![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Nagash on October 7, 2004, at 12:42:44
Hi,
to put a long story short, I don't feel too well. I don't know where it all started as I don't have good recollections of my childhood. However, after my parents divorced I began to have trouble at school. I was ~13 at the time, my grades dropped significantly, I was misbehaving, some teachers detested me, I wasn't very popular (had some friends but people often made fun of me). A teenage first love complicated things even more, I remember that there was a time where I could hardly get up from bed. Performed poorly in sports, my self-esteem was nil, you get the idea.
I received no help from parents (didn't want them in my life in fact), from school or friends (we were too young), so I had to recover myself, but scars remain.
I have a history of drug use. This has been evaluated by a psychologist and no dependence was found, but I do use drugs and don't feel like quitting, because GHB and speed do make my life enjoyable, to some degree.
I've been able to pass high school with good results and start university, so my intelligence isn't much impaired. Still, I feel no pride for the fact that I scored 18th among over 1000 candidates to the University. I can't get any joy from anything.
I have a persisent feeling of emptiness and loneliness. I can cope with it, but world doesn't seem like a nice place.
I have a tendency to engage into toxic relationships, with girls equally liable emotionally or abusive/deceptive ones. For the past 1,5 years even tho I'm young and rather attractive, I have dated nobody.
After periods of severe depression (5 years ago) and anxiety problems (due to a relationship with a possible BPD and difficult exams that, in my parents' opinion, I couldn't fail), now my life is void. I feel numb. Hardly any sexual drive, even on GHB, which has begun troubling me. I have dozens of famale friends, but don't feel attracted to any, and even if I do, I feel that flirting is pointless, because I don't want any closeness, too troublesome.
Yet the emptiness and loneliness remains, the Weltschmerz, the feeling that the whole world is a chain of chemical reactions, all adhere to the 2nd rule of thermodynamics, without any sense or reason.
There were times where I would feel joyful and in awe, be it on LSD, MDMA or even sober. But these were rare events in a dull life.
I've become indifferent and detached. I can go out with my friends, but often feel like it doesn't make any sense, like I'm not there, acting. Most of the time I get out of bed because I force myself to, not because I want to. Everything is an effort. My room is always a mess, my car's a mess. I hate challenges. I oversleep whenever I can. Despite being lethargic, I am anxious at times.
I tried seeking professional help. One psychiatrist would not listen to me, even deny what I'm saying and just put me on drugs. The other one, despite being a wise and charming woman, doesn't seem to help much as she wouldn't come up with any diagnosis other than "depressive temper, triggered by unhappy events, pessimistic approach and hypersensitivity". All the psychologists/therapists see, OTOH, is polydrug abuse and all they say is trying to force me to quit drugs. Like there was any fucking difference between chemicals from the pharmacy and illicit ones.
So at first I was on fluoxetine, 20mg/day. Jitteriness was apparent, mood improvement was nil, so I quit. Then there was venlafaxine (Efectin/Effexor) at 112.5mg/day. Mood improvement was slight, but I developed a rash and hat to quit abruptly. Withdrawals convinced me that I don't want to fuck with this drug ever again. Moclobemide had some improvement on my motivation, but the jitteriness was unbearable, and I was close to a psychosis, partially due to sleep deprivation. Mianserin (Lerivon/Bolvidon) was quite successful at combating my anxiety and insomnia, but left me even more lethargic and indifferent. Melatonin nor 5-HTP didn't improve my sleep. Sulpiride (100mg/day) also left me too lethargic to continue the treatment.
So I take speed to get things done and feel alive. Then I have to take clonazepam for my insomnia, or GHB to take the edge off life (I'd probably be alcoholic otherwise). But this can't go on forever, I want a god damn diagnosis and a medication. I suspect that my problem is dopamine-related, as I also suffer from Restless Legs Syndrome, which, especially on sulpiride or GHB (which can be dopamine antagonists), can become unbearable. Unfortunately, there are no dopamine meds approved for mood disorders in my country, so I have to search on my own.
Other than whilst being kinda fucked up on GHB or speed, the best I've felt was after introspective LSD trips, as hopeless as it sounds.
Is there anything I can do to improve my life? Anything that I could read that would shed some light on my condition? Any meds? I don't have mych faith in psychologists anymore.
Of course, I can go on as long as I have access to GHB, but otherwise, my pillow is wet every other night, my head is full of suicidal ideations, wishes for never being born.This sucks. I don't feel that I'm worthless enough to feel like shit, I think I deserve a decent, joyful life, and I am doing all I can to get one.
If I fail, I might very well take my life from me. Other than hopes for a better tommorow, there is nothing I want to live for. Not my family, not my passions, nothing.If there are any errors or something doesn't make sense, please excuse me, I don't speak English natively.
Posted by Sad Panda on October 7, 2004, at 13:32:10
In reply to Dysthymic, kinda. What else can I try?, posted by Nagash on October 7, 2004, at 12:42:44
> Hi,
>
> to put a long story short, I don't feel too well. I don't know where it all started as I don't have good recollections of my childhood. However, after my parents divorced I began to have trouble at school. I was ~13 at the time, my grades dropped significantly, I was misbehaving, some teachers detested me, I wasn't very popular (had some friends but people often made fun of me). A teenage first love complicated things even more, I remember that there was a time where I could hardly get up from bed. Performed poorly in sports, my self-esteem was nil, you get the idea.
>
> I received no help from parents (didn't want them in my life in fact), from school or friends (we were too young), so I had to recover myself, but scars remain.
>
> I have a history of drug use. This has been evaluated by a psychologist and no dependence was found, but I do use drugs and don't feel like quitting, because GHB and speed do make my life enjoyable, to some degree.
>
> I've been able to pass high school with good results and start university, so my intelligence isn't much impaired. Still, I feel no pride for the fact that I scored 18th among over 1000 candidates to the University. I can't get any joy from anything.
>
> I have a persisent feeling of emptiness and loneliness. I can cope with it, but world doesn't seem like a nice place.
>
> I have a tendency to engage into toxic relationships, with girls equally liable emotionally or abusive/deceptive ones. For the past 1,5 years even tho I'm young and rather attractive, I have dated nobody.
>
> After periods of severe depression (5 years ago) and anxiety problems (due to a relationship with a possible BPD and difficult exams that, in my parents' opinion, I couldn't fail), now my life is void. I feel numb. Hardly any sexual drive, even on GHB, which has begun troubling me. I have dozens of famale friends, but don't feel attracted to any, and even if I do, I feel that flirting is pointless, because I don't want any closeness, too troublesome.
>
> Yet the emptiness and loneliness remains, the Weltschmerz, the feeling that the whole world is a chain of chemical reactions, all adhere to the 2nd rule of thermodynamics, without any sense or reason.
>
> There were times where I would feel joyful and in awe, be it on LSD, MDMA or even sober. But these were rare events in a dull life.
>
> I've become indifferent and detached. I can go out with my friends, but often feel like it doesn't make any sense, like I'm not there, acting. Most of the time I get out of bed because I force myself to, not because I want to. Everything is an effort. My room is always a mess, my car's a mess. I hate challenges. I oversleep whenever I can. Despite being lethargic, I am anxious at times.
>
> I tried seeking professional help. One psychiatrist would not listen to me, even deny what I'm saying and just put me on drugs. The other one, despite being a wise and charming woman, doesn't seem to help much as she wouldn't come up with any diagnosis other than "depressive temper, triggered by unhappy events, pessimistic approach and hypersensitivity". All the psychologists/therapists see, OTOH, is polydrug abuse and all they say is trying to force me to quit drugs. Like there was any fucking difference between chemicals from the pharmacy and illicit ones.
>
> So at first I was on fluoxetine, 20mg/day. Jitteriness was apparent, mood improvement was nil, so I quit. Then there was venlafaxine (Efectin/Effexor) at 112.5mg/day. Mood improvement was slight, but I developed a rash and hat to quit abruptly. Withdrawals convinced me that I don't want to fuck with this drug ever again. Moclobemide had some improvement on my motivation, but the jitteriness was unbearable, and I was close to a psychosis, partially due to sleep deprivation. Mianserin (Lerivon/Bolvidon) was quite successful at combating my anxiety and insomnia, but left me even more lethargic and indifferent. Melatonin nor 5-HTP didn't improve my sleep. Sulpiride (100mg/day) also left me too lethargic to continue the treatment.
>
> So I take speed to get things done and feel alive. Then I have to take clonazepam for my insomnia, or GHB to take the edge off life (I'd probably be alcoholic otherwise). But this can't go on forever, I want a god damn diagnosis and a medication. I suspect that my problem is dopamine-related, as I also suffer from Restless Legs Syndrome, which, especially on sulpiride or GHB (which can be dopamine antagonists), can become unbearable. Unfortunately, there are no dopamine meds approved for mood disorders in my country, so I have to search on my own.
>
> Other than whilst being kinda fucked up on GHB or speed, the best I've felt was after introspective LSD trips, as hopeless as it sounds.
>
> Is there anything I can do to improve my life? Anything that I could read that would shed some light on my condition? Any meds? I don't have mych faith in psychologists anymore.
> Of course, I can go on as long as I have access to GHB, but otherwise, my pillow is wet every other night, my head is full of suicidal ideations, wishes for never being born.
>
> This sucks. I don't feel that I'm worthless enough to feel like shit, I think I deserve a decent, joyful life, and I am doing all I can to get one.
> If I fail, I might very well take my life from me. Other than hopes for a better tommorow, there is nothing I want to live for. Not my family, not my passions, nothing.
>
> If there are any errors or something doesn't make sense, please excuse me, I don't speak English natively.
>
>
Hi,I would think that you have 'atypical depression'. I had all the same symptoms as you plus feelings of guilt. For me Prozac was a failure too, but I had more luck with Effexor. The problem with Effexor is it's side effects but I added a second drug to cover these called Remeron which is very close to Mianserin(brother drugs). This combination has been good, but it didn't help apathy, so recently I changed from Remeron to an older antidepressant Amitriptyline.
For you I would recommend that you try another SSRI(Zoloft or Lexapro) first before trying the older TCAs or MAOIs & I would probably plan on being on more than just one drug too because it is probably rare to find just one drug that does everything.
Cheers,
Paul.
Posted by Cruz on October 7, 2004, at 14:14:04
In reply to Dysthymic, kinda. What else can I try?, posted by Nagash on October 7, 2004, at 12:42:44
It seems our conditions have many similarities. Your are more fortunate since I am currently 45 and have been stuggling with this forever. I do respond quite well to Parnate. Unfortunately it loses its efficacy after 3 months. Maybe it will be effective long term for you. I am currently trying Cymbalta with an occasional Nizoral(to lower Cortisol). Many of us have an imbalance in our endocrine system. It's encouraging to finally see some progress in the understanding of HPA axis irregularities in people with mood disorders. It looks like it will be a few years until treatments are available. I just encourage you to try treatments that are out there now. We just need to get by till these disorders are understood and appropriate treatments are here. Best wishes.
Posted by Nagash on October 8, 2004, at 5:42:19
In reply to I would suggest Parnate » Nagash, posted by Cruz on October 7, 2004, at 14:14:04
Parnate is not registered here ;( Neither is Cymbalta. What do you mean by "HPA axis"? That sounds interesting that any progress is being made. Personally, I have all electrolytes is balance. Haven't checked my FT3,FT4 blood levels and catecholamine concentrations in urine yet.
As for the other post, Lexapro is not registered too. Only Celexa.
I was thinking about Mirapex, but it's quite expensive, and I don't know if I'd convince my doc to prescribe it off label.
> It seems our conditions have many similarities. Your are more fortunate since I am currently 45 and have been stuggling with this forever. I do respond quite well to Parnate. Unfortunately it loses its efficacy after 3 months. Maybe it will be effective long term for you. I am currently trying Cymbalta with an occasional Nizoral(to lower Cortisol). Many of us have an imbalance in our endocrine system. It's encouraging to finally see some progress in the understanding of HPA axis irregularities in people with mood disorders. It looks like it will be a few years until treatments are available. I just encourage you to try treatments that are out there now. We just need to get by till these disorders are understood and appropriate treatments are here. Best wishes.
Posted by craig getty on October 9, 2004, at 17:35:17
In reply to Dysthymic, kinda. What else can I try?, posted by Nagash on October 7, 2004, at 12:42:44
My experience is similar. I've been on many different combos over the past ten years (I'm 33). Here's what I'm on now which is kind of working:
Wellbutrin SR (300 mg)
Adderrall ER (20 - 40 mg)
Clonazepam (as needed...from 0.25 - 1.00 mg)Another combo that worked for a while was:
Wellbutrin SR (400 mg)
Effexor (whatever the max dose is, I can't remember)As far as MAOIs:
Nardil was great for awhile, but it made me too tired. If I ever go on it again, I would want to add a stimulant (6 cups of coffee a day plus Provigil couldn't even help).Parnate did nothing for me, but has helped a lot of people.
Hang in there....
Posted by fuzz54 on October 11, 2004, at 22:19:57
In reply to Dysthymic, kinda. What else can I try?, posted by Nagash on October 7, 2004, at 12:42:44
I'm having the same symptoms. General dysthymic and some social anxiety issues that I've had since childhood. I can relate to the loss of interest in everything and the drop in sex drive and the "why bother" view on even trying to date. Suicidal thoughts too, but I'm fighting those since suicide really really doesn't make any sense except in the middle of depression when my thoughts are all distorted. I'm 27 and it's been getting progressively worse for the last two years. I've finally decided to seek treatment. If I have any success with this I'll let you know. Keep fighting. I get by with the hope that things will get better. I'm guessing that anyone who has ever recovered from this kind of thing would tell you that the depression distorts your view on your situation and that help will come with time if you can be patient.
Posted by nagash on December 10, 2004, at 15:43:00
So it's been 2 months since my initial previous post to the forum:
http://www.dr-bob.org/babble/20041007/msgs/399975.html
Not much has changed. My mental condition is quite OK (it wasn't the other day, tho, but that just happens), but I am still insatisfied. My motivation is ZERO. My chores are absolutely killer for me, god damn, go to a gas station and refuel the god damn car is a god damn punishment, never mind studying for the upcoming exams, which I hence do not exactly view in very bright colors.
So I, dear friends, have decided it is high time to, well... do something?
I'm not the "oh I suck, I'm miserable" depressed kind of person, of course I am far from waking up with a smile, but I cope.What must be addressed first is motivation. SSRIs won't get me motivated, they'll fuck me up.
I've been thinking about something dopamine-related:
Wellbutrin SR (Bupropion)? But I can only afford 150mg/day
Amantadine 100mg/day?
Pergolide (Permax) 1mg/dayQuestionable:
Bromocriptine - because of its moderate efficiacy and fast pooping-out?Mirapex (Pramipexole) is out of question cause I can only afford 0,36mg/day -- worthwhile?
Concerta/Ritalin (Methylphenidate) because it's SOOO controlled here even legit hardcore ADHD people don't get it.Amphetamine - because that's what I'm self-medicating with now. And I managed to develop a funny nauseous-indifferent feeling from it. Only the insomnia and sweaty palms are always there.
When I do a lot in the day, like sports, I don't have trouble sleeping. When I do nothing all day long (as I do now), I have trouble sleeping, which I ameliorate with benzodiazepines and GHB whenever I have access to it. My benzo tolerance is another thing to be addressed, though ;)
I've also ordered Phenibut for its reported nootropic and social-motivational properties. Has anone had any experience with this compound? Or Picamilon? But in terms of social anxiety I don't seem to be bothered by others anymore. I just don't care :(
Thanks for making it to this point of the post :) I hope you can help he choose the best medication to give a shot. Just to get my life back, finally, and possibly get the god damn degree on the god damn academy. Wish me luck, I still have hope.
Posted by Iansf on December 10, 2004, at 16:31:06
In reply to Time to act, at last... ?, posted by nagash on December 10, 2004, at 15:43:00
Since you can't afford more than 150mg Wellbutrin-XR a day, why don't you consider generic buproprion? It's much cheaper, and even if it doesn't come in extended release form, taking it three times a day is not that much of a hassle. Sure, you may forget a dose now and then, but that's not an especially big deal. Bupropion is one of the more motivating drugs, and even if it doesn't turn you into a walking ray of sunshine, it might at least make your life brighter than it is now.
> So it's been 2 months since my initial previous post to the forum:
>
> http://www.dr-bob.org/babble/20041007/msgs/399975.html
>
> Not much has changed. My mental condition is quite OK (it wasn't the other day, tho, but that just happens), but I am still insatisfied. My motivation is ZERO. My chores are absolutely killer for me, god damn, go to a gas station and refuel the god damn car is a god damn punishment, never mind studying for the upcoming exams, which I hence do not exactly view in very bright colors.
>
> So I, dear friends, have decided it is high time to, well... do something?
> I'm not the "oh I suck, I'm miserable" depressed kind of person, of course I am far from waking up with a smile, but I cope.
>
> What must be addressed first is motivation. SSRIs won't get me motivated, they'll fuck me up.
> I've been thinking about something dopamine-related:
> Wellbutrin SR (Bupropion)? But I can only afford 150mg/day
> Amantadine 100mg/day?
> Pergolide (Permax) 1mg/day
>
> Questionable:
> Bromocriptine - because of its moderate efficiacy and fast pooping-out?
>
> Mirapex (Pramipexole) is out of question cause I can only afford 0,36mg/day -- worthwhile?
> Concerta/Ritalin (Methylphenidate) because it's SOOO controlled here even legit hardcore ADHD people don't get it.
>
> Amphetamine - because that's what I'm self-medicating with now. And I managed to develop a funny nauseous-indifferent feeling from it. Only the insomnia and sweaty palms are always there.
>
> When I do a lot in the day, like sports, I don't have trouble sleeping. When I do nothing all day long (as I do now), I have trouble sleeping, which I ameliorate with benzodiazepines and GHB whenever I have access to it. My benzo tolerance is another thing to be addressed, though ;)
>
> I've also ordered Phenibut for its reported nootropic and social-motivational properties. Has anone had any experience with this compound? Or Picamilon? But in terms of social anxiety I don't seem to be bothered by others anymore. I just don't care :(
>
> Thanks for making it to this point of the post :) I hope you can help he choose the best medication to give a shot. Just to get my life back, finally, and possibly get the god damn degree on the god damn academy. Wish me luck, I still have hope.
Posted by nagash on December 10, 2004, at 17:09:54
In reply to Time to act, at last... ?, posted by nagash on December 10, 2004, at 15:43:00
Or, correct me if I'm wrong, doesn't escitalopram (Lexapro) which I haven't tried make people motivated?
Also, what do you think of Piribedil? It's much cheaper in my area, seems to be more selective, cause less somnolence, no narcolepsy, but there's little research...
Posted by nagash on December 10, 2004, at 17:16:30
In reply to Re: Time to act, at last... ? » nagash, posted by Iansf on December 10, 2004, at 16:31:06
Thanks for your input. I can't afford Wellbutrin because I am located in an eastern european country and drug prices are ridiculous here, some are a lot cheaper than in the rest of the world, some are not. Actually, I could afford 450mg Wellbutrin no problem, if that would do the trick.
I am more and more thinking about Piribedil because a common mid-dose (200mg) is comparable to the price of Wellbutrin SR (at 150mg still being a threshold dose).
Also, do you think I should stick to these drugs exclusively or seek a make-me-feel-good SSRI like Lexapro to top it all?
> Since you can't afford more than 150mg
> Wellbutrin-XR a day, why don't you consider
> generic buproprion? It's much cheaper, and even
> if it doesn't come in extended release form,
> taking it three times a day is not that much of
> a hassle. Sure, you may forget a dose now and
> then, but that's not an especially big deal.
> Bupropion is one of the more motivating drugs,
> and even if it doesn't turn you into a walking
> ray of sunshine, it might at least make your
> life brighter than it is now.
Posted by Iansf on December 11, 2004, at 0:38:47
In reply to Re: Time to act, at last... ?, posted by nagash on December 10, 2004, at 17:16:30
> Thanks for your input. I can't afford Wellbutrin because I am located in an eastern european country and drug prices are ridiculous here, some are a lot cheaper than in the rest of the world, some are not. Actually, I could afford 450mg Wellbutrin no problem, if that would do the trick.
>
> I am more and more thinking about Piribedil because a common mid-dose (200mg) is comparable to the price of Wellbutrin SR (at 150mg still being a threshold dose).
>
> Also, do you think I should stick to these drugs exclusively or seek a make-me-feel-good SSRI like Lexapro to top it all?
>
Piribedil is yet another med I have never heard of before - there seem to be so many of them.Personally, I found Lexapro completely ineffective, but don't let that discourage you from trying it. Many people find it very useful. Wellbutrin reduces my depression but doesn't actually allow me to reach a happy state. It kind of leaves me in the middle - not depressed, not happy, just reasonably OK. I've added Cymbalta and it had definitely improved my mood, plus given me more focus. Prozac and Luvox, both serotonin boosting drugs, also lifted my mood a lot, though I didn't like the side effects.
What you say about drug prices surprises me. I would have thought medication would be cheaper in Eastern Europe since so much else is. I know a number of people who have gone to Eastern European countries for dental care because the cost, even with airfare, hotel, etc., is cheaper than in Western Europe. I guess the world is simply inconsistent all around.
Posted by Nagash on December 11, 2004, at 7:05:10
In reply to Re: Time to act, at last... ?, posted by Iansf on December 11, 2004, at 0:38:47
> Piribedil is yet another med I have never heard > of before - there seem to be so many of them.
Piribedil is a novel D3 dopamine agonist, thought to be anti-anhedonic, improve response to stimuli, motivation and reward.
This is exactly what I'm short on.
It's similar to, but more selective than Mirapex.> Personally, I found Lexapro completely
> ineffective, but don't let that discourage you
> from trying it. Many people find it very
> useful. Wellbutrin reduces my depression but
> doesn't actually allow me to reach a happy
> state. It kind of leaves me in the middle - not
> depressed, not happy, just reasonably OK. I've
> added Cymbalta and it had definitely improved
> my mood, plus given me more focus. Prozac and
> Luvox, both serotonin boosting drugs, also
> lifted my mood a lot, though I didn't like the
> side effects.I hate SSRIs because they turn be into zombies, they don't do much to my mood (it's actually OK most of the time), they stop me from thinking about sex, etc etc.
I just thought escitalopram is selectie enough to lack most of the side effects.By the way, cymbalta is not available here I guess. What's the generic name?
> What you say about drug prices surprises me. I
> would have thought medication would be cheaper
> in Eastern Europe since so much else is. I knowYes, most drugs are a lot cheaper.
Pronoran (Piribedil by Servier) costs 10 EUR per 30 tablets a 50mg which is A LOT cheaper I believe.Permax (Pergolide by Eli Lilly) costs 15 EUR per 30 tablets a 0,25mg which is also cheaper. It's down to 4 EUR if you're insured and have Parkinson's.
On the other hand,
Zyban (Bupropion by GSK) costs 33 EUR per 30 tabs a 150mg which I believe is normal price.Seroquel (Quetiapine by AstraZeneca) costs 140 EUR (!) per 60 tabs per 200mg.
So some pharm companies give a fuck, some do not.
On the other hand, as soon as there are generics available, prices drop ridiculously:
Relanium (Diazepam by GSK) costs 0,30 EUR per 20 tabs per 2mg. You heard that right :)> a number of people who have gone to Eastern
> European countries for dental care because the
> cost, even with airfare, hotel, etc., is
> cheaper than in Western Europe. I guess the
> world is simply inconsistent all around.Yes, dental care is much cheaper in Poland, that's true, it's not worse (when in a private clinic), tho. Prices for surgery are also generally cheaper.
Posted by dove on December 13, 2004, at 9:33:20
In reply to Re: Time to act, at last... ?, posted by Nagash on December 11, 2004, at 7:05:10
While Mianserin (Lerivon/Bolvidon) helped with your anxiety and sleep problems, did it agitate your Restless Legs Syndrome? If not, then my first recommendation is to try Remeron (generic-mirtazapine) before bed. At lower doses it is more sleep enhancing, at higher doses (45 mgs.) it is more activating and has more norepinephrine releasing properties (while still being a great sleep enhancer). Combine with Reboxetine or a more activating TCA (Nortriptyline, desipramine).
How much amphetamine are you taking daily? And are you ingesting it (rather than "tweaking" or "spinning")? There are some strategies for lowering tolerance and getting the most out of amphetamine's synergies. Be aware that amphetamine can cause a worsening of depression as well as complicating its treatment (in addition to causing ambivalence to pleasurable activates at higher doses.).
Cymbalta's generic name is duloxetine, a dual reuptake inhibitor, and definitely worth looking into.
Personally, I would try a combo of an activating AD, whether a TCA, SSRI, or SNRI with Remeron (mirtazapine) or Mianserin (Lerivon/Bolvidon). If I was going the Wellbutrin (bupropion) route, I would try that alone for a few weeks before adding anything else. I would also add a CNS stimulant to the first combo, but in small amounts and after a few weeks in order to adjust properly.
I am currently on Effexor 225 mg, Prozac 20 mg, Adderall 40 mg (20, 10, 10), Remeron 45 mg (before bed) with 2 mg of sublingual Melatonin. I have also taken klonopin with this combo for panic attacks and severe anxiety but haven't needed it at all for many (5) months.
One other med I still think is worth looking at is the MAOI Parnate, although it has some food and med interactions that would need to be taken seriously. Parnate and Cymbalta (duloxetine) are the two meds I have in mind should my combo begin to fail. However, I suffer from severe major depression. Lexapro might be something to consider, especially in combo with mirtazapine or mianserin.
just some thoughts...
dove
Posted by Nagash on December 14, 2004, at 8:21:46
In reply to Re: Time to act, at last... ?, posted by dove on December 13, 2004, at 9:33:20
> While Mianserin (Lerivon/Bolvidon) helped with
> your anxiety and sleep problems, did it agitate
> your Restless Legs Syndrome? If not, then mySort of.
> first recommendation is to try Remeron
> (generic-mirtazapine) before bed. At lower
> doses it is more sleep enhancing, at higher
> doses (45 mgs.) it is more activating and has
> more norepinephrine releasing properties (while
> still being a great sleep enhancer). Combine
> with Reboxetine or a more activating TCA
> (Nortriptyline, desipramine).
Remeron is too god damn expensive for what it offers, I guess. And if it also makes me sleep for 10h with additional 2 hours of being a zombie, then it's a no-no.> How much amphetamine are you taking daily? And
> are you ingesting it (rather than "tweaking" or
> "spinning")? There are some strategies for
> lowering tolerance and getting the most out of
> amphetamine's synergies. Be aware thatHard to say as it's black market. I usually take it sublingually, I'd say 30-50mg daily but purity can be anywhere from 60 to 80% here.
I take 1g Magnesium+B6, 15mg DXM to prevent rapid tolerance development and 1200mg Tyrosine daily to help replenish my dopamine.
> amphetamine can cause a worsening of depression
> as well as complicating its treatment (in
> addition to causing ambivalence to pleasurable > activates at higher doses.).I am perfectly aware of that and I am sure I want to quit this drug. As soon as I find a substitute I'll sacrifice those 2 or 3 days of moodines during the withdrawal. Or I might try tapering down.
> Cymbalta's generic name is duloxetine, a dual
> reuptake inhibitor, and definitely worth
> looking into.Not registered here ;( I see it costs $100 for a month's treatment, plus all the unreliableness of an international supply, I think this might be too much hassle for something which has a profile similar to venlafaxine, which didn't work for me, except for producing terrible withdrawals.
> Personally, I would try a combo of an
> activating AD, whether a TCA, SSRI, or SNRI
> with Remeron (mirtazapine) or Mianserin
> (Lerivon/Bolvidon). If I was going the
> Wellbutrin (bupropion) route, I would try that
> alone for a few weeks before adding anything
> else. I would also add a CNS stimulant to the
> first combo, but in small amounts and after a
> few weeks in order to adjust properly.Well, I strongly believe that my anxiety is somehow linked to my motivation. If I am at ease, I am more motivated. GHB did wonders for me, I will give Phenibut a try now.
> I am currently on Effexor 225 mg, Prozac 20 mg,
> Adderall 40 mg (20, 10, 10), Remeron 45 mg
> (before bed) with 2 mg of sublingual Melatonin.
> I have also taken klonopin with this combo for
> panic attacks and severe anxiety but haven't
> needed it at all for many (5) months.This is an impressive cocktail. I would really prefer to stick to 1 or 2 meds, for several reasons.
> One other med I still think is worth looking at
> is the MAOI Parnate, although it has some food
> and med interactions that would need to be
> taken seriously. Parnate and Cymbalta
> (duloxetine) are the two meds I have in mind
> should my combo begin to fail. However, I
> suffer from severe major depression. Lexapro
> might be something to consider, especially in
> combo with mirtazapine or mianserin.I've heard good things about Parnate but it's not registered either :( I can see you have a lot of experience with prescription drugs, mine are smaller and, thus far, mostly negative. This is why I want to evaluate dopaminergic and GABAergic drugs. Especially since both ease up my RLS, so there may exist a link...
> just some thoughts...
Thanks for your input.
Posted by Rhonda Jo on April 5, 2005, at 21:14:41
In reply to Dysthymic, kinda. What else can I try?, posted by Nagash on October 7, 2004, at 12:42:44
Sweetie,
I've been a mom for a long time and I have a lot of children. You sound like you could use a hug and a ride to an NA meeting. my advice is to stop the drug abuse. I don't care what a doctor told you, use are a drug abuser. Find a meeting and start running or walking outside,even when you don't feel like it. Smile and everyone you see, they will smile back.Think of every smile as a hug. You might even make a friend or two along the way.
You are blessed with a life and a good head on your shoulders. Sounds like you are a good student when you want to be. Find your passion.....then throw yourself into it.
good luck....
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