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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by iforgotmypassword on January 23, 2008, at 15:45:31
no real effect. i may be feeling a bit more, maybe not. only evidence of this is the terrible nights i have been having. i have also felt quite wierd at times, more so than normal, which says something.
is day 7 too early to give up on this?
or should i add something dopaminergic? as presumably a main part of the antiglutaminergic strategy of lamotrigine+memantine is to increase the brains ability to use dopamine properly. i just thought using endogenous dopamine would be the most ideal situation. certainly, i may not have a lot of dopamine, given that i have high prolactin, am still producing milk after being off risperidone for months now, and off amisulpride for well over a month.
i was just going to switch to deplin, but maybe keep the lamotrigine. but i don't necessarily see any reason not to taper off both. (the memantine is also not covered, and expensive, more expensive than deplin)
suggestions?
Posted by iforgotmypassword on January 23, 2008, at 15:47:54
In reply to 7th day on lamotrigine + memantine; give up?, posted by iforgotmypassword on January 23, 2008, at 15:45:31
i meant this is the seventh of being on the full doses of both lamotrigine and memantine. (200mg and 20mg respectively) i tapered up to this over the last two months roughly.
Posted by iforgotmypassword on January 24, 2008, at 19:23:22
In reply to 7th day on lamotrigine + memantine; give up?, posted by iforgotmypassword on January 23, 2008, at 15:45:31
Posted by Racer on January 25, 2008, at 1:27:04
In reply to oops., posted by iforgotmypassword on January 23, 2008, at 15:47:54
I wouldn't think seven days is long enough to know what's going to happen, and I hate to think of missing a chance at a good fit because I was impatient for results. That's what I remind myself when I'm trying new meds: "it takes far too long to know what the result will be -- but wouldn't it be a shame to miss out because you don't feel anything yet?"
Did you taper up on both medications at once? Or one at a time? If you started them at different times, did you notice anything helpful with either of them? It could be that, say, increasing the Lamictal would help, or that your idea of keeping the Lamictal and trying Deplin would be more worthwhile. It's hard to say.
I've got a bias against trying to find a dopamine agonist, because I think that the whole catecholamine focus is probably not all that helpful. That is, I think there are some broad strokes that can be painted, but not a lot of shading. (Bad metaphor, but the best I could do.) For instance, my own experience has been that the most helpful drugs for me were noradrenergic, and that serotinergic medications have been more problematic. But I don't think it's really possible to say that I'm deficient in noradrenaline: I think it's more likely that there's either some rational problem between the NTs, or that there's something entirely different going on which responds to those meds. Trying to fine tune the Big Three seems a little iffy to me: not enough is really known about their contribution to depression, etc, for them to be used as part of a recipe. I hope that makes sense?
Also, I think dopamine is over-rated, especially since it's not only a neurotransmitter, but also a precursor. You may not get quite what you bargained for, is what I'm trying to suggest.
Anyway, those is my thinkings, and cheap at half the price...
Good luck.
Posted by Phillipa on January 25, 2008, at 12:12:53
In reply to Re: oops., posted by Racer on January 25, 2008, at 1:27:04
Racer seriously what do you make of this Deplin on it too one day third felt like doing something and some energy then poof gone. Aren't you on a similar new med for a different condition? I feel I need help and no one to give it. New endo is better it seems. Phillipa oh going to start making funny names for my docs too. Don't want a stimulant as that is what I take dopamine to be. Correct my idiot mistakes. I maybe do need the deplin if they are thinking of using it for alzheimers too according to that pdocs I see.
Posted by Racer on January 25, 2008, at 14:09:44
In reply to Re: oops. » Racer, posted by Phillipa on January 25, 2008, at 12:12:53
> Racer seriously what do you make of this Deplin on it too one day third felt like doing something and some energy then poof gone. Aren't you on a similar new med for a different condition?
I take Metan-X, which is a similar medical food marketed primarily towards diabetics, since it helps regulate homocysteine levels. Like Deplin, it includes methylfolate, but it also incorporates pyridoxal 5'-phosphate and methylcobalamin -- forms of B6 and B12. My pdoc likes it better than Deplin because it does contain these other elements, which some people benefit from adding to Deplin.
Forewarned is forearmed -- you know you have an awful lot of anxiety about medications, so you can remind yourself that an awful lot of your reactions to medications stem from anxiety, rather than direct effects of the medications. That's true for many of us here on these boards, so please don't take it as a personal affront -- it's human nature, and it's common. Deplin is made up of a form of B vitamin -- it's not going to act like a traditional medication, it's going to be a lot more subtle than that. I would suggest trying to average your response over weeks, not days.
>I feel I need help and no one to give it.
That's not a good place to be. Have you discussed this with your doctors? That you're not feeling confidence in them, because you want a fuller explanation than they're giving you?
The bad news is that you may never get the level of information you're looking for. You seem to have a very low tolerance for uncertainty, and psychiatry is made up of an awful lot of uncertainty. No one can answer all of the questions you've asked on this board about Deplin -- because no one really knows all the answers to those questions. It might be in your best interest to make a list of those questions, prioritize them -- "these are things that I feel it is important for me to know; these are things I'd like to know for my own satisfaction; these things over here are really idle curiosity" -- and then accept that you'll be well if if you can get some answers in the first category. Learning to cope with uncertainty would be a good skill to work on.
> Don't want a stimulant as that is what I take dopamine to be.I think you've been confused by a lot of what's posted on these boards about dopamine. First of all -- probably most of what's said about the workings of the brain is based more on speculation and hypothesis than on verifiable fact. That's just the state of current research: what's known so far suggests certain things, but it seems as though every week there's a new discovery that implodes an older hypothesis. *No one knows exactly how any of this works.*
Keeping that in mind, here's what I think I know regarding dopamine and stimulants, and all that.
First of all, saying that dopamine is a stimulant is not at all accurate. Dopamine is one of the Big Three neurotransmitters believed to be involved in depression. Dopamine is actually the most confusing of the three, too, so don't feel bad if it hasn't made sense to you: dopamine *is* a neurotransmitter -- nerve cells release it to communicate messages to other nerve cells, hence the name "neuro-transmitter." It's fairly recently been discovered to be a neurotransmitter, though, because dopamine is *also* a precursor to norepinephrine. Our bodies create neurotransmitters from elements in the foods we eat. Tryptophan is the dietary element that we make serotonin from; tyrosine is the element that makes dopamine, some of which is then made into norepinephrine.
Stimulants increase the release of dopamine and norepinephrine, and inhibit their reuptake. (Reuptake happens when other molecules between nerve cells come along and bind to the neurotransmitter in question, then transport it back to the cell which released it. Each of the Big Three has its own reuptake molecule -- unimaginatively but descriptively named "dopamine transporter," "norepinephrine transporter," and "serotonin transporter." Once the used neurotransmitter is returned to the originating cell, MAO breaks it down to its component parts.) So, stimulants affect dopamine, but dopamine is not a stimulant.
The reason you read some much about dopamine on these boards has to do with the brain functions dopamine affects. Again, remember that most of this is not fully understood, so it's a lot more complex than anything I write here. Dopamine is involved in an awful lot of functions, many involving things like movement, sleep, milk production, etc. The functions that are probably best known, though, involve mood, attention, motivation, and addiction. Dopamine is popularly known as the "reward" neurotransmitter, which I think is why so many people here are interested in it -- if you suffer from anhedonia (lack of pleasure), it makes sense to take something that should trigger activity in the reward system of your brain, right?
Here's the thing: the brain is not a simple thing. The individual neurotransmitters are probably not nearly as important as the ratios between them, the areas of the brain where they're active, the interplay between the three neurotransmitters we usually talk about here and other biochemicals in the brain, etc. If you take L-Dopa, the form of dopamine precursor which can cross the blood brain barrier, you can't say, "Hey, you, L-Dopa -- go to the substantia nigra and beef up the dopamine production there." It's not yet possible to target any specific symptom that precisely. (And, of course, since we're talking about dopamine here, some of the L-Dopa would become norepinephrine anyway, but that's beside the point.) Some studies have strongly suggested, for instance, that methylphenidate (Ritalin, et al) actually works by down-regulating dopamine receptors (ie: making them less sensitive) and thus increasing the ratio of serotonin activity in comparison. Other studies have suggested that SSRIs work by down-regulating serotonin receptors and thus increasing the ratio of dopamine activity.
The only thing anyone really knows so far about these medications is that they are helpful for a certain percentage of people who take them. Exactly how that works is not yet fully understood. As of now, there's no way to know which will be helpful for any given person except to try them at an adequate dose for an adequate amount of time. Sometimes you can make certain predictions, but the degree of accuracy is not necessarily all that high.
> Correct my idiot mistakes. I maybe do need the deplin if they are thinking of using it for alzheimers too according to that pdocs I see.
There are things you can do to reduce your risk of developing Alzheimers, many of which would improve your quality of life under any circumstances.
Intellectual stimulation helps -- play chess, do Sudoku puzzles, do logic puzzles, learn a foreign language.
Social interaction helps -- get out of the house, go join a club, meet new people, get involved in something involving other people. I know you've got some agoraphobia issues, and that it's difficult for almost anyone to find new people, but there are options out there.
--Go to MeetUp.com and join a group that shares your interests.
--Go to your local community education campus and take a class.
--Learn to knit: many yarn stores have "stitch and bitch" sessions where everyone sits, knits, and talks.
--Volunteer in your community. There are opportunities in most communities for any interest.
--If you're brave, go hang out in almost any independent coffee house and you'll find someone to talk to.
The important thing in all that, of course, is that you have to go out and do it. That's hard, but it is possible.
Good luck. I hope my explanation was helpful.
Posted by Phillipa on January 25, 2008, at 20:23:16
In reply to A very long explanation, maybe helpful, maybe not » Phillipa, posted by Racer on January 25, 2008, at 14:09:44
Racer thanks. I'm gone most of the afternoon and evening til now buying for ebay then up late posting them after Greg uploads the pics. I'm not afraid of Deplin at all. As my urine lets me see that what is not needed it excreted via kidney. See in nursing so important to see hence why I did get an A in algebra and chemistry but only wasy I did was just do what they said to do. I'm one of those people that have to see like a wound.
And unfortunatedly we can only see the brain on an MRi or something similar. Guess that makes me concrete. Neurotransmitters are very difficult for me to understand. Also Shawn Thomas on neurotransmitters spend some teaching time. I will get it eventually. Funny thing is anxiety is lessening. And a new endo is changing my numbers a good thing. My therapist says to just get out of the house and I am. Love riding the bike and talking to neighbors in the other neighborhood similar to the people I knew and grew up with in Ct. I'll read this again thanks again what was the course called that you took for neurotransmitters? Phillipa
Posted by Phillipa on January 26, 2008, at 8:58:47
In reply to 7th day on lamotrigine + memantine; give up?, posted by iforgotmypassword on January 24, 2008, at 22:46:39
How does deplin compare to a mood stabalizer? Deplin boosts as ad. So I'm a bit confused again. If your prolactin is high isn't that a sign that all is not right with your pituitary gland? Just wondering sorry couldn't be more help. Phillipa
Posted by yxibow on January 26, 2008, at 8:58:47
In reply to 7th day on lamotrigine + memantine; give up?, posted by iforgotmypassword on January 24, 2008, at 22:46:39
> --------------------------
> i posted this on the neurotransmitters board, but got no replies, so i am posting it here if that is okay. i need to make a decision as soon as possible.
> --------------------------
>
> no real effect. i may be feeling a bit more, maybe not. only evidence of this is the terrible nights i have been having. i have also felt quite wierd at times, more so than normal, which says something.
>
> is day 7 too early to give up on this?
>
> or should i add something dopaminergic? as presumably a main part of the antiglutaminergic strategy of lamotrigine memantine is to increase the brains ability to use dopamine properly. i just thought using endogenous dopamine would be the most ideal situation. certainly, i may not have a lot of dopamine, given that i have high prolactin, am still producing milk after being off risperidone for months now, and off amisulpride for well over a month.
>
> i was just going to switch to deplin, but maybe keep the lamotrigine. but i don't necessarily see any reason not to taper off both. (the memantine is also not covered, and expensive, more expensive than deplin)
>
> suggestions?
>
> ---------------------
> and then i added this in a post right after, to be more clear and make more sense
> ---------------------
>
> i meant this is the seventh of being on the full doses of both lamotrigine and memantine. (200mg and 20mg respectively) i tapered up to this over the last two months roughly.
Lamictal has a long taper rightly so to prevent SJS (Stevens Johnson). I'm still wondering whether it will improve my mood or my complex disorder. But I'm just starting at 100 now. I know of someone at 600 so that's a discussion I think you should have with your doctor. 7 days at 100 may not be enough, you may need 200, who knows.
Posted by iforgotmypassword on January 26, 2008, at 8:58:48
In reply to Re: 7th day on lamotrigine + memantine; give up? » iforgotmypassword, posted by yxibow on January 25, 2008, at 1:52:54
yeah, 200 of lam i have been on longer than the 20mg of memantine. maybe over two weeks? or prolly *likely*, i mean.
sometimes i feel bursts of something from lamotrigine dosage increases, sometimes i don't. i don't know where i am at now.
not knowing where i am at is a contant signature of all of my problems put together, so not so much a good sign that i am any sort of upswing at all.
i repeatedly have these short-lived "improvements" other people see, as with the ECT, but i don't feel them. i certainly don't function any better. they're mostly meaningless... maybe i get better at holding relevant context in conversation and steam things together in a more intact fashion on the outside, that isn't how i feel inside.
i am rambling.
Posted by yxibow on January 26, 2008, at 8:58:48
In reply to Re: 7th day on lamotrigine + memantine; give up? » yxibow, posted by iforgotmypassword on January 25, 2008, at 2:10:21
> yeah, 200 of lam i have been on longer than the 20mg of memantine. maybe over two weeks? or prolly *likely*, i mean.
>
> sometimes i feel bursts of something from lamotrigine dosage increases, sometimes i don't. i don't know where i am at now.
>
> not knowing where i am at is a contant signature of all of my problems put together, so not so much a good sign that i am any sort of upswing at all.
>
> i repeatedly have these short-lived "improvements" other people see, as with the ECT, but i don't feel them. i certainly don't function any better. they're mostly meaningless... maybe i get better at holding relevant context in conversation and steam things together in a more intact fashion on the outside, that isn't how i feel inside.
>
> i am rambling.
No you're not, you're describing how you feel.*oops*, I thought you were on 100. But even 200 may not be enough for some people and also true if you've only been on it for 7 days that may not be enough, I think thats more a discussion with your doctor.
This is the end of the thread.
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