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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 59. Go back in thread:
Posted by SLS on November 16, 2009, at 7:36:19
In reply to Re: Dangerously close to the end of the road. Help » SLS, posted by delna on November 15, 2009, at 16:40:41
> > Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?
> I was planning on adding that to the Effexor instead of the wellbutrin. I need the serotonin element for the OCD but of course I can get that from any SSRI like lexapro which is totally non-sedating (but does not impact my depression at all).Clomipramine (Anafranil) might be helpful if it doesn't sedate you. It is good for both depression and OCD. I didn't find it at all sedating. I have seen it recommended to combine clomipramine with an SSRI for treatment resistant OCD. If OCD remains a problem, you can try adding Namenda (memantine). I can't speak from personal experience, but I have read good things about it. I did try Namenda as an augmenter for depression. I did feel a little better in the first week of treatment. Thereafter, it was not helpful to me.
> Do you feel Edronax is a good AD on it's own
No. I think it is a piece of crap.
However, some people do respond well to it. I would rather include things as possibilities than overlook potential treatment success by being too exclusive. I thought that Edronax might offer you NE reuptake inhibition without sedation. I reacted very badly to Edronax. It pushed me into an anxious suicidal state within days of starting it. Yet, desipramine, another selective NE reuptake inhibitor, has treated me well in the past. I guess selective is a relative term. We really don't understand all of the effects of the different antidepressants. In addition, the location of effect is just as important as the effect itself. It is possible that Edronax and desipramine accumulate in different areas of the brain, despite having the same effect on NE reuptake.
> Sorry to be such a bother.
Yes, I lost sleep last night agonizing over how much of a bother you are.
:-) <smile>
Silly.
- Scott
Posted by floatingbridge on November 16, 2009, at 21:02:10
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
Delna,
I've been following your thread. I can only add that Stanford is doing 'new' work in tms, which is supposed to be much less invasive that ect. They are also working on (as probably other institutions) on reducing memory loss that often accompanies ect.
I understand you have had a battery of test to rule out infections, etc. Have you had any sleep studies done?
I wish I had more to offer--my best thoughts to you, Delna,
fb
Posted by delna on November 17, 2009, at 8:39:25
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 16, 2009, at 7:36:19
Posted by delna on November 17, 2009, at 9:00:17
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by floatingbridge on November 16, 2009, at 21:02:10
> Delna,
>
> I've been following your thread. I can only add that Stanford is doing 'new' work in tms, which is supposed to be much less invasive that ect. They are also working on (as probably other institutions) on reducing memory loss that often accompanies ect.I'm really interested in TMS but right now the figures that are being quoted for US hospitals are really high. Not sure I can afford it.
I am considering London (where I am from and am fully insured) but I don't know if they even use TMS there. Waiting to find out....
> I understand you have had a battery of test to rule out infections, etc.Today I sat and carefully examined at my past blood reports and have found that all my tests (over the years) have a raised WBC count. Just slightly raised but still- always raised. Whenever I have had an ESR done it has always been very high which indicates infection. I can't believe that this has been missed or else explained away as 'nothing' Anyway, I am having a blood test tomorrow and then seeing a new physician.
>Have you had any sleep studies done?
I was sent for sleep tests ages ago in London but I didn't fit any of the criteria for a sleep disorder so they never actually conducted the tests. I was thought to have idiopathic hypersomnia. I was on Paxil at the time. When I came off it my sleepiness improved manifold....so finally my pdoc realized that I was super-sensative to sedation.
Having said that, I am currently on no medication apart from lamictal and provigil and am *so* tired I am finding it hard to sit up. I had to sms my mother to come help me get my computer from the floor.
Maybe I need to revisit the sleep avenue too. But for this I will wait till I am back in London.Also I think my depression is getting worse by the second and that is why I am so tired. My pdoc has asked me to choose an AD myself. I cannot continue like this- its crazy.
>
> I wish I had more to offer--my best thoughts to you, Delna,
>
No, you helped alot and thank you for your good wishes.
Love
D
Posted by Katgirl on November 17, 2009, at 11:17:24
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
(I will preface this post by saying that I haven't read the entire thread because my concentration is just not that good today! So my apologies if I repeat something that has already been stated.)
I'm so sorry you aren't doing well Delna. I have been there and I really feel for you. The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
Posted by delna on November 17, 2009, at 11:29:54
In reply to Re: Dangerously close to the end of the road. Help, posted by Katgirl on November 17, 2009, at 11:17:24
> (I will preface this post by saying that I haven't read the entire thread because my concentration is just not that good today! So my apologies if I repeat something that has already been stated.)
> I'm so sorry you aren't doing well Delna. I have been there and I really feel for you. The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!Thank you for your reply and good wishes.
Did you try ECT first or straight to rTMS?
TC
D
Posted by maxime on November 17, 2009, at 12:03:38
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 9:00:17
It is so sad how much you are suffering. I thought that were going to try an SNRI like Effexor or Cymbalta. Did you change your mind?
You are in my prayers.
Posted by floatingbridge on November 17, 2009, at 18:15:56
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 9:00:17
>
> Today I sat and carefully examined at my past blood reports and have found that all my tests (over the years) have a raised WBC count. Just slightly raised but still- always raised. Whenever I have had an ESR done it has always been very high which indicates infection. I can't believe that this has been missed or else explained away as 'nothing' Anyway, I am having a blood test tomorrow and then seeing a new physician.I, too have an elevated WBC that has always been explained away. I'm not sure what an ESR is, but can google that. My shrink wants to send me to an infectious disease specialist--I ma recording temps daily of 99.4-99.8, and on an odd day, up to 100. Most doctors dismiss this. I hope your visit goes well tomorrow, and you find a physician w/ knowledge plus curiosity.
>> Maybe I need to revisit the sleep avenue too. But for this I will wait till I am back in London.
I think this might be good to revisit.
>
> Also I think my depression is getting worse by the second and that is why I am so tired. My pdoc has asked me to choose an AD myself. I cannot continue like this- its crazy.Delna, I am sorry to hear that your are suffering like this AND have so much to deal with--different doctors, 'mysterious' symptoms. O.K. another question. Have you ever tried a plain stimulant--or does your Dx preclude this?
best wishes and thoughts,
hugs,
fb
Posted by delna on November 17, 2009, at 18:26:22
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by floatingbridge on November 17, 2009, at 18:15:56
>
> Delna, I am sorry to hear that your are suffering like this AND have so much to deal with--different doctors, 'mysterious' symptoms.Thank you for your concern
>O.K. another question. Have you ever tried a plain stimulant--or does your Dx preclude this?
I have tried ritalin and it destabilizes me (even at tiny doses) and makes me angry and verbally aggressive. My US pdoc wanted to try me on dexedrine or adderall. (He felt that they may suit me better than ritalin.) But both are illegal in India so it made no sense starting either. :(
> best wishes and thoughts,
>
> hugs,
>
> fbThanks again for your support
Love
D
Posted by Phillipa on November 17, 2009, at 19:14:20
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 18:26:22
A sedimentation rate can be an indication of inflammation or infection. High WBC same. There are various kinds of WBC's some indicate allergies, some infections, some viruses. Love Phillipa
Posted by kirbyw on November 18, 2009, at 1:26:31
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
Delna
If you go to New York I strongly recommend that you see Dr. Ivan Goldberg. It was you who actually "recommended" him to me, as you copied some correspondence with him on a posting. Then I happened to be in New York for 3 days, (just last week) and was able to get in to see him.
He is over 70. We shouldn't let age fool any of us. He knew more about Parnate, which I take, than the whole generation of fast talking Psychiatrists under 50 that are practicing now. He was extremely thorough and extremely wise. He states on his website that his speciality is treatment resistent depression, and clearly he knows what he is doing. If I lived in New York, he would be my Psychiatrist, and perhaps even my therapist. A two hour consultation was $650. This was expensive for me but it was worth it, and I am now going to be following his recommendations.
He is located near 88th and 3rd avenue. Very humble, somewhat cluttered office, and books and papers all around. Looks the office of the typical absent minded professor!
Prior to the appointment, his secretary mails you a very large number of test to fill out and bring with you. 90% are scales to measure how you feel so you can do them very quickly.
For example, questions such as
I am more depressed
a) in the morning
b) at night
c) after eating
d) in social situationsetc. etc.
There are about 70 pages of these questions. Some are as above and some are true false. I was very impressed with how he used these questionaires during the interview to kind of fine tune his analysis of my condition/diagnosis
.
Anyway, if you get to New York, I would strongly suggest that you go see him, maybe see him regularly for a month or so, and see how you do.
Rick
PS Anyone interested can find his website and contact info just by googling "Ivan Goldberg" or Ivan Goldberg Depression, etc.
Posted by Katgirl on November 18, 2009, at 9:15:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Phillipa on November 17, 2009, at 19:14:20
I did not do ECT. I don't think it would have been offered to me and I would have been much to scared to try it. (Although, if rTMS had failed I would have tried) I basically "sent" myself to Canada for rTMS because either none of the medications worked or they made me worse. At that point I had been abjectly suicidal for almost two years and knew that I couldn't hang on any longer. It was my last hope.
Posted by floatingbridge on November 18, 2009, at 15:43:54
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
Kirbyw,
What a great recommendation--! My pdoc is over 70, too. A great age, I think.Delna, how did it go with your new doctor today?
fb
Posted by floatingbridge on November 18, 2009, at 15:47:36
In reply to Re: Dangerously close to the end of the road. Help, posted by Katgirl on November 17, 2009, at 11:17:24
> The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
Katgirl, I'm curious about the idea that the rTMS gave you biochemical stability. If you ever care to expand on that, I'd be interested in hearing what you have to say. You can babble me, because I think it's a bit off thread topic.
best,
fb
Posted by delna on November 18, 2009, at 16:17:50
In reply to Re: Dangerously close to the end of the road. Help » Katgirl, posted by floatingbridge on November 18, 2009, at 15:47:36
> > The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
>
> Katgirl, I'm curious about the idea that the rTMS gave you biochemical stability. If you ever care to expand on that, I'd be interested in hearing what you have to say. You can babble me, because I think it's a bit off thread topic.
>
> best,
>
> fb
>
>hi
just got up for a drink- saw this post
please discuss it here , if its okay by you guys It doesn't matter if its off topic or anything like that, (does it? not sure of the rules). because i too would love to know all abt it and maybe others might too. Change the thread topic if you want to..
But only if you guys are happy to talk about it here and not only on babble mail. whatever suits you guys.
TC
Gnite
Love D
Posted by floatingbridge on November 18, 2009, at 16:20:04
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 18, 2009, at 16:17:50
Delna, that's fine with me, if it's alright with you. I didn't want to be rude.
How have you been today?
fb
Posted by delna on November 18, 2009, at 16:26:20
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by floatingbridge on November 18, 2009, at 16:20:04
> Delna, that's fine with me, if it's alright with you. I didn't want to be rude.
>
> How have you been today?
>
> fbThanks for asking
Am not good- physically. I have fever, threw up and have a headache that wont go away. And am really tired. Going back to sleep.
its totally cool by me. thanks for being so considerate, though!
Gnite
Love D
Posted by delna on November 19, 2009, at 13:27:45
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by maxime on November 17, 2009, at 12:03:38
Posted by delna on November 19, 2009, at 13:44:43
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
> Delna
>
> If you go to New York I strongly recommend that you see Dr. Ivan Goldberg. It was you who actually "recommended" him to me, as you copied some correspondence with him on a posting. Then I happened to be in New York for 3 days, (just last week) and was able to get in to see him.
>
> He is over 70. We shouldn't let age fool any of us. He knew more about Parnate, which I take, than the whole generation of fast talking Psychiatrists under 50 that are practicing now. He was extremely thorough and extremely wise. He states on his website that his speciality is treatment resistent depression, and clearly he knows what he is doing. If I lived in New York, he would be my Psychiatrist, and perhaps even my therapist. A two hour consultation was $650. This was expensive for me but it was worth it, and I am now going to be following his recommendations.
>
> He is located near 88th and 3rd avenue. Very humble, somewhat cluttered office, and books and papers all around. Looks the office of the typical absent minded professor!
>
> Prior to the appointment, his secretary mails you a very large number of test to fill out and bring with you. 90% are scales to measure how you feel so you can do them very quickly.
>
> For example, questions such as
>
> I am more depressed
> a) in the morning
> b) at night
> c) after eating
> d) in social situations
>
> etc. etc.
> There are about 70 pages of these questions. Some are as above and some are true false. I was very impressed with how he used these questionaires during the interview to kind of fine tune his analysis of my condition/diagnosis
> .
> Anyway, if you get to New York, I would strongly suggest that you go see him, maybe see him regularly for a month or so, and see how you do.
> Rick
> PS Anyone interested can find his website and contact info just by googling "Ivan Goldberg" or Ivan Goldberg Depression, etc.Thanks for that info Rick. Glad you found some good help. Will your current pdoc take into account his recommendations?
Actually, I do believe age and experience are a good thing. I have seen pics of him in his office so I know what you mean about the mad professor thing.
I just wrote to him again regarding my bizarre TD symptoms on Geodon and he told me pretty flat out that I should not touch any other AP, except clozapine. And that too only if I have psychosis.What worries me about seeing him is that he seems to treat depressed bipolars with Lamictal and I just don't find that helpful at all (for depression). Plus he doesn't seem keen on treating bipolars with ADs- more with mood stabilizers which have never helped me with the depression. Still I think he is really into treating patient fully and thoroughly as he answers questions just to be helpful and that is so rare. If I am in NYC, I will surely see him. I had wanted to once 4-5 years ago but I thought his fees were really high. But now I think my sister will sponsor me.
I somehow feel he will change my dx (which is a good thing) because although my last two diagnoses (by pretty senior pdocs in the US) have been BP I, I don't think I have that.But I think I fall somewhere on the BP spectrum.... so maybe he will treat me with ADs afterall.
Thanks again
Take care
Love
D
Posted by Katgirl on November 20, 2009, at 8:19:38
In reply to Re: Dangerously close to the end of the road. Help » kirbyw, posted by delna on November 19, 2009, at 13:44:43
Hi, I will post my response here because I have no idea how to do babble mail! Unfortunately, I had a no sleep night last night, so you may not get a response until tomorrow when I'm more coherent, but I just wanted to let you know that I had seen your response and I will be posting about rTMS!! Take care, K
Posted by delna on November 21, 2009, at 0:25:13
In reply to Re: Dangerously close to the end of the road. Help, posted by kirbyw on November 18, 2009, at 1:26:31
Hi Rick,
How difficult is it to get an appointment. Do you have his email- its the weekend so I can't get in touch with his secretary. I want to email him urgently. I need to go to NYC because of a crisis situation there, anyway.
Thanks alot
D
Posted by Katgirl on November 21, 2009, at 10:30:34
In reply to Re: Dangerously close to the end of the road. Help » Katgirl, posted by floatingbridge on November 18, 2009, at 15:47:36
OK, here is my experience with rTMS:
After severe and protracted withdrawal to paxil (lesson here: if you are on a drug that works, don't go off of it!!) I ended up with treatment resistant, suicidal depression that swung between severe agitation/anxiety or all the way to the other end of the spectrum with psychomotor retardation. (The wide spectrum of symptoms may have been due to the all the failed drug trials and subseqeunt withdrawals I went through because of the failed drug trials).
As I've stated previously the rTMS, after a few days left me very overstimulated, but they said this was the "Prozac" effect and that I would probably be a responder after I returned home. They also indicated that the two weeks directly after treatment I would feel worse. Boy, were they right. I cried for two weeks. BUT after those two weeks ALL of my suicidal thoughts were GONE. I can't tell you how huge that was. Killing myself had been in my thoughts literally every second of everyday for two years. It was horrific.
And after that I slowly started to get better. At the time, I think it was hard to gauge just how much it had helped for several reasons: 1)I had expeced rTMS to be like a medication, I was either going to be "all better" (like when I first took paxil) or it was going to fail. I didn't know you could land somewhere in the middle. And so my dissappointment at not being "all better" for awhile made me not fully appreciate some of the benefits I had received. 2) when the trial didn't make me immediately "all better" my now ex-husband left me (he is the one that pressured me relentlessly to go off the paxil. Nice, huh?) So then I was dealing with the stress of a divorce, which doesn't do the most for mental stability.
Upon reflection, I can say that rTMS was the only thing that helped me. It removed the suicidal thoughts and while I wasn't "all better" I at least had enough biochemical stability so that other long terms fixes like therapy, exercise, meditation could actually be helpful. When I was so biochemically messed up therapy etc didn't do ANYTHING for me. I guess you are really bad off when you are too biochemically messed up to be helped by therapy!!
Am I all better today? Not by a long shot. Am I so much better than I was a few years ago. YES YES YES. Is it constant work to get better. YES YES YES. (BUT as I stated previously, WITHOUT the biochemical stability that rTMS gave me, all the "practices" I do now would not work.
So, rTMS helped my depression enough that other things could then be helpful for me. Unfortunately, rTMS did nothing for my anxiety, which continues to plague me horribly. My concentration is also still very poor and I still have mild depression.
Like I stated before, I don't have the life I want, but I DO have a life, which I didn't have at all for five years. I hope that I continue to slowly get better (If I could just get some help with sleep and anxiety, I know it would make a huge difference in my quality of life!) and that maybe in my lifetime some new medications will come out that I can take.
Hope this was helpful! K
Posted by delna on November 21, 2009, at 11:43:27
In reply to Re: rTMs info, posted by Katgirl on November 21, 2009, at 10:30:34
> OK, here is my experience with rTMS:
>
> After severe and protracted withdrawal to paxil (lesson here: if you are on a drug that works, don't go off of it!!) I ended up with treatment resistant, suicidal depression that swung between severe agitation/anxiety or all the way to the other end of the spectrum with psychomotor retardation. (The wide spectrum of symptoms may have been due to the all the failed drug trials and subseqeunt withdrawals I went through because of the failed drug trials).
>
> As I've stated previously the rTMS, after a few days left me very overstimulated, but they said this was the "Prozac" effect and that I would probably be a responder after I returned home. They also indicated that the two weeks directly after treatment I would feel worse. Boy, were they right. I cried for two weeks. BUT after those two weeks ALL of my suicidal thoughts were GONE. I can't tell you how huge that was. Killing myself had been in my thoughts literally every second of everyday for two years. It was horrific.
>
> And after that I slowly started to get better. At the time, I think it was hard to gauge just how much it had helped for several reasons: 1)I had expeced rTMS to be like a medication, I was either going to be "all better" (like when I first took paxil) or it was going to fail. I didn't know you could land somewhere in the middle. And so my dissappointment at not being "all better" for awhile made me not fully appreciate some of the benefits I had received. 2) when the trial didn't make me immediately "all better" my now ex-husband left me (he is the one that pressured me relentlessly to go off the paxil. Nice, huh?) So then I was dealing with the stress of a divorce, which doesn't do the most for mental stability.
>
> Upon reflection, I can say that rTMS was the only thing that helped me. It removed the suicidal thoughts and while I wasn't "all better" I at least had enough biochemical stability so that other long terms fixes like therapy, exercise, meditation could actually be helpful. When I was so biochemically messed up therapy etc didn't do ANYTHING for me. I guess you are really bad off when you are too biochemically messed up to be helped by therapy!!
>
> Am I all better today? Not by a long shot. Am I so much better than I was a few years ago. YES YES YES. Is it constant work to get better. YES YES YES. (BUT as I stated previously, WITHOUT the biochemical stability that rTMS gave me, all the "practices" I do now would not work.
>
> So, rTMS helped my depression enough that other things could then be helpful for me. Unfortunately, rTMS did nothing for my anxiety, which continues to plague me horribly. My concentration is also still very poor and I still have mild depression.
>
> Like I stated before, I don't have the life I want, but I DO have a life, which I didn't have at all for five years. I hope that I continue to slowly get better (If I could just get some help with sleep and anxiety, I know it would make a huge difference in my quality of life!) and that maybe in my lifetime some new medications will come out that I can take.
>
> Hope this was helpful! K
>
>It was very helpful.
Does that mean you are on no meds at all right now?
Posted by Katgirl on November 21, 2009, at 12:26:50
In reply to Re: rTMs info » Katgirl, posted by delna on November 21, 2009, at 11:43:27
I am on no meds, but not by choice! If I could take a medication that would help, I would be on one and have my life back!
Posted by Katgirl on November 21, 2009, at 13:54:38
In reply to Re: rTMs info » Katgirl, posted by delna on November 21, 2009, at 11:43:27
Oh, and I was probably a bit optimistic in saying mild depression. probably closer to moderate most days. Feels mild in comparisson to the "should be in the psych ward, can't walk can't function type of depression I was suffering previously.
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