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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 72 to 96 of 121. Go back in thread:
Posted by SLS on March 2, 2009, at 8:16:23
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 1, 2009, at 21:54:51
Hi Jade.
> I am sorry you aren't getting the response you hoped for. Thats stinks when you've waited so long just to have to wait longer. But it has only been days, you never know. The brain does funny things :-)
Yes. Tell me about it.
> The good news is that he agreed to go to 300mg. So at least you have something to look forward to. So in the end, you will have all you wanted. Not bad. I will be thinking of you and hoping you are feeling well again soon. I have faith it will not be long.
I was basically allowed to relapse for 2 months. I just thought that I could recapture some kind of improvement within days of reaching 300mg. I am beginning to have doubts that it will work at all. At this point, there is no trend in improvement to give me confidence in success.
> Having faith that relief is in sight is the next best thing to remission.
Definitely. It helps to promote patience. I don't have as much faith today as I did yesterday. I am going to try not to focus too heavily on my hour by hour mood status.
> Feel better soon.
Thanks. I'm doing what I can.
> ~Jade aka patient patient
I will try to be a patient patient, too.
Thanks.
- Scott
Posted by garnet71 on March 2, 2009, at 10:40:36
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 2, 2009, at 8:16:23
Sorry you are not feeling well. I know you've tried everything, but am not sure if this drug was a possibility during your trials. This may be a long shot, and the study is over two years old; however, I've never seen discussions here regarding this possibility:
http://www.nih.gov/news/pr/aug2006/nimh-07b.htm
You've probably seen this already, but I wanted to share it just in case you may have missed it.
Hang in there!
Posted by garnet71 on March 2, 2009, at 10:45:56
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
I moved the post so that others could see/discuss the article I posted for Scott.
Posted by SLS on March 2, 2009, at 11:02:01
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
Posted by JadeKelly on March 2, 2009, at 21:53:34
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 2, 2009, at 8:16:23
> Hi Jade.
>
> > I am sorry you aren't getting the response you hoped for. Thats stinks when you've waited so long just to have to wait longer. But it has only been days, you never know. The brain does funny things :-)
>
> Yes. Tell me about it.
>
> > The good news is that he agreed to go to 300mg. So at least you have something to look forward to. So in the end, you will have all you wanted. Not bad. I will be thinking of you and hoping you are feeling well again soon. I have faith it will not be long.
>
> I was basically allowed to relapse for 2 months. I just thought that I could recapture some kind of improvement within days of reaching 300mg. I am beginning to have doubts that it will work at all. At this point, there is no trend in improvement to give me confidence in success.
>
> > Having faith that relief is in sight is the next best thing to remission.
>
> Definitely. It helps to promote patience. I don't have as much faith today as I did yesterday. I am going to try not to focus too heavily on my hour by hour mood status.
>
> > Feel better soon.
>
> Thanks. I'm doing what I can.
>
> > ~Jade aka patient patient
>
> I will try to be a patient patient, too.
>
> Thanks.
>
>
> - ScottHi Scott,
That really stinks that you were allowed to relapse for months. I'm sure its extremely frustrating. I'm glad for you though that you've been able to find Doc's that will even practice out-side the box. I know that doesn't help right now when you feel like hel*.
What I wanted to ask you, didn't you tell me once that, at least with Parnate, you had to wait 6 weeks from the point you reach a therapeutic dose? Meaning, is it possible, that you are having to wait the same time anyone one would from their therapeutic dose (for desipramine, whatever that is)? If thats true, maybe you will have to wait that period added to when you hit 300mg, not with in days of hitting it. Just a thought.
I seem to be feeling that I need to keep titrating to keep same effect, I felt fine last visit so stayed at 80mg Par and 60mg Rit. I can't imagine going much higher than that. He does use Desipramine, but I don't have the knowledge to question his decisions. Any idea what he might do next? So far its been steady increases of Parnate and Ritalin. He seemed surprized that I had responded so fast/well. That surprized me. Now I think it was a day or two after that when I felt it slipping a bit. (Not anything like before).
Just thought I'd take your mind back to Doc mode for a distraction. I'm thoughtful that way.
Please don't rethink your decision; use all those patience skills you've tought yourself and others.
I'm sure its just a matter of time :-)~Jade
Posted by Ron Hill on March 3, 2009, at 4:21:23
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
Garnet,
Thanks for posting the link.
In case anyone wants the full text of the study, here's the link:
http://archpsyc.ama-assn.org/cgi/content/full/63/8/856
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
300 mg/day Trileptal
200 mg/day Lamictal
250 mg/day Keppra
60 mg/day Nardil------------------------------
> I've never seen discussions here regarding this possibility:
> http://www.nih.gov/news/pr/aug2006/nimh-07b.htm
Posted by SLS on March 3, 2009, at 8:00:08
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 2, 2009, at 21:53:34
I am tempted to say, "Phew, that was a close one".
I am feeling somewhat better this morning.
I paid bills and did some other paperwork. I vacuumed my apartment for the first time in over a year. Thank God, I might be more functional in order to take care of my ailing grandmother. Her daughter (my mother) has all but abandoned her. I really need to make things happen.
I anticipate a very variable mood for the next week or so. Thereafter, I will probably experience periodic worsenings on the way towards remission. That's just the way it is. Even at full remission, there may be times when there is a mild medication breakthrough. I like to call these partial worsenings "recessions" rather than "depressions".
Oh yeah, I am beginning to experience insomnia. This has always been a good prognosis side effect for me. I am excited about this. I know this sounds weird, but I hope the insomnia continues. I'll deal with it using Ativan, if my doctor allows it.
- Scott
Posted by Phillipa on March 3, 2009, at 18:36:38
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 3, 2009, at 8:00:08
Scott yeah for you!!!!!! I was getting concerned about you. Hip Hip Horray!!!!! Want to vacuum here also. Need practice? Love Phillipa
Posted by SLS on March 11, 2009, at 6:57:51
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on March 3, 2009, at 18:36:38
Encouraged.
- Scott
Posted by Phillipa on March 11, 2009, at 23:01:05
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 11, 2009, at 6:57:51
Scott will you go please vacuum for me? Love Phillipa don't want to jinx you so will say nothing more.
Posted by SLS on March 16, 2009, at 6:23:25
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on March 11, 2009, at 23:01:05
I am not experiencing the improvement I expected. Depression is getting worse, not better. I have been on desipramine 300mg for only 12 days, so there is still something to hope for.
I might have to go back to nortriptyline.
- Scott
Posted by JadeKelly on March 16, 2009, at 18:50:32
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 16, 2009, at 6:23:25
> I am not experiencing the improvement I expected. Depression is getting worse, not better. I have been on desipramine 300mg for only 12 days, so there is still something to hope for.
>
> I might have to go back to nortriptyline.
>
>
> - ScottHey Scott,
What would the response time be for someone who has never taken Desipramine? Are you still having insomnia?
Remember, its not over yet. Its going to work and you're disappointed at how long its taking. I waited months, remember? ALL on faith. I still can't believe I made it. And you will too. Sorry but 12 days is a little early to start being negative. Hope it hits soon and complete. Ya just never know.
~Grasshopper
Posted by Phillipa on March 16, 2009, at 20:20:01
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 16, 2009, at 6:23:25
Scott I'm sorry. If that's what you need to do so be it. Had a feeling you were not feeling right. I know how you know your body. And remember stay positive in whatever route you chose. Did the pdoc have any comment? Love Phillipa
Posted by JadeKelly on March 16, 2009, at 20:34:58
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 16, 2009, at 6:23:25
Hey Scott,
A story for you...
A Husband takes his wife to play her first game of golf ..... Of course, the wife promptly whacked her first shot right through the window of the biggest house adjacent to the course.
The husband cringed, "I warned you to be careful! Now we'll have to go up there, find the owner, apologize and see how much your lousy drive is going to cost us."
So the couple walked up to the house and knocked on the door. A warm voice said, "Come on in."
When they opened the door they saw the damage that was done: glass was all over the place, and a broken antique bottle was lying on its side near the broken window.
A man reclining on the couch asked, "Are you the people that broke my window?"
"Uh...yeah, sir. We're sure sorry about that," the husband replied.
"Oh, no apology is necessary. Actually I want to thank you... You see, I'm a genie, and I've been trapped in that bottle for a thousand years. Now that you've released me, I'm allowed to grant three wishes. I'll give you each one wish, but if you don't mind, I'll keep the last one for myself."
"Wow, that's great!" the husband said. He pondered a moment and blurted out, "I'd like a million dollars a year for the rest of my life."
"No problem," said the genie. "You've got it, it's the least I can do. And I'll guarantee you a long, healthy life!" "And now you, young lady, what do you want?" the genie asked.
"I'd like to own a gorgeous home complete with servants in every country in the world," she said.
"Consider it done," the genie said. "And your homes will always be safe from fire, burglary and natural disasters!"
"And now," the couple asked in unison, what's your wish, genie?"
"Well, since I've been trapped in that bottle and haven't been with a woman in more than a thousand years, my wish is to have sex with your wife."
The husband looked at his wife and said, "Gee, honey, you know we both now have a fortune, and all those houses. What do you think?"
She mulled it over for a few moments and said, "You know, you're right. Considering our good fortune, I guess I wouldn't mind, but what about you, honey?"
"You know I love you sweetheart," said the husband. I'd do the same for you!"
So the genie and the woman went upstairs where they spent the rest of the afternoon enjoying each other in every way. After about three hours of non-stop sex, the genie rolled over and looked directly into her eyes and asked, How old are you and your husband?"
"Why, we're both 35," she responded breathlessly.
"NO SH!T," He said. "Thirty-five years old and both of you still believe in genies?"
Disclaimer: I make no apologies for this post, it has been proven that laughter is a form of medicine. He needs it. ~Jade
Posted by SLS on March 16, 2009, at 20:55:11
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 16, 2009, at 18:50:32
> > I am not experiencing the improvement I expected. Depression is getting worse, not better. I have been on desipramine 300mg for only 12 days, so there is still something to hope for.
> >
> > I might have to go back to nortriptyline.
> >
> >
> > - Scott
>
> Hey Scott,
>
> What would the response time be for someone who has never taken Desipramine? Are you still having insomnia?
>
> Remember, its not over yet. Its going to work and you're disappointed at how long its taking. I waited months, remember? ALL on faith. I still can't believe I made it. And you will too. Sorry but 12 days is a little early to start being negative. Hope it hits soon and complete. Ya just never know.
>
> ~Grasshopper
>
Hi Grasshopper :-)I misspoke. It has actually been 21 days that I am at the 300mg dosage. It is still too early to give up on it, though. However, I should see something more substantial soon if my drugs are optimized. I see my doctor tomorrow. I received the results from the blood test for 300mg. It came back at 191. The therapeutic range is between 100 - 300. I decided to take an extra 100mg of desipramine tonight to see if I were somehow just short of my therapeutic dosage. There is certainly enough room in blood levels to do this. I would feel noticeably better tomorrow if this were the case. If there is a night and day difference, I am going to have to explain my actions to my doctor. I'm just going to tell him that I couldn't wait anymore. 3 months of deterioration was enough.
So anyway...
I began to recover later in the day today. It is nothing great, but I feel better than I had been over the last few days.
I have to admit that the last few days have been an emotional roller-coaster ride for me. I had suicidal thoughts creep in when I felt that my drugs had stopped working. I was despondent on top of being depressed. Not a good combination.
Still moving forward...
- Scott
Posted by SLS on March 16, 2009, at 21:00:43
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on March 16, 2009, at 20:20:01
> Scott I'm sorry. If that's what you need to do so be it. Had a feeling you were not feeling right. I know how you know your body. And remember stay positive in whatever route you chose. Did the pdoc have any comment? Love Phillipa
We'll see what my doctor has to say tomorrow. One way or the other, I intend to investigate higher dosages of desipramine. Columbia had me up to 450mg in 1982 using blood levels as a guide, so my need for high dosages of desipramine is not without precedent.
- Scott
Posted by Phillipa on March 16, 2009, at 21:08:32
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on March 16, 2009, at 21:00:43
Scott the hill is high and long and I have no doubt in my mind that you will make it and life will be all you wish it to be and even better. Let me know how it goes okay? Please? Love Phillipa
Posted by JadeKelly on March 16, 2009, at 22:50:29
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 16, 2009, at 20:55:11
> > > I am not experiencing the improvement I expected. Depression is getting worse, not better. I have been on desipramine 300mg for only 12 days, so there is still something to hope for.
> > >
> > > I might have to go back to nortriptyline.
> > >
> > >
> > > - Scott
> >
> > Hey Scott,
> >
> > What would the response time be for someone who has never taken Desipramine? Are you still having insomnia?
> >
> > Remember, its not over yet. Its going to work and you're disappointed at how long its taking. I waited months, remember? ALL on faith. I still can't believe I made it. And you will too. Sorry but 12 days is a little early to start being negative. Hope it hits soon and complete. Ya just never know.
> >
> > ~Grasshopper
> >
>
>
> Hi Grasshopper :-)
>
> I misspoke. It has actually been 21 days that I am at the 300mg dosage. It is still too early to give up on it, though. However, I should see something more substantial soon if my drugs are optimized. I see my doctor tomorrow. I received the results from the blood test for 300mg. It came back at 191. The therapeutic range is between 100 - 300. I decided to take an extra 100mg of desipramine tonight to see if I were somehow just short of my therapeutic dosage. There is certainly enough room in blood levels to do this. I would feel noticeably better tomorrow if this were the case. If there is a night and day difference, I am going to have to explain my actions to my doctor. I'm just going to tell him that I couldn't wait anymore. 3 months of deterioration was enough.
>
>
>
> So anyway...
>
> I began to recover later in the day today. It is nothing great, but I feel better than I had been over the last few days.
>
> I have to admit that the last few days have been an emotional roller-coaster ride for me. I had suicidal thoughts creep in when I felt that my drugs had stopped working. I was despondent on top of being depressed. Not a good combination.
>
> Still moving forward...
>
>
> - Scott
>
>
Hi Scott,Glad your keeping in touch here. Its scary, to me anyway, when someone is very depressed and I can't reach them. Could you check in once a day here even just to say on a 1-10 (1 being suckiest) I'm a 3 or an 8. And add whatever else your up to sharing? Deal? Its selfish, I know...but what kind of mentor would you be if no-one knows you are okay? It is your calling.
So I'm a little confused. Is 100-300 Desipramine everyone's therapeutic range, or yours? If you don't respond to 191, but closer to 300, wouldn't it be a no-brainer as to why you are not responding? And why would you only give your therapeutic amount an overnight to work? You know better than I do. You need to think about other options as well. Thats what you told me, good to think ahead. Impress us. Everyone here loves you and even I do in that "your mean but your right" kinda way, haha. Hang in, okay? People care, you'll figure this out. Till tommorow then...let me know if you need more "stories".
~Grasshopper ;-)
Posted by Phillipa on March 17, 2009, at 0:43:21
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 16, 2009, at 22:50:29
Hate to try and answer for Scott but desipramine levels on their own there is a theraputic blood level but combining with parnate is not ideal. Phillipa
Posted by SLS on March 17, 2009, at 10:22:59
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 16, 2009, at 22:50:29
> So I'm a little confused. Is 100-300 Desipramine everyone's therapeutic range, or yours?
This is the range that is accepted to apply to everyone. Of course, there are always exceptions, and this test is to be used as a guide rather than an absolute.
> If you don't respond to 191, but closer to 300, wouldn't it be a no-brainer as to why you are not responding?
Yup. We'll see what my doctor has to say today. I am inclined to give 300mg some more time, though. I would have no problem going up to 350-400mg at some point. However, my previous experience with desipramine was such that going from 300mg to 350mg made no difference.
> And why would you only give your therapeutic amount an overnight to work?
If I were very slightly underdosed, I believe that I would experience a surge of improvement as soon as 24 hours after a loading dose.
> You know better than I do.
Not necessarily!
I think it is a lot easier to tell other people to be patient than it is to be patient for myself. I just hate underperforming in my school work. This is what is placing some urgency in my regaining functionality.
You are quite cool, by the way. Thanks for your encouragement.
- Scott
Posted by Vincent_QC on March 17, 2009, at 12:20:13
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 16, 2009, at 6:23:25
> I am not experiencing the improvement I expected. Depression is getting worse, not better. I have been on desipramine 300mg for only 12 days, so there is still something to hope for.
>
> I might have to go back to nortriptyline.
>
>
> - ScottI'm sorry to hear that Scott...don't be desesperate...it will work for sure... I can send to you the new pills of Nortriptyline I buy 2 weeks ago...lol I take only 6 pills of 10mg ...and it was enought for me...
For now, my PDoc put me off everything...except the Valium and a small dose of Topamax (25mg week 1, 50mg week 2, 75 week 3...)...and he want that I try the new Pristiq, it's avaible in the Canada since this month...my PDoc will recieve some samples boxs next week... For what I read, the Pristiq do very poor on studies...it's less effective than everything avaible on the market for now...with poor results, 20% less goog than the others avaibles AD's... and poor result compare with the regular Effexor-XR...that's strange no? Some inactives metabolites of the Effexor-XR, who was remove from the Effexor because they was aparrently innefective on the the brains seem to lack now in the new Pristiq (who don't have any metabolite inside...)
Strange... The Cymbalta did poor results on studies also...I never try it anyway...
The good news is that the Pristiq is a regular pill format...extended release but in a pill format, not a capsule with small rounds balls made with some plastic inside, so I will be able to crush the pill, so maybe it will work, the gastric by-pass made the other XR in capsule not working very well on me...so I hope it will be ok with that one...and the Marplan importation seem to be impossible to get in the Canada for now...no answer from health canada...nothing also get out of my EKG results...my heart seem ok...but I continue to have fast heart rate pulse and high pressure...even if I don't take anything that can affect my heart like this...The coffee never make my heart acting like this...so I don't see why some people point out that...even my PDoc...and the cigarettes smooking also never do anything on my heart pressure or pulse...Strange....
Anyway...I ask for a small dose of Topamax...it's not effective for social anxiety, but it's good to remove some pain...I always have pain from my gastric surgery...and it's good to loose some weight...the weight I gain on the Cipralex and on the Clomipramine tries also...since the Clomipramine, I never stop gainning weight...at least 5 pounds by week, without changing my food intake...so I hope the Topamax will take care of this issue!!!
I wish you good luck and keep the faith Scott!!!
Bye!
Vincent ;-)
Posted by SLS on March 17, 2009, at 12:31:57
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Vincent_QC on March 17, 2009, at 12:20:13
> I wish you good luck and keep the faith Scott!!!
I will!
Thanks, Vincent.
- Scott
Posted by SLS on March 17, 2009, at 13:06:19
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 17, 2009, at 10:22:59
Hi Jade.
> > And why would you only give your therapeutic amount an overnight to work?
> If I were very slightly underdosed, I believe that I would experience a surge of improvement as soon as 24 hours after a loading dose.
Yup. Feeling better already. What's more, my doctor raised the dosage from 300mg to 350mg without my asking him to do so. He didn't like the descriptions of what I experienced last week. Since there was enough room in the blood levels of desipramine as reported on the results of the blood test, he decided that I was indeed a rapid metabolizer, and had no problem with going up in dosage.
I sure was patient with this one. 12 weeks of being underdosed, and knowing it, was a frustrating experience and an exercise in patience and tolerance. With the exception of last night, I followed my doctor's orders to the letter.
Anyway, I am encouraged by what I am feeling.
- Scott
Posted by JadeKelly on March 17, 2009, at 18:48:41
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 17, 2009, at 13:06:19
> Hi Jade.
>
> > > And why would you only give your therapeutic amount an overnight to work?
>
> > If I were very slightly underdosed, I believe that I would experience a surge of improvement as soon as 24 hours after a loading dose.
>
> Yup. Feeling better already. What's more, my doctor raised the dosage from 300mg to 350mg without my asking him to do so. He didn't like the descriptions of what I experienced last week. Since there was enough room in the blood levels of desipramine as reported on the results of the blood test, he decided that I was indeed a rapid metabolizer, and had no problem with going up in dosage.
>
> I sure was patient with this one. 12 weeks of being underdosed, and knowing it, was a frustrating experience and an exercise in patience and tolerance. With the exception of last night, I followed my doctor's orders to the letter.
>
> Anyway, I am encouraged by what I am feeling.
>
>
> - ScottHey Scott!
> Anyway, I am encouraged by what I am feeling.
You know you can be really irritating sometimes! I'll never get used to it. I'll call it "Scott Speak"
Quite relieved you're better.
I know why you are careful with what you say. I get it. I didn't post on the board until my remission was fully in place for a month. It feels terrible to get all excited, and others, in case of a let down. But it seems you have a lot to be excited about, so I hope secretly your at home jumping up and down on your dirty carpet.
On the flip side, I'm assuming last week was pretty sh*tty, about as sh*tty as it gets maybe??
Don't forget our deal. You didn't reply to that, but I'm holding you to it anyway >:-(So, I do have a couple questions:
How long after he offered to raise to 350, did you counter with, how about 400? 1-2 secs max?Really, though, I'm confused about your dosing. You added 100 yesterday. You felt results today. I think you know where I'm headed. I geuss I'm asking, doesn't that mean you need 400, not 350?
Based on blood results that were taken prior to his increase, he wants you at 350. You just responded to 400. Okay, maybe I'll stop there before I hurt my self.Also by now you should at least be as good as earlier-one would think ;-) Let me know!
~Jade aka grasshopper aka patient patient~
Posted by Phillipa on March 17, 2009, at 20:22:04
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 17, 2009, at 13:06:19
Scott well that's a relief for you. Congrats. Love Phillipa
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