![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 54. Go back in thread:
Posted by Bob on August 20, 2008, at 12:24:42
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 8:03:35
> Don't get mad at me for trying.
>
> Something I read recently demonstrated that, for certain drugs, more is better when it comes to a starting dosage to avoiding side effects. Prozac and Geodon are examples. Prozac at 20mg is probably less problematic than at 5mg. At lower dosages, it can be anxiogenic, at higher dosages it becomes anxiolytic and antidepressive. The same thing has been shown to be true of Geodon. It is less problematic at 40mg than it is at 20mg. I wonder if Abilify follows a similar pattern. I also wonder if at lower dosages, Effexor is more dopaminergic relative to serotonin and norepinephrine and more likely to produce a nausea that lingers.
Scott, have you come across any articles in the med literature that you might be able to point me two about the differing responses at different doses?
>
> With Abilify, I started at 20mg. I had very little problem with agitation, restlessness, or anxiety. The doctor who managed me was pretty smart.Isn't it difficult to say with certainty why you responded the way you did to Abilify since you already had a number of meds on board which would be producing significant anxiolytic effects, and thus fighting any restlessness you might have otherwise gotten from Abilify?
>
> Anyway, I am still on your side, even if my current positive outlook becomes annoying.
>
> Any chance of mixing Wellbutrin with Lamictal?
>
>
> - Scott
>
>
>
Posted by SLS on August 20, 2008, at 12:33:14
In reply to Re: The stakes are too high. » SLS, posted by Bob on August 20, 2008, at 12:24:42
Hi Bob.
Are All Atypical Antipsychotics Equal for the Treatment of Cognition and Affect in Schizophrenia?Chairperson: Stephen M. Stahl, MD, PhD; Faculty: Herbert Y. Meltzer, MD; Jonathan M. Meyer, MD; Lili C. Kopala, MD, FRCPC
Copyright © 2004 The Center for Health Care Education, LLC"Are All Atypical Antipsychotics Equal for the Treatment of Cognition and Affect in Schizophrenia?"
A symposium held at the Hilton New York in New York, New York, on May 2, 2004.
Stephen Stahl:"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Scott
Posted by SLS on August 20, 2008, at 12:35:10
In reply to Re: The stakes are too high. - SLS, posted by Justherself54 on August 20, 2008, at 11:32:39
> I noticed in one of you posts you had put med sensitive in quotes. I consider my self med sensitive or side effect sensitive and so does my pdoc.
Your point is well taken, and I do apologize.
- Scott
Posted by SLS on August 20, 2008, at 12:38:38
In reply to Re: The stakes are too high. - SLS, posted by Justherself54 on August 20, 2008, at 11:32:39
Posted by B2chica on August 20, 2008, at 13:01:21
In reply to Re: The stakes are too high. » Hygieia's Bowl, posted by atmlady on August 19, 2008, at 22:18:53
that's what i want, the perfect AD. but what is that?
i ask myself am i asking/looking for trouble when i venture out and try new meds. when im 'getting by with my old standby zyprexa.
then i think and remember the few months of how i was on a combo way back of zyprex and wellbutrin.
zyprexa gets me to sea level. but thats it. i'm no longer drowning. and i feel i should be happy with that. and i feel guilty for looking further.
but i get tears in my eyes when i remember how much more energy i had, and how i could actually interact with people (or wanted to) and laugh about nothing.how i could have a day...a week go by without thoughts of death breeze through my mind.
***********************
im what you would call 'stable' right now.
but i'm not ...'happy'. i'm getting by. i back to being able to 'pretend' to be happy.
but i'm not. and now it's worse because i can remember how happy i could be.i hate 'playing' with my meds. especially with little to no help from my pdoc who seems to thing no change in my meds might help me????!!
so the only time things change is when i suggest them.
so my paradox, is playing with meds.
am i doing it because i'm forever looking for the "Just right med combo" that may not even be out there for me, or has it become that obsession?i don't know. maybe a little of both.
but i know i can't stop now.
and i usually stick things out if anything too long through horrible SE. only for them not to work after all.the only thing i hate worse than this, is the outside worlds views on this. how most people really don't have a clue about med changes and what we go through.
i'm ranting now because i had to drop a class for the fall because i knew i'd miss more than three classes and she would fail anyone that missed that...no exceptions. i even told her i had medical issues and i asked her if i'd be better off dropping the class? she simply emailed back "yes".but my health is more important right now (i convince myself)
like SLS says...the stakes are too high.
Posted by Justherself54 on August 20, 2008, at 14:26:03
In reply to Re: The stakes are too high., posted by B2chica on August 20, 2008, at 13:01:21
You're right..people don't know what we go through with med changes...I think a lot of us do med changes as we don't want to just exist..we want to live again..and we keep hoping we'll find the right combo that lets us become the person we were before all this happened to us..
Posted by bulldog2 on August 20, 2008, at 15:01:47
In reply to Re: The stakes are too high. » atmlady, posted by Hygieia's Bowl on August 20, 2008, at 7:33:13
> Hey There Ms. atm
>
> > I agree with you, Hy.
>
> I am so very pumped as I rarely get an agreement. ; )
>
> I am slowly realizing I am allowing the posted experiences of a few to cloud how I preceive and evaluate the manner in which folks are going about their treatment plans and maybe, just maybe, I'm not seeing the forest for the trees.
>
> I wish you the very best in your quest. I've been doing well for some years now and it's a wonderful thang.I think you hit the nail on the head. One goes to a p-doc and has a game plan to try meds to get better. Than one comes here for med info and reads rants that meds don't work and someone's life history of med failures. So who does one believe? Do you believe in your p-doc and his meds or the ranter and his failures? I think at times this has caused vacillation and doomed my med trials to failure.It's one thing to start a med trial and endure the sides in the hope you will achieve remission and another to endure sides in a fruitless quest. Once the seeds of doubt are planted there's a good chance the med trial will fail.
I have heard many success stories talking to people who were on ad's. They were not on for life but used them for a while and were able to discontinue when not needed. But when they went to their docs they probably believed the meds had a chance of working. Had they come here first and read the rants who knows what the outcome would have been.
Posted by Bob on August 20, 2008, at 18:00:56
In reply to The stakes are too high., posted by SLS on August 19, 2008, at 8:11:07
> I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
>
> Don't stop.
>
> You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
>
> By the way, drugs work.
>
>
> - Scott
>
Scott:If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?
Bob
Posted by mknight on August 20, 2008, at 19:02:25
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 5:08:11
> I really don't care how people get well, as long as the treatment is inherently safe.
> - Scott
You answered my question a few weeks ago about Nardil being hepatotoxic, but after reading your above sentence, I just have to ask.What about MAOIs and TCAs being hepatotoxic, causing hepatic failure, increasing intraocular pressure, etc?
What about atypical antipsychotics causing tardive dyskinesia, diabetes, etc.
Do you think that the above side effects occur in only a small percentage of the population and the benefit of the proper treatment outweighs the risks?
My reason for asking is that for 14 years I have felt stoned and spacey as if I had smoked marijuana or taken mescaline. I have taken Paxil, Zoloft, Celexa, Prozac, Wellbutrin, Mirtazapine, Methylphenidate, and Dexedrine. The SSRIs make me more stoned. Paxil was like taking LSD. Wellbutrin helps for a few weeks but 6 months later does nothing. Methylphenidate and Dexedrine put me to sleep and cause fatigue.
I have read that hallucinogenic drugs act as an agonist at 5HT2a. So I thought that a 5HT2a antagonist like Mirtazapine would help but it did nothing. My other option is atypical antipsychotics but I am concerned about long term side effects.
I may possibly fit the diagnosis for atypical depression for which MAOIs are supposed to work, but once again I do not want to fix my brain only to destroy my liver.
The only time in 14 years that I have not been stoned is after 2 separate stays in the hospital for an intestinal infection and a burst appendix. I felt completely normal for 5 months after each stay. I was given a sodium, chloride, potassium IV and IV Flagyl and Cipro antibiotics. None of my doctors have any answer for this.
I do not feel depressed just stoned, unmotivated, tired.
Posted by SLS on August 21, 2008, at 1:32:16
In reply to Re: The stakes are too high. » SLS, posted by Bob on August 20, 2008, at 18:00:56
>
> > I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
> >
> > Don't stop.
> >
> > You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
> >
> > By the way, drugs work.
> >
> >
> > - Scott
> >
>
>
> Scott:
>
> If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?Yes. I am an unusual bipolar who stays severely depressed for decades, but who can be made psychotically manic by certain antidepressant drugs. I believe there will be a new diagnosis for this condition added to the DSM V. Furthermore, I spent a few years as an ultra rapid cycler with a period of 11 days marked by 8 days of severe depression followed by 3 days of normalcy. I think most rapid cyclers are true bipolars, whether the reach mania or not.
- Scott
Posted by SLS on August 21, 2008, at 1:50:58
In reply to Re: The stakes are too high. » SLS, posted by mknight on August 20, 2008, at 19:02:25
> I may possibly fit the diagnosis for atypical depression for which MAOIs are supposed to work, but once again I do not want to fix my brain only to destroy my liver.
The risk is rather small and can be monitored for by blood tests assaying liver enzymes. It is worth mentioning, though. I know that Terrence Ketter, MD, now at Stanford, will choose Marplan before Nardil to avoid hepatic stress. I have never known anyone to suffer this reaction. But, then again, I don't know 100,000 people taking Nardil.
> The only time in 14 years that I have not been stoned is after 2 separate stays in the hospital for an intestinal infection and a burst appendix. I felt completely normal for 5 months after each stay. I was given a sodium, chloride, potassium IV and IV Flagyl and Cipro antibiotics. None of my doctors have any answer for this.
I might be able to. It is either an anti-inflammatory property of one of the antibiotics or Lyme disease. How long have you been suffering for?
> I do not feel depressed just stoned, unmotivated, tired.
You know, I discussed "brain fog" with my doctor just last month. Unfortunately, I can't remember the details at the moment, but he had identified several mechanisms by which it could occur. I think he had referred to excessive glutamate.
Your rationale to try Remeron is quite astute. I'm glad you followed up on it just to be sure. Did Remeron make things worse in any way?
- Scott
Posted by seldomseen on August 21, 2008, at 6:39:15
In reply to Re: The stakes are too high. » SLS, posted by mknight on August 20, 2008, at 19:02:25
You are not the first to speculate that there might be a connection between depression/malaise and intestinal problems/treatments.
There has been a lot of discussion regarding inflammation and mental illness.
Do you take fish oils?
Seldom
Posted by Bob on August 21, 2008, at 14:16:50
In reply to Re: The stakes are too high. » Bob, posted by SLS on August 21, 2008, at 1:32:16
> >
> > > I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
> > >
> > > Don't stop.
> > >
> > > You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
> > >
> > > By the way, drugs work.
> > >
> > >
> > > - Scott
> > >
> >
> >
> > Scott:
> >
> > If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?
>
> Yes. I am an unusual bipolar who stays severely depressed for decades, but who can be made psychotically manic by certain antidepressant drugs. I believe there will be a new diagnosis for this condition added to the DSM V. Furthermore, I spent a few years as an ultra rapid cycler with a period of 11 days marked by 8 days of severe depression followed by 3 days of normalcy. I think most rapid cyclers are true bipolars, whether the reach mania or not.
>
>
> - Scott
>
>
I think if I searched long and hard enough I could find a doctor to classify me as BP not otherwise specified, but I'm not sure how it would change my treatment. I've never been full manic at all, and have only experienced what I would call true hypomania from meds, so whatever I have it's strange. Problem with any type of a bipolar diagnosis is that then docs start talking mood stabilizers, and for me that mean depression, lethargy, fatigue, confusion and even suicidality from some.
Posted by Cecilia on August 22, 2008, at 0:25:23
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 8:03:35
> Don't get mad at me for trying.
>
> Something I read recently demonstrated that, for certain drugs, more is better when it comes to a starting dosage to avoiding side effects. Prozac and Geodon are examples. Prozac at 20mg is probably less problematic than at 5mg. At lower dosages, it can be anxiogenic, at higher dosages it becomes anxiolytic and antidepressive. The same thing has been shown to be true of Geodon. It is less problematic at 40mg than it is at 20mg. I wonder if Abilify follows a similar pattern. I also wonder if at lower dosages, Effexor is more dopaminergic relative to serotonin and norepinephrine and more likely to produce a nausea that lingers.
>
> With Abilify, I started at 20mg. I had very little problem with agitation, restlessness, or anxiety. The doctor who managed me was pretty smart.
>
> Anyway, I am still on your side, even if my current positive outlook becomes annoying.
>
> Any chance of mixing Wellbutrin with Lamictal?
>
>
> - Scott
>
>
>
I'm not mad at you, just frustrated and hopeless. Maybe it's theoretically possible that for some meds higher doses have fewer side effects than lower ones. but it certainly doesn't seem very likely. I know with Prozac it certainly didn't work that way for me , when this "magic" pill first hit the market it only came in 20 mg capsules, even though the manufacturers's own research demonstrated that 5 mg worked for almost as many people as 20, with fewer side effects. I found the insomnia and anxiety horrible at 20, had an idiot doctor who when I said, "this doesn't work" had me double to 40, of course I couldn't tolerate that at all and dropped it. 16 years later I decided to give Prozac another try, asked my doctor for the now available liquid version, started at 1mg/day and worked up over months. Was able to tolerate it that way, but it never did anything for my depression.Is there supposed to be a synergistic effect between Wellbutrin and Lamictal? Both had unpleasant side effects and no beneficial effects. Definitely had adequate trials of each, again working up over many months.
Cecilia
Posted by SLS on August 22, 2008, at 8:50:08
In reply to Re: The stakes are too high. » SLS, posted by Cecilia on August 22, 2008, at 0:25:23
> > Any chance of mixing Wellbutrin with Lamictal?
> Is there supposed to be a synergistic effect between Wellbutrin and Lamictal?
My doctor and his colleagues seem to think so.
- Scott
Posted by mknight on August 22, 2008, at 15:36:36
In reply to Re: The stakes are too high. » mknight, posted by seldomseen on August 21, 2008, at 6:39:15
> You are not the first to speculate that there might be a connection between depression/malaise and intestinal problems/treatments.
> There has been a lot of discussion regarding inflammation and mental illness.
>
> Do you take fish oils?
>
> SeldomI have a lot of sensitivities to foods. Fruit, fruit juice, sugar, bread, potatoes, and rice all send me through the roof as far as a stoned, fat head, headache type of feeling. The only foods I can eat without either an immediate or next day reaction are meat and vegetables. Even then, one day out of seven, ground beef and steamed cabbage will give me a splitting headache and I will be spaced out all day.
Before taking any psychotropic drugs, I tried anything on the market that you could name. Fish oil is about the only item I have not tried. I did try flax oil for omega-3, but that depends on your body being able to convert it, so it may not have proved anything.
Posted by mknight on August 22, 2008, at 15:59:10
In reply to Re: The stakes are too high., posted by SLS on August 21, 2008, at 1:50:58
> > None of my doctors have any answer for this.
>
> I might be able to. It is either an anti-inflammatory property of one of the antibiotics or Lyme disease. How long have you been suffering for?All of my problems started in Oct 1994. I have seen 20 different doctors including neurologists, osteopaths, chiropractor, MDs, psyphiatrists, psychologists, and naturopath. To my knowledge, I have not been bitten by a tick.
> Your rationale to try Remeron is quite astute. I'm glad you followed up on it just to be sure. Did Remeron make things worse in any way?
I could notice the antihistamine effects but nothing else. One reason I thought about atypical antipsychotics is because of the ability to antagonize 5HT2a and also block D2 which some sources say hallucinogenics enhance. But I am seriously concerned about long term damage from taking them.
Posted by Phillipa on August 22, 2008, at 19:46:02
In reply to Re: The stakes are too high. » SLS, posted by mknight on August 22, 2008, at 15:59:10
Hi Twin as I also was diagnosed with long dated chronic lymes disease by an infection control expert and a rheumatologist as ANA was 2800 and something to 1. Same timing as thyroid issue. From that day on couldn't tolerate meds. No tick bite either but the deer tick is as tiny as a piece of pepper so they can quite easily be missed. No flus or rheumatic symtoms. Just the postive titers and bands that are used in the diagnosis. Used to be a poster lunesta and he directed me to a lymes forum don't know if still exists as unfortunately the moderator died of chronic lymes a few years ago. Maybe google lunesta and see if there is a thread to me? Phillipa
Posted by bulldog2 on August 23, 2008, at 9:03:08
In reply to Re: The stakes are too high. » mknight, posted by Phillipa on August 22, 2008, at 19:46:02
> Hi Twin as I also was diagnosed with long dated chronic lymes disease by an infection control expert and a rheumatologist as ANA was 2800 and something to 1. Same timing as thyroid issue. From that day on couldn't tolerate meds. No tick bite either but the deer tick is as tiny as a piece of pepper so they can quite easily be missed. No flus or rheumatic symtoms. Just the postive titers and bands that are used in the diagnosis. Used to be a poster lunesta and he directed me to a lymes forum don't know if still exists as unfortunately the moderator died of chronic lymes a few years ago. Maybe google lunesta and see if there is a thread to me? Phillipa
It seems you don't read or remember what people write to you. Once you get bitten by a tick carrying lyme's disease you will have positive titers forever. I have written that to you many times.I was bitten by a tick years ago and treated with antibiotics and still have elevated titers.
Having elevated titers does not mean you have chronic lyme's disease!!!!!If you had chronic lyme's you would know it as the pain is unbearable and all the joints ache. You would also be treated with intravenous antibiotics.You were a nurse you should know this. When you get vaccines you get titres for that disease! Doesn't mean you have that disease.
What I found odd is that I explained this to you numerous times and you still state you have chronic lyme's disease.No flus or rheumatic symtoms. These are your words. In chronic lyme's disease you would have these symptoms. After the initial bite there may not be symtoms but later on there would have to be symtoms to call it chronic lyme's. Also they would be treating you with intravenous antibiotics (treatment for chronic lyme's).
Posted by Phillipa on August 23, 2008, at 18:52:26
In reply to Re: The stakes are too high., posted by bulldog2 on August 23, 2008, at 9:03:08
Think what you like that is your perogative. And have a great day. Phillipa
Posted by elanor roosevelt on August 23, 2008, at 21:32:35
In reply to Re: The stakes are too high. - SLS, posted by Justherself54 on August 20, 2008, at 11:32:39
I am sorry you are having a hard time with the parnate. while i was taking it i lost weight and had no joint pain.
i hope it works for you
Posted by elanor roosevelt on August 23, 2008, at 21:40:30
In reply to Re: The stakes are too high., posted by B2chica on August 20, 2008, at 13:01:21
so much of the med-bashing comes from disappointment.
and the disappointment seems to grow when a number of years go by without something new to help us.what i find more upsetting than the med-bashing is the number of replies give to the lurkers.
i hate to see people put so much energy into replying to antagonists who use the "pull yourself up by your bootstraps" approach
perhaps that energy could be better spent on supporting each other
Posted by bulldog2 on August 24, 2008, at 10:44:02
In reply to Re: The stakes are too high. » bulldog2, posted by Phillipa on August 23, 2008, at 18:52:26
> Think what you like that is your perogative. And have a great day. Phillipa
it's not what I think it's the facts. Positive titres are not chronic lyme's disease. You have no symptoms. Have you ever been treated with antibiotics? If you had chronic lyme's there would have been antibiotic treatment.
You ask the same questions about meds over and over and post the same comments about your thyroid and lyme's disease over and over.Where is this all going? If you have chronic lyme's than you should get treatment for it. It seems as if you play the victim and come here for sympathy. As long as you are a victim you cannot get better. Riding your bike once a day will not lead to a cure.You need a plan whatever that might be. For two years you have stated that you cannot take two meds until your thyroid is balanced. When will that be? This is really very sad. You are not really taking in what people say. You never really listen so to speak but just endlessly post and make posts that often have nothing to do with the original poster but some unrelated comment.
So what is it that you want here? You don't believe meds work and often state how people you know are doing much better off of meds.
So what is it you seek? What is your plan? You will ride your bike into remission or into oblivion? You state that you were a nurse and have no knowledge of meds. That is very confusing.
Wake up and smell the coffee for the clock keeps moving. You are wasting valuable time.
Posted by Phillipa on August 24, 2008, at 19:00:47
In reply to Re: The stakes are too high., posted by bulldog2 on August 24, 2008, at 10:44:02
I think a month in the hospital with a pic line and Rocephin constitutes being treated and then two years of biaxin long lasting in three months intervals is being treated. What does that have to do with posting I've very curious to know what's new. Many lurkers do the same but don't write. Have a great evening. Phillipa
Posted by Phillipa on August 25, 2008, at 12:31:36
In reply to Re: The stakes are too high., posted by bulldog2 on August 23, 2008, at 9:03:08
Right now the CDC does not believe in long term antibiotic treatment for lymes as it's expensive and can also be dangerous. Last year a lymes doc here had to go to court for treating Iv lymes for long term theraphy. There must be a link to the CDC article as was in the lymes newsletter. And please do not disclose what was discussed in private. That is breach of confidentiality. Via E-mail or babblemail that is my opinion. Maybe that's why I do have arthritis and you? Food for thought is all. Have a great day again. Phillipa
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.