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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by ihatedrugs on June 17, 2013, at 23:23:06
What would you say are the best meds for low/mid grade chronic depression. I've had several major depressive episodes in my life but now it seems as if it's just a chronic lack of enjoyment and motivation. I'm taking Lex 20mg, Vyvanse 40mg and Xanax, Ambien. I was also taking Lamictal and Wellbutrin in addition to the above mentioned but discontinued them after a year as I really didn't feel any change. I used to get strong depressive episodes lasting for 1 to 6 months then lifting on their own and I would be perfectly fine. Now for the past 10 years and taking meds I haven't really felt quite right. My life is pretty good but can't seem to enjoy it. What could I try. I'm so tired.
Thanks
ihatedrugs
Posted by jono_in_adelaide on June 18, 2013, at 0:14:52
In reply to Best meds for dysthymia, posted by ihatedrugs on June 17, 2013, at 23:23:06
If Welbutrin didnt work, I'd try nortriptyline or desipramine
Posted by ihatedrugs on June 18, 2013, at 8:33:24
In reply to Re: Best meds for dysthymia, posted by jono_in_adelaide on June 18, 2013, at 0:14:52
> If Welbutrin didnt work, I'd try nortriptyline or desipramine
Wellbutrin didn't seem to give a robust effect. What do you think of Parnate. I've never tried it and heard it's pretty effective. Hope you are doing well.
Posted by sigismund on June 18, 2013, at 9:23:31
In reply to Best meds for dysthymia, posted by ihatedrugs on June 17, 2013, at 23:23:06
>What would you say are the best meds for low/mid grade chronic depression.
I never took the dose of Parnate high because my insomnia was aggravated. Other than that I had no problems with it. With me I just feel old and sick, I think it is, or maybe not. Tianeptine was not too bad (and not too good), but I don't think it would be as good as Vyvanse. I liked agomelatine at first but it made my sleep worse eventually. I have never taken an SSRI. What do you think the Lex is doing for you that is helpful?
Posted by sigismund on June 18, 2013, at 9:29:42
In reply to Re: Best meds for dysthymia, posted by ihatedrugs on June 18, 2013, at 8:33:24
Actually, I have considered taking low dose deprenyl and rhodiola with *sufficient* something (Ambien and trimipramine and something else) to allow me to sleep.
Years ago I was taking that and for several days I enjoyed everything, more or less, but my sleep was wrecked. I was not taking a heap either....1 or 2 mg deprenyl citrate and 1 or 2 at the most rhodiola caps both first thing.
I am uncertain how to approach this....whether to preserve sleep as the first priority, or whether to go for improving my day. For me, deprenyl and rhodiola was way nicer than Parnate, but who knows, it may not be the same now.
Posted by sigismund on June 18, 2013, at 9:35:12
In reply to Re: Best meds for dysthymia, posted by sigismund on June 18, 2013, at 9:29:42
I might even try going here. It would cost a lot. One of our politicians had very obvious good results with it.
Posted by sigismund on June 18, 2013, at 9:43:27
In reply to Re: Best meds for dysthymia, posted by sigismund on June 18, 2013, at 9:35:12
Sorry for the multiple posts but anyway.......
I could look at this from another angle. Get rid of the heavy metals (mercury, lead, thallium) somehow or other, probably the Cutler protocol. No idea how long it would take or if it is actually achievable. Then lower the benzo dose or (ideally but not very likely) eliminate it altogether. My dysphoria might be reduced.
Posted by Phillipa on June 18, 2013, at 9:45:10
In reply to Best meds for dysthymia, posted by ihatedrugs on June 17, 2013, at 23:23:06
I think when it reaches dysthymia and that is where I am. I just don't think meds help. What helps I'm clueless. I try and do things. But then after a while those things become boring? So I would love to know also. I'm stopping the Lexapro as found I sleep better without. Phillipa
Posted by SLS on June 18, 2013, at 10:39:49
In reply to Best meds for dysthymia, posted by ihatedrugs on June 17, 2013, at 23:23:06
> What would you say are the best meds for low/mid grade chronic depression. I've had several major depressive episodes in my life but now it seems as if it's just a chronic lack of enjoyment and motivation. I'm taking Lex 20mg, Vyvanse 40mg and Xanax, Ambien. I was also taking Lamictal and Wellbutrin in addition to the above mentioned but discontinued them after a year as I really didn't feel any change. I used to get strong depressive episodes lasting for 1 to 6 months then lifting on their own and I would be perfectly fine. Now for the past 10 years and taking meds I haven't really felt quite right. My life is pretty good but can't seem to enjoy it. What could I try. I'm so tired.
Regarding MAOIs, I found that Nardil was better for anhedonia than Parnate.
Low-dosage amisulpride has been used for treating dysthymia. Perhaps Abilify or Latuda would help. Also, take a look at acetyl-L-carnitine.
- Scott
Posted by Beckett on June 18, 2013, at 20:38:09
In reply to Re: Best meds for dysthymia » ihatedrugs, posted by SLS on June 18, 2013, at 10:39:49
Scott, how is Nardil for energy? I like that it helps anhedonia, but I have such chronic fatigue. I would not be able to take adderall with Nardil.
Posted by SLS on June 19, 2013, at 0:56:24
In reply to Re: Best meds for dysthymia » SLS, posted by Beckett on June 18, 2013, at 20:38:09
> Scott, how is Nardil for energy?
I found Nardil energizing - more so than Parnate. Anergia is a prominent feature of my depression. Nardil can sometimes produce sedation as a startup side effect. I found that this disappeared quickly.
> I would not be able to take adderall with Nardil.
You could if your doctor would let you.
I have tried combining Parnate with Focalin and Adderall, although not all together. I don't recall combining stimulants with Nardil, though. Some doctors prescribe stimulants to treat the hypotension and daytime sedation that can accompany treatment with MAOIs.
- Scott
Posted by sigismund on June 19, 2013, at 7:19:53
In reply to Re: Best meds for dysthymia » ihatedrugs, posted by SLS on June 18, 2013, at 10:39:49
Scott, which of Nardil's side effects bothered you the most?
I took a tablet of Nardil what seems like a hundred years ago and could have sworn I noticed it, and what's more liked it very much.
Posted by tecknohed on June 19, 2013, at 9:02:47
In reply to Best meds for dysthymia, posted by ihatedrugs on June 17, 2013, at 23:23:06
Easy - low doses of cannabis. And that is not meant as encouragement but its simply fact. I know some USA states now allow cannabis for health purposes, so I feel safe that I have enough backup to avoid any unnecessary arguments. Like I said, SMALL doses. If you feel 'stoned' you've taken too much and can lead to paranoia. I've had to recently give up cannabis due to memory problems, but I did actually use it upon waking & it would give me a great mood to start to day without compromising energy. Like I said, SMALL doses. Used as a medicine I see no problem, unlike people who just smoke it to get 'mashed'.
teck
Posted by SLS on June 19, 2013, at 10:01:09
In reply to Re: Best meds for dysthymia » SLS, posted by sigismund on June 19, 2013, at 7:19:53
> Scott, which of Nardil's side effects bothered you the most?
1. Dizziness (hypotension)
2. Urinary retention
3. Anorgasmia - resolved after a few months> I took a tablet of Nardil what seems like a hundred years ago and could have sworn I noticed it, and what's more liked it very much.
I can't prove it, but I think Nardil exerts acute effects that are in addition to its MAO inhibition. These would include an energizing effect and perhaps an anxiolytic effect. I doubt that these things are due to GABA transmaminase inhibition. I could be wrong about this, though. Unfortunately, there is no incentive to study Nardil anymore.
- Scott
Posted by Beckett on June 19, 2013, at 16:38:00
In reply to Re: Best meds for dysthymia » sigismund, posted by SLS on June 19, 2013, at 10:01:09
I thought all the maois broke down to or had some relation to amphetamine...?
Posted by tecknohed on June 19, 2013, at 17:15:59
In reply to Re: Best meds for dysthymia » SLS, posted by Beckett on June 19, 2013, at 16:38:00
I thought everyone knew that Nardil manipulated GABA in a positive way. When I was on Nardil & 1.5mg clonazepam, I decided to stop the benzo. And my pdoc reasured me that being on 90mg Nardil meant I could simply stop the clonazepam without tapering. He was right. From what I remember one of Nardil's metabolites is responsible for its pro-GABA effects.
I now take the MAOI Marplan (isocarboxazid), another hydrazine derivative but which has no such effect on GABA. Hence why I need 4mg clonazepam daily.
Posted by Phillipa on June 19, 2013, at 18:19:35
In reply to Re: Best meds for dysthymia, posted by tecknohed on June 19, 2013, at 17:15:59
I wonder what ever happened to Ace the Nardil Champ? Anyone know?
Posted by SLS on June 19, 2013, at 21:03:37
In reply to Re: Best meds for dysthymia » SLS, posted by Beckett on June 19, 2013, at 16:38:00
> I thought all the maois broke down to or had some relation to amphetamine...?
Not that I am aware of. There has always been some debate about Parnate being metabolized to amphetamine, but I am dubious that this is the case. Some small percentage of selegiline (Emsam) is metabolized into amphetamine and methamphetamine. I am not aware of Nardil and Marplan having this property.
- Scott
Posted by damnthislife on June 20, 2013, at 16:34:20
In reply to Re: Best meds for dysthymia » Beckett, posted by SLS on June 19, 2013, at 0:56:24
> > Scott, how is Nardil for energy?
>
> Anergia is a prominent feature of my depression.
> - ScottInteresting. You're one of the few that I have found that says low energy is a big problem with their depression. I take it you're atypical? Have you tried Emsam? I'm starting that in a few weeks. This will be my first MAOI. Nardil and Parnate next if this fails.
Posted by tecknohed on June 20, 2013, at 18:16:42
In reply to Re: Best meds for dysthymia, posted by damnthislife on June 20, 2013, at 16:34:20
> Interesting. You're one of the few that I have found that says low energy is a big problem with their depression.I'm sorry but are you kidding??? Everybody I know who suffers from depression also suffer from low energy/lethargy/somnolence/hypersomnia.
Perhaps I misunderstood you?
Posted by Phillipa on June 20, 2013, at 20:44:23
In reply to Re: Best meds for dysthymia, posted by damnthislife on June 20, 2013, at 16:34:20
So you are going on emsam? Congrats!!! Phillipa
Posted by damnthislife on June 21, 2013, at 8:02:40
In reply to Re: Best meds for dysthymia » damnthislife, posted by tecknohed on June 20, 2013, at 18:16:42
Technohed,
Sorry, I should have worded that better. Usually when I see those complain about depression, I usually don't see most complain about lack of energy and general tiredness.
Posted by damnthislife on June 21, 2013, at 8:05:59
In reply to Re: Best meds for dysthymia » damnthislife, posted by Phillipa on June 20, 2013, at 20:44:23
Hey Phillipa!
Yes sir! Picked up my script two days ago. Cannot start it until a week after July. Coming off Prozac and Bupropion.
BTW... sorry I haven't gotten back to you, yet. Things have been crazy at home as we're currently looking for a new home.
Posted by Phillipa on June 21, 2013, at 9:35:55
In reply to Re: Best meds for dysthymia, posted by damnthislife on June 21, 2013, at 8:05:59
Please do and that is fabulous that you have your emsam!!! Phillipa
Posted by tecknohed on June 21, 2013, at 9:59:48
In reply to Re: Best meds for dysthymia, posted by damnthislife on June 21, 2013, at 8:02:40
> Technohed,
>
> Sorry, I should have worded that better. Usually when I see those complain about depression, I usually don't see most complain about lack of energy and general tiredness.No problem. I could have been more tactful myself.
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