![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 55. Go back in thread:
Posted by SLS on May 19, 2009, at 15:12:22
In reply to Breaking through the wall., posted by SLS on May 18, 2009, at 6:59:44
I just wanted to thank all of you for your thoughtful replies. I will try to answer each post individually later. Right now, I am short on energy and time.
I am still feeling "stuck", but I am doing better now than I had been while taking the memantine (Namenda) at 20mg. I may perform a quick experiment and try taking a small dose of memantine to see if there is a therapeutic window in my case.
Thanks again.
- Scott
Posted by floatingbridge on May 20, 2009, at 21:52:32
In reply to Breaking through the wall., posted by SLS on May 18, 2009, at 6:59:44
Scott,
Higher doses of abilify tanked me. Other than that, I want to offer you but my best wishes for remission.
Candace
Posted by SLS on May 21, 2009, at 5:19:13
In reply to Re: Breaking through the wall., posted by Zana on May 18, 2009, at 8:53:03
> Can you describe your mood? How can you tell you are not quite "there" yet?
1. Anergy - a lack of energy both psychic and physical.
2. Lack of interest to do anything. Content to stare into space.
3. Cognitive slowing.
4. Impaired memory - short term and long-term potentiation.
5. Amotivation - can't get started doing anything.
6. Flat affect - not animated.
> I'm wondering if adding a stimulant like provigilI reacted badly to Provigil. It made my depression worse and more painful. Your suggestion of using a stimulant of some sort is a good one. Thanks.
> You give so much to others. I hope you get a lot of good imput.
Thanks. I sometimes forget to take care of me. I am very happy to see so many helpful replies.
- Scott
Posted by SLS on May 21, 2009, at 5:23:04
In reply to Re: Breaking through the wall., posted by Phillipa on May 18, 2009, at 10:46:37
> Scott I don't know. What haven't you tried?
maprotiline (Ludiomil)
mianserin (related to Remeron)
fluvoxamine (Luvox)
pramepexole (Mirapex)
milnacipran
agomelatineThere aren't too many others.
> What do your docs suggest?
His last suggestion was to revisit memantine (Namenda). It helped a little at first, then hurt a lot as time progressed.
> I sincerely wish I had to knowledge to help.
I know you do, Jan. Thank you.
- Scott
Posted by SLS on May 21, 2009, at 5:33:21
In reply to Re: Breaking through the wall., posted by Relapse on May 18, 2009, at 11:52:32
Hi.
> I know this is not new news. Also, you may have already have tried this (not sure because I've only been here a few months). Last but not least, I am on the lower end concerning technical knowledge of the meds.
A little knowledge can go a long way if used judiciously and the intelligence to be found in the uncommon use of common sense. The most brilliant of ideas can come from anyone, and I appreciate your kind input.
> But I still wanted to mention this because it's a big strategy with my pdoc. He augmented 600 mg to my 150 of Zoloft.
Unfortunately, lithium hurts me more than it helps. I feel worse on it, plus the added flattening of affect, increased passivity, and lack of creativeness. Just blah.
> I've read some good success stories concerning MAOI's and lithium
Yes. Adding lithium to Parnate had been a frequently used strategy before the SSRIs came along.
I'm glad you are responding to treatment again. The choice of lithium shows some very good clinical practice.
- Scott
Posted by SLS on May 21, 2009, at 5:42:54
In reply to Re: Breaking through the wall., posted by uncouth on May 18, 2009, at 11:55:35
> my thinking is just to push up the parnate as far as it will go...
I have been as high as 150mg. It definitely feels like a different drug in this high dosage range. It provided moderate improvement, but not for long. I added desipramine, amphetamine, bromocriptine, and T4 together with Parnate 120mg.
> there is articles on psychotropical.com from a doctor who uses parnate who seems to think it's teh best a/d by far as long as your not afraid of pushing the dose higher.
Interesting. I have always found Parnate to provide me with a more stable improvement than Nardil. It probably has much to do with the fact that I am bipolar.
> either that or adding namenda to fight poop out which supposedly (i don't have experience myself) it does.This seems to be a notion that is becoming more popular. Memantine produced a nice "kick" during the first week. Thereafter, it made me feel worse and, I believe, PREVENTED any further improvement. In a way, perhaps memantine makes things "stick" better. I wonder how it would affect me had I waited to respond more fully first before adding it.
It's obvious that I really extend myself to produce some pretty silly ideas. It breeds hope for me, though, that there are alternatives to be found in uncertainty. I can't be certain that memantine wouldn't work in such away as to prevent poop-out.
Good thinking. Thanks.
Can you tell me more about your experience with agomelatine?
- Scott
Posted by SLS on May 21, 2009, at 5:44:59
In reply to Re: Breaking through the wall., posted by bulldog2 on May 18, 2009, at 12:28:37
> Maybe toggle between things that have worked. Go back and retry nardil. Retry deplin with an maoi.This is a brilliant idea that has been supported by some doctors whom are not petrified to play with MAOIs. One doctor I know used to cycle one of his patients between Parnate and Nardil. It was the only thing that kept him well.
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 5:54:14
In reply to Re: Breaking through the wall., posted by shasling on May 18, 2009, at 13:12:18
> Parnate is a double edged sword,nice a few days,then dead and drab the next
I react exactly this way to Parnate when I am not combining it with other drugs.
> but it for me does give the days of remission,somthing no other med has done.
How precious is a single day of remission. I try to keep close to me the memories of being in remission so that I am that much sure of the biological nature of my condition, and that life is worth living when one emerges from the depths.
> many i feel it a drug that must be augmented.
Definitely.
> I read you meds,and they sound good,i will say this and you might not agree,or others but,Agreement is irrelevant. Your offering alternative suggestions and descriptions of personal anecdotes is precious.
> LAMICTAL in my case totaly killed parnte,like a grey cloud over it making almost impossable to work.
I will keep this in mind. It sounds like what memantine did to me for the 6 weeks I took it.
> I quickly removed it and added gabpentin instead.
Sounds good to me. How do you feel that gabapentin is helping? If you experience an inadequate response to it, don't forget about pregabalin (Lyrica). It operates on the same calcium channel receptor subsection (alpha-2-delta).
The exchange of information and ideas on Psycho-Babble is invaluable.
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 6:04:21
In reply to Re: Breaking through the wall. » SLS, posted by ricker on May 18, 2009, at 14:42:29
> Hi Scott, sorry to hear you have regressed with your treatment.
> How would you describe your symptoms?1. Anergia
2. Loss of interest
3. Amotivation
4. Cognitive slowing
5. Memory impairments
6. Flat affect
7. Heavy sighing
8. Dysautomia (imbalance in autonomic system)
> Is your depression such that you lose all desire/motivation?Totally.
> How often, and long do you sink into the depression?
Although I had brief bouts of moderate depression after age 10, it became SEVERE by age 17. Since that time, I have only spent a few days at a time in remission due to treatment, and one 9 month period of stable full remission at age 27. In other words, my depression never remits spontaneously. I have been depressed for decades with no relent.
> Do you, or have you in past, suffered with anxiety/panic?
Yes. Social anxiety/phobia was a major part of what I experienced earlier in my history.
> Don't mean to sound nosy, but it would help me in understanding your pattern and maybe offering proactive advise.
Much appreciated.
> Yes, I know, the wall can seem quite thick at times, but we will continue to fight, if not through it, then up and over it!God damned right.
> Please keep well, Rick
You do the same, Scott
Posted by SLS on May 21, 2009, at 6:11:05
In reply to Re: Breaking through the wall., posted by Sigismund on May 18, 2009, at 15:54:43
> Well, 35 is better than 15 which is where you were years ago.
I cannot believe that you would take so much interest in me as to remember that.
> I felt at the time that you had to work damn hard for that 15%, so it's better that you have had to work damn hard for 35. It was the Lamictal and Abilify that made the extra improvement.
Yes. Thank you again!
> I dunno anything about those drugs.
Neuroscientists sometimes feel the same way about these drugs. There is an overwhelming amount of data coming from investigation so far, but little understanding. The jigsaw puzzles has very few pieces that fit together so far.
Thanks for your thoughtful reply.
- Scott
Posted by SLS on May 21, 2009, at 6:14:33
In reply to Re: Breaking through the wall., posted by bleauberry on May 18, 2009, at 17:02:28
> I am sure you know, Scott, that the antipsychotics combined with antidepressants can have some magic. Not by themselves, but in combination. Who knows why. It is probably some intricate mechanisms involved with the 5ht antagonism and to a lesser degree the DA antagonism.
>
> So, if you have not already tried them, I thought I would mention the two that seem to do best (at a non-scientific scan) in pubmed studies. Zyprexa and Risperdal.I reacted to both drugs wonderfully for about a week. Thereafter, nothing good enough to justify their continuation.
Abilify is the one that is helping at the moment. It is a stable response, thank God.
> And I certainly would not rule out any of the conditions that cause depression. Where the brain is not the primary problem, but some unseen unsuspected assault on the brain is. I know you've had thorough testing, but those aren't the kind of tests I'm thinking of. Too unreliable and too vague. They miss a lot. They often pronounce someone normal when in fact they are quite ill.
>
> But that's a different topic.
Understood.:-)
Valid and valuable ideas.
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 6:21:27
In reply to Re: Breaking through the wall., posted by desolationrower on May 18, 2009, at 17:09:12
> scott you're bipolar right. perhaps you're trying to get to a level of hyperthymia you associate with normal
You brough a smile to my face. This has been suggested to me numerous times. It is a very valid concern, and I would say that some of the time I spent on Nardil 20 years ago qualifies. However, I am sure of what remission feels like without hyperthymia, as I spent 6 months in a normothymic state 22 years ago while being treated with Parnate + desipramine.
Thanks. Great question.
- Scott
Posted by SLS on May 21, 2009, at 6:41:14
In reply to Re: Breaking through the wall. » SLS, posted by jedi on May 18, 2009, at 20:29:25
> Hi Scott,
> How is your anxiety level?
Pretty low. Most of the health care professionals have a hard time believing it. To make a long story short, after I was informed by one of my more brilliant doctors that anxiety would prevent me from responding well to treatment and increase the liability for relapse, I have been using CBT to keep stress to a minimum. It took a few years of practice, but CBT really did the trick.
> Lately I've felt my depression start to return which is normal for me after several weeks off Nardil. This time I'm going to add back in the clonazepam and try to stay off Nardil for as long as I can. I'm hoping that by increasing GABA I may be able to hold off the major depression, since anxiety is a major trigger of my depression.
What about Xanax (alprazolam)? It has proven antidepressant properties. A sister drug, adinazolam is used specifically for anxious depression. I tried this during an open label investigation. It is a very "clean" drug. I felt like I was taking nothing. Unfortunately, my depression felt the same way, but a significant number of people are helped by this drug.
> Does the Lamictal increase GABA for you enough to help with anxiety?
It is hard to say. It does more for depression than anxiety. Lamictal seems to work by inhibiting the release of glutamate rather than act directly on GABAergic neurons. I guess GABA is potentiated because Lamictal is also a sodium channel blocker.
> I've never used Lamictal but I have used gabapentin in the past. Any ideas for me on how to increase GABA without going back to the benzos on a daily basis?
1. Depakote - some people find this drug mildly depressing.
2. Lyrica - a variant of Neurontin.* TCAs - doxepin, trimipramine, amitriptyline don't work on GABA directly, but are known to reduce anxiety along with depression.
* Seroquel
> There were times, while coming off clonazepam where it got pretty dicey.
I can imagine. I've been there myself. I particularly hated the brain "lightning" that I experienced. They felt different from SRI withdrawal brain "zaps".
> If it were not for the memory impairment, I would just go on high dose clonazepam and relax.
Hmm. Does Xanax do the same thing?
> I'm not bipolar, but I have had hypomanic episodes when first starting Nardil. My depression is atypical and IMHO this disease lies somewhere on the bipolar spectrum.
I agree.
> maybe a mood stabililer such as Lamictal would be good for me. Thoughts?
Definitely. It is a personal theory of mine that Lamictal works to increase dopaminergic activity downstream in the nucleus accumbens through a process known as disinhibition. I guess I do find Lamictal calming. It helps take away the anxious part of an agitated depression.
> Good Luck Scott,
Much appreciated, Jedi.
- Scott
Posted by SLS on May 21, 2009, at 6:43:56
In reply to Re: Breaking through the wall., posted by greywolf on May 18, 2009, at 20:41:28
> Scott:
>
> Have you tried augmenting with Cytomel? Thyroid hormone has been shown to be effective in some people.Yes. I know it is frustrating to hear, but Cytomel (T3) was tried on me in 1982. It made me feel much worse. We rechallenged me twice just to make sure. I find thyroxine (T4) mildly helpful. Now that you got me thinking about it, I'll remember to tell my doctor.
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 6:46:44
In reply to Re: Breaking through the wall., posted by Elanor Roosevelt on May 18, 2009, at 21:51:40
> I can't offer any advice
> But wanted to thank you for reminding me to return to my hope for remissionPart of my sense of hope lies in uncertainty. There is NO ONE who can be certain that you will not one day find an effective treatment. Usually, someone on Psycho-Babble can come up with something I haven't tried yet.
> hang in thereWill do!
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 6:47:47
In reply to Re: Breaking through the wall., posted by desolationrower on May 19, 2009, at 0:15:49
> i think creatine would be a helpful addition, btw.
Hmm. Thanks. I had never thought to try it.
- Scott
Posted by SLS on May 21, 2009, at 6:51:25
In reply to Re: Breaking through the wall., posted by Zana on May 19, 2009, at 14:32:44
> So where does all this leave you?
>
> ZanaIt leaves me smiling. The replies to my original post have pleasantly surprised me.
I forgot to add your name as the previous poster on my first reply post in this series. Sorry.
It feels GREAT to be surrounded by such positive and constructive people.
Thanks.
- Scott
Posted by SLS on May 21, 2009, at 6:53:45
In reply to Re: Breaking through the wall., posted by floatingbridge on May 20, 2009, at 21:52:32
> Higher doses of abilify tanked me.
Are you still taking Abilify at a reduced dosage? I know one person who responds wonderfully to 2.5mg whom cannot tolerate even 5mg.
> Other than that, I want to offer you but my best wishes for remission.
:-)
Thanks.
- Scott
Posted by ParnateStarted2008 on May 21, 2009, at 7:31:11
In reply to Breaking through the wall., posted by SLS on May 18, 2009, at 6:59:44
Hi SLS,
Ive been on quite a cocktail in the past two years. First the cocktail included Nardil(up to 105mg). It just wasn't working so I switched to Parnate overnight last August while keeping the rest of the cocktail the same.
Had same Parnate experience as most people do: Each dose increase worked wonderfully for a few days, then would stop.
Now I sit at 100mgParnate/day.
I was using 200mg Lamictal from way back even before I started Parnate.
I have just successfully "cleaned my cocktail" to ONLY 100mgParnate/day. (even no sleep aids, most nights)The interesting part: each time I lowered my Lamictal by 50mg I was in remission for 1-3 days in exactly the same way it felt like at every parnate dose increase. The night before last night was my last Lamictal dose. Again tonight I have more energy, MUCH less anx, lots of motivation, and feel a way better.
Ill see how long this 'usually' short window of remission will last and let you know. MAybe it will stay since ill be totally off Lamictal, maybe it was dulling the Parnate the whole time...
Anyway Im so happy to say Im back to a baseline of just Parnate where I can feel solely IT and will augment from here if I have to..
What a great thread by the way hey! losts of good input on augmentors and experiences.
Posted by SLS on May 21, 2009, at 10:23:18
In reply to Re: Breaking through the wall., posted by ParnateStarted2008 on May 21, 2009, at 7:31:11
> The interesting part: each time I lowered my Lamictal by 50mg I was in remission for 1-3
A sizable percentage of people experience this with Lamictal. It fools many into thinking that a lower dosage is what will work best. Unfortunately, it doesn't seem to work that way.
- Scott
Posted by Meltingpot on May 21, 2009, at 11:05:14
In reply to Breaking through the wall., posted by SLS on May 18, 2009, at 6:59:44
Hi Scott,
I know the feeling of getting to a certain point (which is so so) but being unable to get past that.
I know you know so much about medication that I wouldn't even want to try to advise you.
But have you thought about maybe switching to staying off all MAOIs for a period (trying something else) in the hope that they will eventually work again and get you back into remission (like with the Parnate and Desipramine) or would that be too risky for you?? I'm clutching at straws but I am hoping that if I stay completely off SSRI drugs for a year then maybe the Seroxat will work again afterwards.
This probably sounds like a wishful thinking kind of theory (and it is) but I really don't know what to do myself anymore. I'm just very glad I have Zyprexa which seems to help with a lot of my symptoms. I have a feeling that abilify would help me too.
Denise
Posted by ricker on May 21, 2009, at 13:59:07
In reply to Re: Breaking through the wall. » ricker, posted by SLS on May 21, 2009, at 6:04:21
Hi Scott, you must feel a bit overwhelmed having to reply to so many posts! Just goes to show how appreciated you are here, It tugs at me that you have helped so many throughout your own personal struggles, I believe what goes around, comes around, so your turn should be coming shortly. :-)
Is it fair to say that in your earlier years, anxiety/social phobia was the predominant symptom?
Did you find as you aged, the classic depression symptoms took hold with more intensity?
That's how my pattern seemed to develop, as my depression worsened, strangely my anxiety lessened to a degree, although I feel the anxiety has manifested into what is referred to as BP2.I've also noticed that your cocktail includes meds geared towards stimulating NE, Nortriptyline, Abilify?
Do you think they would have been to stimulating /anxiety provoking in the earlier years of your depression?As mentioned, maybe there is something in you that requires a regime that involves rotating drug therapy? Something with a subtle, gradual change that would prevent relapse. I like the idea of alternating maoi's, frequency would be the key question as to success.
So maybe you are very close? Maybe it's a matter of how your cocktail is administered, rather than looking to pile on, or swap out additional medication, other than a second maoi?
If anyone can figure out a successful cocktail, I'd bet it would be you. Your wisdom and, most importantly, strength and determination will see to that!
Please remain optimistic Scott, each day brings new hope.
Take care, Rick
Posted by metric on May 21, 2009, at 16:15:38
In reply to Re: Breaking through the wall., posted by SLS on May 21, 2009, at 5:19:13
> > Can you describe your mood? How can you tell you are not quite "there" yet?
>
> 1. Anergy - a lack of energy both psychic and physical.
>
> 2. Lack of interest to do anything. Content to stare into space.
>
> 3. Cognitive slowing.
>
> 4. Impaired memory - short term and long-term potentiation.
>
> 5. Amotivation - can't get started doing anything.
>
> 6. Flat affect - not animated.
>
>
> > I'm wondering if adding a stimulant like provigil
>
> I reacted badly to Provigil. It made my depression worse and more painful. Your suggestion of using a stimulant of some sort is a good one. Thanks.You've taken d-amphetamine before haven't you? Did it stop working or worsen your depression?
Posted by SLS on May 21, 2009, at 16:23:00
In reply to Re: Breaking through the wall. » SLS, posted by metric on May 21, 2009, at 16:15:38
> > > Can you describe your mood? How can you tell you are not quite "there" yet?
> >
> > 1. Anergy - a lack of energy both psychic and physical.
> >
> > 2. Lack of interest to do anything. Content to stare into space.
> >
> > 3. Cognitive slowing.
> >
> > 4. Impaired memory - short term and long-term potentiation.
> >
> > 5. Amotivation - can't get started doing anything.
> >
> > 6. Flat affect - not animated.
> >
> >
> > > I'm wondering if adding a stimulant like provigil
> >
> > I reacted badly to Provigil. It made my depression worse and more painful. Your suggestion of using a stimulant of some sort is a good one. Thanks.
>
> You've taken d-amphetamine before haven't you? Did it stop working or worsen your depression?Amphetamine helped me for the first 3 days I took it. Thereafter, I just felt somewhat sleepy, but I did not notice a worsening of my depressive symptomology.
By the way, thanks for providing the link for the rat study you posted along another thread. It is very well done.
- Scott
Posted by Phillipa on May 21, 2009, at 20:26:54
In reply to Re: Breaking through the wall. » metric, posted by SLS on May 21, 2009, at 16:23:00
Scott need to give some info to you. Love Phillipa
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.