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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Marty on August 8, 2008, at 23:13:41
In the last 2 or 3 weeks my mood was bad and some med changes 4 days ago made me irritable and somehow strangely paranoid about my girlfriend: She left me tonight and now I'm not going well as you can guess. This is nightmarish.HELP would be greatly appreciated. I usally help more people than I request help but now I feel pretty *ucked. That's in those time I highly appreciate the fact that there is more knowlegeable poeple here thab me.
*** Diagnostic:
1.Possible Bipolar Type 2 OR the soon to be included in DSM-V Type "Depression with flip into mania ONLY caused by some meds".2.Anxiety and Generalized Social phobia (somehow atypical because episodic).
--------------------------------------------*** Troubles with meds.. Hypersensitivity:
Some meds works well but when it does I suffer TOO MUCH from ->
1. Can't stand the sexual side effect with I'm VERY sensitive too. General anesthesia, E.D, lack of libido and anorgasmia are a problem at my age to say the least and makes me feel miserable. Note that Serotonergic or not I seem to keep a level of those side effect even MANY months after. Post-SSRI E.D. is highly probable but, as you can guess, not DXed.
2. Makes me kind of dumb and makes me think 'abnormaly' like slight mania does: strange ideas etc. Cognitive skills greatly decrease(memory, focus, executive functions etc) and render me dysfunctional at an adult form of ADD. (Am I ADD ? .. Ritalin makes me nuts, senses overstimulation painful etc)
3. Amotivational and the emotional numbness.
----------------------------------------------*** Meds I've tried:
1. All SSRIs except Prozac, Serzone and Luvox.
2. SNRIs: Tried Effexor XR.
3. TCA: only atypical Tianeptine and Wellbutrin.
4. MAOIs: Nardil, Parnate and Moclobemide.
5. MS: Lamictal, Lithium, Epival, Phenytoin, Topomax and other. I think I didn't try Carbamazepine.
6. Gabapentin, Pregabalin.
7. Clonazepam, Alprazolam, Ativan, Buspar.
8. Risperdal, Seroquel, Orap, Zyprexa.
9. T4, Amantadine, Cyproheptadine, Yohimbine, Desyrel, Testosterone, Cabergoline, Ritalin.
-------------------------------------------No doubt I forgot a couple thing here. I'm exhausted and in pain and that doesn't help.
Any proposition of what I could try next ? I'll glady tell you how I responded to some of those meds in my list if you ask me.
Thanks for the help. It means a lot to me.
/\/\arty
Posted by Phillipa on August 9, 2008, at 0:44:20
In reply to I'm going to hell. Help would be good ! Pb elite?, posted by Marty on August 8, 2008, at 23:13:41
Might not be the elite but sorry about your girlfriend. I'll have to write you. Phillipa
Posted by uncouth on August 9, 2008, at 0:46:50
In reply to I'm going to hell. Help would be good ! Pb elite?, posted by Marty on August 8, 2008, at 23:13:41
Feel better but remember --
THERE IS A DIFFERENCE BETWEEN GRIEF AND DEPRESSION.
Your legitimate mental illness doesn't make it any easier, but your challenge right now is to figure out how to feel the grief and sadness independent of the low mood you've felt in the past.
Meditation can help -- really, anything that lets you feel the pain and fear and anxiety and loss and distress. But feel it for what it is, not for what it isn't.
Coming on PB to try and figure out which med combo will take away this pain or solve this latest life problem isn't what you need to be doing. What you need to be doing is calling a friend, crying, or going to sleep -- not attempting to solve the problem!
I highly recommend "The MIndful way through Depression". Most helpful book I've read in ages.
Posted by SLS on August 9, 2008, at 5:14:18
In reply to I'm going to hell. Help would be good ! Pb elite?, posted by Marty on August 8, 2008, at 23:13:41
You could choose the SRI that helped you most and add either Wellbutrin or nortriptyline to it. You might want to add further Lamictal and/or Trileptal.
As you know, I am on a combination of Nardil and nortriptyline. You could use Parnate instead of Nardil. These combinations are perfectly safe IF you stick to a plan of slow titration.
You HAVE NOT been on a TCA as the term is most often used. This excludes amineptine, tianeptine, and carbamazepine, all of which also have a tricyclic structure, but are not in the dibenzazapine series. TCAs to consider would be desipramine, nortriptyline, and clomipramine. The former two are the least troublesome in terms of side effects. Clomipramine produces the most side effects, sharing them with both other TCAs and SSRIs. However, clomipramine is perhaps the most efficacious non-MAOI drug.
My current regime:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
NAC 1800mg
*Lovaza (Fish oil)*I discontinued fish oil temporarily to see if it was responsible for the surge in improvement I experienced earlier this week.
You, of course, are in the middle of a traumatic psychosocial stress; the processing of which will probably take weeks. You may be confusing grief with depression, or the grief precipitated a worsening of the biological depression.
- Scott
Posted by blueboy on August 9, 2008, at 8:07:44
In reply to I'm going to hell. Help would be good ! Pb elite?, posted by Marty on August 8, 2008, at 23:13:41
So sorry about the terrible stuff you are going through. It sounds like CBT would help you cope a bit. It doesn't make the disease any better but it does help incrementally.
All I could suggest is that you make sure you've given the mood stabilizers a full chance. Your symptoms are fairly much like mine. SSRI's and SSNRI's just tore me up. They can be very bad for bipolar conditions. I'm trying Lamictal right now, which luckily has almost no side effects for me and seems to be helping a little.
I've given up expecting a miracle cure. I'm just looking to get a little better. Like, the Lamictal seems, at least, to be helping with my insomnia, so I'm hoping it has toned down my daily cycling. But I'm at 200mg and titrating up at present, so I'll keep going and see what it does.
Posted by Marty on August 9, 2008, at 14:28:14
In reply to I'm going to hell. Help would be good ! Pb elite?, posted by Marty on August 8, 2008, at 23:13:41
Thanks to everyone who replied me.
You all had something interesting and I'll take some time to think about those ideas/points of view.
I glad that I can tell you that I feel much better today even if not too well.
Here's what I did:
- Acceptance before going to bed. Seing the breakup from a philosophic point of view etc.
- Added 50mg of Lamictal before bed for a total of 100mg/day. I suspect it is helping A LOT right now. I cannot explain such a dramatic mood change from yesterday without including Lamictal as a major factor. For who doesn't know yet Lamictal has some antidepressant properties in small doses especially for the Bipolars.- Didn't took Tianeptine before bed like I did the last 3 night. It was the main cause for the 3 last bad days I had: I was a little obsessional, inner rage, subtil paranoia etc that to this day has only been caused by TOO MUCH wellbutrin (especially without a mood stabilizer) and by Parnate.
-Didn't took Tianeptine today at all. My brain has adapted to a point where even half a dose is too much and feels like a bad neuroleptic... (cheap theory, I know)
- Not sure how much it helped and that's somehow counterintuitive: took .50mg Clonazepam (usually I take .25mg) and .25mg Alprazolam. And a Tylenol 500mg for a headache I've developped while crying. I specify the Tylenol because you may all doubt about that but EVEN Tylenol or Advil is able to modulate my mood positively for a couple hours. That's how much I'm sensitive.
.... I woke up positive about almost everything and had a better outlook on life that since a couple weeks/month. Never had such a fast recovery before and it doesn't feel at all like even the slightest hypomania. Not excited at all.What does that mean for me ? My Bp2 diagnostic isn't official and several years of med trial failed to make me maniac.. but Lamictal at that dose would have such a dramatic effect on me ? Any though on that would be appreciated.
Thanks again!
/\/\arty
Posted by Mickapoo on August 15, 2008, at 8:57:06
In reply to Re: I'm going to hell. Help would be good ! » Marty, posted by SLS on August 9, 2008, at 5:14:18
> My current regime:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> Deplin 7.5mg
> NAC 1800mg
> *Lovaza (Fish oil)
>
> *I discontinued fish oil temporarily to see if it was responsible for the surge in improvement I experienced earlier this week.
>
> - ScottScott- any effects from discontinuing the fish oil? Curious...
Posted by SLS on August 15, 2008, at 9:30:49
In reply to Re: I'm going to hell. Help would be good ! » SLS, posted by Mickapoo on August 15, 2008, at 8:57:06
> > My current regime:
> >
> > Nardil 90mg
> > nortriptyline 150mg
> > Lamictal 200mg
> > Abilify 20mg
> > Deplin 7.5mg
> > NAC 1800mg
> > *Lovaza (Fish oil)
> >
> > *I discontinued fish oil temporarily to see if it was responsible for the surge in improvement I experienced earlier this week.
> >
> > - Scott
>
> Scott- any effects from discontinuing the fish oil? Curious...Upon discontinuing the fish oil, I experienced a bit of a let-down. I have since restarted it and am improving. Even had I not experienced an improvement, I was going to continue taking the fish oil for the potential long-term benefits. Mainly, I was interested in providing the brain with enough raw material to allow it to heal from the damage long-term depression can cause. Of course, there is also the benefits of enhancing cardiovascular health.
I would like to suggest that most of my continued improvement is facilitated by taking N-acetylcysteine (NAC). I'll let you know more as my recovery progresses. Again, though, my original motivation to take NAC was to protect and enhance the recovery of the brain. It wasn't until later that I stumbled upon the Berk study that demonstrates the efficacy of NAC in treating bipolar depression. Taking these two substances is really a "no brainer" because each serves two distinct purposes.
- Scott
Posted by Marty on August 15, 2008, at 11:40:45
In reply to Re: I'm going to hell. Help would be good ! » Mickapoo, posted by SLS on August 15, 2008, at 9:30:49
> > > NAC 1800mg
---
How would you describe the effect and side effects of chronic NAC after a while ? does it clear some 'brain fog' and amotivation ?And when taken acutely, just one time lets say in the morning, does it make you feel something at all ? stimulation? anxiolitic? less energy? more motivation ?
I'm thinking about trying it... btw, how much it cost to take it at that dosage every day for a month ?
Thanks Scott,
/\/\arty
Posted by mickapoo on August 15, 2008, at 11:43:26
In reply to Re: I'm going to hell. Help would be good ! » Mickapoo, posted by SLS on August 15, 2008, at 9:30:49
> > > My current regime:
> > >
> > > Nardil 90mg
> > > nortriptyline 150mg
> > > Lamictal 200mg
> > > Abilify 20mg
> > > Deplin 7.5mg
> > > NAC 1800mg
> > > *Lovaza (Fish oil)
> > >
> > > *I discontinued fish oil temporarily to see if it was responsible for the surge in improvement I experienced earlier this week.
> > >
> > > - Scott
> >
> > Scott- any effects from discontinuing the fish oil? Curious...
>
> Upon discontinuing the fish oil, I experienced a bit of a let-down. I have since restarted it and am improving. Even had I not experienced an improvement, I was going to continue taking the fish oil for the potential long-term benefits. Mainly, I was interested in providing the brain with enough raw material to allow it to heal from the damage long-term depression can cause. Of course, there is also the benefits of enhancing cardiovascular health.
>
> I would like to suggest that most of my continued improvement is facilitated by taking N-acetylcysteine (NAC). I'll let you know more as my recovery progresses. Again, though, my original motivation to take NAC was to protect and enhance the recovery of the brain. It wasn't until later that I stumbled upon the Berk study that demonstrates the efficacy of NAC in treating bipolar depression. Taking these two substances is really a "no brainer" because each serves two distinct purposes.
>
>
> - ScottVery interesting. I'd like to see if that helps me as well. I believe I already have some, just haven't been diligent about taking it! How much fish oil do you take per day?
Posted by SLS on August 15, 2008, at 12:32:01
In reply to Re: I'm going to hell. Help would be good ! » SLS, posted by Marty on August 15, 2008, at 11:40:45
> > > > NAC 1800mg
> ---
> How would you describe the effect and side effects of chronic NAC after a while ? does it clear some 'brain fog' and amotivation ?
>
> And when taken acutely, just one time lets say in the morning, does it make you feel something at all ? stimulation? anxiolitic? less energy? more motivation ?
>
> I'm thinking about trying it... btw, how much it cost to take it at that dosage every day for a month ?
>
> Thanks Scott,
> /\/\artyI've reduced my dosage of NAC to 1200mg. I think the higher dosage was making me sleepy. I would rather not declare victory at this point, but I will certainly keep you informed. I have felt better since 5 days ago after about a week of treatment. However, I had started fish oil at the same time, so I don't know for sure which substance is responsible. My guess, though, is that it is the NAC. I like the idea that NAC acts as an antioxidant as well as being a precursor of glutathione.
I paid $23 for 150 600mg capsules. I use the Vitamin Shoppe brand. It is cheap stuff.
- Scott
Posted by SLS on August 15, 2008, at 12:43:41
In reply to Re: I'm going to hell. Help would be good ! » SLS, posted by mickapoo on August 15, 2008, at 11:43:26
> Very interesting. I'd like to see if that helps me as well. I believe I already have some, just haven't been diligent about taking it! How much fish oil do you take per day?
Each capsule contains 465mg EPA and 375mg DHA. I take 4 capsules per day. I must admit that I am still confused as to which substance is helping more: NAC or fish oil. However, fish oil is raw material for the assembly of neuronal membranes (lipid bilayer). This can only be a good thing.
- Scott
Posted by Marty on August 15, 2008, at 14:28:15
In reply to Re: I'm going to hell. Help would be good ! » Marty, posted by SLS on August 15, 2008, at 12:32:01
Okay Thanks for the details Scott.. I'll wait a couple days before giving it a try since I've made enough changes in my medication in the last days./\/\arty
---
> I've reduced my dosage of NAC to 1200mg. I think the higher dosage was making me sleepy. I would rather not declare victory at this point, but I will certainly keep you informed. I have felt better since 5 days ago after about a week of treatment. However, I had started fish oil at the same time, so I don't know for sure which substance is responsible. My guess, though, is that it is the NAC. I like the idea that NAC acts as an antioxidant as well as being a precursor of glutathione.
>
> I paid $23 for 150 600mg capsules. I use the Vitamin Shoppe brand. It is cheap stuff.
>
>
> - Scott
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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