![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 61. Go back in thread:
Posted by SLS on August 18, 2004, at 8:30:05
In reply to Re: Shouldn't there be a limit to this, tried rTMS, posted by denise1904 on August 17, 2004, at 18:49:09
Hi Denise.
> Thanks for responding, must be difficult to take, me moaning about rTMS not working when ECT hastn't worked for you either.
Depression is hell. Yours is no less a hell for you than mine is for me, right?
> Do you know what kind of ECT you had and have you got any idea why it didn't work for you?I had a course of 15 treatments in 1991. The first 6 were unilateral left; the rest were bilateral. I felt some improvement after the fifth treatment, but it quickly faded, and I felt no improvement thereafter.
> I'm beginning to wonder if the cells they're actaully trying to activate in my brain actually exist anymore, it scares the hell out of me.
They do exist. They are capable of being re-activated, and new ones are always being born. That's about all I can guarantee you.
> I've seen you on this board for several years now and I really hope that when your ship finally comes in it will be the biggest and best.
Thank you. I'm counting on it!
> Can I ask you how old you are,44 years.
> how long you've had this,
10 - 15: mild to moderate
15 - 17: moderate and episodic
17 - present: severe and chronic; no spontaneous remissions> what you've tried so far and what has worked the best for you?
A doctor hit the bullseye in 1987. Parnate 60mg + desipramine 125.
After 6 months of euthymia (normothymia), I gradually became hypomanic and then severely manic. The doctor discontinued the antidepressants and gave me lithium. Depression returned in 2 months. MISTAKE - he decided not to go back to the original treatment. Prozac was just approved, and he wanted to play with the new toy. After a series of failed trials with monotherapies, returning to the original combination treatment never worked again. Not an unusual story, I'm afraid.
> Also, have you ever had an MRI scan or thought about having one?In 1992, I was one of the first people to have a PET scan (positron emission tomography) at the National Institutes of Health. My cerebral cortex was essentially blue - cold - no activity. It should have been yellow-orange (except for the ventricles - liquid-filled reservoirs of cerebrospinal fluid). It is scary to see such a global dysfunction. I'm thinking about requesting them to send me copies of the pictures. I really should. Maybe I should have a SPECT scan to find out which structures in particular are hypo- or hyper- active. Maybe the information will eventually have some value in choosing treatments.
Have you tried lithium 300-600mg to augment antidepressants? Which drugs have made you feel better, and which ones have made you feel worse?
How are you doing today?
- Scott
Posted by alesta on August 18, 2004, at 8:51:08
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 18, 2004, at 7:39:23
Aren't you guys open to the idea that we might be going somewhere after we die? There's no evidence to the contrary, but there is evidence to support it. (*please* don't ask me to look up specific evidence right now-too unmotivated.) but the evidence i'm talking about concerns near-death experiences, or NDEs. why don't you maybe do a Google search on NDEs or near-death experiences and see what you come up with. after much research on this, i am convinced that these are real, and that there is no end. rather, it is more like a beginning because what awaits us is so amazing. life here on earth is supposed to be hard, but this is only temporary. the reason we're here is to learn to love. that's it. this is like one big, long lesson. when we die is when life really begins. you don't want to give up and kill yourself, however, not because you'll go to hell, but because you'll just have to come back and deal with the same problems, until you learn the lessons. so that's why it's not a solution.
i just thought i'd share that. By the way, i'm not religious (i am "spiritual" though).
amy
Posted by alesta on August 18, 2004, at 8:52:51
In reply to Re: Shouldn't there be a limit...SLS Irene, posted by alesta on August 18, 2004, at 8:51:08
j
Posted by SLS on August 18, 2004, at 16:25:21
In reply to Re: Shouldn't there be a limit...SLS Irene, posted by alesta on August 18, 2004, at 8:51:08
Hi Amy.
I really like your belief system - especially the learning to love part.
- Scott
Posted by Dr. Bob on August 18, 2004, at 18:46:21
In reply to Re: Shouldn't there be a limit...SLS Irene, posted by alesta on August 18, 2004, at 8:51:08
> Aren't you guys open to the idea that we might be going somewhere after we die?
Sorry to interrupt, but I'd like to redirect follow-ups regarding this to Psycho-Social-Babble. Here's a link:
http://www.dr-bob.org/babble/social/20040811/msgs/379219.html
Thanks,
Bob
Posted by iris2 on August 18, 2004, at 19:06:56
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 18, 2004, at 7:39:23
Scott,
Thanks for the input.
I did try effexor before it was even on the market in a hospital. I thought it had great potential within a few days but I had to discontinue it after 3 weeks because of my bladder. I thought so highly of it I tried it two or three more times. Now I can take one dose and am in pain for a few weeks so although I think it has every indication of lifting my mood and soothing anxiety I cannot tolerate it.
I also had great experiense with Parnate but aver many years it pooped out. I waited over a year to retry it and still nothoing. I have tried many times to go "clean" but after a week or two I am totally non functioning and inevitably end up with a suicide attempt.
Was it you that you are saying about the etc. If not I had 6 bilateral treatments than the docter stopped them as I became beligerent. Ayear or so later I had 12 lateral treatment and they did nothing but mess with my memory.
AS far as taking the amisulpride with a stimulant I am taking between 40 -100mg ritalin daily. I cannot tolerate any others I have tried.
I take it from my experience with effexor you might look at the milnacipran or Cymbalta (which I have as everyone been waiting for forever) as opposed to the amineptine?
I could go any of these routes. Who knows maybe the amisulpride will be the end all!!!
Are you on Cymbalta now? If so keep me posted?I'll look up these other suggestions I know not of, then I'll get my crystal ball out and shine it up!
No one can give a suggestion with any perfect expectation that it will work in this field, no matter how learned one is. Yet my experience tells me that someone that knows the chemistry behind the name has a better chance at having an educated guess than someone like me who does not understand the chemistry so well. I do get that certain things in certain classes of meds work better for some or for me. ANd certain combo's better but I do not understand it all well enough to get it quite right when trying new things.
You do not sound diorganized, just trying to communicate what you know without overdue inluence.I would not have asked you if I did not trust your judjement. I expect that people would understand that knowone has THE answer.
Best of luck to you.
What are you trying or what is working for you?
irene
Posted by denise1904 on August 18, 2004, at 21:23:19
In reply to Re: Shouldn't there be a limit to this, tried rTMS ?denise1904, posted by SLS on August 18, 2004, at 8:30:05
Hi Scott,
Trying to work out how long altogether you've suffered with this? You say 17 to present but not sure how long this is, is this the amount of years or the age? In your notes you always come across as so logical, in control and composed.
Sorry to ask so many questions but when I start feeling desperate I just tend to start bombarding everyone with questions, like a child I suppose saying "why, why why!"
Having a better day today took my usual medication this morning, mainly because since I've been in Vancouver having rTMS skipped a couple of doses of my antidepressant medication, am supposed to take 40 to 60mg a day and yesterday was the pits.
The worse thing about this depression and when I get into that state is there seems to be absolutely nothing I can do myself to get myself out of it and that's the awful thing. I hate the fact that I seem to have no control over the way I feel. And then I get myself into a turmoil because I want to take control and end it but I know I can't, time seems to stand still and every second is an eternity. I just want the mind I had four years ago back (I know that sounds silly). Knowing that without this medication I feel a total mess scares the hell out of me. I feel that the person I am today is a much much weaker person.
Thanks for reassuring me that I do have Serotonin cells still in that area of my brain, sometimes it feels as though nothing is there, just a rock.
When you had the Pet Scan did they not give you any indication as to why they thought there was no activity?
Three years ago (seems longer I felt as though I was in hell most of the time, and Zyprexa was the only thing that relieved it (thank God for it) nothing seemed to work and I went through the usual combinations including addition of Lithium anyway about a year ago after trying Nardil the psychiatrist decided to try me on Seroxat 40mg again even though it hadn't worked a year earlier and for some reason my life started to feel more bearable. About the same time my mum started going to church to pray for me and a friend started to pray for me too. I'm not particularly religious but something helped, not sure if it was the Seroxat or the prayers but it's worth bearing in mind.
How are you feeling lately Scott after the me me me bits and do you ever wonder what the hell happened or do you know?
Just to give you some backround to me.
Approx 17 to 24 Mild Depression
Hit approx 24 and started to feel worse.
24 to 27 - Depression free with Prothiaden (Dothiepin)
27 to 32 - Depression free with Seroxat.
32 to 35 - Depression free with no medication.
35 - Suicidal Depression, tried all sorts of medication.
Denise
Posted by denise1904 on August 18, 2004, at 21:33:52
In reply to Re: To Scott, posted by denise1904 on August 18, 2004, at 21:23:19
Scott,
If I were you I know I'd be asking myself over and over again why ECT didn't work for me? I'm sure you must have asked yourself that question, have you come up with any theories or do you think it is a pointless question to ask?
Also, is whatever you're taking now helping you at all, are there any things that help you?
Denise
Posted by SLS on August 19, 2004, at 6:56:07
In reply to Re: Shouldn't there be a limit to this, tried rTMS » SLS, posted by iris2 on August 18, 2004, at 19:06:56
Hi Irene
> I did try effexor before it was even on the market in a hospital.
Boston?
> I also had great experiense with Parnate but aver many years it pooped out.
Sorry. One doesn't hear about Parnate poop-out as often as Nardil poop-out.
> I have tried many times to go "clean" but after a week or two I am totally non functioning and inevitably end up with a suicide attempt.
I think the initial relapse is the worst. Things sometimes improve somewhat after a few weeks. Even so, this resulting state might be well below the threshold of tolerability. It is for me. That's why I really don't feel that I can afford to remain clean.
> Was it you that you are saying about the etc. If not I had 6 bilateral treatments than the docter stopped them as I became beligerent.
How so?
> AS far as taking the amisulpride with a stimulant I am taking between 40 -100mg ritalin daily. I cannot tolerate any others I have tried.
> I take it from my experience with effexor you might look at the milnacipran or Cymbalta (which I have as everyone been waiting for forever) as opposed to the amineptine?I wish amineptine were still around. I would have tried it by now. You know, I don't recall anyone combining amineptine with another antidepressant. How about you?
> Are you on Cymbalta now? If so keep me posted?
I had my doctor write a prescription for Cymbalta yesterday. The pharmacy said that it would arrive sometime today. I'll be taking 30mg for one week, and then 60mg.
> What are you trying or what is working for you?
The thing that has helped keep my head above water over the last 5 years or so has been a combination of Lamictal + antidepressant. It allows me to function about 15% better than my unmedicated baseline. I had been using Lamictal 300mg + imipramine 300mg until recently. I reduced the Lamictal and added memantine to mitigate the cognitive side effects produced by Lamictal, and weaned off imipramine in preparation for taking Cymbalta.
I am looking forward to trying Cymbalta, and am somewhat excited about it, but I am by no means counting on it. I am trying to anticipate its failure so that I don't become suicidally disappointed should it happen. By the way, there is another alternative for using a drug with a combined NE/5-HT reuptake inhibition - sibutramine (Meridia). I don't have it high on my list of things to try, but I know of a prominent pdoc in Princeton who uses it quite a bit, Peter Mueller.
- Scott
Posted by SLS on August 19, 2004, at 7:30:11
In reply to Re: To Scott, posted by denise1904 on August 18, 2004, at 21:23:19
Hi Denise.
> Trying to work out how long altogether you've suffered with this? You say 17 to present but not sure how long this is, is this the amount of years or the age?
Age. I'm 44 now (going on 23).
> In your notes you always come across as so logical, in control and composed.
I know. I have a gift for deception. :-)
> Having a better day today
Every little bit is a blessing, I guess.
> The worse thing about this depression and when I get into that state is there seems to be absolutely nothing I can do myself to get myself out of it
I don't think it is realistic to expect to. Unfortunately, our brains seem to behave in ways that are not greatly influenced by what we do with our minds. This is not normal. I think it is good to try, though, as long as you don't beat yourself up if it doesn't help much. There is something redeeming about trying and not getting anywhere if you realize that the obstacle is so formidable. The measure of achievement lies not in how high the mountain, but in how hard the climb.
> and that's the awful thing. I hate the fact that I seem to have no control over the way I feel.
I was so pissed off when I found out that my depression was biological. I wanted it to be psychological so that it would be in my power to conquer. I don't mind working for things, so I was more than willing to go for psychotherapy - which I did. Of course, it didn't help.
> And then I get myself into a turmoil because I want to take control and end it but I know I can't, time seems to stand still and every second is an eternity.
That is an absolutely perfect description. One of my doctors made the estute observation that depression has a quality of timelessness. When you are in the middle of it, it doesn't seem to have had a beginning and can have no end.
> I just want the mind I had four years ago back (I know that sounds silly). Knowing that without this medication I feel a total mess scares the hell out of me. I feel that the person I am today is a much much weaker person.
I know.
I believe I am weakened, but not necessarily a weaker person. Watch how strong you become once you are unshackled. It is amazing.
> Thanks for reassuring me that I do have Serotonin cells still in that area of my brain, sometimes it feels as though nothing is there, just a rock.
In a state of depression, there is so much of the cerebral cortex that is left inactive, that it feels as if it is not there at all. But it is there. When the controlling circuits are reset, it wakes up and will be there for you to access.
> When you had the Pet Scan did they not give you any indication as to why they thought there was no activity?
That is the question they were trying to answer. I'm sure each investigator had their "pet" theories (sorry, I couldn't resist), but I think they were as overwhelmed by the scope of the hypofunction as were the patients.
> Three years ago (seems longer I felt as though I was in hell most of the time, and Zyprexa was the only thing that relieved it (thank God for it) nothing seemed to work and I went through the usual combinations including addition of Lithium anyway about a year ago after trying Nardil the psychiatrist decided to try me on Seroxat 40mg again even though it hadn't worked a year earlier and for some reason my life started to feel more bearable. About the same time my mum started going to church to pray for me and a friend started to pray for me too. I'm not particularly religious but something helped, not sure if it was the Seroxat or the prayers but it's worth bearing in mind.
I occasionally ask people to pray for me. You never know.
> How are you feeling lately Scott after the me me me bits and do you ever wonder what the hell happened or do you know?
I have a good idea what happened. Of course, it involves a congenital vulnerability for depression and bipolar disorder. Among the stressors that I believe helped to initiate the depression were physical and emotional abuse as a child along with neglect. By age 10, my affect was flat and my interest in doing things reduced. I was particularly sensitive to the social pressures of high-school. Within a single hour at age 17, things turned dramatically worse. I remember looking up at the clock during my math class and noting the time when the blackness descended. It was 1l:10am. There was nothing on my mind at the time. It was simply a biological cataclysm.
> Just to give you some backround to me.
>
> Approx 17 to 24 Mild Depression
>
> Hit approx 24 and started to feel worse.
>
> 24 to 27 - Depression free with Prothiaden (Dothiepin)
>
> 27 to 32 - Depression free with Seroxat.
>
> 32 to 35 - Depression free with no medication.
>
> 35 - Suicidal Depression, tried all sorts of medication.:-(
- Scott
Posted by iris2 on August 19, 2004, at 10:49:49
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 19, 2004, at 6:56:07
Scott,I felt heart warmed when I read what you wrote to Denise about cell rejuvenation and cerebral cortex functioning again. I have been ill for 30 years and many times experience such a low cognitive function. I always feel like my brain is slowly dying off. Used to be quick and smart in school and had a wry sense of humor. All gone now.
You mentioned Meridia once before and I remembered it but I thought it was something my sister took for obesity and for some reason thought it had been taken off the market.I am keenly interested in how this works for depression? My initial introduction to "mental illness" at age 15 was anorexia nervosa, for about a year. I weighed 59lbs before I ate much again. For the next 29 years to present I have had bulimia. So this might be something helpful.
I just asked about the ect. because of my own experience. It is in a prior post. Sorry if it was intrusive or misinterpreted.
I have been looking forward to trying Cymbalta for a few years. I am going to talk with my pdoc today but he is so out of it most of the time I doubt I will get a good suggestion from him so I will still have to decide myself what is next.
I still have some amineptine. I thought it was still around, though very expensive. I have not looked for a while. If I see I cannot order it I will not bother trying it.
>By the way, there is another alternative for using a drug with a combined NE/5-HT reuptake inhibition - sibutramine (Meridia).
I do not understand NE/5-Ht so well. Can you elaborate or simply compare it with similar drugs so I can understand it better? Perhaps a link if you have one on the top of your head or under your arm! I know I am a pest.
Thanks for being you,
irene
Posted by SLS on August 20, 2004, at 17:24:08
In reply to Re: Shouldn't there be a limit to this, tried rTMS » SLS, posted by iris2 on August 19, 2004, at 10:49:49
Hi Pest.
:-)
> I do not understand NE/5-Ht so well. Can you elaborate or simply compare it with similar drugs so I can understand it better? Perhaps a link if you have one on the top of your head or under your arm! I know I am a pest.
This will have to be short - sorry. I have a date with the circus.
NE = norepinephrine
5-HT = serotoninSome drugs, like the SSRIs (Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro), only work on one neurotransmitter - in this case, serotonin. Others work primarily on norepinephrine (desipramine, nortriptyline, reboxetine, maprotiline). Some work on both. Most of the tricyclics and Effexor inhibit the reuptake of both 5-HT and NE, but not always equally. Effexor, in particular, is much more potent on 5-HT than NE. Cymbalta is still biased towards 5-HT, but not as much. It is more balanced. I guess you could say that Cymbalta is a better-balanced version of Effexor. It *might* thus produce an antidepressant effect similar to high dosages of Effexor, but with milder side effects - especially those involving sexual function and apathy. We'll have to see about that.
In general, it is becoming apparant that drugs that work on multiple neurotransmitters are more effective than those that are selective to only one. Effexor, for example, seems to get more people well, gets each person more well, and poops-out less often than the SSRIs.
> Thanks for being you,
That is the nicest thing that anyone can ever say to me. Thank you.
Ditto.
Please don't ever be reluctant to ask questions of anyone here. It's what makes this place work. My explanation was overly simplified, so don't be afraid to dig deeper. Most drugs, even the "selective" ones, are biologically active at sites other than the ones considered to be primary. It is difficult to conclude which properties are essential, and which are unnecessary or undesirable.
- Scott
Posted by iris2 on August 20, 2004, at 18:53:31
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 20, 2004, at 17:24:08
> Hi Pest.
>
> :-)
>
> > I do not understand NE/5-Ht so well. Can you elaborate or simply compare it with similar drugs so I can understand it better? Perhaps a link if you have one on the top of your head or under your arm! I know I am a pest.
>
> This will have to be short - sorry. I have a date with the circus.
>
> NE = norepinephrine
> 5-HT = serotonin
>
> Some drugs, like the SSRIs (Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro), only work on one neurotransmitter - in this case, serotonin. Others work primarily on norepinephrine (desipramine, nortriptyline, reboxetine, maprotiline). Some work on both. Most of the tricyclics and Effexor inhibit the reuptake of both 5-HT and NE, but not always equally. Effexor, in particular, is much more potent on 5-HT than NE. Cymbalta is still biased towards 5-HT, but not as much. It is more balanced. I guess you could say that Cymbalta is a better-balanced version of Effexor. It *might* thus produce an antidepressant effect similar to high dosages of Effexor, but with milder side effects - especially those involving sexual function and apathy. We'll have to see about that.
>
> In general, it is becoming apparant that drugs that work on multiple neurotransmitters are more effective than those that are selective to only one. Effexor, for example, seems to get more people well, gets each person more well, and poops-out less often than the SSRIs.
>
> > Thanks for being you,
>
> That is the nicest thing that anyone can ever say to me. Thank you.
>
> Ditto.
>
> Please don't ever be reluctant to ask questions of anyone here. It's what makes this place work. My explanation was overly simplified, so don't be afraid to dig deeper. Most drugs, even the "selective" ones, are biologically active at sites other than the ones considered to be primary. It is difficult to conclude which properties are essential, and which are unnecessary or undesirable.
>
>
>
> - ScottThanks,
This gets so complicated. I read stuff and there is just so much more involved than what I asked. The effects on dopamine D1 and D2 and so much much more. I was trying to understand some similarities to drugs that worked that I might have taken . I would at some point like to study this more in depth. But I will have to find a starting point.
From what you said it does appear that Duloxetine would probably be a good start. ANd reboxetine did help some also. I was trying to "compare" it with how Parnate works and it was like sudden blindness. It does make sense since none of the several SSRI's I tried did anything at all. Cocaine seems to have done the best but well ...
Don't be a clown!
I missed the ballet. It was a free concert in the park. It is one of the few joys I still get out of life but it rained so I guess they did not have it.
Have fun,
irene
Posted by Denise1904 on August 22, 2004, at 15:16:55
In reply to Re: To Scott » denise1904, posted by SLS on August 19, 2004, at 7:30:11
Scott,
Thanks for your previous response, my depression started at 17 although don't know the exact time and at the time never associated it with being depressed, thought I was just dying!
Anyway I know you are thinking of trying rTMS from your previous threads, are you going to participate in a trial of rTMS if this Cymbalta doesnt't work out?
Denise
Posted by SLS on August 23, 2004, at 7:37:13
In reply to Re: To Scott, posted by Denise1904 on August 22, 2004, at 15:16:55
> Anyway I know you are thinking of trying rTMS from your previous threads, are you going to participate in a trial of rTMS if this Cymbalta doesnt't work out?
Hi Denise.
Hmm.
That's a tough question.
I was thinking about trying mifepristone, otherwise known as RU-486. You take it for a week, then feel better, then stop taking it, and stay feeling better. It is supposed to reset the HPA axis. Really weird. My guess is that some people will need to have maintenance treatments every so often. It has been reported successful in psychotic depression and is being studied for bipolar depression at the NIMH, NIH.
Columbia University in NYC had been doing research into rTMS. I contacted the research director. She was interested in me, but I wanted to try Cymbalta first. You've got me thinking, though. Maybe I should try that next. Maybe I won't need to. Wouldn't that be cool?
So, what's going on with you?
- Scott
Posted by Denise1904 on August 23, 2004, at 12:08:04
In reply to Re: To Scott, posted by SLS on August 23, 2004, at 7:37:13
Scott,
I've heard of RU-486, but didn't realise you take it for a week, then feel better, then stop taking it, and stay feeling better, that sounds too good to be true, has it been clinically proven yet and do you know of anyone else who's tried it?
Me well have just got back from Vancouver where I went to actually have the rTMS treatments, they didn't work but fortunately the Seroxat still helps so didn't feel as devastated about it as I could have done. Tried cutting down though as of yesterday from 40mg to 30mg and feel below par today. Other people on the course of rTMS apparently improved so it's still worth a go I suppose just costly if you go privately to have it.
I'd be really interested to know how you get on if you do try RU-486, that sounds great to take something and then be able to come off it and still feel better.
Denise
Posted by Denise1904 on August 23, 2004, at 12:10:26
In reply to Re: To Scott, posted by Denise1904 on August 23, 2004, at 12:08:04
Ah yes, I remember now, istn't that an abortion drug?
Denise
Posted by iris2 on August 23, 2004, at 15:56:36
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 20, 2004, at 17:24:08
Hey Scott,
"I am looking forward to trying Cymbalta, and am somewhat excited about it, but I am by no means counting on it. I am trying to anticipate its failure so that I don't become suicidally disappointed should it happen."
I was just explaining why I "seem" better to my father because I have not been cycling on and off meds and do not have that anticipation leading to suicidal depression. I agree that we should be very aware of this.
By the way I think I remember you stating an interest if I tried milnacipran? I am getting a script for it so it will be a few weeks. Let me know if you have any interest in the result. I am interested in the Cymbalta. I tossed a coin as to which of the two to try.
My "crystal Ball" was out of commission that day!
irene
Posted by SLS on August 24, 2004, at 6:00:46
In reply to Re: To Scott, posted by Denise1904 on August 23, 2004, at 12:08:04
Hi Denise.
> I've heard of RU-486, but didn't realise you take it for a week, then feel better, then stop taking it, and stay feeling better, that sounds too good to be true, has it been clinically proven yet and do you know of anyone else who's tried it?
There are a couple of research groups reporting success with it, but it is far from proven.
Yes, mifepristone (RU-486) is the French "abortion" drug, but it has other uses. Besides blocking progesterone receptors, it potently blocks cortisol receptors as well. Because of this, it is being used to treat Cushing's Disease, a condition in which the adrenal glands become overactive and secrete too much cortisol. Because there are theories suggesting that the adrenals, controlled by the hypothalamus and pituitary glands, secrete too much cortisol in depression, mifepristone was chosen to try treating refractory cases. Supposedly, a 7 day course of treatment yielded long-lasting results. Since I have only read the abstract and a few reviews, I don't know the details.
I'm sorry the rTMS proved inadequate. Have you ever tried imipramine or any other tricyclics? (I apologize if you have answered this question already).
- Scott
Posted by SLS on August 24, 2004, at 6:06:25
In reply to Re: Shouldn't there be a limit to this, tried rTMS » SLS, posted by iris2 on August 23, 2004, at 15:56:36
Hi Irene.
> By the way I think I remember you stating an interest if I tried milnacipran? I am getting a script for it so it will be a few weeks. Let me know if you have any interest in the result. I am interested in the Cymbalta. I tossed a coin as to which of the two to try.
>
> My "crystal Ball" was out of commission that day!
Good luck with the Milnacipran! I really hope it works for you.With Cymbalta, I felt a quick little "blip" improvement for a few hours after my first 30mg dose. Although I have felt nothing good since, I really don't expect anything until I have been on 60mg for at least two weeks. I don't move up in dosage for another two days. So far, I can't detect any side effects.
- Scott
Posted by Denise1904 on August 24, 2004, at 10:54:48
In reply to Re: To Scott » Denise1904, posted by SLS on August 24, 2004, at 6:00:46
Hi Scott,
That sounds great, taking a drug and it putting you back to normal again and then just being able to come off it and still be normal. That's what I want as I feel like Humpty Dumpty who just wants to be put back together again. I just hope there are no withdrawal effects from it. Will you be able to get hold of any from your Psychiatrist?
As far as tricyclics go, yes the first AD I ever took was prothiaden (think you know it as Dothiepin) when I was 24 and it worked wonders at a dose of only 75mg. Ironically I never really expected it to do anything as had never heard of antidepressants at that time and didn't believe I was depressed.
But this time round, with this episode or whatever you want to call it, which started 3 years ago (I'm now 38) tried the prothieden and went up to 300mg and it didn't work and all I ended up with was more anxiety and a seizure. The only thing that got me through those days was 10mg of Zyprexa when I was really, really desperate.
How do you know that your HPA axis is off kilter, have you had one of those dexamone (not sure how to spell it) suppression tests and how long have you been taking the Cymbalta?Denise
Posted by iris2 on August 24, 2004, at 11:10:39
In reply to Re: Shouldn't there be a limit to this, tried rTMS, posted by SLS on August 24, 2004, at 6:06:25
Scott,Thanks for telling me about your exerience with Cymbalta. I am interested and would appreciate it if you could update me about it at some later time?
I will be posting my experience with Milnacipran as I have read several posts inquiring about it.
By the way I sent a post to Andrewb for the information on Amisulpride. Is he still around? The post seemed to go through. Sometimes they do not get returned right away though.
I am doing well on it. I will not bore you with the details, as there is a lot of information on psycho-babble about it.
I do have one question of course!!
I am ordering the Milnacipran at 50mg I believe gel caps (so they cannot be cut) I did not order 25mg ones to begin with because of the expense. I can still do this. I plan on taking 50mg a day to start then 50mg b.i.d. What is your opinion?
irene
By the way I really appreciate all the help you have given to me.
irene
Posted by SLS on August 24, 2004, at 13:29:03
In reply to Re: To Scott, posted by Denise1904 on August 24, 2004, at 10:54:48
Hi there Humpty Dumpty.
> That sounds great, taking a drug and it putting you back to normal again and then just being able to come off it and still be normal. That's what I want as I feel like Humpty Dumpty who just wants to be put back together again. I just hope there are no withdrawal effects from it. Will you be able to get hold of any from your Psychiatrist?
I have made some preliminary contacts that should help me find mifepristone on a compassionate use basis. Believe it or not, the FDA has placed mifepristone on its "fast track" program for investigation into its use in depression. I guess the data from the initial studies were pursuasive enough.
Your experience with Dothiepin represents a scenario that is far too common. I hope doctors will soon be able to determine who needs to stay on an antidepressant long-term so as not to foster a circumstance of treatment-resistance by multiple exposures to medication.
> How do you know that your HPA axis is off kilter, have you had one of those dexamone (not sure how to spell it) suppression testsYup. My DST (dexamethasone suppression test) came back abnormal. Other tests have shown my cortisol levels to be too high.
> and how long have you been taking the Cymbalta?
I am day 5 of Cymbalta. I have been taking only 30mg, which is considered to be lower than what the manufacturer recommends as a starting dose. My doctor is being cautious. I'll defer to his judgment on this. I actually experienced a mood/function lift for a few hours after my first dose. Right now, the only side effect that is emerging is sleepiness. It is significant, though, and would be a real obstacle were it to continue. I think it will pass, though. I'm trying to keep up with a log of my experience with Cymbalta as a thread below listed as "Cymbalta (duloxetine) - report". I'll try to keep the subject line the same, as it gets edited from time to time.
What has been you history with the MAOIs (monoamine oxidase inhibitors)?
Zyprexa really can be a life-saver. I'm glad it did the job for you. I take a small amount of Abilify. I recieved a robust antidepressant effect during the first week. I think it still helps prevent me from reaching the desperate suicidal states that I sometimes experience. The one caveat when using Abilify is that it often produces anxiety and restlessness in the beginning. It usually passes, but it is important to understand that it is a likely startup side effect.
- Scott
Posted by SLS on August 24, 2004, at 13:39:57
In reply to Re: Shouldn't there be a limit to this, tried rTMS » SLS, posted by iris2 on August 24, 2004, at 11:10:39
Dear Irene,
> Thanks for telling me about your exerience with Cymbalta. I am interested and would appreciate it if you could update me about it at some later time?
I'm trying to maintain a log of my experience with Cymbalta along a thread titled "Cymbalta (duloxetine) - report". The one thing that is important to report is the emergence of somnolence (profound sleepiness). I'm guessing that it is just a startup side effect that will eventually pass.
> I will be posting my experience with Milnacipran as I have read several posts inquiring about it.
I look forward with excitement to see how you do with it. Good luck!
> By the way I sent a post to Andrewb for the information on Amisulpride. Is he still around? The post seemed to go through. Sometimes they do not get returned right away though.
How did you post to him - email? I use to have a copy of the synopsis he composed regarding amisulpride, but it got lost when I transfered data to my new computer.
> I am doing well on it. I will not bore you with the details, as there is a lot of information on psycho-babble about it.
I don't get bored. Did you feel an improvement within the first few days? How is it treating you otherwise?
> I do have one question of course!!
>
> I am ordering the Milnacipran at 50mg I believe gel caps (so they cannot be cut) I did not order 25mg ones to begin with because of the expense. I can still do this. I plan on taking 50mg a day to start then 50mg b.i.d. What is your opinion?The dosage range for milnacipran (Ixel) is 50-200mg per day. It has a half-life of 8 hours. I think your plan makes sense.
> By the way I really appreciate all the help you have given to me.
I apologize that my posts are so short. I wish I had the mental energy to elaborate on things more. I hope you don't mind if I say a little prayer for you. I don't think it could hurt. :-)
Take care,
- Scott
Posted by iris2 on August 24, 2004, at 17:41:11
In reply to Re: Shouldn't there be a limit to this, tried rTMS » iris2, posted by SLS on August 24, 2004, at 13:39:57
> I apologize that my posts are so short.Your posts are great. I always come away with a smile, and that takes some doing!
> Did you feel an improvement within the first few days? How is it treating you otherwise?
I have had improvement on the amisulpride within the first couple of days I call it a mood shift. Not much motivation stuff. Definitely taking a lot less benzo's and less oxycontin after the first couple of days on it. So having less anxiety for sure.
> How did you post to him - email?
emailed AndrewB.I think about you often, that is my way of prayer.
Wishing this works for you.
irene
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.