Psycho-Babble Medication Thread 1110621

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

TMS, Ketamine, ECT ... last chance!

Posted by PCB on June 9, 2020, at 21:24:53

Anyone get off, decrease medications for severe depression, possible bipolar 2 with TMS, ECT, Ketamine or Marjuana? Ive been posting here for 25 years and still cant get off Nardil. Because 50 lbs weight gain, insomnia, sexual dysfunction and restrictive diet ... I have never been able to marry, be a good son and can barely work a full time job. Im come up to 50 soon and this really is my last chance on having maybe any okay 10 to 20 year of the end of my life.

Anyone have luck with TMS, ECT, Ketamine or Marjuana?

Sincerely,

Last chance to have a life

PS Twenty five years ago I was told something big will come out to treat our depression. Shockingly no silver bullet has come out for me. All I ever wanted was an average marriage, average kids, big stressful mortgage, difficult in-laws, some regular medical problems like high blood pressure or even a mild heart attack. But no, a lot of us have Treatment Refractory mood disorders which has made even a bad life possible. I would take a difficult marriage, low paying job and credit card debit in a second instead of depression. But nope, we are the .5 to 1 % despite trying 25 different treatments, who suffer without a spouse, average job, etc. We suffer and died alone

 

Re: TMS, Ketamine, ECT ... last chance!

Posted by SLS on June 10, 2020, at 8:17:13

In reply to TMS, Ketamine, ECT ... last chance!, posted by PCB on June 9, 2020, at 21:24:53

What are your reasons for wanting to discontinue Nardil?


- Scott

 

Re: TMS, Ketamine, ECT ... last chance! » PCB

Posted by linkadge on June 10, 2020, at 8:51:47

In reply to TMS, Ketamine, ECT ... last chance!, posted by PCB on June 9, 2020, at 21:24:53

I would say that CBD rich cannabis (CBD:THC = 2:1) has been very beneficial for me. I still do relapse periodically, but feel closer to myself than with multiple medications.

Linkadge

 

Re: TMS, Ketamine, ECT ... last chance!

Posted by PCB on June 10, 2020, at 10:10:50

In reply to Re: TMS, Ketamine, ECT ... last chance!, posted by SLS on June 10, 2020, at 8:17:13

Hey SLS,

Mainly 50 lbs gain weight. As a health care provider I know with my BMI about 29 to 30 I am at higher risk for hypertension, diabetes, cancer. My left hip has mild arthritis which will only get worse. And of course being fat reduces chances dating and advancing at work.

Insomnia for which ambien barely helps

Sexual dysfunction. Again hard to date when your fat and impotence

Doctors dont know the diet. I swear my dentist gave me epinephrine with lidocaine even though I told him about Nardil and the restrictions

Ankle swelling

Worry that so few people take Nardil, there will be a shortage one day

I think we talked about this before, but Dr Fredrick Quitken The Godfather of Nardil told me that Nardil works 90% of the time but only 10% can tolerate it.

So TMS is making me worse, I all I have to choose between is Nardil and being fat, forever single, high blood pressure and diabetes or maintenance ECT with the inability to work at my high level job and this possibly of long term cognitive loss.

And also, I have been on over 25 medication and the only ones I could not tolerate were despramine and Wellbutrin but to worsen of my panic attack. Of the other TCA, parnate, SSRI, lithium, SNRIs, depakote I had side effects but they were tolerable and I never complained. Nardil was really the first and only medication that I have had difficulties with and have tried to replace

 

Re: TMS, Ketamine, ECT ... last chance! » PCB

Posted by SLS on June 10, 2020, at 19:07:11

In reply to Re: TMS, Ketamine, ECT ... last chance!, posted by PCB on June 10, 2020, at 10:10:50

Hi, PCB.

> Mainly 50 lbs gain weight. As a health care provider I know with my BMI about 29 to 30 I am at higher risk for hypertension, diabetes, cancer. My left hip has mild arthritis which will only get worse. And of course being fat reduces chances dating and advancing at work.

I totally get it unfortunately.

> Insomnia for which ambien barely helps

One of the problems with Ambien is that it has such a short half-life. It is used to initiate sleep, but doesn't do a very good job of keeping people asleep (sleep maintenance). Years ago, when nothing else worked to treat my insomnia while taking Parnate + desipramine, my doctor combined Halcion (the most potent benzodiazepine that has a very short half-life) to initiate sleep and Ativan to maintain it.

> Ankle swelling

Very common. Im glad I dont get that.

> Worry that so few people take Nardil, there will be a shortage one day

Yes and if you stop taking it now, my future is less secure. :-)

> I think we talked about this before, but Dr Fredrick Quitken The Godfather of Nardil told me that Nardil works 90% of the time but only 10% can tolerate it.

Wow. I didnt know that.

I was a patient of Dr. Quitkin. He and Michael Liebowitz were big proponents of Nardil for atypical depression and social anxiety.

> So TMS is making me worse, I all I have to choose between is Nardil and being fat, forever single, high blood pressure and diabetes or maintenance ECT with the inability to work at my high level job and this possibly of long term cognitive loss.

Linkadge made a rather important comment regarding dominant handedness. It reminded me how critical frequency and laterality are in TMS treatment outcome. Are there any left-handed people in your family? Giving TMS on the wrong side of the brain (for that individual) can make someone feel worse instead of better. There are several different types of TMS that have emerged. You might want to look into deep TMS (dTMS).

> And also, I have been on over 25 medication and the only ones I could not tolerate were despramine and Wellbutrin but to worsen of my panic attack. Of the other TCA, parnate, SSRI, lithium, SNRIs, depakote I had side effects but they were tolerable and I never complained. Nardil was really the first and only medication that I have had difficulties with and have tried to replace.

Have you responded well to a drug that later became ineffective?

I imagine you have tried Effexor already. What about Trintellix? Intrestingly, Trintellix can enhance cognitive function, even when there is no improvement in depression. Its worth trying.


 

Re: TMS, Ketamine, ECT ... last chance! » SLS

Posted by PCB on June 10, 2020, at 20:02:28

In reply to Re: TMS, Ketamine, ECT ... last chance! » PCB, posted by SLS on June 10, 2020, at 19:07:11

Hey SLS,

Thanks for the reply. I really appreciate it!

> > Insomnia for which ambien barely helps
>
> One of the problems with Ambien is that it has such a short half-life. It is used to initiate sleep, but doesn't do a very good job of keeping people asleep (sleep maintenance). Years ago, when nothing else worked to treat my insomnia while taking Parnate + desipramine, my doctor combined Halcion (the most potent benzodiazepine that has a very short half-life) to initiate sleep and Ativan to maintain it.

So anything with a longer half life leaves me a little sedated in the morning. So I take 5 mg at bedtime and wake up at 2 AM and take the other half.

> > Worry that so few people take Nardil, there will be a shortage one day
>
> Yes and if you stop taking it now, my future is less secure. :-)

Hahaha. Maybe the one good thing about going to TMS is the technician said alot of patients there take Nardil. So I take that back, you are safe ;)

> > I think we talked about this before, but Dr Fredrick Quitken The Godfather of Nardil told me that Nardil works 90% of the time but only 10% can tolerate it.
>
> Wow. I didnt know that.
>
> I was a patient of Dr. Quitkin. He and Michael Liebowitz were big proponents of Nardil for atypical depression and social anxiety.

Yes, Nardil really works! Quitkin said right after the "90% work, 10% tolerate comment" that he didn't even prescribe nardil anymore. He said "I just give Prozac." (the only ssri out when I saw him). He did say I could lower the dose and add ritalin to nardil. Wow! Nardil and Ritalin made me so high ... I suspect that how it feels to do narcotics. I hated the feeling

> > So TMS is making me worse, I all I have to choose between is Nardil and being fat, forever single, high blood pressure and diabetes or maintenance ECT with the inability to work at my high level job and this possibly of long term cognitive loss.
>
> Linkadge made a rather important comment regarding dominant handedness. It reminded me how critical frequency and laterality are in TMS treatment outcome. Are there any left-handed people in your family? Giving TMS on the wrong side of the brain (for that individual) can make someone feel worse instead of better. There are several different types of TMS that have emerged. You might want to look into deep TMS (dTMS).

So the really reason I don't want to continue TMS is I am back together with my on and off girlfriend of 2 years. I really can't afford to be depressed for 6 weeks without her breaking it off. I broke things off before, so she is giving me a test period where I have to be really good before she will say we are officially dating again. Otherwise I wouldn't worry about doing 6 weeks of TMS and being bedridden and nonfunctional. This sounds corny, but I really love her and she is my *main* antidepressant. She inspires me, walk in the parks are amazing, just my life is so much better with her. So if things go well, maybe TMS in 3 to 6 months. Also no lefties. But great thought!

> > And also, I have been on over 25 medication and the only ones I could not tolerate were despramine and Wellbutrin but to worsen of my panic attack. Of the other TCA, parnate, SSRI, lithium, SNRIs, depakote I had side effects but they were tolerable and I never complained. Nardil was really the first and only medication that I have had difficulties with and have tried to replace.
>
> Have you responded well to a drug that later became ineffective?

Nope. But I do have a strong family of Bipolar and Unipolar disorder. I have always been concerned I am Bipolar II or III (technically according to Hagop Akiskals bipolar subtypes, I might be type IV? after failing 3 or more antidepressants. I have tried lithium and depakote monotherapy and really felt worse trying to see if I was Bipolar I or maybe II. So all my docs have said no Bipolar, but I probably am unipolar or some form of mild bipolar spectrum. Actually my mother is unipolar and father was Bipolar I. I started wonder if I am some strange of combination disorder being both unipolar and bipolar making so I can't respond to any medications (It a strange thought, but maybe I got some strange gene combination that antidepressants put me into agitated bipolar depression and mood stabilizer send me into deep depression


> I imagine you have tried Effexor already. What about Trintellix? Intrestingly, Trintellix can enhance cognitive function, even when there is no improvement in depression. Its worth trying.
>

Really interesting you said that. So I switched my pdoc this year and he had me do all sorts of consults ... ECT, TMS, pharmacogenetic testing. My pharamcogentic test did list Trintellix and I thought I would switch to that off nardil and then start TMS. But the TMS doc said no, to start TMS and try tapering off nardil after 2 weeks.

P.S. what really got me to try TMS was this article .... https://journals.sagepub.com/doi/abs/10.1177/1078390311403479?journalCode=japa

I actually talked to this kind gentleman and asked him what maintenance ECT was like. He said he stopped ECT several year ago because he now does TMS! Later I found out he takes nardil too, but I didn't get the dose. I hope it wasn't a high dose, but a low dose with TMS.

 

Re: TMS, Ketamine, ECT ... last chance!

Posted by SLS on June 11, 2020, at 3:54:23

In reply to Re: TMS, Ketamine, ECT ... last chance! » SLS, posted by PCB on June 10, 2020, at 20:02:28

Hi.

> I actually talked to this kind gentleman and asked him what maintenance ECT was like. He said he stopped ECT several year ago because he now does TMS! Later I found out he takes nardil too, but I didn't get the dose. I hope it wasn't a high dose, but a low dose with TMS.

Do you think Nardil-induced weight gain is dosage dependent? I really don't know.

Of all the drugs you've tried, which ones helped most.

Lithium produces a bimodal effect on glutamate activity and intracellular signalling. For me, lithium has a bimodal clinical effect that might be a reflection of these things. Low dosages help depression while high dosages worsen it. 300 mg/day of lithium is perfect for me in that it adds to the efficacy of Parnate. At 450, things switch. I feel worse.

https://academic.oup.com/ijnp/article/18/6/pyu058/672908

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiezs_usPnpAhWXQjABHXiOD_EQFjABegQIChAD&url=https%3A%2F%2Fwww.nature.com%2Farticles%2F4000444.pdf%3Forigin%3Dppub&usg=AOvVaw17YyW6pj9ItMcpgYFuKJeA


- Scott

 

Re: TMS, Ketamine, ECT ... last chance! » SLS

Posted by PCB on June 11, 2020, at 5:19:51

In reply to Re: TMS, Ketamine, ECT ... last chance!, posted by SLS on June 11, 2020, at 3:54:23

I think Nardil weight gain is related to dose, although it may not be a straight linear one to one relationship. Above 45 mg the depression lifts a little and so does the weight. 45 and below the weight starts to drop and Im fully depressed.

Me to! Actually 450 is the sweet spot for me. Over that aweful. Although I havent mention I was good on 200 imipramine and 900 lithium for one year in my 20s. I had a serum level of .7. But lithium alone or with an antidepressant since then, I only benefit from 450.

 

Re: TMS, Ketamine, ECT ... last chance! » SLS

Posted by ed_uk2010 on June 11, 2020, at 15:10:13

In reply to Re: TMS, Ketamine, ECT ... last chance!, posted by SLS on June 11, 2020, at 3:54:23

RE availability,

It's been many months since the UK version of Nardil was available here. As a result, we were initially using imports from the US, but they have suspended sales to the UK temporarily, due to insufficient stock. Presumably, the unanticipated increased demand for the US products from abroad has caused a temporary market shortage in the US. I would ensure that you request your next supply in good time, because it appears that certain US wholesalers may be out-of-stock.

The UK version of Nardil tablets won't be available for a year or more, unfortunately.... assuming it is actually re-launched here at all. Some patients have been told they have to switch, and others already have ... often with poor results (to say the least).

The good news is that certain Specials Manufacturers (rather similar to what you call compounding pharmacies) are now manufacturing phenelzine capsules on site, in the UK. We are able to supply patients with these, instead of the imported tablet version. It will come as a huge relief to some that an unlicensed capsule version is finally available for UK patients unable to switch medication. Awareness of the capsule version is currently low, but I expected it to increase over the next few weeks/months. We may end up with 2-3 companies manufacturing the capsules.

In other countries, such as Australia, I'm unsure of the current situation, but I expect it is much worse than the UK. In spite of the high prices charged, we are fortunate to have numerous Specials Manufacturers available - all are aimed at producing products to fulfill the needs of patients unable to be treated with any approved/licensed medication. In particular, they specialise in making liquid forms of medication normally only available as tablets.

 

Re: TMS, Ketamine, ECT ... last chance!

Posted by SLS on June 12, 2020, at 10:26:10

In reply to Re: TMS, Ketamine, ECT ... last chance! » SLS, posted by ed_uk2010 on June 11, 2020, at 15:10:13

> RE availability,

> The UK version of Nardil tablets won't be available for a year or more

OMG!!!

Why the shortage? What's true today that wasn't true a year ago?


- Scott

 

Re: TMS, Ketamine, ECT ... last chance! » SLS

Posted by ed_uk2010 on June 12, 2020, at 15:40:27

In reply to Re: TMS, Ketamine, ECT ... last chance!, posted by SLS on June 12, 2020, at 10:26:10

> Why the shortage? What's true today that wasn't true a year ago?

Yep, the shortage is huge. A lot of countries have been affected. I believe the issue wrt the UK is that Kyowa Kirin, the Japanese company who purchased the manufacturing authorisation (licence) for Nardil a couple of years ago don't actually make the product themselves. I could be wrong, but I believe they use Recipharm as the contract manufacturer for this line. It appears that the manufacturer have told Kyowa Kirin that they are not currently able to produce any, for some reason. As far as I know, Australia and NZ have already had to withdraw a lot of patients from the medication.

Most areas of the UK are also looking to switch patients off phenelzine... if they haven't been switched already. We are not doing any switches locally - we are using the unlicensed capsule version which is currently being manufactured by at least two companies in the UK, soon to become three.... although, there could already be other 'Specials' manufacturers selling it that I don't know about.

 

Re: TMS, Ketamine, ECT ... last chance! » ed_uk2010

Posted by linkadge on June 14, 2020, at 13:43:31

In reply to Re: TMS, Ketamine, ECT ... last chance! » SLS, posted by ed_uk2010 on June 12, 2020, at 15:40:27

How do you 'switch a patient off phenelzine'? You mean do a different brand, or to a different drug?

Most patients are on phenelzine because literally nothing else works.

Linkadge

 

Re: TMS, Ketamine, ECT ... last chance! » linkadge

Posted by ed_uk2010 on June 15, 2020, at 12:48:02

In reply to Re: TMS, Ketamine, ECT ... last chance! » ed_uk2010, posted by linkadge on June 14, 2020, at 13:43:31

> How do you 'switch a patient off phenelzine'? You mean do a different brand, or to a different drug?

I mean to a different drug. A lot of patients in the UK (and probably various other countries) have been forced to stop phenelzine completely.

Locally, we are supplying an unlicensed product through the hospital so that no one has to switch/stop.

 

Re: TMS, Ketamine, ECT ... last chance!/PCB

Posted by Stargazer2 on June 17, 2020, at 9:16:26

In reply to TMS, Ketamine, ECT ... last chance!, posted by PCB on June 9, 2020, at 21:24:53

Get evaluated for Ketamine. Nothing to lose. Everything to gain. I had it about 18 months ago. It did something and I would recommend it and have it again if my condition goes back to where I was pre treatment. I did go off Nardil but went back in it. Some are able to stop their meds, I was not. I also added DLPhenylalanine which is an amino acid which can help depression and pain. I believe that it has been the key to open the door along with Ketamine and Nardil.
My depression is Treatment resistant and I would be dead if my will to fight this beast diminished. I came close a few times.
But definitely find a Ketamine expert in your state and be evaluated. Dont go to a Ketamine clinic run by anesthesiologists. My doc is a psychiatrist and goes it in her office. It is not covered yet by insurance. I paid $500 per treatment. That is an average cost. I think the ASKP is the group of Ketamine experts nationally.

 

Re: TMS, Ketamine, ECT ... vote for Ketamine

Posted by alchemy on June 22, 2020, at 20:14:20

In reply to Re: TMS, Ketamine, ECT ... last chance!/PCB, posted by Stargazer2 on June 17, 2020, at 9:16:26

Not a magic bullet for me but it offers a slight lift. I "sniff" 60 mg 2x week.
TMS was lame for me.
ECT helped once, but not other times.
Did you gain the weight right after starting Nardil?

 

Re: TMS, Ketamine, ECT ... last chance!/PCB » Stargazer2

Posted by alchemy on June 23, 2020, at 22:36:33

In reply to Re: TMS, Ketamine, ECT ... last chance!/PCB, posted by Stargazer2 on June 17, 2020, at 9:16:26

> I also added DLPhenylalanine which is an amino acid which can help depression and pain. I believe that it has been the key to open the door along with Ketamine and Nardil.

I'm interested in your experience with DL Phenylalaline. What are your symptoms, how did it help, and has it caused issues with continued use?

 

Re: TMS, Ketamine, ECT ... last chance!/PCB

Posted by Stargazer2 on June 24, 2020, at 11:13:42

In reply to Re: TMS, Ketamine, ECT ... last chance!/PCB » Stargazer2, posted by alchemy on June 23, 2020, at 22:36:33

All I can say is Even during my 11 Ketamine treatments the suicidal thinking returned. The first few IV K treatments were awesome and I felt normal and my friends said you are a different person. I was more comfortable going out, talking to people and just plain relaxed in my own skin. As the K treatments spread out to once a month my depression would re-emerge at about 2-3 weeks. I could always push it out until a month had passed and have another Treatment
( I paid $500 out of pocket and hired a driver to bring me and pick me up. It was a 4-5 hour time commitment).

I had tried DL-P a few yrs ago with Zero improvement. It was on this site that someone suggested trying it. Anyway I started it again very slowly and for some reason whether it was the K opening up my neuro circuitry, or something else Like drug combination,, the suicidality stopped and now I no longer need to have monthly Ketamine treatments.
I buy it on-line. The brand is LifeBest ( I think) and despite the bottle saying take 1-3 capsules a day. I had remission of SI at 1 capsule a week. I stopped Ketamine over a year ago and I am on the following meds:
Nardil 45 mg w am
Ritalin 5 mg 1-2/day,
thyroxine 125 mcg q am
Lithium ER 300 mg 1-2/ week
DL Phenylslanine 500 mg 1-2/week
Seroquel 50 for sleep.

SG2

 

IV Ketamine/DL Phenyalanine/Alchemy

Posted by Stargazer2 on June 24, 2020, at 11:16:11

In reply to Re: TMS, Ketamine, ECT ... last chance!/PCB, posted by Stargazer2 on June 24, 2020, at 11:13:42

Above post for you.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.