couple of days. did not want to move. waiting for night to hit the drugstore to get my k. i surprised myself and went in the afternoon to get the klonopin. god how i hate when my concentration is shot. just that 'buzz' that is so hard to explain to people who have never been thru it. i am so med sensitive. i have been stuck on 2mg of klonopin forever...
i will see the doc on thursday's treatment. i wonder if she will want to 'make-up' monday's missed one over the weekend. she and her assistant are very flexible with scheduling. i guess when you are making $9k per patient you'll be motivated. lol
today was a much better day. made it to treatment and did some errands. did some house cleaning. very few intrusive thoughts. then, my niece came over with a friend and cooked me a fab dinner. what a difference healthy food makes.
we talked for several hours. socialization is tiring, but so critical i realize for my depression. i was able to concentrate fully the whole night. no depression really. i think/hope i will sleep well. i am tired.
a good day today. i'll take it.
i am saying 'yes' to more social engagements. most of them are at night and close to home, but still i am hoping this is a change in the right direction. i spend so much time alone as i mentioned before. it's hard to break that comfort zone i love/hate.
listened to a bit of music today. first time in several days. i'll post one of the songs that really touched me in a following post. it is a john lennon cover. sometimes when his music comes on i have to turn it off due to anhedonia. or, the pain of not feeling his music anymore is too painful. but, today i felt it again. and, i had the windows down singing along. big difference between singing out loud in your car to lennon as compared to madonna. ha!
still, i need/want to fight more. i'm hoping for a miracle as i said. the tech and the doc keep saying many people have gotten better. but, still. how much can any treatment do without a 'push' from ourselves? will everyday be a battle just to get out of bed? i guess i need to slow down and just take it one-day-at-a-time as i have been for the least 4+ years. it's all that some of us can do...
oh yeah, almost forgot; i am showering more...
Posted by johnLA on August 20, 2014, at 2:09:53
In reply to Re: deep tms days 8 and 9 » johnLA, posted by SLS on August 15, 2014, at 8:12:53
> Hi John.
>
> Thanks for your generous postings. I find them invaluable.
>
> I don't think you could ask for a more optimistic scenario for your response pattern to TMS treatment. Your doctors' description of the order in which the features of depression improve mirrors that seen with a good-prognosis response to drug treatment in more severe cases. My best and longest-lasting remission developed most gradually over the course of two months rather than two weeks. Unfortunately, the doctor elected to discontinue treatment after nine months. I never responded to that same treatment again.
>
>
> - Scottthanks scott. i really appreciate your good words. i know this has been a tough summer for you. man i hope this deal works for BOTH of us.
i am so sorry that you had a good combo working and then to have that taken away. you are a true warrior. i think one of my very first posts to you 3+ years ago was this tolstoy quote;
'the greatest warriors are time and patience.'
i would say you are an inspiration to many of us here. keep fighting scott. it helps many of us here.
god bless you scott.
john
Posted by johnLA on August 20, 2014, at 2:29:01
In reply to going for deep tms..., posted by johnLA on August 3, 2014, at 10:56:55
last week after robin william's death i posted a post i made on a news site. i mentioned that i wish lennon and marley were still alive. i guess i wrote that because they seemed to make so much sense out of things when you could be feeling really low. and, i am pretty sure lennon knew a bit about depression.
fate. we greeks believe in it. maybe too much. but, sometimes things happen. like today; i rarely put the radio on as mentioned. heard this version of 'imagine.' thought at first, hmmm...lennon had an unbelievable voice. always yearning, asking, hoping. and, this song is epic. i was not expecting much...
about a third of the way in i was singing. thinking how i would definitely add to this to my 'beatles' unit in my music appreciation class. cried a little. not too much. sad that i am not teaching. but, hopeful that i may again someday.
also, i dedicate this song to scott/sls. i hope you are not offended scott. i mean it in goodwill. hoping some of you others too that are not listening anymore might 'feel' a bit as i did today.
Posted by johnLA on August 20, 2014, at 3:38:32
In reply to Re: deep tms days 8 and 9 » johnLA, posted by SLS on August 15, 2014, at 8:12:53
Posted by SLS on August 20, 2014, at 8:03:14
In reply to Re: deep tms days 8 and 9, posted by johnLA on August 20, 2014, at 2:09:53
Hi John.
Thanks for your kind words.
I spent most of the summer after Memorial Day lying motionless on the couch. I had neither the motivation nor the energy to venture across the room to play on my computer. My system was very much upset when I switched from nortriptyline to desipramine. I have been on desipramine numerous times in the past, but never reacted to it so adversely. Fortunately, after a brief discontinuation and a few dosage manipulations, I am now feeling better.
> i am so sorry that you had a good combo working and then to have that taken away. you are a true warrior. i think one of my very first posts to you 3+ years ago was this tolstoy quote;
>
> 'the greatest warriors are time and patience.'
Perfect.:-)
- Scott
Posted by SLS on August 20, 2014, at 8:09:41
In reply to song i 'felt' today/dedication to scott/sls » johnLA, posted by johnLA on August 20, 2014, at 2:29:01
> https://www.youtube.com/watch?v=MHCPfs6EGCA
One of my favorites. I used to sing it at karaoke.
- Scott
Posted by Phillipa on August 20, 2014, at 18:49:28
In reply to day 10, weekend, day 11 and day 12 of deep tms... » johnLA, posted by johnLA on August 20, 2014, at 2:03:53
Congrats showering more now up and at umm. And do not forget your klonopin!!!! Phillipa
Posted by johnLA on August 31, 2014, at 9:42:36
In reply to Re: deep tms days 8 and 9, posted by johnLA on August 20, 2014, at 2:09:53
well, i have completed 4 weeks of deep tms. yay!
i made it to 18 out of 20 sessions. missed 2 days because i just couldn't move my butt.
i am not cured that is for sure. and, to be honest, i was hoping for more of a response by this point.
the good;
1. moving more. i have literally been almost stuck to my bed for 4 years now. i can't decide if it is laziness, boredom, or depression. i think it is all 3. i was always a bedroom guy. lol but, as i mentioned previously, never like this. still, i have to look at the past 4 weeks and there has been improvement.
i need to give myself credit for getting someplace 90% of the time. this is new. can't forget that.
went to the beach finally a few times. even swam and caught waves for close to 1 hour straight 1 day. i got out of the water and looked at how 'pruned-up' my finger-tips were. many years since that has happened.
doing a bit more socially. still mostly at night. can't seem to like that sun again. i think i mentioned that i was always indoors during the height of the daylight. i am comfy in dark spaces. teaching film history was perfect. :) i always enjoyed the late afternoon sun. still, going to treatment in the middle of the day is like who turned on the stadium lights? not sure if i am agoraphobic. a little stress getting out of the house. i think it is more just i am a creature of habit.
2. music comes and goes. sometimes i can really feel a song. other times i have to turn the music off. often a song will take to me to a sad or regretful place, so i just turn it off. sigh. silence is good/bad.
3. personal hygiene. better, but not showering every day. seems like every 2 or 3 days now. at my worst i was going a week or so w/out showering. good gawd. shaving too comes and goes. i never did shave everyday. still, sometimes i let my beard go for a week. just not my look. a few days looks good actually. he-he.
4. weight. have lost some more since stopping the remeron. not exercising like i had hoped to. i did get a new gym bag! that should arrive soon. my gorgeous gym is just waiting down the road for me to go break a sweat or even start gentle with swimming. still, i think i've lost about 10 pounds. i am about 10 pounds over my regular weight still. diet has been good/bad. been drinking/sipping some high quality fish oil. seems to help my digestion. though i never had a problem there.
the bad;
1. as i said i was hoping for more of a response. the doctor said i will do an 'index' of 30 to 40 treatments before we start tapering. hmmm. she also highly suggested talk therapy. tired of talking about my crap. she mentioned that when people come-out of a depression that they often need help 'grieving' loss. like my career, lost time, what do i do now?, etc. i'd be more willing to do talk therapy again if i felt like i was coming-out of my depression. again, she keeps telling me mood is the last to improve. and, that my scores have dropped a lot on the depression intake. just doesn't feel like it.
2. sleep hygiene. just horrendous. i really wonder if the klonopin has messed me up there? or, the lack of a schedule is causing it? it is daunting not to have to be any place at a given time. this is behavioral i'm thinking. but, i have no motivation to 'do' something. except clean the house and get something to eat. the nightmares will not let up. worse when i use remeron on occasion. really would like to try and get off that klonopin. i never even used to remember my dreams before depression.
3. what happens when we get to 40 treatments and still no response? she is mentioning lamictal. i will see my regular doc next week. i will ask him about that. he has tried more 'activating' meds on me. most have done nothing or made me feel very anxious or out of it. argh. i have not tried a mood stabilizer. we haven't talked why she is recommending it. isn't that more for bipolar 1 and 2? i have been told by a psych doc friend that mood stabilizers can make a depressed person more 'social.' maybe that is what she is thinking. i will need to ask her about why she is suggesting lamictal.
if anybody has anything to say about lamictal, besides the rash, please let me know. i am curious what it might be able to do for me.
so, that is it for now. really wish i had a more positive report.
still wishing and hoping and praying for something magical...
Posted by johnLA on August 31, 2014, at 9:45:27
In reply to Re: song i 'felt' today/dedication to scott/sls » johnLA, posted by SLS on August 20, 2014, at 8:09:41
> > https://www.youtube.com/watch?v=MHCPfs6EGCA
>
> One of my favorites. I used to sing it at karaoke.
>
>
> - Scottlol scott. i used to be a snob about that song and felt that lennon was the 'only' one who should sing it.
good to know you like it too.
Posted by johnLA on August 31, 2014, at 9:47:10
In reply to Re: day 10, weekend, day 11 and day 12 of deep tms... » johnLA, posted by Phillipa on August 20, 2014, at 18:49:28
> Congrats showering more now up and at umm. And do not forget your klonopin!!!! Phillipa
thanks phillipa.
yeah, that friggin' klonopin. want off at some point...
Posted by Beckett on August 31, 2014, at 13:15:16
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
You're half way through? (I'm not sure I understood that correctly.)
Posted by SLS on August 31, 2014, at 14:49:43
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
> if anybody has anything to say about lamictal, besides the rash, please let me know. i am curious what it might be able to do for me.
I came up with a silly idea a number of years ago.
I read that certain glutamate pathways efferent from the thalamus and hippocampus actually inhibited dopamine activity in mesolimbic structures, namely, the nucleus accumbens and the ventral tegmental area. Lamictal reduces glutamate release in both the thalamus and hippocampus, and might therefore act to disinhibit dopamine neurons and increase dopamine release in the nucleus accumbens and ventral tegmental area, regions that participate in reward and mood. I just want to mention that other glutamate pathways act to stimulate dopamine release. That's why it is often better to conceptualize the brain as a network of wires rather than a bucket of chemicals. Where a neuron is routed is at least as important as which neurotransmitter it uses to transduce the message it carries. Remember, the same receptor can be excitatory or inhibitory depending on its location along the cell membrane.
One line of reasoning:
1. There are glutamate neurons arising from the thalamus and hippocampus.
2. These glutamate neurons are routed to two mesolimbic structures that are important for the experience of reward and good mood.
3. The neurons in the mesolimibic structures that are responsible for reward and good mood are driven by dopamine.
3. When the glutamate neurons from the thalamus and hypothalamus are innervated (activated), they inhibit (reduce) the firing rate of the dopamine neurons in the mesolimbic structures.
4. Too much glutamate leads to too little dopamine in this case.
5. Lamotrigine (Lamictal) inhibits the release of glutamate from neurons located in the thalamus and hippocampus. The firing rate of glutamate neurons is therefore reduced. Less glutamate leads to more dopamine.
* This kind of functional relationshop is known as disinhibition.
6. By disinhibiting dopamine neurons via the inhibition of glutamate release by lamotrigine, people may experience an improvement in the severity of their depression as the activity in the nucleus accumbens and ventral tegmental area is increased.
7. Since the ventral tegmental area innervates the prefrontal cortex, it may be that lamotrigine yields an increase in activity here, too. If so, one might expect an improvement in some other aspects of mood and cognitive function. Unfortunately, lamotrigine also blocks sodium channels. The cognitive and memory impairments this produces usually obscures any enhancement in prefrontal cortical activity. There may be other mechanisms that contribute to these cognitive side effects. I haven't looked into it.
- Scott
Posted by Phillipa on August 31, 2014, at 21:04:49
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
John to me it sounds like you have a come a long way. I am so glad for you. Phillipa
Posted by johnLA on September 1, 2014, at 10:37:47
In reply to Re: 4 weeks of deep tms..., posted by Beckett on August 31, 2014, at 13:15:16
> You're half way through? (I'm not sure I understood that correctly.)
hi beckett.
yeah, i realize my thread/post was confusing.
the original plan was to do an 'index' of 20 treatments and then, re-evaluate the course of treatment on how i was feeling.
when we started the doc had hoped that by treatment #20 i would be in a place to start tapering or doing maintenance; 2 to 3 tmes per week. for a few weeks or even much longer. similar to ect in some ways.
my depression scores have dramatically improved. yet, i really don't feel that great. again, she has said mood is the last to improve.
the plan is to do 10 more treatments and then start the taper.
as i mentioned i was really hoping to have more of a response by this point.
she is off on vacation so her tech is doing the treatments this week. i will ask about at what point is somebody considered a non-responder. i think i remember the doc saying that she had patients that needed up to 50 treatments in a row before tapering.
thanks for following my thread. let me know if you have any other questions.
john
Posted by johnLA on September 1, 2014, at 10:46:15
In reply to Re: 4 weeks of deep tms... » johnLA, posted by SLS on August 31, 2014, at 14:49:43
wow scott.
i understood about 80% of all that. and, you delivered the info in a very 'gentle' way. i appreciate that greatly.
theory aside;
1. what can lamictal possibly do for a anergic depression? i have heard it can be 'pro-social' in it's action.
2. i have read about the 'dumbing' effect it can cause on cognitive ability. any more info on your end about this?
3. could you explain the sodium channel deal a bit more? you mentioned this causes cognitive impairments.
4. lamictal; worth a try? still, need to talk to her and my regular pdoc. i'm not too sure my regular doc will be keen to use it.
thanks again so much for such a detailed reply.
john
Posted by johnLA on September 1, 2014, at 10:47:12
In reply to Re: 4 weeks of deep tms... » johnLA, posted by Phillipa on August 31, 2014, at 21:04:49
Posted by SLS on September 1, 2014, at 12:38:44
In reply to scott/sls; lamictal ?'s » SLS, posted by johnLA on September 1, 2014, at 10:46:15
> wow scott.
>
> i understood about 80% of all that. and, you delivered the info in a very 'gentle' way. i appreciate that greatly.
>
> theory aside;
>
> 1. what can lamictal possibly do for a anergic depression? i have heard it can be 'pro-social' in it's action.My depression is primarily one of anergia and cognitive impairment along with lack of interest and anhedonia. I find Lamictal to be energizing and antidepressive. At 200 mg/day, I don't think that I experience very much cognitive impairment as a side effect. Since I have been taking Lamictal for quite a few years, I cannot be absolutely sure as to the degree of residual impairments that might still exist. For me, the cost/benefit ratio leans in the direction to continue Lamictal treatment.
> 2. i have read about the 'dumbing' effect it can cause on cognitive ability. any more info on your end about this?
Cognitive impairments produced by Lamictal are dosage-dependent. It makes sense to establish the lowest effective dosage. I would set 200 mg/day as an initial target dosage to titrate up to. Most people find this to be optimal. This will take at least four weeks to attain so as to avoid the precipitation of a rash-reaction. I see most people respond robustly to a dosage range of 150 - 300 mg/day.
> 3. could you explain the sodium channel deal a bit more? you mentioned this causes cognitive impairments.
Sodium ions must be transported in and out of the neuron in order for the neuron to send its message. This is accomplished via the passage of ions through a membrane channel, and must occur rapidly and unimpeded in response to changes in voltage. When these sodium channels are blocked by anticonvulsants like Lamictal, neurons are inhibited from firing (propogating an action-potential). In this case, blocking sodium channels impairs cognitive and memory function.
> 4. lamictal; worth a try?
I think so. It can help in the treatment of both bipolar disorder and unipolar major depressive disorder. However, it seems to me that it produces better results when combined with an antidepressant, atypical antipsychotic, or another anticonvulsant.
> still, need to talk to her and my regular pdoc. i'm not too sure my regular doc will be keen to use it.
What are your doctor's objections to treating you with Lamictal?
- Scott
>
> thanks again so much for such a detailed reply.
>
> john
Posted by johnLA on September 1, 2014, at 15:30:04
In reply to Re: scott/sls; lamictal ?'s » johnLA, posted by SLS on September 1, 2014, at 12:38:44
again;
wow. :)
thank-you so very much for walking me thru the lamictal ?'s and the other ?'s as well.
you should really be a teacher scott. there are online teaching programs. i think you have much to offer to a larger audience.
k; to answer your last question about my doctor's reluctance to lamictal. there is none that i know of. lol i have yet to see him to even toss the idea at him. i think i may have posted it wrongly and may have come across that he would be hesitant. not the case.
i guess i should have said i will be 'curious' as to what he thinks of lamictal for me.
last questions and i'll leave you alone for today. ;)
1. i am super med sensitive. i really like the idea of titrating up slowly on lamictal. thanks for telling me that the cognitive issues are usually dose related. i mean i was on 5mg of prozac and i felt wired/confused/anxious/headaches/etc. i am curious if there is 'low dose' response to lamictal?
glad you mentioned it being energizing and anti depressive. this would be absolutely 2 core symptoms of relief for me. also, being anhedonic. you make me hopeful, if i decide on this route.
2. you write that it is more robust when added with another antidepressant, ap, or anticonvulsant.
any chance it could work alone? or, play well with my 2mg of klonopin? klonopin and coffee are about the two best drugs i have tried in the last 4 years. seriously.
the deep tms doc seems to be pretty optimistic about using lamictal alone. i may be wrong on that, since we have not spoken too much about it. still, she seems keen on it for some reason for me.
she has mentioned several times that i lived most of my life w/out medication. she is not ruling-out that deep tms, plus booster/maintenance can get me better. she just mentioned lamictal as a possibility once i reach 'remission.' i'd still very much would like to go med free. i guess time will tell. i still have many more deep tms treatments to go.
thanks again scott. i don't know what else to share with you in regards to my gratefulness.
hmmm...have you thought of creating your own website? no disrespect to dr bob, but i think, again, you have a gift that could help many people. and, you could earn some income from it too. i don't mean that as a pushy thing, but you deserve to be compensated i feel more than just a 'thank-you' in cyber-space.
god bless you scott.
john
Posted by SLS on September 1, 2014, at 18:55:44
In reply to thnx so much scott :) a few more ?'s... » SLS, posted by johnLA on September 1, 2014, at 15:30:04
With regard to lamotrigine and cognitive impairments:
It is also important to acknowledge the role that glutamate release inhibition might play in the production of cognitive impairments by lamotrigine - particularly learning and memory. It may be that the combination of sodium channel blockade and glutamate release inhibition acts synergistically to produce these side effects.
> 1. i am super med sensitive. i really like the idea of titrating up slowly on lamictal. thanks for telling me that the cognitive issues are usually dose related. i mean i was on 5mg of prozac and i felt wired/confused/anxious/headaches/etc. i am curious if there is 'low dose' response to lamictal?
I would not discount that possibility, but I doubt that it is very common.
It often occurs that someone will experience a transient improvement in depression at a dosage as low as 50 mg/day. For most people, I think this is a sort of startup effect that quickly disappears. A second transient improvement may then occur upon a dosage increase from 50 mg/day to 100 mg/day. This phenomenon often fools people into thinking that they will eventually recapture the lost antidepressant response if they continue treatment at the lower dosages. Many of them resist increasing the dosage to 200 mg/day. To complicate matters, some people experience a transient improvement upon dosage decreases. This only reinforces for some the notion that lower dosages are more effective than higher dosages.
> 2. you write that it is more robust when added with another antidepressant, ap, or anticonvulsant.
>
> any chance it could work alone?Yes. Most of the clinical trials for bipolar depression that reported a therapeutic effect for lamotrigine employed monotherapy. It makes a great deal of sense for you to try monotherapy first.
> or, play well with my 2mg of klonopin? klonopin and coffee are about the two best drugs i have tried in the last 4 years. seriously.
I wouldn't make any other changes at this point. As far as the combining of lamotrigine and clonazepine, I have not seen anything that would lead me to believe that you should be concerned with its safety.
You are great for my self-esteem!
:-)
I will keep your vocational suggestions in mind.
- Scott
Posted by johnLA on September 22, 2014, at 3:37:52
In reply to Re: thnx so much scott :) a few more ?'s... » johnLA, posted by SLS on September 1, 2014, at 18:55:44
well i have done 7 weeks of deep tms.
i made it to 31 out of 35 days.
this is the most activity i have done in over four years since my depression started.
has it worked? yes. 100%? no.
i start a m/w/f 3 times a week taper later today. this may go on indefinitely. the doc has said that i should see continued improvement during the taper. the taper could last as long as 12 more weeks.
she does have 1 patient who comes in, i think, 2 times a week continuously.
i have been showering more. made my goal of getting to the beach 10 times this summer. thinking about work too. what exactly i am not sure. i have been much more social. music really sounds good. not all the time. but, especially on days of treatments.
less time coming to babble. ;)
there has been improvement.
my scores on the depression intake have dramatically decreased. i think when i give her my scores later today i will probably score in the 'mildly' depressed category.
all good with that.
i couldn't give you a % on how improved i am. sometimes i have absolutely no depression. i mean zero. other times, i had it bad and did not make treatment. still, the last 7 weeks have had the highest # of good days/moments that i have experienced since my depression began.
still some sleep issues. some bad dreams. cutting klonopin to 1.5mg per night. taking occasional remeron to sleep. really want off the klonopin. have felt no real anxiety dropping to 1.5mg over the last several weeks. wondering if this is also giving me some boost.
still a fight.
i was hoping for more 'magic.' but, i need to realize i am not done with treatment so far and that i really have gotten better from the time i started.
i also think i will be posting less here. i need to break some habits. this is a good place. but, i literally need to stop spending so much time talking, researching, thinking about depression. i think a start will be to get off the computer and get outside more. this has been happening the last 7 weeks.
i hope i am making sense?
i believe this treatment works. i will go 3 times a week for the rest of my life if i have to.
i also know some promising new things are hopefully coming in the future. i feel; optimistic. in fact i will do one more post i found listing some things that may be coming out in the next 1 to 3 years or so..
if you can afford it, or if your insurance covers it, i can highly recommend deep tms.
godspeed good health to all of us.
john
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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