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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by g_g_g_unit on August 2, 2012, at 7:21:40
Long story short .. been on 60mg of Parnate for some time now and just finding it too stimulating (i.e. no benefits on anxiety, chronic insomnia, etc.). I've heard higher doses can be more calming, but my p-doc won't prescribe anymore.
Anyway, I'm taking 1.5mg of Klonopin at night to sleep, and 0.5mg in the morning, but it still isn't really sufficient.. the stimulant effect of each dose is meant to have a 2.5 hour half-life, so I take 15mg every 3 hours, but just find that there's a cumulative effect that leaves me feeling kinda wired, confused and unable to focus properly.
I'm planning to taper off it, but I really need to be able to concentrate on a project over the next week. Lowering the dose probably wouldn't help, because there'd be a lag between the stimulant effect and MAO levels, which would just end up messy (I tried this for several days).
Is there anything I could take to kind of put a 'cap' on DA/NE? Would NAC work for this? Tried magnesium, but it just potentiated the stimulant effect.
Posted by SLS on August 2, 2012, at 12:42:58
In reply to any way to calm down DA/NE?, posted by g_g_g_unit on August 2, 2012, at 7:21:40
> Long story short .. been on 60mg of Parnate for some time now and just finding it too stimulating (i.e. no benefits on anxiety, chronic insomnia, etc.). I've heard higher doses can be more calming, but my p-doc won't prescribe anymore.
>
> Anyway, I'm taking 1.5mg of Klonopin at night to sleep, and 0.5mg in the morning, but it still isn't really sufficient.. the stimulant effect of each dose is meant to have a 2.5 hour half-life, so I take 15mg every 3 hours, but just find that there's a cumulative effect that leaves me feeling kinda wired, confused and unable to focus properly.
>
> I'm planning to taper off it, but I really need to be able to concentrate on a project over the next week. Lowering the dose probably wouldn't help, because there'd be a lag between the stimulant effect and MAO levels, which would just end up messy (I tried this for several days).
>
> Is there anything I could take to kind of put a 'cap' on DA/NE? Would NAC work for this? Tried magnesium, but it just potentiated the stimulant effect.NAC is a good guess. It was the first thing that popped into my head as I began reading your post. You might be experiencing overactive glutamate circuits secondary to NE activation. NAC dampens glutamate hyperactivity. It is certainly worth a try. NAC is a rather benign substance. I tried it, but I felt more depressed during the first week. I discontinued it at that point. Looking back on it, my worsened state could have been the natural course of my illness. I never rechallenged myself with it. NAC might be a good adjunct to Lamictal, another glutamate suppressant. A friend of mine is currently trying this combination along with low-dosage Abilify.
- Scott
Posted by g_g_g_unit on August 3, 2012, at 0:59:57
In reply to Re: any way to calm down DA/NE? » g_g_g_unit, posted by SLS on August 2, 2012, at 12:42:58
> NAC is a good guess. It was the first thing that popped into my head as I began reading your post. You might be experiencing overactive glutamate circuits secondary to NE activation. NAC dampens glutamate hyperactivity. It is certainly worth a try. NAC is a rather benign substance. I tried it, but I felt more depressed during the first week. I discontinued it at that point. Looking back on it, my worsened state could have been the natural course of my illness. I never rechallenged myself with it. NAC might be a good adjunct to Lamictal, another glutamate suppressant. A friend of mine is currently trying this combination along with low-dosage Abilify.
>
>
> - ScottThanks Scott. I've tried it before as well and it caused breathing difficulties and also might have made me more depressed, but I'm willing to put up with that for the meantime.
Do you know if it's necessary to take NAC on an empty stomach? Also, is there a dose you would suggest trying? Or do you at least know the safe dose range?
Posted by Lao Tzu on September 26, 2012, at 13:18:04
In reply to any way to calm down DA/NE?, posted by g_g_g_unit on August 2, 2012, at 7:21:40
You may want to ask your doctor for a less activating antidepressant, perhaps an SSRI??? Something more calming. I take Zoloft, and it isn't very activating for me. Ask your doctor if you have any questions.
Lao
Posted by alexcanada on March 14, 2013, at 1:27:28
In reply to Re: any way to calm down DA/NE? » g_g_g_unit, posted by SLS on August 2, 2012, at 12:42:58
Hi Scott. I'm glad you continue to post regularly as your posts are usually a wealth of knowledge.
Lamictal for me had very positive effect on mood and ability to feel some happiness but I felt progressively more tired and extremely cognitively dull. I felt more stupid by the day.
You mention lamictal being a glutamate suppresent. What other meds or substances are glut suppressants? Or what might give me the benefits of Lamictal but without the cognitive detriment?
Any insight at all would be greatly appreciated.
-strong melancholic depression, very poor drive, motivation, interest, cognition.
> NAC is a good guess. It was the first thing that popped into my head as I began reading your post. You might be experiencing overactive glutamate circuits secondary to NE activation. NAC dampens glutamate hyperactivity. It is certainly worth a try. NAC is a rather benign substance. I tried it, but I felt more depressed during the first week. I discontinued it at that point. Looking back on it, my worsened state could have been the natural course of my illness. I never rechallenged myself with it. NAC might be a good adjunct to Lamictal, another glutamate suppressant. A friend of mine is currently trying this combination along with low-dosage Abilify.
>
>
> - Scott
Posted by SLS on March 14, 2013, at 5:45:39
In reply to Glutamate suppressant » SLS, posted by alexcanada on March 14, 2013, at 1:27:28
Hi AlexCanada.
> Lamictal for me had very positive effect on mood and ability to feel some happiness but I felt progressively more tired and extremely cognitively dull. I felt more stupid by the day.
What dosage of Lamictal are you at?
What other drugs are you taking?
Perhaps lowering the dosage of Lamictal slowly will get rid of the cognitive side effects while retaining its antidepressant effects. Lamictal is a deceptive drug. It can produce fleeting improvements at low dosages as one titrates upward. The tendency is to continue titrating in an attempt to recapture this robust response to the point of developing cognitive impairments. This happened to me. At first, 300 mg/day seemed to be a good dosage. However, problems with memory and "brain-fog" developed. Eventually, I discovered that 200 mg/day was my optimum dose. The thing is, you might experience a temporary rebound depressive reaction if you reduce the dosage too quickly.
> You mention lamictal being a glutamate suppresent. What other meds or substances are glut suppressants?
Minocycline. This old antibiotic was discovered to have an array of effects in the brain, including anti-inflammatory and anti-glutamatergic. Memantine, ketamine, and amantadine, also exert anti-glutamatergic effects localized to the NMDA receptor. Minocycline really works. I take 200 mg/day, which is probably the "sweet spot" for most people.
> -strong melancholic depression, very poor drive, motivation, interest, cognition.
Do you feel worse in the morning with have early morning insomnia? Are you underweight or have poor appetite? How about psychomotor disturbances - agitation or retardation?
How do you respond to TCA (imipramine, desipramine, clomipramine, amitriptyline, nortriptyline)? What about SNRI (Effexor, Pristiq, Cymbalta, Savilla, clomipramine)?
You'll noticed that clomipramine is listed as both a TCA and a SNRI. It is perhaps the most effective antidepressant with the possible exception of a MAOI.
You might consider combining (Effexor or Pristiq) with Wellbutrin + Lamictal. I received some benefit from a combination of Effexor + nortriptyline + Lamictal.
I do best when taking a combination of MAOI + TCA.
Currently, I am taking:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 450 mg/day
Abilify 10 mg/day
minocycline 200 mg/day
prazosin 10 mg/dayThat covers about everything. I know someone with a rather severe depression who benefits from a combination of Lamictal + minocycline + Abilify. She takes no "traditional" antidepressants.
- Scott
Posted by alexcanada on March 18, 2013, at 6:08:50
In reply to Re: Glutamate suppressant » alexcanada, posted by SLS on March 14, 2013, at 5:45:39
> Hi AlexCanada.
>
> > Lamictal for me had very positive effect on mood and ability to feel some happiness but I felt progressively more tired and extremely cognitively dull. I felt more stupid by the day.
>
> What dosage of Lamictal are you at?
>
> What other drugs are you taking?I'm not on lamictal anymore. Was last year. I mentioned it due to the positive initial effect it had on enhanced ability to enjoy things. I was on a low dose but I am very med sensitive. Was on 25mg and later 50mg, possibly 75mg. I felt extremelty cognitively impaired.
I am currently taking:
valium 0.62mg 4 times daily (2.5mg total). ritalin 1.25mg 3-4 times daily (3.75-5mg total).
Gabapentin 100mg. (will likely raise to 200)
Resveratrol 500mg. (likely will quit since likely interaction with future ssri)
Omega 3 500/70 epa/dha 1000mg. (might quit)
I used to take magnesium citrate, and b6. Magnesium is capable of increasing positive emotions but is very inconsistent. Sometimes made me feel worse. Also can be sedating.>
> Perhaps lowering the dosage of Lamictal slowly will get rid of the cognitive side effects while retaining its antidepressant effects. Lamictal is a deceptive drug. It can produce fleeting improvements at low dosages as one titrates upward. The tendency is to continue titrating in an attempt to recapture this robust response to the point of developing cognitive impairments. This happened to me. At first, 300 mg/day seemed to be a good dosage. However, problems with memory and "brain-fog" developed. Eventually, I discovered that 200 mg/day was my optimum dose. The thing is, you might experience a temporary rebound depressive reaction if you reduce the dosage too quickly.
>
> > You mention lamictal being a glutamate suppresent. What other meds or substances are glut suppressants?
>
> Minocycline. This old antibiotic was discovered to have an array of effects in the brain, including anti-inflammatory and anti-glutamatergic. Memantine, ketamine, and amantadine, also exert anti-glutamatergic effects localized to the NMDA receptor. Minocycline really works. I take 200 mg/day, which is probably the "sweet spot" for most people.
>
What kind of effect does Minocycline generally have for depression/anxiety? Or how has it effected you? I have given some consideration to Mino in the past. I think you were the one whom originally mentioned it to me but it may not have been available in Canada. I'd have to check.Memantine I tried last year and it had an extremely potent effect on me. I took a very small dose too. On the first night I think there was some small positive effect. On the 2nd day I was able to write very intellectually and express great detail of my thoughts but I also became quite dissassociated. First time I ever felt such a sensation. My mood also became darker and I felt extremely uncomfortable and just could not wait for it to wear off. It took almost 2 days to do so I think. Initially it felt promising but it really became frightening on that 2nd day.
> > -strong melancholic depression, very poor drive, motivation, interest, cognition.
>
> Do you feel worse in the morning with have early morning insomnia? Are you underweight or have poor appetite? How about psychomotor disturbances - agitation or retardation?
>Middle of the night I might possibly feel my best. Each part of the day feels a bit different. Not much consistency. Mornings can be better than day time though sometimes I wake up feeling absolutely terrible, perhaps benzo hangover syndrome, I don't know. Right now it's hard to say but often I have had absolutely dreaded mornings and felt slightly better as day goes on. Though evenings often do not feel good and often worse than my afternoons in some way. My mood may feel darker but I may be more inclined to turn on the television.
I am a little bit underweight. Appetite is generally quite poor but Gabapentin has boosted my appetite and food does taste better now.
Psychomotor retardation definitely. It was more severe few weeks ago and it was too difficult to even post on this forum. I could not formulate my thoughts well. Getting out of bed was sometimes very difficult, even basic things such as showering or shaving would be something I'd often push myself towards. Generally my cognition is often quite poor.
> How do you respond to TCA (imipramine, desipramine, clomipramine, amitriptyline, nortriptyline)? What about SNRI (Effexor, Pristiq, Cymbalta, Savilla, clomipramine)?
>I was on Desi or possibly another. It's hard to recall despite my journal listings. I do know that I wasn't able to give a TCA a full trial due to strong anxiety. My doctor was dismissive about other TCAs for some reason. Might have been since I possibly tried two. He did suggest Ludiomil but I have not had success in finding much information on such an old medication. Is Ludiomil worth it? Is it significantly harsher than an SSRI? How might the side effects compare to say Parnate?
Also I may look into Clomipramine. I don't think I've tried it. I'll have to ask my doctor. Is it more activating or sedating?
> You'll noticed that clomipramine is listed as both a TCA and a SNRI. It is perhaps the most effective antidepressant with the possible exception of a MAOI.
>
> You might consider combining (Effexor or Pristiq) with Wellbutrin + Lamictal. I received some benefit from a combination of Effexor + nortriptyline + Lamictal.I had a lot of severe anxiety from Effexor and was not able to complete a trial but Pristiq is a future possibility if I take it with gabapentin due to the strong anti-anx effect.
Wellbutrin did not appear to help me. Cymbalta neighter. Savella looked very promising from info but not available in Canada.
>
> I do best when taking a combination of MAOI + TCA.
>
> Currently, I am taking:
>
> Parnate 80 mg/day
> nortriptyline 150 mg/day
> Lamictal 200 mg/day
> lithium 450 mg/day
> Abilify 10 mg/day
> minocycline 200 mg/day
> prazosin 10 mg/day
>I tried to have a TCA added on when I was taking Parnate but my doctor would not agree. Parnate used to help to some degree but of course wore off.
> That covers about everything. I know someone with a rather severe depression who benefits from a combination of Lamictal + minocycline + Abilify. She takes no "traditional" antidepressants.
>
>
> - ScottThanks for the suggestions and advice. Sometimes I am able to feel quite defeated and discouraged on here since sometimes people do not even respond to my topics. Too often I feel that it's not even worth posting because I feel too helpless. Gabapentin has enabled me to be a bit more optimistic in terms of improving my health so I am thankful for that.
I have a doc apt today and he has been considering trying me on Prozac. Paxil helped me before it lost effect. Celexa and Zoloft did not though. Celexa horrible fierce anxiety. Zoloft emotionally numbing, and very dull zombie like mood.
I will mention Clomipramine to him but do you think Prozac might be ideal given my past results? He also wanted to try me on Ludiomil/Maprotiline. Is there anything you can tell me about it or how it may compare to other meds?
I don't know if you are well versed in 'alternatives' but do you know if Resveratrol (herbal SNRI at higher doses, anti-oxidant) or ginkgo biloba could be a bad idea with SSRIs or meds in general? I have not been able to find conclusive results aside from possible ssri interaction. I likely will be stopping it very soon.
This is the end of the thread.
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