![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Christ_empowered on April 16, 2022, at 17:44:46
direct quote from my newest (professional, probably temporary) prescriber.
what's the point, again?
Posted by undopaminergic on April 17, 2022, at 5:45:36
In reply to 'anything can happen with psych drugs...', posted by Christ_empowered on April 16, 2022, at 17:44:46
> direct quote from my newest (professional, probably temporary) prescriber.
>
> what's the point, again?To find relief, as far as possible?
-undopaminergic
Posted by SLS on April 17, 2022, at 10:47:40
In reply to 'anything can happen with psych drugs...', posted by Christ_empowered on April 16, 2022, at 17:44:46
> direct quote from my newest (professional, probably temporary) prescriber.
>
> what's the point, again?
Undopaminergic is right.Your doctor is right.
As an example, some anti-seizure medications can actually trigger seizures in patients who had previously been seizure-free for years. Doctors often want to find a substitute for Tegretol (carbamazepine) because it requires regular blood tests to detect the onset of agranuloctyosis. This reaction can be fatal.
https://pubmed.ncbi.nlm.nih.gov/16194719/
I became suicidal at least 4 times after beginning treatment with a new drug. Unfortunately, having an "antidepressant" exacerbate depression is all to common.
Why did I use quotes?
A molecule doesn't know that it is an antidepressant. It doesn't know that it is a laxative. Once research scientists label a molecule something other than a molecule, its value as a tool becomes limited. For instance, Paxil was found to have value in treating anxiety disorders after it was approved by the FDA for only one indication - depression. Perhaps opposite sides of a single Paxil molecule binds to different receptors. Now, someone has to re-educate Paxil so that it knows it is an anxiolytic.
Stupid, I know. However, humans tend to label things in order to help them make sense of the world.
- Scott
Posted by Jay2112 on April 17, 2022, at 12:53:00
In reply to Re: 'anything can happen with psych drugs...' » Christ_empowered, posted by undopaminergic on April 17, 2022, at 5:45:36
> > direct quote from my newest (professional, probably temporary) prescriber.
> >
> > what's the point, again?
>
> To find relief, as far as possible?
>
> -undopaminergic
>YES...that oh so desperate, sweet relief! That is really the heart of it all. I still remember, on the day of my first psych appointment. I was in such depressive tatters, soulfully exhausted on a scorching hot summer day in 1994. At about 4 in the afternoon, I took my first psych drug ever, lorazepam, and it was like the hand of god gently lay me into my bed. That evening, I took my first dose of amitriptyline, and I slept a sweet sleep that I so deeply needed. Like "st. joeseph's aspirin for the soul", as weeks went by, my life became, well, "LIFE", again.
I still take amitriptyline (and other meds as well) to this day, and it is my absolutely MOST reliable medication!! A recent study found the drug to likely be the most reliable antidepressant available....with some give and take. But, 'tis life!
Jay
Posted by SLS on April 17, 2022, at 20:10:00
In reply to Re: 'anything can happen with psych drugs...', posted by Jay2112 on April 17, 2022, at 12:53:00
> > > direct quote from my newest (professional, probably temporary) prescriber.
> > >
> > > what's the point, again?
> >
> > To find relief, as far as possible?
> >
> > -undopaminergic
> >
>
> YES...that oh so desperate, sweet relief! That is really the heart of it all. I still remember, on the day of my first psych appointment. I was in such depressive tatters, soulfully exhausted on a scorching hot summer day in 1994. At about 4 in the afternoon, I took my first psych drug ever, lorazepam, and it was like the hand of god gently lay me into my bed. That evening, I took my first dose of amitriptyline, and I slept a sweet sleep that I so deeply needed. Like "st. joeseph's aspirin for the soul", as weeks went by, my life became, well, "LIFE", again.
>
> I still take amitriptyline (and other meds as well) to this day, and it is my absolutely MOST reliable medication!! A recent study found the drug to likely be the most reliable antidepressant available....with some give and take. But, 'tis life!
>
> Jay
Was clomipramine (Anafranil) among the drugs mentioned?In general, I think clomipramine is the strongest TCA. The side effects suck, though. You end up getting the side effects of both a TCA and SSRI, including sexual side effects.
There is one drug that is rarely spoken about nowadays, but is probably the most potent antidepressant agent in existence. It is a MAOI called clorgyline. The NIH used it as their "ace-in-the-hole" for their most difficult cases. They gave it to me. I responded to it at a time when I was refractory to every other drug. However, it never became a marketed drug. Clorgyline is specific (as opposed to selective) for the MAO-A subtype. It is incapable of inhibiting MAO-B. The lesson to be learned from clorgyline is that inhibiting MAO-A without affecting MAO-B is sufficient to produce a robust antidepressant response. Interestingly, EMSAM (selegiline), an MAO inhibitor that is selective for MAO-B at low dosages, does not exert an antidepressant effect until the dosage is high enough to begin inhibiting MAO-A. Both enzymes break down dopamine and norepinephrine. However only MAO-A breaks down serotonin.
As I mentioned, clorgyline never made it to market. No drug company ever tried to develop it. Since the patent on clorgyline expired, there was no incentive to develop it. The only source of a preparation made for human consumption was at the NIH. Unfortunately, some patients who were taking it experienced cardiological adverse events. The research clinicians never gave me any details. I'm guessing that it was some sort of valvulopathy. Only some lucky rats get clorgyline now.
- Scott
Posted by Jay2112 on April 17, 2022, at 21:55:01
In reply to Re: 'anything can happen with psych drugs...' » Jay2112, posted by SLS on April 17, 2022, at 20:10:00
> > > > direct quote from my newest (professional, probably temporary) prescriber.
> > > >
> > > > what's the point, again?
> > >
> > > To find relief, as far as possible?
> > >
> > > -undopaminergic
> > >
> >
> > YES...that oh so desperate, sweet relief! That is really the heart of it all. I still remember, on the day of my first psych appointment. I was in such depressive tatters, soulfully exhausted on a scorching hot summer day in 1994. At about 4 in the afternoon, I took my first psych drug ever, lorazepam, and it was like the hand of god gently lay me into my bed. That evening, I took my first dose of amitriptyline, and I slept a sweet sleep that I so deeply needed. Like "st. joeseph's aspirin for the soul", as weeks went by, my life became, well, "LIFE", again.
> >
> > I still take amitriptyline (and other meds as well) to this day, and it is my absolutely MOST reliable medication!! A recent study found the drug to likely be the most reliable antidepressant available....with some give and take. But, 'tis life!
> >
> > Jay
>
>
> Was clomipramine (Anafranil) among the drugs mentioned?
>
> In general, I think clomipramine is the strongest TCA. The side effects suck, though. You end up getting the side effects of both a TCA and SSRI, including sexual side effects.
>Imipramine was...I believe it is on the WHO list of essential medications. Clomipramine makes me very sad, and cry heavily...for some odd reason. When my dog passed last year, I was on it, and cried constantly. Fluoxetine (Prozac) was able to slow that down.
And amitriptyline, for me anyways, I think works well because of the strong anticholinergic properties. My hypersensitivity to choline seems quite evident. When I am really depressed, I get the slow, cold sweats, and inability to relax.
But, I think we all get different and inconsistent results because of our biology. My Dad had a list of allergies a mile long, and responded well to doxepin, with it's powerful antihistamine properties. Now there are those DNA tests, regarding most effective drugs, with I think point in the right direction.
Your experience with clorgyline sounds very interesting. It seems like certain drugs, even with the same mechanism of action, muck around to create a delicate balance that works in some, but not in others. I have this feeling we may start to see more money poured by drug companies back into psychiatry as diseases like Parkinson's and Alzheimer's explode with the aging population. (I'm already old...how long do we have to wait??..lol)
I'd really like to get to this 'anything can happen' point with drugs...really. Nothing "bad" of course...but I think there is so, so, SO much more potential to be had. Like that article you posted Scott about a new, unrealized subset of serotonin receptors, was it? Or a drug that adjusts MAOI A and B, works on GABA, or the other many amines. I'd just wish that they'd hurry up with this stuff...or go back and pull some of the best of older drugs that may not work for person A, but K and Z respond well. (I still remember wanting to try protriptyline.)
Really, they could very likely save many, many lives, especially after all that is going on in this mad world.
Jay
Posted by Lamdage22 on April 18, 2022, at 0:01:39
In reply to Re: 'anything can happen with psych drugs...' » SLS, posted by Jay2112 on April 17, 2022, at 21:55:01
Right I had a pretty hardcore spiritual experience with MAOI, followed by psychotic symptoms. Then again I was fine on it for quite a while. It made me more belligerent. If I wasn't abused 24/7, I might do well on it. But it is not good if you "have to" take a lot of abuse. Neuroleptics make it easier to take abuse.
Posted by undopaminergic on April 18, 2022, at 6:33:50
In reply to Re: 'anything can happen with psych drugs...' » Jay2112, posted by SLS on April 17, 2022, at 20:10:00
>
> Only some lucky rats get clorgyline now.
>Perhaps, but if you really want it, why not order it as a chemical? I mean something like 99%+ pure clorgyline powder. It is not a controlled substance.
I ordered 2.5 kgs of phenylethylamine (PEA) years before it came onto the market as a supplement for human consumption.
-undopaminergic
Posted by SLS on April 18, 2022, at 9:09:14
In reply to Re: 'anything can happen with psych drugs...' » SLS, posted by Jay2112 on April 17, 2022, at 21:55:01
Hi, Jay.
Nice post. I'm glad you discovered so much about your unique responsivity to drug treatment. I really appreciate your descriptions.
> > Was clomipramine (Anafranil) among the drugs mentioned?
> >
> > In general, I think clomipramine is the strongest TCA. The side effects suck, though. You end up getting the side effects of both a TCA and SSRI, including sexual side effects.
> >
>
> Imipramine was...I believe it is on the WHO list of essential medications. Clomipramine makes me very sad, and cry heavily...for some odd reason. When my dog passed last year, I was on it, and cried constantly. Fluoxetine (Prozac) was able to slow that down.
>
> And amitriptyline, for me anyways, I think works well because of the strong anticholinergic properties. My hypersensitivity to choline seems quite evident. When I am really depressed, I get the slow, cold sweats, and inability to relax.
>
> But, I think we all get different and inconsistent results because of our biology. My Dad had a list of allergies a mile long, and responded well to doxepin, with it's powerful antihistamine properties. Now there are those DNA tests, regarding most effective drugs, with I think point in the right direction.
> Your experience with clorgyline sounds very interesting. It seems like certain drugs, even with the same mechanism of action, muck around to create a delicate balance that works in some, but not in others. I have this feeling we may start to see more money poured by drug companies back into psychiatry as diseases like Parkinson's and Alzheimer's explode with the aging population. (I'm already old...how long do we have to wait??..lol)
>
> I'd really like to get to this 'anything can happen' point with drugs...really. Nothing "bad" of course...but I think there is so, so, SO much more potential to be had. Like that article you posted Scott about a new, unrealized subset of serotonin receptors, was it? Or a drug that adjusts MAOI A and B, works on GABA, or the other many amines. I'd just wish that they'd hurry up with this stuff...or go back and pull some of the best of older drugs that may not work for person A, but K and Z respond well. (I still remember wanting to try protriptyline.)
Protriptyline exacerbated my depression tremendously. I don't know why (of course). If I recall properly, it is biased towards blocking norepinephrine reuptake. Reboxetine made my depression much worses. It's selective for inhibiting NE reuptake, I believe. That drug made me suicidal to the point where I told my parents that I was getting my affairs in order.
- Scott
Posted by undopaminergic on April 18, 2022, at 10:06:58
In reply to Re: 'anything can happen with psych drugs...' » Jay2112, posted by SLS on April 18, 2022, at 9:09:14
>
> Protriptyline exacerbated my depression tremendously. I don't know why (of course). If I recall properly, it is biased towards blocking norepinephrine reuptake.
>Like nortriptyline?
> Reboxetine made my depression much worses. It's selective for inhibiting NE reuptake, I believe.
>It is. It relieved my emotional issues, by worsening my depersonalisation/derealisation, ie. it numbed my emotions. Permanently.
How do you react to ephedrine?
-undopaminergic
Posted by SLS on April 18, 2022, at 23:38:23
In reply to Re: 'anything can happen with psych drugs...' » SLS, posted by undopaminergic on April 18, 2022, at 10:06:58
> >
> > Protriptyline exacerbated my depression tremendously. I don't know why (of course). If I recall properly, it is biased towards blocking norepinephrine reuptake.> Like nortriptyline?
I really can't say. It think protriptyline might exert both NE reuptake inhibition and a strong anticholinergic effect. I have a tendency to focus on dopamine as being the common denominator in my case.
> > Reboxetine made my depression much worses. It's selective for inhibiting NE reuptake, I believe.>
> It is. It relieved my emotional issues, by worsening my depersonalisation/derealisation, ie. it numbed my emotions. Permanently.I am profoundly sad to know this. The risk we take with antidepressants is a reflection of how little we understand. In order to treat everyone effectively, we need to think of each brain as having a unique topography that must be mapped before choosing a path to follow.
- Scott
Posted by Lamdage22 on April 19, 2022, at 8:41:10
In reply to Re: 'anything can happen with psych drugs...' » undopaminergic, posted by SLS on April 18, 2022, at 23:38:23
>The risk we take with antidepressants is a reflection of how little we understand. In order to treat everyone effectively, we need to think of each brain as having a unique topography that must be mapped before choosing a path to follow.
Are they researching with this in mind? I always think there is a natural way to completely fix most mood disorders, it just isnt known. Aside from Psychotherapy which is known.
Posted by SLS on April 19, 2022, at 10:29:30
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 19, 2022, at 8:41:10
> >The risk we take with antidepressants is a reflection of how little we understand. In order to treat everyone effectively, we need to think of each brain as having a unique topography that must be mapped before choosing a path to follow.
>
> Are they researching with this in mind? I always think there is a natural way to completely fix most mood disorders, it just isnt known. Aside from Psychotherapy which is known.Psyhotherapy can be and important adjunct to biological interventions should the mood state be the result of a *persistent* alteration of what is presumed to be brain function.
Stress can be a killer. Psychosocial stress can wreak havoc with a biologically vulnerable brain. It is a frequent scenario that the very first biologically-driven depressive episode is triggered as the result of a psychological stress that had no biological contribution to its origin. However, this same vulnerable brain is left even more vulnerable with each successive depressive episode such that the threshold of stress necessary to trigger the next biological depression is lowered. At some point, no psychosocial stress is necessary for the pathological depressive neurobiology to appear and persist on its own. Major Depressive Disorder is a self-reinforcing phenomenon - a positive feedback loop.
Take this into consideration, if the psychosocial stress is reduced by psychotherapy early in the course of someone's disease, the threshold of stress necessary to trigger depression remains high enough to prevent subsequent episodes. Psychotherapy has a place in TRD as well. Reducing psychosoocial stress will give treatment a better chance of working.
- Scott
Posted by Lamdage22 on April 19, 2022, at 11:03:40
In reply to Re: 'anything can happen with psych drugs...' » Lamdage22, posted by SLS on April 19, 2022, at 10:29:30
Right, there are tons of different types of Psychotherapy and even within the same type of therapy, no therapist is the same.
Posted by Lamdage22 on April 19, 2022, at 11:57:11
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 19, 2022, at 11:03:40
Sometimes behind depression there is a disordered personality.
Posted by SLS on April 19, 2022, at 16:48:00
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 19, 2022, at 11:57:11
> Sometimes behind depression there is a disordered personality.
More often, I think it is disordered parents.
- Scott
Posted by Lamdage22 on April 20, 2022, at 0:05:44
In reply to Re: 'anything can happen with psych drugs...' » Lamdage22, posted by SLS on April 19, 2022, at 16:48:00
> > Sometimes behind depression there is a disordered personality.
>
>
> More often, I think it is disordered parents.
>
>
> - ScottRight but this often leads to a disordered child.
Posted by Lamdage22 on April 20, 2022, at 0:55:58
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 20, 2022, at 0:05:44
We can't change the parents, that is why I left them out. The problem is passed along the generations for sure. I am the first to point that out.
Posted by SLS on April 20, 2022, at 8:57:42
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 20, 2022, at 0:05:44
> > > Sometimes behind depression there is a disordered personality.
> >
> >
> > More often, I think it is disordered parents.
> >
> >
> > - Scott
>
> Right but this often leads to a disordered child.
Presicely.To avoid this fact when it is part of someone's life history is to ignore the hope of working to recapture order out of disorder. To relieve one of the pscychosocial stress that contributed to the onset and persistence of depression (or other mental illnesses) can be only work to one's advantage.
Allowing the old disordered though patterns to persist untreated is to retain indefinitely the paychodynamics that triggered the depression in the first place. Identifying the first few dominoes to fall in the chain of events that generated the alterations in brain function is important to remove the causative factors.
Childhood adversity, especially neglect, is an almost universal contributor to the subsequent dysregulation in the neurobiology of the brain. The longer one remains depressed, the greater the risk of developing treatment resistance. The same thing applies to the number of depressive episodes one experiences.
The idea that I'm trying to convey is that psychotherapy + pharmacotherapy (or other biological interventions) is more effective than pharmacotherapy alone. This is supported by almost every clinical study published on the topic.
The need for psythotherapy as an adjunct to pharmacotherapy is not universal.
- Scott
Posted by Lamdage22 on April 20, 2022, at 9:07:06
In reply to Re: 'anything can happen with psych drugs...' » Lamdage22, posted by SLS on April 20, 2022, at 8:57:42
It is a spectrum right? No ones illness is 100% biological or 100% psychological. We all are somewhere in between. For me I think psychology is more important. It took me a while to figure that out.
Posted by Lamdage22 on April 20, 2022, at 9:09:41
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 20, 2022, at 9:07:06
I mean now that I am on a baseline that is workable. I can't quit the meds. But I shouldn't expect them to take me all the way to remission either.
Posted by Jay2112 on April 20, 2022, at 19:04:16
In reply to Re: 'anything can happen with psych drugs...' » Lamdage22, posted by SLS on April 20, 2022, at 8:57:42
> > > > Sometimes behind depression there is a disordered personality.
> > >
> > >
> > > More often, I think it is disordered parents.
> > >
> > >
> > > - Scott
> >
> > Right but this often leads to a disordered child.
>
>
> Presicely.
>
> To avoid this fact when it is part of someone's life history is to ignore the hope of working to recapture order out of disorder. To relieve one of the pscychosocial stress that contributed to the onset and persistence of depression (or other mental illnesses) can be only work to one's advantage.
>
> Allowing the old disordered though patterns to persist untreated is to retain indefinitely the paychodynamics that triggered the depression in the first place. Identifying the first few dominoes to fall in the chain of events that generated the alterations in brain function is important to remove the causative factors.
>
> Childhood adversity, especially neglect, is an almost universal contributor to the subsequent dysregulation in the neurobiology of the brain. The longer one remains depressed, the greater the risk of developing treatment resistance. The same thing applies to the number of depressive episodes one experiences.
>
> The idea that I'm trying to convey is that psychotherapy + pharmacotherapy (or other biological interventions) is more effective than pharmacotherapy alone. This is supported by almost every clinical study published on the topic.
>
> The need for psythotherapy as an adjunct to pharmacotherapy is not universal.
>
>
> - ScottHey guys,
I have a couple of comments as the counsellor here..lol. First, as horrible as a childhood one has had, what is important is now...the here and now. Not yesterday, not tomorrow..at least as far as recovery goes. That is also part of mindfullness.This is what we use to save people's lives:
"The consistent practice of training the mind to attend in the present moment without judgment rather than pursue thoughts and feelings about the past or anticipations about the future is the technique integrated into psychotherapy and behavioral interventions."
from: https://focus.psychiatryonline.org/doi/10.1176/foc.8.1.foc19
The forever argument in psychology is the nature/nurture one. Biology or the envirnonment? Well, sometimes both, some one or the other. Meds and therapy are the evidence-based, best practise. If you can get both, you are much likelier to succeed in overcoming, or better managing, your mental illness.
Seriously, consider this route...it took me 20 years to do so, and despite some setbacks, I am a very high-functioning person with bipolar disorder. Seek out *certified* counsellors, therapists, and social workers, who will make your progress much better. DO NOT try to go it alone.
Jay
Posted by SLS on April 20, 2022, at 20:12:11
In reply to Re: 'anything can happen with psych drugs...', posted by Lamdage22 on April 20, 2022, at 9:07:06
> It is a spectrum right? No ones illness is 100% biological or 100% psychological. We all are somewhere in between. For me I think psychology is more important. It took me a while to figure that out.
I strongly disagree with that. In my experience, "depression" can be everything from being depressed that your dog died was hit by a Good Humor truck to rapid-cycling bipolar disorder. And what about depressive reactions to drugs like clonidine. My mother, who had high blood pressure began treatmtent with clonidine. I don't think she had a depressed day in her life. Within a week of starting clonidine therapy, she became visibly slowed-down and depressed. She stopped reading and brushing her hair. I immediately recognized what was happening. It was a concern of mine from the beginning. We had her stop taking clonidine and she was better in 5 days.
So, yes, I do believe that people are located along a spectrum, including its poles.
- Scott
Posted by Lamdage22 on April 20, 2022, at 23:23:51
In reply to Re: 'anything can happen with psych drugs...' » Lamdage22, posted by SLS on April 20, 2022, at 20:12:11
Right, there is stuff like NMDA receptor encephalitis too. That is 100% biological. But for most of us speaking here we are on a spectrum.
Posted by Jay2112 on May 1, 2022, at 21:55:07
In reply to Re: 'anything can happen with psych drugs...', posted by Jay2112 on April 20, 2022, at 19:04:16
I honestly didn't mean to be some kind of authority or 'know it all'. Every single one of your opinions matter. I am sorry.
Jay
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Dr. Bob is Robert Hsiung, MD,
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