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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 239 to 263 of 317. Go back in thread:
Posted by europerep on March 13, 2012, at 8:30:48
In reply to europerep, posted by JohnLA on March 12, 2012, at 23:20:38
> silly discussion really. depression is so unique to each of us that to make blanket statements about what one can and cannot do while depressed makes absolute no sense.
True, that would make no sense, but I haven't done that.
And there is nothing lost in translation here, at least as far as I can see. My thoughts on this subject are actually fairly simple.
Posted by ed_uk2010 on March 13, 2012, at 15:42:44
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on March 13, 2012, at 7:03:28
One thing I'm unsure about is how your prazosin dose was determined. Is 6mg the most you can tolerate without excessive hypotension? .....although I have no idea whether >6mg would be any more effective.
FWIW, I don't think anyone is trying to upset you on this thread, I think they are simply commenting on the eloquence of your posts, which is much greater than most people who have read many books!
Posted by SLS on March 13, 2012, at 17:07:52
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 13, 2012, at 15:42:44
> One thing I'm unsure about is how your prazosin dose was determined.
Clinical titration. My starting dose was 3 mg. I actually felt better at this dosage, but I would lose the benefit towards the end of a dosing period. I take prazosin t.i.d. At 6 mg, things evened out. Who knows, I might have responded just as well to 4 or 5 mg. Since the prazosin was so tolerable, I felt that there was no harm in giving myself some headroom with the 6 mg dosage.
> Is 6mg the most you can tolerate without excessive hypotension?
No. I was able to tolerate more, but there was no additional benefit from going higher. I went to 9 mg.
Man, it feels good to feel good. Things are so much brighter and clearer.
- Scott
Posted by ed_uk2010 on March 15, 2012, at 18:13:13
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 13, 2012, at 17:07:52
Given prazosin's very short half-life, how do think you would fare on 1mg to 1.5mg four times a day?
Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular. Doxazosin is much more widely used than prazosin as an antihypertensive due to its long duration of action and less precipitous initial fall in BP.
I am delighted at your recent progress, by the way :)
Posted by SLS on March 15, 2012, at 18:34:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 15, 2012, at 18:13:13
> Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular.
Does doxazosin cross the BBB as readily as prazosin?
> I am delighted at your recent progress, by the way :)
Thanks, Ed. I appreciate it.
- Scott
Posted by SLS on March 16, 2012, at 13:19:26
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 15, 2012, at 18:13:13
> > Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular.
> Does doxazosin cross the BBB as readily as prazosin?
I couldn't find an answer to this question. Maybe you will have better luck.
I found a few studies that reported doxazosin as being effective in treating PTSD. It would certainly be an attractive alternative to prazosin if this were true.
- Scott
Posted by ed_uk2010 on March 17, 2012, at 13:59:08
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 16, 2012, at 13:19:26
>Does doxazosin cross the BBB as readily as prazosin?
I did find a bit of information. It said that doxazosin is less lipid-soluble than prazosin and may not cross the BBB very well. So, I guess doxazosin might not be as effective.
One thing about prazosin is the short half-life, apparently only 2-3 hours. What do you think of the idea of taking smaller doses more frequently?
>
> I couldn't find an answer to this question. Maybe you will have better luck.
>
> I found a few studies that reported doxazosin as being effective in treating PTSD. It would certainly be an attractive alternative to prazosin if this were true.
>
>
> - Scott
Posted by SLS on March 22, 2012, at 7:49:16
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 17, 2012, at 13:59:08
Hi Ed.
I apologize for waiting so long to respond to your insightful post.> One thing about prazosin is the short half-life, apparently only 2-3 hours. What do you think of the idea of taking smaller doses more frequently?
It actually took about 36 hours for me to relapse when I discontinued prazosin abruptly. I wanted to be sure that it was contributing to my improvement since I added Parnate and prazosin at the same time. Upon rechallenge with prazosin, I was able to recover the therapeutic response rather quickly. It seems that t.i.d. dosing is sufficient.
As usual, thanks for your concern and valuable feedback and advice.
- Scott
Posted by SLS on March 22, 2012, at 7:58:06
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 22, 2012, at 7:49:16
Still responding...
Things are not happening fast enough for me, though. However, it appears that I am still progressing towards remission, albeit gradually. I still experience brief periods of feeling worse. However, each peak is higher than the one before, and each valley less deep. Robert Post would explain to his chronic TRD patients to expect this sort of thing, even when the ideal treatment for an individual is found.
At this rate of improvement, I am hoping to return to work within a year. I am already getting out to socialize more. Socializing in large gatherings is still uncomfortable, especially because I have nothing to say so as to engage in "chit-chat".
- Scott
Posted by Beckett on March 22, 2012, at 8:12:53
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 22, 2012, at 7:58:06
Chit-chat may be a pleasant skill, but it is overrated,
Just saying. Even the well among us will often avoid chit-chat.
Anyway you go, you Go Scott:) !
Posted by Phillipa on March 22, 2012, at 20:55:17
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 22, 2012, at 7:58:06
This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Posted by SLS on March 23, 2012, at 0:33:09
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on March 22, 2012, at 20:55:17
> This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Yup. Thanks.
:-)
- Scott
Posted by SLS on March 24, 2012, at 9:58:08
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on March 23, 2012, at 0:33:09
Yesterday was the best day yet - maybe 35% improved.
The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
- Scott
Posted by Bob on March 24, 2012, at 15:50:40
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
> Yesterday was the best day yet - maybe 35% improved.
>
> The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
>
>
> - Scott
>Indeed. Unfortunately I have found that sexual dysfunction really wears you down over time. That's me though.
Posted by sigismund on March 24, 2012, at 18:13:16
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So you are on 6mg/d, Scott?
Posted by Phillipa on March 24, 2012, at 20:18:04
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So what if you now have or are getting a life there are lots of other things. What if you had a serious medical condition that rendered you this way like prostrate cancer? Phillipa
Posted by SLS on March 25, 2012, at 5:27:35
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 24, 2012, at 18:13:16
> So you are on 6mg/d, Scott?
Yes. I take 2 mg three times a day. In the grand scheme of things, this is a fairly low dose. I experienced an improvement in depression at 3 mg/day, but my "mood" was too variable during the day, and it was obviously at its worst at the end of a dosing period. I don't doubt that 3 mg/day will be sufficient for some people, though.
I'm sure you saw that the dosage range of prazosin for treating hypertension is 6 - 20 mg/day; with some people going as high as 40 mg/day.
When I first started 6 mg/day, I experienced fatigue and sleepiness. However, those things disappeared within a week.
Prazosin caused a diminution of my sex-drive almost immediately. I imagine that some libido will emerge as my depression remits. Prazosin has NOT produced erectile dysfunction nor anorgasmia. I can still enjoy sex once I get started.
- Scott
Posted by phidippus on April 3, 2012, at 18:44:29
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
Its upregulating dopamine! How is it killing your sex drive???
Eric
Posted by SLS on April 3, 2012, at 20:40:58
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 3, 2012, at 18:44:29
> Its upregulating dopamine! How is it killing your sex drive???
I really don't know, but I'm not particularly happy about it.
Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though. I began looking into this only after I recognized a major reduction in sexual appetite. If this is as bad as side effects get for me, it is worth the trade-off. I am hoping that I will recoup some libido as the depression evaporates.
In certain areas of the brain, NE alpha-1b receptors act as a gate to allow throughput for dopamine circuits afferent to the limbic system. Closing the gate by blocking these receptors serves to attenuate the increased locomotor activity produced by psychostimulants like cocaine. I don't know if this is also true of appetitive drives and cravings.
- Scott
Posted by phidippus on April 5, 2012, at 16:11:25
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
Are you planning on taking up cocaine?
Eric
Posted by sigismund on April 5, 2012, at 16:38:14
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
>Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though.
Some people said that on askapatient.
Posted by SLS on April 5, 2012, at 18:26:15
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 5, 2012, at 16:11:25
> Are you planning on taking up cocaine?
>
> Eric
No.Why do you ask?
- Scott
Posted by SLS on April 5, 2012, at 18:30:32
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 5, 2012, at 16:11:25
> > Are you planning on taking up cocaine?
> >
> > Eric
> No.
>
> Why do you ask?
Actually, prazosin can reduce cravings for cocaine.
- Scott
Posted by uncouth on April 5, 2012, at 22:28:21
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 5, 2012, at 18:30:32
hey scott, what is your dosing schedule for prazosin? my pdoc just prescribed it for me for refractory insomnia...both falling asleep and staying asleep...incicentally i also have high blood pressure. nothing else for sleep has worked...only thing that kinda works was saphris and i had to take it multiple times per night. hoping prazosin can help turn off my brain so i can fall and stay asleep.
i started on 2mg at night last night, and couldn't sleep still, so tonight upped it to 6mg. what do you take? can you describe it's effects on your sleep latency and quality?
incidentally, i noticed today that my mood was very stable despite the extreme sleepiness. although it could have been from the zyprexa i popped last night to finally help me fall asleep.
is anyone else using prazosin for...anything? besides scott?
Posted by SLS on April 6, 2012, at 1:32:33
In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 5, 2012, at 22:28:21
> hey scott, what is your dosing schedule for prazosin? my pdoc just prescribed it for me for refractory insomnia...both falling asleep and staying asleep...incicentally i also have high blood pressure. nothing else for sleep has worked...only thing that kinda works was saphris and i had to take it multiple times per night. hoping prazosin can help turn off my brain so i can fall and stay asleep.
What psychiatic conditions do you suffer from?
I hope the prazosin works to help you sleep. I take 6 mg/day in three divided doses of 2 mg. One can take 20 mg/day or more safely with this drug. Your doctor chose a good dosage for you to enhance sleep. Some people with PTSD go up to 12 mg or higher
I can't say that prazosin helps keep me asleep. Perhaps I am not taking enough at night to see a difference. My sleep is choppy, and I wake up a several times during the night. This disturbed sleep is the result of both adding Parnate and poor sleep hygiene. I allow myself to sleep too much during the day. I often fall asleep somewhere between 7:30 PM to 9:00 PM and wake at midnight. I have trouble going back to sleep after that. I just took some Ativan so that I can get through the rest of the night. I will use a sleep aid only occasionally.
What drugs have you already tried to treat insomnia? What were the dosages and outcomes? Do you have any trouble falling asleep initially? I once had complete insomnia when I first combined Parnate and desipramine. Combining two BZDs helped: triazolam (Halcion) to initiating sleep and lorazepam (Ativan) to maintain sleep. It worked like a charm, and I had very little hangover the next morning. A more modern combination might use zaleplon in place of the triazolam.
Would your doctor be willing to try GHB (Xyrem)?
Linkadge or Phiddipus might be of help to you. I have a list of treatments in mind, but I would rather know what you have tried first before describing alternatives. I believe Sigismund has already tried prazosin for sleep. Perhaps he will comment here.
I believe that it is justified to be as aggressive in the use of drugs to treat insomnia as it is for using drugs to treat MDD and BD.
http://www.leeheymd.com/charts/dep5.html
This is not a comprehensive list. Each drug has it strength and weaknesses and treat different presentations of medical conditions.
alprazolam
amitriptyline
buspirone
carbamazepine
chloral hydrate
chlordiazepoxide
chlorpheniramine
clonazepam
clorazepate
cyproheptadine
diazepam
diphenhydramine
doxepin
estazolam
eszopiclone
flunitrazepam
flurazepam
gabapentin
hydroxyzine
lorazepam
melatonin
midazolam
mirtazepine
nitrazepam
phenytoin
pregabilin
promethazine
propoxyphene
quetiapine
ramelteon
requip
Seroquel
temazepam
tiagabine
trazodone
triazolam
trimipramine
valproate
zaleplon
zolpidem
zopicloneIf all else fails, one may elect to treat insomnia with the cautious and responsible use barbiturate:
amobarbital
pentobarbital
phenobarbital
secobarbital> incidentally, i noticed today that my mood was very stable despite the extreme sleepiness. although it could have been from the zyprexa i popped last night to finally help me fall asleep.
Well, prazosin worked rather quickly for me to improve depression and reduce its variability during the day. Lithium has also helped with this also, but acts more so to stabilize my depression throughout the week.
By the way, I continue to improve gradually. The ride is not entirely smooth, though. This is to be expected in my case. Right now, my improvement ebbs and flows rather gently; the general direction of improvement still being upwards towards remission. Periodic worsenings now last for hours rather than days. I am gaining more and more confidence in my therapeutic response.
I am wondering if combining guanfacine and prazosin would yield somnolent effects without causing too much dizziness.
- Scott
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