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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 83. Go back in thread:
Posted by bassman on September 24, 2006, at 13:00:18
In reply to Re: Time for Maoi-- Listen to SLS, jaclin, exq » Jost, posted by Phillipa on September 24, 2006, at 12:32:44
You always write such comforting notes to people...esp., I notice, when not many other people have responded. Anyone reading what you've written would know you as a caring person-which, BTW, the world is very short on at the moment. See the pdoc, see what can be done, and most of all, hang in there and try to see the presnet moment as "just a bad time"-I KNOW how hard that is, but it may well be realistic. And keep us all updated on what's happening with you!
Love,
bassman
Posted by SLS on September 24, 2006, at 13:00:28
In reply to Re: Time for Maoi-- Listen to SLS, jaclin, exq, posted by Jost on September 24, 2006, at 11:38:35
> You've just got to close your eyes and jump (or dive) into the water. You'll be able to swim--
"even if you get some water into your nose, or the noise underwater is scary at first."
This is a great statement. Some of the drugs that work the best can feel the weirdest when you first start taking them. Be prepared for this. Just take things one step at a time with these drugs. Side effects that appear early in treatment often disapper later or lessen in intensity. For me, Nardil was sedating at first and left me feeling foggy, but became energizing and produced clarity of thought later on.
If you feel more comfortable with Emsam right now, that's ok. It has demonstrated both energizing and anxiolytic effects. These are the things you need. If after giving Emsam a full trial of at least 3 weeks at a dosage of at least 9mg/24hr, you do not feel any better, you can move on to one of the other MAOIs. Because of your GAD, I would suggest making Nardil your next stop. There are people who respond to one MAOI and not to another, just like all the other antidepressants. No one knows why. That's just the way it is. In a way, that will always offer hope whenever you come across a drug that you haven't tried yet. I'm sorry to have to spoil your depressed mood. :-) There is hope for you in MAOIs. No guarantees, but hope.
Don't neglect your emotional and psychological health. Medication doesn't deal with issues, people do. Medication corrects the affective environment within which issues exist and makes them much easier to process and deal with. A biological depression creates psychological and social issues as it destroys one's life. Unfortunately, when this depression disappears, these issues don't disappear with it. It takes work to clean up the mess. Psychotherapy and counselling can be a big help in accomplishing this. Things are much harder while the depression is still present, but progress is not impossible. Sometimes, accomplishment is simply to learn ways to cope with depression and anxiety, and to live in the moment. Since you're not doing anything anyway, why don't you start cleaning up the mess while you're waiting for these drugs to work and get a head-start on things?
- Scott
Posted by notfred on September 24, 2006, at 13:11:52
In reply to Time for an MAOI - Sorry - Above For » Phillipa, posted by SLS on September 24, 2006, at 11:10:41
>
> Avoid people who speak with negavitity. Avoid cynicism. They are sinkholes and will drain you of your positive energy.Agreed. Seek out those who have the skills you wish to aquire. If you are looking for a sucessful outcome then what is to gain by focusing on others
negative outcomes ?
>Time for a real MAOI. What do you think?Totally. Being consertative, everyone should try several MAOI's once the usual suspects of meds has been tried. At least in the context of depressives
and anxiety problems.After 10 years of no remission I think a consult with a top psycoharmacologist is well worth it.
Posted by Phillipa on September 24, 2006, at 13:16:14
In reply to Re: Time for Maoi--, posted by Jost on September 24, 2006, at 12:59:30
Jost if Greg were home with me I wouldn't be so afraid. I have to take care of the pups. And when he goes to work I go right after him as I'm afraid of being alone. Then once there I'm bored but afraid to leave. I hate myself. See when I was talking a lot with Robert David he used to even call me on the phone from California and talk me through things. He's doing well and may even give it up sometime. Oh well he's not me. See making decisions is the hardest part. And the last time at the pdoc she asked if I wanted the hospital . I said no as the last time there they put in geriatrics and pulled all the benzos out from under me and put me in withdrawal sent me home what a mess. So I can never go into a hospital again. As you can see this is a parmount decision for me. I'm still at 25mg of luvox per the pdoc. So that's two more weeks. Oh why does life have to be so hard? Love Jan
Posted by jaclinhyde on September 24, 2006, at 13:17:54
In reply to Re: Time for Maoi -- Other stuff too. » Phillipa, posted by SLS on September 24, 2006, at 13:00:28
Honestly Phillipa, I would skip Emsam and just go for the big MAOI guns like Nardil, Marplan or Parnate. Emsam doesn't pack the powerful punch that the others do. I am on it now and although I know it is working I wasn't that bad before taking it. I did need something but could get by albeit miserably without it. You however need to start on something that has a proven successful track record for almost everyone who takes it. Like me Phillipa serotonin probably isn't your problem or isn't the only brain chemical that needs tinkering with. There is dopamine and norepinephrine too. An Maoi hits them all. If I were your doctor I would go with Parnate as it is the quickest acting and won't produce any sleepiness like Nardil and Marplan usually do at the beginning. Plus you would have the added bonus of no weight gain (normally) and in fact some weight loss is possible. Don't know if you need that bonus or not.
Sounds to me like you need to get off the SSRI rollercoaster.
I will babblemail now that I have figured out how to change my email address here :-)
Hugs and much love,
Terri
Posted by SLS on September 24, 2006, at 13:26:45
In reply to Re: Time for Maoi -- Other stuff too. » Phillipa, posted by SLS on September 24, 2006, at 13:00:28
After reading what you wrote last, perhaps you can disregard most of my previous post.
I don't want to shove psychotherapy down your throat, but I know it sounds like I am. If you are worried about sexual tension in psychotherapy, find a woman therapist. I don't know, Jan. It is a lot of work. If it is not right for you at this time, then it just isn't.
I know it is hard for you to decide what to do.
Depression and anxiety are contributing to this.
Just know that I care.
Some people are telling you not to do anything that doesn't feel right.
Jost is giving you a gentle nudge.
I don't know what to tell you.
* Definition of insanity:
"Doing the same thing over and over and expecting different results."
Do the Luvox thing or give it up. Work up to 300mg as tolerated for 6 weeks. Don't waste any more time with this thing. Do it or don't do it. If you did it already, move on.
Refresh my memory: How high a dosage did you reach and how long were you at that dosage? How did you feel at that dosage?
- Scott
Posted by linkadge on September 24, 2006, at 14:48:58
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!He, posted by notfred on September 24, 2006, at 0:02:17
I didn't find the ratings for meds on crazy meds particularly encouraging.
Linkadge
Posted by notfred on September 24, 2006, at 15:00:37
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!He, posted by linkadge on September 24, 2006, at 14:48:58
> I didn't find the ratings for meds on crazy meds particularly encouraging.
>
> LinkadgeI would not expect you to.
Posted by Phillipa on September 24, 2006, at 15:46:45
In reply to Re: Time for Maoi -- Other stuff too. » Phillipa, posted by SLS on September 24, 2006, at 13:26:45
Scott luvox started the whole thing in a way. My TSH when out of range anxiety requiring 2mg Iv ativan from the pdoc I worked with. So I was hospitalized for the first time. I was doing fine on l0mg of paxil and xanax and the nightly beer. But the pdoc I worked with called my pdoc cause she couldn't believe he let me drink on xanax. So in the hospital when they adjusted my synthroid he said let me try something else. He gave me a first dose of 50mg of luvox. I sat there waiting for side effects . None so the next day 50mg am 50mg pm. When discharged I was on 200mg of luvox still feeling fine. I forgot to add that this was when he put me on choral hydrate and said I couldn't drink anymore. Then he walks up to me shaking his head no and says you don't want to go back to work do you? I stupidly said no. Anyway at home he raised it to 250mg. I was taking it with the 4-6mg of ativan and chloral hydrate at night. I was relaxed and celexa came out and he asked if I go in a trial he needed l0 people I said no. So next time he saw me because I was simply relaxed with arm on the back of the chair he said I was catatonic and needed off luvox and on celexa. Big mistake and this is also when the lymes was found to be chronically active. I felt like s*it. Changed pdocs she started luvox again. She got me up again and for two or three weeks I thought I was hypomania I felt so good. She said no I just didn't know what feeling good was. Then it stopped working that way. Downhill again but not severe axiety was the main problem with it controlled I was fine at home alone. So all the other meds were tried and luvox was the only one I could tolerate and not afraid of. I haven't been on a high dose in 9 years or so. So that's the luvox story. Sorry so long. Love Jan ps he put me on Disability in the hospital.
Posted by SLS on September 24, 2006, at 16:05:30
In reply to Re: Time for Maoi -- Other stuff too. » SLS, posted by Phillipa on September 24, 2006, at 15:46:45
> Scott luvox started the whole thing in a way. My TSH when out of range
What was it?
> I was doing fine on l0mg of paxil and xanax and the nightly beer.
Ok. Let's remember that.
> But the pdoc I worked with called my pdoc cause she couldn't believe he let me drink on xanax.
So, the doctors then proceeded to fix things.
> So in the hospital when they adjusted my synthroid he said let me try something else. He gave me a first dose of 50mg of luvox. I sat there waiting for side effects.
Why did you do that? Most people don't sit in a doctor's office waiting for side effects after taking the first dose. Was this at your request?
> So next time he saw me because I was simply relaxed with arm on the back of the chair he said I was catatonic and needed off luvox and on celexa.
I can't believe this.
> So all the other meds were tried and luvox was the only one I could tolerate and not afraid of.
Why are you afraid of meds?
> I haven't been on a high dose in 9 years or so.
Like I said, either do it now or don't do it at all.
Is it fair to say that you think it is possible that Luvox would work again if the dosage was raised to 300mg?
I guess one of the things you should do is to get your thyroid checked. Are you still taking synthroid?
- Scott
Posted by bassman on September 24, 2006, at 16:49:02
In reply to Re: Time for Maoi -- Other stuff too. » Phillipa, posted by SLS on September 24, 2006, at 16:05:30
My story is so similar. Paxil, Xanax and three nightly beers were the best combo for me ever. I had 3-4 wonderful years with that combo. I woke up every morning just absolutely ready to rock and roll! Then I was Stupid and decided to eliminate the Xanax and everything went to Hell. Since then I think I've learned I need an SSRI plus Xanax for any help...
Posted by Jost on September 24, 2006, at 18:55:23
In reply to Re: Time for Maoi -- Other stuff too., posted by bassman on September 24, 2006, at 16:49:02
Phillipa, Until today, you have said you were very interested in trying Emsam.
You've said this a lot, for the last month or two. And I think you have really meant it.
You've also said that luvox, while it worked well for you at a higher dose in the past, was not something that you could tolerate at therapeutic doses. I'm not sure of the history of the feelings and experiences you've had with luvox. However, more recently, you've said that benzos are the only meds you trust, and that luvox is one that you'd rather stop.
I support your taking Luvox, or Emsam, or any other AD or treatment that you think will help.
But, as Scott says, you need to take a clear direction, follow through, and see what happens.
I would only add that you need to take that direction and fight against all the second-guessing, revising your strategy in midcourse, and lowering the med again with out an adequate trial, only to find yourself stymied, and at a standstill.
Given the timing of these huge doubts, I have to ask: are you undermining yourself here? pulling the support out from under your determination to carry out a decision you've made?
If so, this is a dilemma that has emotional, and psychological underpinings. One that needs to be addressed, so that you can move forward.
Isn't Scott's suggestion of therapy, someone to talk to, to help you sort out your reactions, and your best interests, one that makes sense here? Even if you take Emsam, or take Luvox, there seem to be some issuess from your past that are getting in your way here. One that don't need to.
Jost
Posted by blueberry on September 24, 2006, at 18:59:37
In reply to Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!!, posted by Phillipa on September 23, 2006, at 21:33:16
So sorry Phillipa! Darn I wish you felt well.
I like the idea of MAOI. But, in the STAR*D research program though, of people who got to the stage where it was time for an maoi only about 20% of them responded. Clinical studies show about 30% to 50% response. I don't know why they are touted so strongly at pbabble. Maybe real world experience is different than clinical experience.
All I can suggest is to look into classes of meds you haven't tried, even if they don't make sense. Actually, especially if they don't make sense. TCAs, stimulants, remeron, antipsychotics, depakote, lithium.
For me, it is ECT at the hospital beginning at 6:00 am. I predict it will either be real good or real bad. But meds have been real bad.
Posted by bassman on September 24, 2006, at 19:32:18
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by blueberry on September 24, 2006, at 18:59:37
Good luck, blueberry.
Posted by johnnyj on September 24, 2006, at 19:47:46
In reply to Re: Can't Take it AnyMore! - Time for an MAOI » johnnyj, posted by SLS on September 24, 2006, at 11:07:55
Well said Scott, you made me feel better :)
Hope is what we (I) have to cling to. I always try to remember that at one particular moment when I feel bad that that moment is not indicitive of what or who I am. The next moment quite possibly be better.
I cut my lithium dose about 5 weeks ago (pdoc ok this) and last night I didn't take the 300 mg. Today I had some very good moments. I don't know why but I think the lithium was causing some confusion, numbness, and probably other things. I will take it a day at a time and I hope Phillipa you do the same. You have much to live for and enjoy. You are young!
johnnyj
Posted by Phillipa on September 24, 2006, at 20:01:25
In reply to Re: Time for Maoi -- Other stuff too. » Phillipa, posted by SLS on September 24, 2006, at 16:05:30
Scott yes I've had all sorts of thryroid tests done. At the hospitalization time it was 22. Now it's between l-3 the new reccomentations.
It was night when I was given the first dose of luvox and they had us in recliners for relaxtion time. I waited for side effects cause I always got them. I wasn't in a doctor's office.
Well he did say I was catatonic scared me to death. Meds killed my Mother that's why I fear them. And yes in the hospital the doc proceeded to fix things for himself more than me as he didn't want the pdocs I worked with to think I still drank beer. (Last year he was in the New Bern news for the FBI raiding his office cause he overchaged insurance companies and was doing Ptsd testing on veterans and got them all disability). This was the pdoc the hospital I worked for sent all patients to see I had no choice. At first he was great did psychtherapy and had massage therapists for an hour massage before sessions. And after reading this site with poop out I do wonder if 300mg would work. Do You? Did I leave anything out? Love Jan
Posted by Jost on September 24, 2006, at 20:03:37
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by blueberry on September 24, 2006, at 18:59:37
Take care. blueberry.
Hope it goes well,Jost
Posted by Phillipa on September 24, 2006, at 20:04:04
In reply to Re: Time for Maoi -- Other stuff too., posted by bassman on September 24, 2006, at 16:49:02
So you still drink the beer? Love Jan
Posted by SLS on September 24, 2006, at 20:04:21
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by blueberry on September 24, 2006, at 18:59:37
Hi Blueberry.
> But, in the STAR*D research program though, of people who got to the stage where it was time for an maoi only about 20% of them responded.
Where can I find these results?
Thanks.
Good luck with your treatment!
- Scott
Posted by bassman on September 24, 2006, at 20:06:21
In reply to Re: Time for Maoi -- Other stuff too. » bassman, posted by Phillipa on September 24, 2006, at 20:04:04
Yes. Wellbutrin, Xanax, Prozac, Klonopin, and beer.
Posted by Phillipa on September 24, 2006, at 20:10:59
In reply to Re: Time for Maoi -- Other stuff too. Phillipa, posted by Jost on September 24, 2006, at 18:55:23
Jost I totally agree. I've tried a lot of therapists that will accept medicaire my only insurance and none want to relive the past. But I feel that to move forward the past has to be left behind and I can think all I want about it but need help in going through each stage. A lot of years. I clicked with one young girl in the ER. Unfortunately she was new to the area too and knew no one and she only works for the hospital. I've had some that only want to talk about religion or their meds. And one believe it or not a man who said Lucky Ducky. Two sessions out of there. And when people say interview a few first where do they get the money? And I've even asked about self=pay and they won't take it. Stupid. Love Jan
Posted by Phillipa on September 24, 2006, at 20:13:23
In reply to Re: Time for Maoi -- Other stuff too., posted by bassman on September 24, 2006, at 20:06:21
So where is this big taboo that pdocs have against drinking? Love Jan
Posted by Phillipa on September 24, 2006, at 20:36:25
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » Phillipa, posted by blueberry on September 24, 2006, at 18:59:37
Blueberry good luck. Wish I had your e-mail to talk to you. Love Jan
Posted by Jost on September 24, 2006, at 20:51:20
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!Help!! » blueberry, posted by SLS on September 24, 2006, at 20:04:21
The following site has a summary of the most recent papers from STAR*D.
In one study, particpants who'd failed in trials of three prior ADs were given Parnate or a combination of venlafaxine and mirtazapine. The results weren't encouraging-- the responses (I assume remission rates) were 7% for Parnate, 14% for the combination, the differences not considered statistically significant. However, improvement on the scale they use was greater for the combination (about 25%) than Parnate (quite low, can't remember, could have been 4%).
They published several papers, but overall, apparently, non-responders don't do well after earlier rounds of the study.
http://69.41.173.145/ww/www.nlm.nih.gov/medlineplus/antidepressants.htmlJost
Posted by SLS on September 24, 2006, at 22:07:42
In reply to Re: Can't Take it AnyMore !!!!!!!!!!!!!!!!!!!!!!He, posted by Jost on September 24, 2006, at 20:51:20
> They published several papers, but overall, apparently, non-responders don't do well after earlier rounds of the study.
I guess we are just going to have to do better, then.
TRD is TRD. That's the bad news.
We have the advantage of using many more drugs in different combinations. I wonder how many more people would get well if they were to add low-dose lithium to their treatment (300-600mg). It is the forgotton miracle drug. Lamictal might be an alternative as an augmenting agent. We have a couple of people who found their miracle pill in Lyrica.
Do you see why it becomes such a good idea to bring as many drugs to market as possible, regardless of their similarity? Creating treatments for people with TRD is sometimes evidence-based and sometimes closer to alchemy. Clinical experience has demonstrated that an individual can respond quite disparately to different drugs within a class. The more SSRIs, the better, as long as it doesn't prevent or delay the development of novel drugs. Let the market weed out the duds. I'm amazed that Ludiomil (maprotiline) is still on the market. That's one drug I haven't tried yet. It's supposed to be a piece of crap, but obviously it works great for some people. I hope it stays on the market. It will give me one more ray of hope to keep me going if I near rock-bottom. That's the great thing about this whole thing - uncertainty. You can't be certain how you are going to respond to anything. There is always the chance that you will respond therapeutically to just about anything. That's the good news.
Where did you find the Parnate study?
- Scott
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