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Dr. Bob is Robert Hsiung, MD,
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Posted by Geezer on July 17, 2002, at 16:19:15
In reply to Re: I disagree. » Geezer, posted by mist on July 17, 2002, at 15:26:10
Thanks Mist,
I do try to respect the opinions of others and their right to voice them; thanks to you for the same. I think there is a lot to Dr. Bob's policy of "please be civil" - you can use up a lot of energy arguing - not something we always have a lot of.
This is a "hot topic" for me. I am very anxious to see emperical testing and better meds. to treat this illness. At this point psychopharm. is in a very primitive stage, I have been treated since 1962, the meds of today have fewer side effects for some people but are no more effective (talking ADs now, not APs). I got 30 years completed in the Cardiac Pacemaker business before complete disability in 1998. I guess you never give up hope.
Very best regards,
Geezer
Posted by Ritch on July 17, 2002, at 23:34:26
In reply to Re: slowed thoughts » Ritch, posted by mist on July 17, 2002, at 15:37:37
> Mitch, your description pretty much fits the type of depression I've had. Slowed thoughts can even become stopped thoughts! Sometimes a darkness would come into my mind that felt like it could obliterate it, when I tried to think even one thought or half a thought. Like my thinking would be smothered by this darkness and just stop.
Hi,My pdoc thinks I am one of those "limbic-depressive ADHD" subtypes of late (with mixed bipolar). I wouldn't disagree. I have had the best response to low-dose stimulants for bipolar depressions (with NO hypomania). Stims tend to "cascade" into panic for me, unfortunately, after a few weeks. So they are pretty much out-that's OK because panic is the worst feeling I ever have experienced (even worse than the mixed depressive bleakness). So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
MItch
Posted by mist on July 18, 2002, at 0:50:16
In reply to Re: I disagree., posted by Geezer on July 17, 2002, at 16:19:15
>I got 30 years completed in the Cardiac Pacemaker business before complete disability in 1998. I guess you never give up hope.
Your situation sounds difficult, but it's good that you haven't given up. I agree it can be frustrating that the research isn't farther along. We were all born too early. :)
Posted by mist on July 18, 2002, at 1:13:42
In reply to Re: slowed thoughts » mist, posted by Ritch on July 17, 2002, at 23:34:26
>So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
Are these meds effective for you?
I believe I have Limbic ADD (in addition to unipolar depression). I have all the signs of it and have since childhood. I'm hoping to try provigil and see if it does anything, or else Adderal or another stimulant. I'm afraid of ADs because of reactions I've had to them which rendered me as incapacitated as the depression, so until something better comes out I'd rather try other types of meds.
Posted by Dr. Bob on July 18, 2002, at 7:32:55
In reply to Re: I disagree., posted by Geezer on July 17, 2002, at 16:19:15
> You maybe right, it is a bit like arguing politics or religion, everybody has an opinion.
> I do try to respect the opinions of others and their right to voice them; thanks to you for the same.
Thanks to both of you! :-)
Bob
Posted by Ritch on July 18, 2002, at 10:07:53
In reply to Re: slowed thoughts » Ritch, posted by mist on July 18, 2002, at 1:13:42
> >So I am currently on Depakote, Klonopin, Effexor, Wellbutrin (all low-dose-esp. the AD's).
>
> Are these meds effective for you?
>
> I believe I have Limbic ADD (in addition to unipolar depression). I have all the signs of it and have since childhood. I'm hoping to try provigil and see if it does anything, or else Adderal or another stimulant. I'm afraid of ADs because of reactions I've had to them which rendered me as incapacitated as the depression, so until something better comes out I'd rather try other types of meds.
Mist,Yes, they do work reasonably well. After trials of all sorts of "mood stabilizers" Depakote works the best for hypomania and temper outbursts (mixed hypomania-rage reactions) that I can tolerate. The only thing I don't like is a little weight gain (I have countered it with a super low-fat diet and increased exercise, however). Lithium worked better for the depressive side of things, but I have to push the dose up in order for it to control the hypomania and irritability (as well), and when I get the dose of lithium up it becomes tough to tolerate because of the gastrointestinal upset it causes me. Klonopin keeps the panic attacks away and helps with social anxiety. It also seems to settle hypomania as well. But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now). Effexor+Wellbutrin.... Well, the Wellbutrin comes the closest to being a stimulant as possible (of the AD's). All I am really taking that for is so I can stay AWAKE during the day, otherwise I will be yawning, sleepy, etc, all day long (I am just taking 18.75mg). I can't tolerate it as well when I am hypomanic-it is more prone to setting off rages. The Effexor.. well I just take about 12.5 mg a day, that's it. Any more and it will disrupt my sleep and give me bad heartburn and reflux. All the SSRI's aggravate my reflux problems bigtime. I wonder if duloxetine, when it comes around next year, will be weak enough on the serotonergic side for me to tolerate, and yet still be activating and alerting enough for me to concentrate. Wellbutrin by itself is too anxiogenic. Effexor by itself is too "numbing". I never realized just how numbing SSRI's can be until I raised the dose up on the Effexor-whew!
Mitch
Posted by Geezer on July 18, 2002, at 11:00:09
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
Hey Mitch,
I called Lilley about 3 weeks ago. All they would tell me is they have a "target release date" of 2003. If what I have read is correct, Duloxatin should have a 50%-50% effect on serotonin and norep. from the first dose. With Effexor, it is my unserstanding, you have to wade through a lot of serotonin effect before you get to the norep. Correct me if I am wrong.
Geezer
Posted by Ritch on July 18, 2002, at 22:20:22
In reply to Re: slowed thoughts, posted by Geezer on July 18, 2002, at 11:00:09
> Hey Mitch,
>
> I called Lilley about 3 weeks ago. All they would tell me is they have a "target release date" of 2003. If what I have read is correct, Duloxatin should have a 50%-50% effect on serotonin and norep. from the first dose. With Effexor, it is my unserstanding, you have to wade through a lot of serotonin effect before you get to the norep. Correct me if I am wrong.
>
> Geezer
Hi,I was reading a post here recently that mentioned the transporter affinity ratios for Effexor and Cymbalta (duloxetine). Effexor is supposed to have approx. 30x more affinity for serotonin reuptake transporters than NE reuptake transporters, whereas duloxetine is supposed to have approx. 9x more affinity for serotonin reuptake transporters than for NE reuptake transporters. So, I view Effexor and duloxetine as SSRI's that also happen to block NE reuptake to a significant extent. And that's what Effexor *feels* like, anyhow. I have heard all of the stuff about boosting the Effexor dosage to get to a more significant NE reuptake. UGGH, I can't go there, because what is happening is Effexor probably "flattens" out on its ability to block reuptake of serotonin at some point (a saturation effect) and then the blockade of NE reuptake continues to increase significantly with further increased doses. Yuck. I would rather take a selective NE reuptake inhibitor, that happens to block reuptake of serotonin to a *lesser* extent, AND just take a *low* dose of *that* one antidepressant.
Mitch
Posted by mist on July 19, 2002, at 0:53:24
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
>But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now).
I found klonopin effective for social anxiety as long as I didn't take it every day. When I did, it make me more depressed. On an ocassional, as needed basis it was good. I'd like to get another klonopin prescription when I can stand to deal with the medical/mental health establishment again. I'm hoping I can get .25 mg tablets. I'm very sensitive to substances and can't take a high dose of anything.
It's great that you've found a combination of meds that works for you.
Posted by Ritch on July 19, 2002, at 10:22:43
In reply to Re: slowed thoughts » Ritch, posted by mist on July 19, 2002, at 0:53:24
> >But, I have to be careful with Klonopin when I am depressed and I will feel better if I cut the dosage (which I am doing now).
>
> I found klonopin effective for social anxiety as long as I didn't take it every day. When I did, it make me more depressed. On an ocassional, as needed basis it was good. I'd like to get another klonopin prescription when I can stand to deal with the medical/mental health establishment again. I'm hoping I can get .25 mg tablets. I'm very sensitive to substances and can't take a high dose of anything.
>
> It's great that you've found a combination of meds that works for you.
Mist,You mentioned .25mg tablets-that's what I would like to get. I don't think they make them that small (I thought scored .5mg tabs were the smallest). I feel better just taking .25mg at bedtime on a regular basis instead of .5mg (definitely has lifted some of the depression). However, I just need a 1/4 tablet sometimes during the day (.125mg-PRN basis), and it's a hassle to have to do the tablet microsurgery-especially when the stuff is so cheap anyhow. I still get a good anti-anxiety effect with just a 1/4 tab.
Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
Mitch
Posted by mist on July 20, 2002, at 14:56:42
In reply to Re: clonazepam question » mist, posted by Ritch on July 19, 2002, at 10:22:43
>Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
Mitch, were you able to find out from your pharmacist?-mist
Posted by Ritch on July 20, 2002, at 16:28:17
In reply to Clonazepam in .25mg tabs? » Ritch, posted by mist on July 20, 2002, at 14:56:42
> >Does anybody know if .25mg tabs are being made nowadays? I can ask my pharmacist today I suppose.
>
> Mitch, were you able to find out from your pharmacist?
>
> -mistHi,
Evidently .5mg tablets are the smallest available either in generic or patent Klonopin.
Oh well...
Posted by mist on July 20, 2002, at 22:14:47
In reply to Re: Clonazepam in .25mg tabs? » mist, posted by Ritch on July 20, 2002, at 16:28:17
Posted by bob on July 21, 2002, at 1:04:01
In reply to Too bad. I hate cutting those things too. (nm) » Ritch, posted by mist on July 20, 2002, at 22:14:47
Posted by mist on July 21, 2002, at 19:05:13
In reply to Re: slowed thoughts » mist, posted by Ritch on July 18, 2002, at 10:07:53
>Wellbutrin.... (I am just taking 18.75mg).
What is the smallest dose it comes in? Do you have to cut it? (I called my pharmacy and they said 75mg was the smallest they sold.) I'm thinking of taking it (I'm sure I can get a prescription). However, I only feel safe taking a fraction of the smallest amount most other people would take to start.
Posted by Ritch on July 22, 2002, at 10:04:47
In reply to Smallest Wellbutrin dose? » Ritch, posted by mist on July 21, 2002, at 19:05:13
> >Wellbutrin.... (I am just taking 18.75mg).
>
> What is the smallest dose it comes in? Do you have to cut it? (I called my pharmacy and they said 75mg was the smallest they sold.) I'm thinking of taking it (I'm sure I can get a prescription). However, I only feel safe taking a fraction of the smallest amount most other people would take to start.
Yep, 75mg immediate-release is the smallest tab you can get. I have to quarter the tabs with a utility knife. You have to be careful-you have to use quite a bit of pressure on these generic bupropion tabs! The film coating is rather heavy. Even a pill crusher has a tough time with them. I could probably handle taking an intact WB 100mg SR tab right now-it is just that bupropion messes up my sleep so badly. It tends to provoke early-morning awakenings for me.Mitch
Posted by mist on July 23, 2002, at 0:22:53
In reply to Re: Smallest Wellbutrin dose? » mist, posted by Ritch on July 22, 2002, at 10:04:47
Posted by phil_b on October 1, 2002, at 15:37:07
In reply to Hopeful about duloxetine, posted by Mr. Scott on February 3, 2002, at 12:47:28
I just read an article in Medscape about duloxetine (Cymbalta). Apparently it has a "cleaner" side-effect profile meaning that the side effects (as you probably know, there are ALWAYS side-effects), are less and less bothersome. Here are some potential benefits of duloxetine over Effexor:
>duloxetine at 80 mg/day (starting dose is 60) does not induce hypertension
>duloxetine does not produce any clinically significant effects on body weight
>duloxetine was shown to be safe and well-tolerated in a dose range of 40-120 mg/day (administered BID) or at 60 mg daily
>BUT, no differences between treatment groups were detected in female sexual function when it was compared to Paxil; and males experienced greater orgasm delay just like Paxil.
Well, 4 out of 5 is not bad. I am in chronic pain and take Pamelor (nortryptiline), the old fashioned TCA, but it does really help. I really dislike the side effects of Pamelor and am hoping that duloxetine will work better for me. I am also hoping that it can be used in conjuction with Pamelor - using lower doses of each and achieving a better side effect profile.
I contacted Eli Lilly to volunteer for a study using duloxetine but could not because of other meds I am taking (pain meds). I spoke to a study coordinator who told me she was very impressed with the study's findings. It should be available by prescription late this year or early 2003. Apparently, duloxetine is being studied for "stress urinary incontinence" also.
Posted by klp on December 20, 2002, at 20:23:46
In reply to Re: Hopeful about duloxetine, posted by phil_b on October 1, 2002, at 15:37:07
Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
Posted by DaveW on December 27, 2002, at 23:00:28
In reply to Re: Hopeful about duloxetine, posted by klp on December 20, 2002, at 20:23:46
> Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
Atomoxetine has been approved under trade name Strattera as a norepinephrine reuptake inhibitor and according to Lilly will be generally available in January '03. See Strattera.com for info.
Posted by DaveW on December 27, 2002, at 23:21:13
In reply to Re: Hopeful about duloxetine, posted by DaveW on December 27, 2002, at 23:00:28
> > Any word on when it will be approved? It's the only thing that seemed to help me. I only got to use it for a trial period.
>
>
> Atomoxetine has been approved under trade name Strattera as a norepinephrine reuptake inhibitor and according to Lilly will be generally available in January '03. See Strattera.com for info.Additional note: Keep in mind that atomoxetine and duloxetine are not the same. Duloxetine (Cymbalta) has been issued an "approvable" letter from the FDA, but this does not mean it has been approved for use. It appears that it will work on norepinephrine and serotonin simultaneously. Go to Lilly.com for updates.
>
Posted by Noa on January 1, 2003, at 13:25:28
In reply to Re: Hopeful about duloxetine, posted by DaveW on December 27, 2002, at 23:21:13
Can someone explain the differences between duloxetine and atamoxetine? Also, how are they same/different from reboxetine? Thanks.
Posted by BekkaH on January 1, 2003, at 13:36:40
In reply to Re: duloxetine and atamoxetine, posted by Noa on January 1, 2003, at 13:25:28
Hi Noa,
Duloxetine is both a norepinephrine reuptake inhibitor AND a serotonin reuptake inhibitor. Atomoxetine (Strattera) is a norepinephrine reuptake inhibitor. Reboxetine is also a norepinephrine reuptake inhibitor.
Posted by Noa on January 1, 2003, at 15:05:12
In reply to Re: duloxetine and atamoxetine-Noa, posted by BekkaH on January 1, 2003, at 13:36:40
Posted by Chris Doe on May 25, 2003, at 14:07:32
In reply to Re: Real Depression, posted by OldSchool on February 11, 2002, at 10:11:49
Ok as a person diagnosed with dysthymia i will tell you first hand IT IS A REAL DEPRESSION! Dysthymia its true is a milder form of depression but the longevity of it alone is depressing, people with dysthymia are also 10 times more likely to develope "deep" or "severe" forms of depression. Dysthymia may not incapacitate me but let me tell you it makes my life really hard. Keeping a job is nearly impossible and social situations are a totaly different story. Yes its true major depression is different but dysthymia has caused me many of the same negative effects and also has alot of the same symptoms just fewer of them. Hope this helps.
> >
> >
> >
> > I disagree. Real depression IS the sadness/hopelessness/suicidal thoughts “stuff” you are talking about. People respond to depression in different ways…because you have insomnia doesn’t mean that if someone sleeps 22 out of 24 hours doesn’t mean they aren’t clinically depressed. Severe depression can also make you GAIN thirty pound without trying and not increasing your appetite. Real depression affects different people in different ways…as for the dry ejaculation, I can’t comment, as I’m a woman. However, I don’t understand if REAL depression is not being able to get it up, how could you even have a dry ejaculation…but again, I’m “only” a woman…depression regardless of how ‘severe’ is still REAL DEPRESSION!!!!! Suicidal thoughts with or without other symptoms of clinical depression are a very serious matter, and someone that’s suffering from fake depression doesn’t have suicidal thoughts.
>
>
> Look, I am just trying to make you aware that there are varying degrees of severity of mental illness. Have you ever been to a mental hospital and been to the "lockup" ward? Where the psychotic people are? Where the doctors just keep you drugged up for days. Are you going to honestly tell me that "dythymia" is as severe or as serious as that?
>
> There are varying degrees of severity when it comes to mood disorders. For example, classic manic depression (bipolar disorder) is WAY more serious than dysthymia. And the melancholia subtype of major depression (severe sleeping, eating, sex drive and cognition probs) is way more severe than dysthymia.
>
> A person with dysthymia can usually still generally function in the world, still work some type of job, etc. It is irritating to read about people who stop modern class antidepressants for trivial reasons (sexual dysfunction, weight gain, dry mouth) when your depressed as dirt, cant sleep good and losing weight like crazy and cant work cause you cant think clearly.
> >
> >
> > >
> > > Real depression is a physical disease. Its not mental illness. All "mental illnesses" should be formally reclassified as Neurological diseases. I get irritated as hell when I read sleep problems in depression being described as "somatic" complaints. Fuck psychiatry. Its way more than a "somatic complaint." If you cant sleep good, your "mental health" as well as your physical health is going to deteriorate.
> > >
> >
> > Depression is depression and I’m not going to argue the matter of physical vs. mental illness. Why should it be formally reclassified as a Neurological disease?
>
> Because all severe forms of mental illness are brain based illnesses. Severe mental illness causes changes in the brain. Things would be much better for all of us if society just started thinking of these problems as neuro diseases and not as "emotional" problems. Trust me on this, all of us "mentally ill" people would be taken much more seriously if our society perceived our problems as physically based, neuro diseases of the brain.
>
> All behavior, both normal and abnormal, is mediated thru neuronal function ie, the brain.
>
> > What if you sleep ‘too good’? Is your physical health going to deteriorate as well? Your symptoms are not the only symptoms of depression. There isn’t only “one” way to be depressed….Different people process things differently, the same disorder/disease can have different effects on different people. If that weren’t the case then we’d only need one med for each disorder, right?
> >
> >
> > > Im sorry to put things so graphically for you, but Im just trying to point out some major differences between REAL depression and mild depression. There ARE differences.
> > >
> >
> >
> >
> > Thanks for the apology, you are graphic…I realize you are trying to point out the differences between the different FORMS of depression, and I agree there are differences…BUT they are all REAL DEPRESSION!
>
> Sure its all real depression, but there are degrees of severity. Some cause disability more than others. Dysthymia or situational depression rarely causes longterm disability.
>
> >
> >
> >
> > > A person with the severe kind of depression is just grateful for any relief they get thru meds. They are grateful for just a good night of sleep...hell, just being able to sleep at all for some is a feeling of wonderment and joy. Drug side effects seem rather trivial compared to this severe kind of depression.
> > >
> >
> >
> >
> > I disagree again…ppl become REALLY depressed (vs. unreal) by weight gain, lack of sexual desire/performance, and other side effects of medication.
>
> LOL...again its obvious you never had real depression before.
>
> >True, being able to sleep is a relief, as well as WAKING UP can be. To you drug effects seem trivial, however, that isn’t the situation with everyone.
>
> Sure its not the situation with everyone. For people who have milder forms of depression, these folks havent yet experienced the severe breakdown in basic physiological bodily functions that severe depression causes. What psychiatry classifies as "somatic" complaints. For someone who hasnt yet experienced the real thing, SSRI side effects are bothersome.
>
> All I have to say about that is wait til you get nailed by the big one. Real melancholic SEVERE major depression. Or psychotic depression. Or manic depression. LOL hehehe Trust me, you wont care about "SSRI side effects" anymore. You will thank God just for the fact you have these drugs so you can sleep and not end up going crazy.
>
> >
> >
> >
> > > Im sorry to put it this way, but its just the way it really is. Too many dysthymic depressives and people with "life stress" are taking SSRIs in my opinion and obviously they get turned off by these side effects. But guess what? Many of them dont really have real depression to begin with. A lot of these kind of people just need to do the talk therapy thing and stop partying so much, cut out the booze and increase the aerobic exercise.
> > >
> >
> >
> > I’m sorry you put it that way too. It’s really sad because you know; people with “life stress” kill themselves everyday. Why do you think these people party so much, and drink too much alcohol? Why do you think they aren’t really depressed in the first place?
>
> A person with true depression...clinical depression wouldnt even be partying to begin with. Plenty of people with dysthymia or mild depression self medicate with booze and recreational drugs however.
>
> I found after I became clinically depressed my response to booze totally changed. I found out that I didnt get a beer buzz anymore and booze didnt make me feel loose and happy anymore. Booze just made me sadder, more depressed, cry more and made my insomnia MUCH worse.
>
> Many cases of "mild depression" and dysthymia are caused by or exacerbated by alcohol. And too often the person doesnt even realize its the booze causing their dysthymia. Cut out booze totally and see how your mood lifts if you have dysthymia.
>
> >
> >
> >
> >
> >
> >
> > >
> > > Thats why I wish psychiatry was just formally merged into Neurology. Let the people who have real mental illness go to Neurologists. And let the people who just have mild depression or "Woody Allen depression" go to some talk therapy asshole. I dont have the patience for all this psychology/psychobabble crap after what Ive been thru. It gets on my nerves and its an insult to me after what Ive been thru. I have a REAL PHYSICAL disease and I am not going to stop taking my meds cause of "sexual dysfunction" or "dry mouth."
> > >
> >
> >
> > Your attitude regarding Psychiatry really concerns me. I’m amazed at your hatred toward the mental health field. What exactly do you consider ‘real mental illness’?
>
> Here is my personal definition of "real mental illness."
>
> 1) schizophrenia and all psychotic disorders
> 2) classic manic depression AKA bipolar type 1
> 3) major depression, especially the melancholia or psychotic depression subtypes
> 4) all of the anxiety disorders
>
> >I don’t know what a psychiatrist did to you to warrant such venom toward all psychiatrists, but it sure seems that way. I don’t have much patience either, and I’ve been through more than my share of bad things in life.
>
>
> >
> > Have your meds cured you? Are you now functioning, sleeping, eating normally, and being a normal person in society?
>
> Hell no. Im hanging out on psychobabble arent I? What do you think people who hang out here are like? Many of them are treatment resistant.
>
> >I’m not trying to be facetious, sarcastic and/or whatnot, I’m honestly curious as to how your meds have helped.
>
> As Ive already told you several times, meds dont work for me very good. Somewhat, enough to keep me afloat and alive but thats all. Im hardly in remission which is what Id like. Like I said, Id gladly trade some "SSRI side effects" for a drug that sent me into remission and kept me there. Antidepressant side effects are rather trivial to me.
>
> Old School
> >
> >
> > Kiddo
> >
> >
> > > Old School
>
>
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Dr. Bob is Robert Hsiung, MD,
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