Psycho-Babble Medication Thread 1121168

Shown: posts 1 to 5 of 5. This is the beginning of the thread.


To Linkadge: Expertise and a different approach.

Posted by SLS on December 1, 2022, at 12:03:17

To: Linkadge,

Cc: Psycho-Babble,

Please read this entire post giving it your full attention. The decisions are yours, not mine. They are not even your doctors.

Which of the following drugs do you not have access to?

1. Nortriptyliine

2. Wellbutrin / bupropion

3. Lithium

4. Lamictal / lamotrigine (?)

This is the regime that I thought was better than running back to Effexor - a drug that you can't tolerate at dosages that most people respond to (150-300 mg/day). NO NARDIL is necessary. I never said that it would be. Are you exquisitely sensitive to side-effects of Effexor? Right now, it seems that you are. Did you experience these same side effects to the same degree the very first time you took Effexor? What dosage of Effexor were you able to tolerate the first time you took it?

You have never tried combining the drugs that I listed above, right? (Different is different). I should think that it is worth trying at this juncture. At the very least, it would require you to abstain from taking SRIs for a few months. (3 seems to be the magic number).

Is it a genius treatment?

Not even close. It is simple and logical. Why did you stop taking nortriptyline if it gave you a 75% improvement? That's a HUGE number. Is it logical that you did this? Keeping nortriptyline on board indefinitely while you build a regime around it is a no-brainer.

Wellbutrin helped you to an unsatisfactory degree. But it did help you. Adding it is another no-brainer.

Lithium continues to improve your condition at 300 mg/day. Dont change it. Keep it exactly at 300 mg/day. Doing this is another no-brainer.

Lamotrigine? Unless you had intolerable side effects in the past, taking lamotrigine at a dosage between 200-300 mg/day might be a necessary component of your treatment regime. You reported in the past that you had suspicions that there was a bipolar component of your depressive illness. Isn't there a first-degree relative that is bipolar or schizoid? If so, then adding lamotrigine is another no-brainer.

If you can tolerate lamotrigine at 200 mg/day, It makes little sense to discontinue it as you go through subsequent drug trials. Adding lamotrigine as an adjunct to treat TRD unipolar depression is pretty close to being a no-brainer. If you are experiencing side effect that are of great magnitude and persistent, just discontinue it. Be aware that side effects often disappear over the course of weeks or months. Responding well to *any one dosage* often takes 3-4 weeks, so wait before increasing the dosage. For me, this was true of cognitive and memory impairments. I found them to be more of a startup side effect than a persistent one. START LOW and GO SLOW. Don't allow a rapid titration to *trigger* side effects.

One of the first tidbits of wisdom bestowed upon me as a patient at Columbia Presbyterian was that "pulsing" antidepressants is perhaps the worst thing you can do (Frederick Quitkin). It makes people less responsive to antidepressants and often produces a sensitivity to side effects. Use Quitkin's advice - not mine. Stay away from SRIs for 3 months. This is another no-brainer.

Pulsing is just one of the things that you *seem* to be unaware of. You can't talk to Quitkin or any of the other research clinicians I saw. They are all dead.

Do you think for one second that I would settle for a merely palliative treatment? I decided to leave Columbia when, after much research into the dopamine system, I decided that Wellbutrin was a logical next step. It was still investigational at the time. Quitkin refused my request. This was on top of telling me that I was likely to be in the 85% who were not treatable (Michael Liebowitz). I made a phone call to Donald Sweeney. I forgot how I found him. He had been using Wellbutrin in a clinical trial. When I spoke to him, I described my rationale for using pro-dopaminergic drugs. He told me that Wellbutrin didn't work the way I thought it did, even though it was listed as a dopamine reuptake inhibitor. However, he said that the drug looked good. Sweeney's clinical trial of Wellbutrin had been completed. So, he recommended that I try Baron Shopsin.


Donald Sweeney - Obituary.


Baron Shopsin memorium in "Nature":


Baron Shopsin was one of the first investigators of lithium in America, and a protege of Nathan Klein when they were both at NYU.


Shopsin also went on to help describe schizoaffective disorder as a single illness. His books are still out there somewhere.


One of Shopsin's last papers:

Shopsin was one of the psychopharmacologists who asked me to help him write a paper for publication. Interestingly, it was to be about amoxapine and the unethical practices of the FDA in approving it. After poking around the medical school library at Rutgers, I discovered evidence to corroborate Shopsin's thesis. Unfortunately, Shopsin relocated from NYU in Manhattan to Indianapolis, so the project remained incomplete. That was in 1986.


This is a more recent treatise regarding the same thesis:

"From FDA to GSK: The Dangerous Partnership between Government and Big Pharma"


The only drug that Shopsin saw me very much improved on was nomifensine. It was an investigational drug that was a potent dopamine reuptake inhibitor. It was used as the "gold standard" biological probe to investigate dopamine function.

Shopsin insisted that nomifensine (later to be approved as Merital) was "a piece of sh*t", but he eventually relented. It was the only drug that he ever saw me significantly improved on. However, the antidepressant response to nomifensine didn't last for more than a week. Shopsin was an investigator of Wellbutrin, and treated me with it using a dosage of 900 mg/day. It exacerbated my depression to a moderate, but very perceptible degree. When I discontinued it, I experienced a discontinuation rebound-improvement. This was a common reaction for me with tricyclics and MAOIs. However, this never occurred when discontinuing SSRIs. I can't remember it happening with SNRIs either.


An extremely important example of how the same drug can affect the same person in very different ways is represented by my experience with Effexor. I have been on Effexor at least a handful of times with some success at a dosage of 300 mg/day. 225 mg/day was ineffective. The last time I tried Effexor, things were very different. I had just switched to Effexor immediately after a trial of Trintellix. Trintellix effectively played the role of an experimental pretreatment to Effexor. Upon starting Effexor, I reacted to it in a very different way. It exacerbated my condition and gave me some pretty severe zombie brain-fog effects. It felt very strange and resembled dissociation.

Effexor, then, is one drug that produces different clinical effects, depending upon which drug(s) preceded it. Stay away from SRIs during these drug trials (experiments). Use all of your tricks to ameliorate your depression as you move from drug trial to drug trial. Keep your head above water. These are palliative measures only, since that seems to be the limit to what they are capable of helping you.

* And for God's sake, restart nortriptyline and leave it there indefinitely (if you did indeed experience a 75% improvement on it).

Once your trial of above drugs is complete, you will probably be at the 3 month mark. Then you can reintroduce a SRIs. I would add either Effexor or Pristiq before going with any other SRIs. KEEP IN PLACE the above drugs if you reach dosages that are normally therapeutic.

If you reach another dead end, then make phone calls to doctors and ask them (through their secretaries) if they use Nardil to treat depression. If you turn up empty after calling as many doctors you can find locally (1-2 hours by car), then contact university psychiatric departments. Either they will place you into a research study or treat you outright. I would expect them to provide you with Nardil if they feel its warranted.

I am absolutely sure that you will think of alternative strategies to find treatments outside the sphere you have been stuck in for decades.

Searching for expert clinicians who will treat you with a MAOI if necessary should take up *all* of your time - not studying neuropsychopharmacology. Let the medical community do that.

This the best that I can contribute right now. Oh yeah. Moclobemide is a sh*tty drug for *most* people. I've described why in the past. Descriptions of my experience with moclobemide was clinical and observational rather than being biological guesses. Psychiatrists in clinical practice often give greater weight to their observations and those of their colleagues.

Let the doctors determine if you are an odd-ball that responds only to sub-therapeutic dosages of standard antidepressants. Personally, I am dubious of this. You may have developed an alteration in the dynamics of your serotonin system(s). Although this might be your current reactivity to SRIs, this could be the result of pulsing these drugs repeatedly.

Let the doctor be the doctor as long as he or she is a good one and has your confidence. Whether or not a doctor uses MAOIs is a good index of experience and competence.

That's it. The rest is up to you.

Just get the f*ck well...

... and don't lecture me anymore.


- Scott


Re: To Linkadge: Expertise and a different approach.

Posted by linkadge on December 1, 2022, at 14:35:46

In reply to To Linkadge: Expertise and a different approach., posted by SLS on December 1, 2022, at 12:03:17

Why would I read a lengthy post of yours, when clearly you have not read a short one of mine? I don't have the intellectual capacity right now to go through a post of that length (with links). What is (in one paragraph) the top thing you are trying to tell me?



Re: To Linkadge: Expertise and a different approach.

Posted by linkadge on December 1, 2022, at 14:46:02

In reply to To Linkadge: Expertise and a different approach., posted by SLS on December 1, 2022, at 12:03:17

I never requested anything. This is the opposite of lecturing somebody.



Re: To Linkadge: Expertise and a different approach. linkadge

Posted by SLS on December 1, 2022, at 17:46:04

In reply to Re: To Linkadge: Expertise and a different approach., posted by linkadge on December 1, 2022, at 14:46:02

Dear Linkadge,

Cc: Psycho-Babble


Why should you read something of mine that is so long?

At this point, I really don't care if you read it or not. It doesn't seem to matter to you the efforts that others (me) invest in you in order to help you achieve remission.

C'est la vie.

Obviously, my starting this thread, which is a repost of what I wrote to you personally along another thread, is meant for all to read and perhaps profit from. You elected not to read, so...

In my not-so-humble opinion, you wasted the last 22 years of your life, and still elect to continue to travel along the same circular path. If you never get well, it won't be because the medical community couldn't get you well. It will be because you couldn't.

Do you really think that I went out of my way to write interminably long posts to you in an attempt to get only you well? Do you really think that I want to help you because we are friends? (That won a smirk). Think of me as being riddled with altruism such that I looked past your antipathy towards me. It's been a whole lot of years, right my friend?

If you are truly looking to achieve remission, you should go back and read every word in my post to you. Every single word. Every single link. I am convinced that my post contains wisdom far beyond anything you or your doctor will ever come close to possessing. Most of the pioneers in the field who treated me in the 1980s are now dead. They told me things you will never see in the medical literature, and it certainly won't come from your doctor - Whether a GP or psychiatrist. If your doctor is a GP, that would explain why you were never prescribed MAOIs. I hope that this is not the case, though. Which of the doctors who treated you were willing to prescribe a combination of:


2. MAOI + Wellbutrin

3. High-dosage Parnate (150 mg/day)
+ Desipramine 300 mg/day
+ (methylphenidate or amphetamine)
+ supratherapeutic dosages of T4 thyroid hormone
+ Throw a little Parlodel in there, too.


Good luck with that.


Did you think I was showing off?

I was.

My clinical knowledge is at least as valuable as your knowledge of neuropsychobiology. Mine was at least valuable enough to help me attain remission - at least temporarily.

My efforts really weren't for you only, Linkadge. It was for everyone else. I thought people should finally get a better idea as to my background and knowledge base. If you don't find my CLINICAL information and suggestions to you compelling, then I guess you will go back to studying gene alleles, the transmembrane G-protein receptors they encode for, and the functional receptor molecule domains as they facilitate signal transduction and create second messenger cascades. It sounds like a good way to spend / waste the rest of your life. See, I can sound smart, too. The hell if it got me anywhere - although clinical researchers and successful clinicians always love talking to me about all sorts of neuropsych stuff. I've picked many a brain. Networking is good, too. If you find one good one, they will usually lead you to other good ones. It works.

* My hope is that others might see in me what you refuse to look at - another resource.

Linkadge - The wisdom isn't mine. Don't you get it? I'm sharing the wisdom of two generations of psychopharmacologists, many of whose names litter the medical literature. This wisdom will probably not be made available to you directly by me again. I don't see the purpose. I hope this changes at some point. In the meantime, I hope others find some of what I wrote to you as being valuable for themselves, as they continue with their pursuit of mental health.

I hope your depression remits spontaneously.

I don't think you ever much cared for me since we both appeared on the board 22 years ago. Lots and lots of fighting. In 2001, you were shouting at the top of your lungs (figuratively) that these drugs don't work. Huh? Why are you now taking them? Did you finally change your opinion and come to agree with me after all?

It is with great effort that I remained civil - or at least tried. Forgive the occasional sarcasm.

I hope your research and self-experimentation yield results.

- Scott

* I didn't have the wits about me to proofread this thoroughly.


Re: To Linkadge: Expertise and a different approach. linkadge

Posted by SLS on December 1, 2022, at 19:19:31

In reply to Re: To Linkadge: Expertise and a different approach., posted by linkadge on December 1, 2022, at 14:46:02

> I never requested anything. This is the opposite of lecturing somebody.

Now, you get it...


Posted by linkadge on November 25, 2022, at 16:07:55

"SLS, you have to realize that genetically, everybody is different. For example, a variation in the serotonin transporter gene alone could make SSRIs either tolerable or completely intolerable. You may have the LL version of the SERT gene and wonder why other people are whining so much about SSRIs. The experience of somebody with the low acting version might be hell on earth and wondering why ANYBODY can tolerate the drug. Some of these drugs are just simply not hitting the correct mood target of the patient involved. So, what are they left doing??? Clearly their experience of 'following medical advice' and 'being a good patient' has got them nowhere."


I didn't know any of that. Thanks for sharing.

- Scott

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,

Script revised: February 4, 2008
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.