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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on April 2, 2005, at 5:35:33
In reply to Re: I got up at 5pm...I sorta know how you feel » ed_uk, posted by Slinky on April 1, 2005, at 20:07:59
Hi!
>I'm passed normality.
Me too :-S
Regards,
Ed.
Posted by ed_uk on April 2, 2005, at 5:40:21
In reply to Re: I got up at 5pm..... » ed_uk, posted by zeugma on April 1, 2005, at 21:15:23
Hi Z!
>It might help to take a sedating AD like trazodone at the same time every night. This way you'll get more sleep at night.
I think you could be right but trazodone often causes a 'hangover' and makes it difficult to wake up in the morning- I'd be worried about that happening to me. I could ask for Provigil but I'm pretty sure my pdoc wouldn't even consider it. All 'stimulants' are seen as being the 'Devil's drugs' here, everything gets 'treated' with Effexor.
>I've slept for 24 hours at a time on several occasions.
At the most, I've probably slept about 19hrs, this was not uncommon when I was depressed.
Kind regards,
Ed.
Posted by ed_uk on April 2, 2005, at 5:41:13
In reply to Re: I got up at 5pm..... » ed_uk, posted by KaraS on April 1, 2005, at 21:26:08
Hi Kara!
Thank you for your kind words :-)
Ed xx
Posted by ed_uk on April 2, 2005, at 5:42:24
In reply to hey ED... try this, posted by Spriggy on April 1, 2005, at 21:48:42
LOL Spriggy it's true- but I'd get an antipsychotic, not an MAOI!!
Ed x
Posted by ed_uk on April 2, 2005, at 5:46:00
In reply to Re: I got up at 5pm..... » ed_uk, posted by Sarah T. on April 2, 2005, at 0:32:40
Hi Sarah!
Thank you for your kind words :-)
>From your post, I couldn't quite figure out what medicines you're on now. Are your current medications exacerbating your sleep/wake difficulties? You mentioned that you want to take an MAOI. Have you ever been on an MAOI before?
I'm just on lofepramine 140mg/day, it doesn't really affect my sleeping at all. I've taken moclobemide (Manerix) but it didn't help, my pdoc wouldn't prescribe a 'proper' MAOI, he'd never prescribed one before and he wasn't going to start with me!
>Do you have Daylight Savings Time in the U.K.?
Oh yes, we had to put the clocks forward! YUCK.
Kind regards,
Ed.
Posted by TamaraJ on April 2, 2005, at 10:11:32
In reply to Re: I got up at 5pm..... » zeugma, posted by ed_uk on April 2, 2005, at 5:40:21
Hi Ed,
> I think you could be right but trazodone often causes a 'hangover' and makes it difficult to wake up in the morning- I'd be worried about that happening to me.
>
~~ FWIW, I tried Trazadone last spring, and the 'hangover' was terrible for me. I was only taking 25mg, which I took as early as about 10pm. Even on that low dose, I couldn't function before noon the next day! I would just keep fading in and out of sleep all morning. And, even after the effects wore off, I was sluggish, lethargic and down for the remainder of the day. That being said, my body may well have adjusted to the effects of the traz after having taken it for a longer period of time, but I wasn't willing to go through that horrid hangover effect any longer.You might want to talk to Larry about Melatonin, if you can get it over the counter in the UK. I think ome people do quite well using it to regulate their sleep cycles.
Take care Ed.
All the best,
Tamara
Posted by ed_uk on April 2, 2005, at 11:13:39
In reply to Re: I got up at 5pm..... » ed_uk, posted by TamaraJ on April 2, 2005, at 10:11:32
Hi Tamara!
>You might want to talk to Larry about Melatonin, if you can get it over the counter in the UK. I think ome people do quite well using it to regulate their sleep cycles.
You could be right, it might help :-) It's a shame that it's not available over the counter here. It's not approved in the UK so doctors rarely prescribe it.
Ed xxxxxxxxx
Posted by Sarah T. on April 2, 2005, at 13:05:06
In reply to Re: I got up at 5pm...I sorta know how you feel » ed_uk, posted by Slinky on April 1, 2005, at 20:07:59
> ,,> I'm passed normality.
>> ~~SlinkySlinky, that means you're supra-normal!
Posted by Bob on April 2, 2005, at 13:55:16
In reply to Re: I got up at 5pm..... » TamaraJ, posted by ed_uk on April 2, 2005, at 11:13:39
I have always wondered about whether others out there were suffering from the same ridiculous sleep cycle problems I have been dealing with for so many, many years. Any medecine with an SRI component in it eventually causes me to sleep a minimum of 10 hours, and many times 15, 16, 18, etc. To me, it's always been the worst feeling in the world to wake up so late and realize you've missed the entire day. What's even more infuriating is to realize that most people don't get this problem when they take these meds. The worse one of all for me was Effexor. Then of course, when I tried to get off, the withdrawl practically crushed me. I tried all kinds of ways to keep myself awake, including stimulants, melatonin, 5-HTP, and other compounds. Some of them worked for a little while (melatonin and stimulants), but evenutally they all faded out, and I was left sleeping 15 or so hours per day. I don't think I've ever come across one doctor or fellow patient who was able to help me with this. Ironically, one day on this board, I saw a thread about MAOIs where the poster claimed they made him sleep all the time. That was disheartening.
Bob
Posted by ed_uk on April 2, 2005, at 14:34:23
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 2, 2005, at 13:55:16
Hi Bob!
>Ironically, one day on this board, I saw a thread about MAOIs where the poster claimed they made him sleep all the time.
Although MAOIs *can* cause people to sleep excessively, they can also reduce hypersomnia in other people. Do you think you'll try one? Perhaps Parnate.
Ed.
Posted by Bob on April 2, 2005, at 14:53:20
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 2, 2005, at 14:34:23
> Hi Bob!
>
> >Ironically, one day on this board, I saw a thread about MAOIs where the poster claimed they made him sleep all the time.
>
> Although MAOIs *can* cause people to sleep excessively, they can also reduce hypersomnia in other people. Do you think you'll try one? Perhaps Parnate.
>
> Ed.I don't know what I'll do next. Just about everything I've tried in my life has been a disaster, including between 35 and 40 psychoactives. Believe it or not, I'm currently near the end of a cycle of ECT treatments, for the first time ever. I don't have a lot of confidence in it right now. The day of the treatments (at least the first part) I feel great, and practically cured. Then the days after are difficult, with anxious depression, and confusion. I'm losing faith.
The only major class of meds I've never tried are MAOIs, but I am so prone to side effects, and so sensitive to withdrawl, that I'm not sure it wouldn't be my worst experience to date. I can't really rule anything out, but I'm not looking foward to it, anyway.
I can't believe how much this condition sucks.
Posted by ed_uk on April 2, 2005, at 15:08:48
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 2, 2005, at 14:53:20
Hello Bob,
I'm sorry to hear that the ECT isn't providing you with any sustained benefits.
>The only major class of meds I've never tried are MAOIs, but I am so prone to side effects, and so sensitive to withdrawl, that I'm not sure it wouldn't be my worst experience to date.
Many people respond to MAOIs after nothing else has helped, several people on this board have found that. Tricyclic antidepressants are often ineffective for people with hypersomnia, MAOIs can work well in these people. Please don't give up.
Kind regards,
Ed.
Posted by TamaraJ on April 2, 2005, at 18:03:32
In reply to Re: I got up at 5pm..... » TamaraJ, posted by ed_uk on April 2, 2005, at 11:13:39
> Hi Ed!
>
> You could be right, it might help :-) It's a shame that it's not available over the counter here. It's not approved in the UK so doctors rarely prescribe it.
>
~~ If you wanted to try it, perhaps you could order from an on-line, natural supplements supplier. Or is it restricted for import into the UK and can only be prescribed by a physician?Also, I know you are aware of the research done on using thyroid meds to augment ADs. Perhaps that is something that your pdoc might consider, if you can make a strong enough argument for a trial (there seems to be quite a bit of research to substantiate its effectiveness as an augmenting agent). Anyway, I am just including the following website because it seems to have a lot of info on studies done on augmenting with thyroid meds.
http://www.modern-psychiatry.com/thyroid.htm
Take care,Tamara
xxx
Posted by ed_uk on April 2, 2005, at 18:30:11
In reply to Re: I got up at 5pm..... » ed_uk, posted by TamaraJ on April 2, 2005, at 18:03:32
Hi Tamara!
>Or is it restricted for import into the UK and can only be prescribed by a physician?
Yes, I think it's restricted. I could import it anyway though, I very much doubt I would get into trouble. Thank you for the suggestion :-)
> Perhaps that is something that your pdoc might consider........
I will ask at my next appointment- in a couple of weeks. Thank you for the link, it was very good. Just out of curiousity, do you still have dessicated thyroid in Canada? It hasn't been available in the UK for decades! I think they call it 'Armour' in the US but I could be wrong.
Ed xxxx
Posted by banga on April 2, 2005, at 18:47:27
In reply to Re: I got up at 5pm..... » TamaraJ, posted by ed_uk on April 2, 2005, at 18:30:11
I think they call it 'Armour' in the US but I could be wrong.
>
> Ed xxxxHi Ed!
It is, indeed, armour thyroid in the US...B.
Posted by KaraS on April 2, 2005, at 21:01:03
In reply to Re: I got up at 5pm..... » TamaraJ, posted by ed_uk on April 2, 2005, at 18:30:11
I think they call it 'Armour' in the US but I could be wrong.
>
> Ed xxxx
There are actually a couple of other natural dessicated thyroid meds in the U.S. They are Westhroid and Naturethroid. They are both made by the same company. The Naturethroid has fillers that are more hypoallergenic. I haven't tried either of them yet though some holistic doctors do prefer them over Armour.
Posted by Bob on April 3, 2005, at 10:16:24
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 2, 2005, at 15:08:48
> Hello Bob,
>
> I'm sorry to hear that the ECT isn't providing you with any sustained benefits.
>I had another period of feeling reasonable last night, but by this morning it was gone again. In a way it is hard to deal with, because I get little fleeting windows of feeling reasonable, and then they are gone. Maybe the good times will become more often, but I am somewhat dubious.
> >The only major class of meds I've never tried are MAOIs, but I am so prone to side effects, and so sensitive to withdrawl, that I'm not sure it wouldn't be my worst experience to date.
>
> Many people respond to MAOIs after nothing else has helped, several people on this board have found that. Tricyclic antidepressants are often ineffective for people with hypersomnia, MAOIs can work well in these people. Please don't give up.
>
> Kind regards,
> Ed.I've had significant problems with weight gain, hypersomnia, loss of sexuality, akathisia (at least sometimes), and even difficulty urinating sometimes with many meds. These include SSRIs, Tricyclics and Effexor. Trying meds like Lithium and Depakote have mainly produced problems with weight oversleeping, and sex. I don't think I would ever rule out MAOIs, but would be surprised if many of the same side-effects wouldn't be there, and it seems to me like some of the best things in life, such as sex and food, are severely cramped with these meds.
Posted by ed_uk on April 3, 2005, at 12:03:34
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 3, 2005, at 10:16:24
Hi Bob,
>I had another period of feeling reasonable last night, but by this morning it was gone again. In a way it is hard to deal with, because I get little fleeting windows of feeling reasonable, and then they are gone. Maybe the good times will become more often, but I am somewhat dubious.
How far into your course of ECT are you? How often are you having it? 2-3 times a week?
>I don't think I would ever rule out MAOIs, but would be surprised if many of the same side-effects wouldn't be there, and it seems to me like some of the best things in life, such as sex and food, are severely cramped with these meds.
The MAOIs have a different mechanism of action to all of the other other antidepressants. Tranylcypromine (Parnate) would certainly be worth considering. Have you asked your psychiatrist about trying an MAOI? Since the MAOIs are completely different to any of the antidepressants you've tried so far, they could be very beneficial- you might be surprised. Optimist is currently doing well on a high dose of Parnate with no side effects at all.
Ed.
Posted by Bob on April 3, 2005, at 13:43:58
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 3, 2005, at 12:03:34
> Hi Bob,
>
> How far into your course of ECT are you? How often are you having it? 2-3 times a week?I believe tomorrow's treatment will be number 13, but I'm not sure. At first they were M-W-F, and then they switched to M and F.
> The MAOIs have a different mechanism of action to all of the other other antidepressants. Tranylcypromine (Parnate) would certainly be worth considering. Have you asked your psychiatrist about trying an MAOI? Since the MAOIs are completely different to any of the antidepressants you've tried so far, they could be very beneficial- you might be surprised. Optimist is currently doing well on a high dose of Parnate with no side effects at all.
>
> Ed.No side-effects at all? Uhhhh, I dunno. Anyway, I have discussed MAOIs, but we decided to try this first. I have had such a terrible time with medecines, that I wanted to take a break. I realize that MAOIs may prove to be a magic bullet, but I've got to believe it's a long shot. What I'm really afraid of is what has always happened before: I get on a therapeutic dose of the stuff, and then a very unpleasant side effect develops, such as anger, agitation, or sexual obsession, or excessive weight gain, extreme lethargy/drowsiness, or whatever else. Then, I can't get off it quickly, so my life becomes a daily, living hell as I try to taper down. Past experiences like this have been nothing short of life threatening. Even if the med does work, I've never been on one that keeps working. Nevertheless, I won't rule them out.
Posted by ed_uk on April 3, 2005, at 14:11:52
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 3, 2005, at 13:43:58
Hi Bob,
>I believe tomorrow's treatment will be number 13........
How many treatments will you be having? What side effects have you had so far?
>No side-effects at all? Uhhhh, I dunno.
He had some mild sexual dysfunction for a few days and then no side effects from then on. You can babblemail him if you like! Many people do have side effects from MAOIs, there's no doubt about that, I just wanted you to know that some people don't. Since the MAOIs are very different to any of the other antidepressants, you might find that you like them. Interestingly, some people seem to do much better on one MAOI than on another... the three main MAOIs are phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan).
Which antidepressants have caused you the worst side effects in the past?
Ed.
Posted by Bob on April 3, 2005, at 22:20:45
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 3, 2005, at 14:11:52
> How many treatments will you be having? What side effects have you had so far?
>I'm not sure what the plan is. I am either almost done, or they want to try for "maintenance ECT". However, since it doesn't seem to be going that well to me, I have my doubts about maintenance treatments. I guess I will find out more tomorrow, and then I see my psychiatrist on Tues. I'll know more than, I figure. All I can say now is that I expected to feel better than I do.
>
> He had some mild sexual dysfunction for a few days and then no side effects from then on. You can babblemail him if you like! Many people do have side effects from MAOIs, there's no doubt about that, I just wanted you to know that some people don't. Since the MAOIs are very different to any of the other antidepressants, you might find that you like them. Interestingly, some people seem to do much better on one MAOI than on another... the three main MAOIs are phenelzine (Nardil), tranylcypromine (Parnate) and isocarboxazid (Marplan).
>
> Which antidepressants have caused you the worst side effects in the past?
>
> Ed.
>
>I am aware that the MAOIs are different, but I have had a very bad record with just about every med, including things like lamictal, SSRIs, tricyclics, and whatever else. I think it would be unrealistic to expect little or no side-effects from an MAOI, since they have a rep for even more problems than tricyclics. Sometimes I get a short-lived response from the meds, but eventually it becomes a burden, and then the challenge is withdrawing off of it without endangering my life, which I haven't always been successful at. A few of the side-effects I almost always get are: significant weight gain, significant sexual dysfuntion, urinary hesitancy, and sometimes one or all of the following: anger, apathy, akathisia, hypersomnia, jaw tightness, constant yawning, and migraine headaches. Not all of the meds produce all the same effects, but those are some of the major ones that have shown up multiple times. I have become much more reticent over the years at trying new meds, as it has become very, very difficult to go on and off of them. My body cannot bounce back any longer. A full list of all the side-effects I've had from all the meds would take up this server, as well as the next two days of my time. I'm a poster child for rare/uncommon problems, and yes, I got the rash from the lamictal, and kidney stones from Topomax.
Anyway, right now I'm embroiled in this ECT thing, so I have to see how that plays out. BTW, what is your situation with treatment and response? I don't think I asked that before, did I?
Bob
Posted by Bob on April 3, 2005, at 22:38:04
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 3, 2005, at 14:11:52
One thing that scares me about Nardil is the almost guaranteed weight gain, and the fact that pretty much nobody is sexually functional on that med. I've also heard bad things about urinary retention on MAOIs, especially Parnate. Yes, I might not get those problems, but they seem awful common from my readings on this board.
Posted by ed_uk on April 4, 2005, at 8:35:47
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 3, 2005, at 22:20:45
Hello Bob,
>One thing that scares me about Nardil is the almost guaranteed weight gain, and the fact that pretty much nobody is sexually functional on that med. I've also heard bad things about urinary retention on MAOIs, especially Parnate. Yes, I might not get those problems, but they seem awful common from my readings on this board.
Sexual side effects are common with Nardil, particularly at first. Parnate seems to be considerably better in terms of sexual side effects. Weight gain also seems to be more common with Nardil than with Parnate. Urinary retention is quite common with MAOIs. Parnate might be a better choice for you than Nardil.
>However, since it doesn't seem to be going that well to me, I have my doubts about maintenance treatments.
I can understand that. Do you think any of the benefits have lasted more than a day?
>they have a rep for even more problems than tricyclics.......
It's not always the case though because the MAOIs are so different to the TCAs. Some people who hate TCAs do really well on an MAOI.
>BTW, what is your situation with treatment and response? I don't think I asked that before, did I?
Lofepramine helps my depression somewhat, I'm not entirely satisfied though. At least I don't have any major side effects from it which is a nice change! I often need an SSRI for anxiety and OCD, not at the moment though. They make me very apathetic, I always need an afternoon nap if I'm on an SSRI.
What is your diagnosis?
Kind regards,
Ed.
Posted by Bob on April 4, 2005, at 15:09:57
In reply to Re: I got up at 5pm..... » Bob, posted by ed_uk on April 4, 2005, at 8:35:47
> Hello Bob,
>
> >One thing that scares me about Nardil is the almost guaranteed weight gain, and the fact that pretty much nobody is sexually functional on that med. I've also heard bad things about urinary retention on MAOIs, especially Parnate. Yes, I might not get those problems, but they seem awful common from my readings on this board.
>
> Sexual side effects are common with Nardil, particularly at first. Parnate seems to be considerably better in terms of sexual side effects. Weight gain also seems to be more common with Nardil than with Parnate. Urinary retention is quite common with MAOIs. Parnate might be a better choice for you than Nardil.
>
> >However, since it doesn't seem to be going that well to me, I have my doubts about maintenance treatments.
>
> I can understand that. Do you think any of the benefits have lasted more than a day?The treatments have seemed to help my body somewhat physically, more than mentally. My sleep cycle was severely delayed to the point where I could not get up early in the morning, and was always staying up late. The ECT has seemed to push that back closer to normal, although I don't know how long that will last when I stop. Also, I was getting a lot of akathisia and uncomfortableness in my muscles, which the ECT has also helped with, somewhat. Of course, if I go back on an antidepressant, I have no doubt that these things will be back in a flash. Mentally, it seems that the benefits for the ECT don't really last longer than a day, or two at the most, and usually not even that long.
>
> >they have a rep for even more problems than tricyclics.......
>
> It's not always the case though because the MAOIs are so different to the TCAs. Some people who hate TCAs do really well on an MAOI.
>
> >BTW, what is your situation with treatment and response? I don't think I asked that before, did I?
>
> Lofepramine helps my depression somewhat, I'm not entirely satisfied though. At least I don't have any major side effects from it which is a nice change! I often need an SSRI for anxiety and OCD, not at the moment though. They make me very apathetic, I always need an afternoon nap if I'm on an SSRI.
>
> What is your diagnosis?My diagnosis is major depressive disorder, with coexisting GAD. When I read about you needing a SSRI for anxiety and OCD, it reminded me very much of myself. I too get significant apathy and fatigue/drowsiness from SSRIs. Unfortunately, I find it very difficult to go on and off of these meds, so it is no small matter to change from one drug to another, or to add or subtract a med from the cocktail. For the few weeks when I started the ECT treatments, I was drug free for probably the first time in almost 12 or 13 years! Now, I'm taking Ativan as an adjunct to the treatments.
As for starting on Parnate or Nardil, I would be worried about the obsessive and anxious aspects of my nature, since it would be out of the question to mix SSRIs, or anything else for that matter, with MAOIs.
Honestly, I don't know what I'm going to do next.
I find it remarkable that you have almost no side-effects from lofepramine. That's no small victory.
Bob
>
> Kind regards,
> Ed.
>
>
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Posted by ed_uk on April 4, 2005, at 17:30:27
In reply to Re: I got up at 5pm..... » ed_uk, posted by Bob on April 4, 2005, at 15:09:57
Hi Bob,
>Mentally, it seems that the benefits for the ECT don't really last longer than a day, or two at the most, and usually not even that long.
I'm sorry it hasn't helped much. Have you considered any of the other 'somatic' treatments such as rTMS or VNS?
Btw, have you ever had CBT? What have you tried in terms of herbs and supplements?
St. John's Wort, Trimethylglycine, L-tryptophan, Omega-3, Vitamin B Complex etc.>When I read about you needing a SSRI for anxiety and OCD, it reminded me very much of myself. I too get significant apathy and fatigue/drowsiness from SSRIs. Unfortunately, I find it very difficult to go on and off of these meds, so it is no small matter to change from one drug to another, or to add or subtract a med from the cocktail.
Yes... apathy, drowsiness and fatigue have always been my reason for coming off SSRIs. Paxil was the most sedating. SSRIs also make me EXTREMELY sweaty which can cause problems at times. When I was working in a shop the sweat was dripping down my face onto the counter- it was very embarrassing!
>As for starting on Parnate or Nardil, I would be worried about the obsessive and anxious aspects of my nature, since it would be out of the question to mix SSRIs, or anything else for that matter, with MAOIs.
Nardil is often very effective for anxiety- more so than most antidepressants. Parnate hasn't been studied much in anxiety but some people do find it helpful. Parnate occasionally exacerbates anxiety. MAOIs are generally only slightly effective for obsessive-compulsive disorder though, do you suffer from OCD?
>.....since it would be out of the question to mix SSRIs, or anything else for that matter, with MAOIs.
Various psych drugs can be safely combined with MAOIs. Benzodiazepines do not interact with MAOIs. You could still take Ativan if you need it.
>I find it remarkable that you have almost no side-effects from lofepramine.
Have you ever tried it? I find it very tolerable. I've tried two other TCAs as well, amitriptyline (Elavil) and dothiepin (Prothiaden). Both caused bad side effects: severe drowsiness and lethargy, dry mouth, dizziness, urinary hesitancy, blurred vision etc. Lofepramine doesn't even compare!
Ed.
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