![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by raisinb on December 13, 2008, at 21:53:41
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 13, 2008, at 14:14:22
I don't know a lot about the other meds I mentioned, as I haven't been on them. Others on this board have.
On Remeron, I *did* experience mild hallucinations and crazy, crazy dreams that were hard to get--mentally or emotionally--out of once I was awake. This was on a 30 mg dosage. These are common side effects and not necessarily dangerous, though if they freak you out a good deal, I can see why you wouldn't want to take it. Take things you read online with a grain of salt. People's experiences vary so widely. One person's wonder drug can send another person into major psychosis or suicidal depression, or cause terrible side effects.
Posted by crittercuddler on December 14, 2008, at 3:54:43
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
d/r -
I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.
Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.
Posted by crittercuddler on December 14, 2008, at 3:57:59
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by azalea on December 13, 2008, at 21:51:00
azalea,
OTC - I take fish oil and a organic whole food multi vitamin daily. I have been doing that for only a couple of weeks. I often miss days though because I am in bed not wanting to live, much less get up and take a vitamin. I also have been taking gingko biloba for that same amount of time hoping it would help with my tinnitus.
I am not taking any prescriptions right now.
Posted by crittercuddler on December 14, 2008, at 4:01:56
In reply to Re: SSRI insomnia, restlessness, poor concentratio » crittercuddler, posted by raisinb on December 13, 2008, at 21:53:41
raisanb - Thank you for the reminder. :-)
All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else. I spend 30 minutes trying to pick out boxed tea in the grocery store... so you can imagine the difficulty I have with a decision like this. I am just convinced that I will make the wrong decision and be miserable forever. I am so caught up in the OCD thinking cycle. :-(
Posted by crittercuddler on December 14, 2008, at 6:58:21
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 13, 2008, at 19:08:44
So, should I try inositol or N Acetyl cysteine?
Or can I try both of them together?
Posted by Racer on December 14, 2008, at 10:51:06
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by crittercuddler on December 14, 2008, at 4:01:56
>I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical.
A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.
And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
> All the possible drug combinations overwhelm me very much. I am constantly obsessing about how endless my search will ultimately be to find the "perfect" combo and I just end up spiraling deeper into depression. Whatever I am prescribed, through research and much obsessing I soon decide it would probably be a better idea that I be on something else.It sounds as though you're aware that your obsessiveness in this area is not serving you well. Aside from all the psychological aspects, it also seems to be preventing you from staying with any course of treatment long enough to benefit from it.
Can you think of anything you might try to improve your ability to tolerate these adjustment periods?
It also sounds to me as though you may be getting into a vicious circle of expecting bad side effects, which creates anxiety about whether you'll experience them, leading to symptoms which might be the anxiety and might be side effects of the medication, and so on. Do you think there might be an element of the self-fulfilling prophecy there?
I do wish you luck.
Posted by Phillipa on December 14, 2008, at 17:57:58
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 6:58:21
Personally I'd try the nefedazone as one pdoc here started me on it and no anxiety. And believe me meds make if anxious. He the pdoc did start at low doses so as to alleviated anxiety. Might be useful for you. Love Phillipa
Posted by desolationrower on December 14, 2008, at 19:18:44
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 14, 2008, at 3:54:43
> d/r -
>
> I see you mentioned an NRI could help an SSRI work faster and better. My next question would be, would it also help me tolerate the SSRI better? Also, when you say NRI, you don't mean an SNRI (like Cymbalta or Effexor), do you? Are you considering Serzone an NRI? I read that it does inhibit NE uptake, but it is also described by other terms as well so I wasn't sure. I am guessing that you were suggesting Serzone as an NRI since you mentioned it in the same paragraph.
>
nri would be probably desipramine, nortryptiline, atomoxetine, or reboxetine. they can be energizing and nort is the most sedating so maybe that one, though the cleaner ones can sedate some people too. you said you took it before, what symptoms did it make you feel more deprssed? They might help somehwat with your depression, prevent/counteract the cognitive side effects you experience on sris, and make make an sri more effective and work faster. Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working. Oh, and there was that one study with buspirone+pindolol without a ssri that had a faster response too. I guess i forgot about pindolol; noone uses it because it only hastens response, not increases no. of responders. But thats important for you. all these were tested for depression not ocd btw. Don't know why you doctors didn't add that. don't be easy on the pindolol most studies didn't use enough for it to have an effect.nefazodone is a weak serotonin and norepinin reuptake inhibitor, but a stronger 5ht2 antagonist, so its an unusual drug. i wouldn't say thats a best option, but it might help depression somewhat.
> I must say that looking at Dr. Bob's fact sheet on nefazadone is encouraging where he mentions that is seems to not cause insomnia, or as he put it "sleep disturbances". Of course, I wouldn't count on that to be true for me. I guess I would just have to see. Also, I of course like how you said NRIs can help congnition. Of course, they also say SSRIs are supposed to help with memory and concentration by alleviating depression! Perhaps that would be the case were I able to get back on one and stay on it long enough. I will ask my doctor about it.
>
> I have been hospitalized three times this year, each for a week, already. Each time I was titrated up quickly or started on a dose of an SSRI I couldn't handle. I spent all three weeks with terrible insomnia. The acute hospitalization strategy has not worked for me. With my sensitivity issues, it is just not practical. This year was the first time I had ever had to go to a hospital for the depression and OCD being so out of control.ouch, that sounds bad.
> Do the glutamatergics show efficacy in alleviating depression, or just in OCD?
hm, not sure about rizulwhatever, but both of the others have some positive evidence, i think added to other ADs for treatment resistant people.
> I do remember reading about inositol last year. I had forgotten about it though. I get so wrapped up in trying to get an a prescription drug since one had worked for me in the past.
>
> I know, I am stuck on the desire to want back on an SSRI myself, as well. I have been endlessly trying being driven by that desire for three years now. It is so frustrating.oh, i just realized too to ask: what sleep drugs did you try when on an ssri? its the 5ht2 receptors that are thought to cause the agitation/insomnia; high dose cyproheptadine, mirtazapine or a trycyclic (and which one, i don't think they all count)? some drug with strong 5ht2a/c blockade. fluoxetine is a decent 5ht2c antagonist, so the fact it caused less insomnia might be b/c of that.
theres no reason you couldn't start inositol and NAC together, along with another drug too...usually doing one thing at a time you know what is doing what, but i'm impatient so i don't like that...
have you talked to your pdoc about bipolar? the reaction to antidepressant could possibly be because of that.
-d/r
Posted by NewQuestions on December 15, 2008, at 14:31:12
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
See this thread: "Strange shift in 5HT tolerances" started by zzz7. Also, see anything posted by me.
I am experiencing similar sensitivities after years of SSRI use. I have tried almost every drug I can think of. I don't know what the resolution is. I have found a handful of people with similar experiences. If you need more details, I am happy to provide them. These drugs have left me unbalanced, and yet I can't take them anymore. I am very frustrated.
Posted by crittercuddler on December 15, 2008, at 21:47:56
In reply to Re: SSRI insomnia, restlessness, poor concentration » crittercuddler, posted by Phillipa on December 14, 2008, at 17:57:58
Thank you Phillipa. I have Nefazodone on my list of meds to talk to my doctor about tomorrow.
Posted by crittercuddler on December 15, 2008, at 22:07:30
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 14, 2008, at 19:18:44
d/r - Thank you so much for your wonderfully detailed and thoughtful posts. You are giving me so much help! Thank you so much!!! :-)
"you said you took it before, what symptoms did it make you feel more deprssed?"
>I have come to believe that me feeling more depressed and odd while on nortriptyline the time I tried it was because I was also taking Remeron with it... which I think I have discovered I don't tolerate well. It was comforting to read about other people who had the same experience with Remeron.
"Pfizer put a patent on reboxetine+pindolol treatment for OCD. I suppose that have some chance of working."
>I live in the United States and Reboxetine is not available here. I read that the reason for that is that there was conflicting evidence as to its efficacy compared to more established treatments.
"Don't know why you doctors didn't add that."
>The doctor that I had back when I was still on medicine was incompetent. I wish I would have had a good doctor that kept up with her research. Perhaps I could have been augmented properly and avoided these last three years of misery. Even the doctor I have now, while much better, admits that he doesn't have time to keep up with research. It is so frustrating that while being so sick I have to take up the slack for my doctor... doing my own research. It makes me so angry. =( I mean, I get it... they are human and after a long day of seeing patients the last thing they want to do is go home and do research. BUT, I think that is something you have to be prepared for if you are going to be a competent doctor. You are going to have to make that sacrifice. Is is the nature of the job. Right? It is just crazy how these doctors don't know what I can go look up so easy in a book- and this information is critical to my care- it is not like it is some random fact. Ugh. I am going to go to the doctor tomorrow and talk to him about 5HT2A antagonists. All this time I have been expressing how I don't understand this mystery of me being intolerant to SSRIs and that might help me. I don't know why he didn't mention it. Also, we talked about how I can tolerate Seroquel, which works on Serotonin, and his answer for that was that Seroquel just hits Serotonin the least of the atypicals. He didn't even mention that the reason I was likely to tolerate it was because of 5HT2A antagonism. Ugh!!!
"have you talked to your pdoc about bipolar?"
>It had been postulated by my last doctor that I might be biploar 2, but it was more like a soft bipolar. My reaction to SSRIs is physical, not mental. I don't get mania or hypomania in a mental sense. It seems like a purely physical thing. I don't have insomnia because my mind is racing... you know? My current doctor does not think I am bipolar... but of course he is not going to rule it out 100%.
"what sleep drugs did you try when on an ssri?"
>I tried a low dose Trazadone for one dose while in the hosptial. At a low dose it didn't help me sleep. Seroquel does help me sleep when on an SSRI, but at the 25mg I have used for that purpose it doesn't help with the other symptoms. I haven't desired to be on Seroquel more than a PRN basis.
Posted by crittercuddler on December 15, 2008, at 22:14:07
In reply to Re: SSRI insomnia, restlessness, poor concentratio, posted by NewQuestions on December 15, 2008, at 14:31:12
New Questions-
Thank you so much. It is comforting to know there are others like me out there. Maybe we can figure this out together.
Did augmenting an SSRI with a 5HT2A antagonist not help? That is what people have been encouraging me to do.
I will look up that post. Thank you. Keep me updated, okay?
Posted by yxibow on December 15, 2008, at 23:22:12
In reply to Two comments » crittercuddler, posted by Racer on December 14, 2008, at 10:51:06
> A lot of times I read things on this board about people being "medication sensitive," with a negative implication involved. The way I see it, being sensitive to a medication can be a very, very good thing -- it means that one is sensitive to the effects of a medication, which is a necessary component for any medication to be effective. If you're not sensitive to its effects, after all, it isn't likely to work.Its a curious opposite view I haven't seen, but unfortunately medication sensitivity for me hasn't brought good things. I am unusually sensitive to some side effects, which may be genetic, somatic, its hard to say, but definitely very real.
>
> And while there are a lot of good arguments in favor of a slow, gradual upward titration on medications, the argument I use with my psychopharmacologist is the opposite: since I'm going to experience adjustment effects every time a dosage is increased, let's titrate more quickly and get it over with. I don't mean going from 0 to 60 at NASCAR speeds, but I do mean not cutting pills into quarters to start with. It's hard, but again -- the strategies we have in place to help me tolerate the adjustment phase work to minimize my distress at a faster titration schedule.
Well that works for some people, but titrating up on Anafranil at 75 and then going up to 100 because I sort of insisted that well, that might be good because I prefer more changes in medication, as though that will make things better -- it doesn't always, in fact it backfired with me being in a very wierd wired, jumpy, and not pleasant place.
Went back to 75, and its going to percolate for a while. The way the brain responds to psychotropics isn't overnight, which is why I always wonder when I see people ditching a medication a week after taking it because it either did nothing or it had a side effect. Medications will always have side effects.I mean, if its something life threatening or life reducing, it may have to be stopped to be prudent, but sometimes focusing on improving yourself in other ways while the medication takes its time is equally valuable.
-- tidingsJay
Posted by desolationrower on December 15, 2008, at 23:56:18
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 15, 2008, at 22:07:30
hey no problem. couple things:
reboxetine is just an nri, the other ones such as tcas would likely work as well; reboxetine is nice b/c it is less potent in bringing side effects.
5ht2 antagonists somtimes worsen OCD, so be aware of that; you seem to have different reactions to 5ht meds though, so its hard to tell
good luck with your apointmnet
-d/r
Posted by zzz7 on December 16, 2008, at 3:05:05
In reply to SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 13, 2008, at 6:39:29
Hi CC,
I had jerks like that when I tapered Klonopin 5mg. They went away after a few weeks.
Lamictal seems to be doing a good job for me right now, but only 12.5 mg daily.
Good luck.
Posted by crittercuddler on December 16, 2008, at 3:31:48
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 15, 2008, at 23:56:18
How do 5HT2A antagonists sometimes worsen OCD? I remember reading that the atypical anti-psychotics can do that when used alone and not in conjunction with an SSRI (not sure how)... but I wasn't planning on using one alone.
That would be really lousy if that happened to me because I don't see any other options for me other than to try an augment an SSRI or a SNRI with an SARI, the TCA nortriptyline, or an atypical anti-psychotic in order to help the agitation, anxiety, insomnia, muscle jerks... etc.... and ALL of those have some kind of 5HT2A antagonism.
From what I read, the SARIs are the strongest 5HT2A antagonists (nefazodone and trazadone) and I after that I don't know where the atypicals (like Seroquel, Risperdal, or Zyprexa) and the TCA nortriptyline would fall into order at.
All the drugs I am left to work with (if I cut out SSRIs and SNRIs all together) have 5HT2A antagonism to some degree. Except Buproprion and I don't see that helping me by itself with major depression and OCD.
Ugh... I am so tired. My brain is fried. No more research or thinking about this tonight. I have been looking at this stuff so long my understanding is starting to regress because I am so exhausted.
I will let you all know how it goes at the doctor tomorrow.
Oh, btw, I made some suggestions to NewQuestions.... maybe you could swing by that thread to check them and see if they are right.
????? Thanks. :-)
Posted by desolationrower on December 16, 2008, at 11:20:54
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 16, 2008, at 3:31:48
Sorry, i didn't mean to say 5ht2a blockade definatly worsens OCD. It might well reduce it. This book has a summary of some of the evidence http://books.google.com/books?id=Kxi2JiBgNGoC&pg=PA79&lpg=PA79&dq=5ht2a+ocd+antagonist&source=web&ots=ydUPgmFxMF&sig=0zhUB2irck2IE2jI2Icng172aGc&hl=en&sa=X&oi=book_result&resnum=7&ct=result#PPA79,M1
desipramine is a tca nri that doesn't really affect 5ht2a. its more likely to cause insomnia though. Protriptaline too (i cannot find its binding value at 5ht2a), though it has some extra side effects. atomoxetine also.
Baclofen might help with anxiety, sleep, and muscle jerks...i don't think its helpful iwth OCD.
don't worry too much about the meds...theres a million options...good luck with the doctor
-d/r
Posted by crittercuddler on December 16, 2008, at 17:26:57
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 16, 2008, at 11:20:54
Things went okay at the doctor today. I typed up a summary of all the things I have learned here over the last few days along with medication combos that we might try based on them. My psychiatrist is very willing to collaborate with me and hear my ideas, which I like. Sometimes though he might be all to willing to go along with my lead though which might be neutralizing my OCD. Perhaps I could use a bit more control on his part. We have detailed discussion about how drugs work, etc... He appears to be the most competent doctor I have had so far. Often times I am not the only one who causes our appointment to go long because he too always has a lot to say and examples to give, etc...
For now, based on what we talked about he wants me to try Risperdal .25mg and see if I can tolerate it, and then we will look at anti-depressants. He is basing this approach on the belief that my system needs a kind of salve if you will, which is the same line of thinking he was using when perscribing AEDs to me in order to premedicate me. BUT, I wasn't able to stay on Gabapentin, Depakote, Trileptal, or Lamictal for any length of time though.... so perhaps this will work instead.
To be honest I am not hopeful. :-(
We didn't talk too much about anti-depressants today because he doesn't want to prescribe two meds at once based on my fear and reactions. But, he has my list for when we do.
Hopefully we will get there and can discuss those soon.
Doesn't Baclofen work on GABA? Isn't it a GABA reuptake inhibitor or something? I don't want any medicine that works on GABA. After my terrible experience from using Klonopin long term and the withdrawal I suffered and perhaps am still suffering from I am more than happy to leave my GABA alone. At least by direct methods.
Thank you again d/r.
Posted by desolationrower on December 16, 2008, at 22:26:07
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 16, 2008, at 17:26:57
> Things went okay at the doctor today. I typed up a summary of all the things I have learned here over the last few days along with medication combos that we might try based on them. My psychiatrist is very willing to collaborate with me and hear my ideas, which I like. Sometimes though he might be all to willing to go along with my lead though which might be neutralizing my OCD. Perhaps I could use a bit more control on his part. We have detailed discussion about how drugs work, etc... He appears to be the most competent doctor I have had so far. Often times I am not the only one who causes our appointment to go long because he too always has a lot to say and examples to give, etc...
That sounds like its working well. Sometimes i'm not sure how much to talk about drug actions with my pdocs, i'm not sure if i need to explain why something might work/how it works, or if they know already. I like my current one but it is weird he knows i'm taking memantine but not what it is for. It sounds like you're well organized. I just show up, I actually don't really talk about gsk-3 or whatever with my doc.
> For now, based on what we talked about he wants me to try Risperdal .25mg and see if I can tolerate it, and then we will look at anti-depressants. He is basing this approach on the belief that my system needs a kind of salve if you will, which is the same line of thinking he was using when perscribing AEDs to me in order to premedicate me. BUT, I wasn't able to stay on Gabapentin, Depakote, Trileptal, or Lamictal for any length of time though.... so perhaps this will work instead.
Hopefully it will be helpful. Low dose risperidone is a pretty clean medication. I noticed a decrease in pressure of self-harming thoughts and better sleep.
> To be honest I am not hopeful. :-(
I am!
> We didn't talk too much about anti-depressants today because he doesn't want to prescribe two meds at once based on my fear and reactions. But, he has my list for when we do.
>
> Hopefully we will get there and can discuss those soon.Did you include the OTC options?
> Doesn't Baclofen work on GABA? Isn't it a GABA reuptake inhibitor or something? I don't want any medicine that works on GABA. After my terrible experience from using Klonopin long term and the withdrawal I suffered and perhaps am still suffering from I am more than happy to leave my GABA alone. At least by direct methods.
it is a GABA-B agonist (benzos affect GABA-A). So it is similar but not exactly the same. Perhaps it is too close.
-d/r
Posted by crittercuddler on December 18, 2008, at 1:21:53
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 16, 2008, at 22:26:07
"That sounds like its working well. Sometimes i'm not sure how much to talk about drug actions with my pdocs, i'm not sure if i need to explain why something might work/how it works, or if they know already. I like my current one but it is weird he knows i'm taking memantine but not what it is for. It sounds like you're well organized. I just show up, I actually don't really talk about gsk-3 or whatever with my doc."
> I like to go to my appointments with a bulleted outline of what I want to talk about, although I don't have the motivation very often to make one. This time I had so much I wanted to talk about that I felt it was definitely necessary to organize my thoughts and give us any chance of getting through it all. Also, if I make one it helps me worry less that I will forget to mention something important. I am not shy about bringing things up with my doctor. I figure it won't hurt if he does know. I think he knows that I am bringing it up in order to explain my reasoning and not challenging his authority or expertise as a doctor. I am glad I have a doctor that I can do that with. It is important that I feel like we are collaborating... a meeting of the minds if you will. A few times I have told him stuff he didn't know about. After reading my paper he got out his drug book and said he wanted to "look up some things". I don't know whether to be happy or concerned about that.... He looked up stuff for quite a bit.
"i'm taking memantine"
> Namenda, right? So do you have OCD too? What are you taking it for?"Hopefully it will be helpful. Low dose risperidone is a pretty clean medication. I noticed a decrease in pressure of self-harming thoughts and better sleep."
> The first night I took it, and tonight, it kicked in and I started to feel sleepy. Not as sleepy as Seroquel, but still it was pronounced. When I tried to sleep though, both nights, I haven't been able to. It kind of feels like it is activating me and making me drowsy at the same time. It is an uncomfortable feeling. :-( Very uncomfortable. I hope it does help with the suicidal thoughts, because I still have them very often. I am having them bad tonight.
"Did you include the OTC options?"
> I told him I was taking NAC now. It didn't seem like he had heard of it. He asked me what supplements I took. I told him fish oil and my multi-vitamin. He suggested that I try inositol. I was pleased that he brought that up himself. He said he had always wanted to suggest it, but the opportunity hadn't presented itself. I ordered some of it and will get it in a few days. Should I split it up in two doses?"it is a GABA-B agonist (benzos affect GABA-A). So it is similar but not exactly the same. Perhaps it is too close."
> Yeah, too close for comfort.
I am worried about the Risperdal making my OCD worse using it alone. My OCD is already incredibly bad so I can't risk that. I popped a fluvoxamine 50mg tonight because I am worried. I also took it because of the suicidal thoughts.
You said nortriptyline was shown to help an SSRI work faster for OCD. Can you send me links to the studies? I wanted to send them to my doctor.
Well, bye for now.
-michelle
Posted by crittercuddler on December 18, 2008, at 1:43:01
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:21:53
Racer-
I just wrote you a long reply and it is not showing up. I clicked on one of your replies earlier in my history in order to do this. Is it not working because I did it that way? Should I just have clicked on the last post? Do you know?
Anyway, I just wanted to briefly, right now, thank you so much for your wonderful suggestions and apologize that I somehow overlooked replying to you before.
When I feel better I will retype it. Blah. :o(
Posted by crittercuddler on December 18, 2008, at 1:51:02
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:43:01
Racer-
Maybe I can summarize it....
Some questions for you,
1. Can you describe to me how your OCD flares up when you are trying to get on a medicine? Specifically, like what kind of thoughts?
2. How do you draw the line between assurance from the doctor and neutralizing?
3. Why do you like Zoloft the best?
4. What specific things was your doctor able to do that kept you going on a medicine when you were scared?
I have access to my doctor through email and at first he would reply promptly to me. The longer I have seen him though I have noticed that he now either doesn't reply at all or he takes like a week when before it would only take a day. Many times I am asking him to write me a different prescription though when I email him because I am convinced I shouldn't be taking whatever it is that I just started taking. So, I am thinking he is not replying because he realizes he is contributing to my neutralizing or because he just doesn't think anything he is going to say will help because it never does, or I am just emailing him too much and he is trying to make a point...?
Posted by desolationrower on December 18, 2008, at 13:51:29
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 1:21:53
> > I like to go to my appointments with a bulleted outline of what I want to talk about, although I don't have the motivation very often to make one. This time I had so much I wanted to talk about that I felt it was definitely necessary to organize my thoughts and give us any chance of getting through it all. Also, if I make one it helps me worry less that I will forget to mention something important. I am not shy about bringing things up with my doctor. I figure it won't hurt if he does know. I think he knows that I am bringing it up in order to explain my reasoning and not challenging his authority or expertise as a doctor. I am glad I have a doctor that I can do that with. It is important that I feel like we are collaborating... a meeting of the minds if you will. A few times I have told him stuff he didn't know about. After reading my paper he got out his drug book and said he wanted to "look up some things". I don't know whether to be happy or concerned about that.... He looked up stuff for quite a bit.
heh, your writing seems organised. i guess i'm not surprised.
> > Namenda, right? So do you have OCD too? What are you taking it for?
Well, my box is actually 'adementa'. I like some of these foriegn drug brand names, they're quite descriptive. HAve dementia? Take Adamenta! Or 'eldepryl.'
I don't have OCD, although when i was a kid i think i had such tendencies...i wouldn't be able to stop shooting basketball until i had some unimportant percentage, and so i'd stay outside for hours trying...also had weird obsession with imagining touching every telephone pole while riding in a car...things like that, but somehow i was able to realize this and now i have no problem cutting off these thoughts...when one is young the brain is quite flexible, it is amazing
I take the memantine as add-on to the parnate i take, to reduce tolerance to stimulant effects, to increase antidepressant effects, generally to help with inattentiveness and lack of activation...
> > I told him I was taking NAC now. It didn't seem like he had heard of it. He asked me what supplements I took. I told him fish oil and my multi-vitamin. He suggested that I try inositol. I was pleased that he brought that up himself. He said he had always wanted to suggest it, but the opportunity hadn't presented itself. I ordered some of it and will get it in a few days. Should I split it up in two doses?I'm not sure of its half-life so that would probably be a good idea. Also, be careful starting at the full dose, some people have gastro-intestinal perturbations if taking a full dose right away, although this goes away with time (i never experienced any problems). Dose splittnig would help this. It is like sugar so you can take it in your tea if that is your, uh, 'cup of tea' (i prefer a drop of milk...) or in with some lemon juice as lemonade or something like that. takes a bit to dissolve all of it.
> You said nortriptyline was shown to help an SSRI work faster for OCD. Can you send me links to the studies? I wanted to send them to my doctor.
Here is a article with numerous cites for some of the other treatments, like NAC. It appears fairly comprehensive. http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=645
For nort,
J Clin Pharm Ther. 1998 Apr;23(2):155-9.Click here to read Links
Combination of clomipramine and nortriptyline in the treatment of obsessive-compulsive disorder: a double-blind, placebo-controlled trial.
Noorbala AA, Hosseini SH, Mohammadi MR, Akhondzadeh S.Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran.
OBJECTIVE: There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone. METHOD: Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo. RESULTS: Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD. CONCLUSION: As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD.
Not exactly your situation, but similar->
J Affect Disord. 2002 Feb;68(1):59-65.Click here to read Links
Does SSRI augmentation with antidepressants that influence noradrenergic function resolve depression in obsessive-compulsive disorder?
Mancini C, Van Ameringen M, Farvolden P.Anxiety Disorders Clinic, McMaster University Medical Centre, Hamilton Health Sciences Corporation, McMaster Site, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. mancini@fhs.mcmaster.ca
BACKGROUND: Obsessive compulsive disorder (OCD) often coexists with major depressive disorder (MDD). Serotonergic antidepressant medications have emerged as the treatment of choice for both OCD and MDD. In the usual course of events, both the patient's OCD and depressive symptoms improve in parallel following initiation of serotonin reuptake inhibitor (SRI) treatment for OCD. However, such is not always the case. We report here on a series of ten patients whose OCD but not depression improved following a trial of SRI therapy. METHOD: Ten patients with OCD and comorbid MDD who experienced a worsening or exacerbation of depressive symptoms while being maintained on an adequate dose of SRI therapy were treated using a combination of SRIs and agents with effects on noradrenergic reuptake. Response to treatment was based on clinician-ratings of severity and improvement of OCD and MDD (CGI-S and CGI-I). RESULTS: Following augmentation, nine of the ten patients had a significant improvement/resolution of their MDD, with little further change in the severity of their OCD. LIMITATIONS: Inferences from the results of this study are limited by the lack of a control group, the small sample size, and the use of nonstandardized ratings as measures of symptom severity. CONCLUSIONS: These results are of practical significance to clinicians insofar as they suggest a possible guideline to clinicians treating depression in OCD with SSRIs without success.
PMID: 11869783 [PubMed - indexed for MEDLINE]
uh, so another study from Iran->
http://journals.tums.ac.ir/upload_files/pdf/3511.pdf
Combination of Citalopram and Nortriptyline in the Treatment
of Obsessive-Compulsive Disorder: A Double Blind,
Placebo-Controlled Trial
Abbas Ali Nasehi, MD
1
Marzieh Tavakoli, MD
2
Firoozeh Raisi, MD
2,3
1 Iran Helal Institute of Applied Science &
Technology
2 Psychiatry and Psychology Research Center,
Roozbeh Hospital, Tehran University of Medical
Sciences, Tehran, Iran
3 Department of Psychiatry, Roozbeh Hospital,
Tehran University of Medical Sciences, Tehran,
Iran
Corresponding author:
Firoozeh Raisi,
Assistant Professor of Psychiatry,
Psychiatry and Psychology Research Center,
Roozbeh Hospital, Tehran University of Medical
Sciences, South Kargar Avenue,
13337,Tehran, Iran
Email:raisi_f@yahoo.com
Tel: +98-21-55412222
Fax: +98-21-55419113
Objective: The fact that some antidepressants with strong effects on
serotonin reuptake blockade fail to relieve obsessive-compulsive
symptoms has caused growing interest in investigating noradrenergic
function in obsessive-compulsive disorder (OCD) . In light of the
above, we undertook a trial to investigate whether the combination of
citalopram with nortriptyline is more effective in treating obsessive-
compulsive symptoms than citalopram alone.
Method: 40 patients who met the DSM-IV criteria for OCD were
included in the study. Patients were allocated in a random fashion: 20
patients to citalopram 40mg /day plus nortriptyline 50mg /day, and 20
patients to citalopram 40mg /day plus placebo.
Results: Both protocols significantly decreased the scores of the
Yale-Brown Obsessive Compulsive Scale (Y-BOCS) over the trial
period, but the combination of citalopram and nortriptyline showed a
significant superiority over citalopram alone in the treatment of OCD.
Conclusion: As this study indicates, nortriptyline improves the
efficacy of citalopram. In addition, a rapid onset of action is one of the
advantages of this combination. This study supports further
investigation of the noradrenergic serotonergic hypothesis in OCD.
Iran J Psychiatry 2006; 1: 54- 58Another NRI which improves sri response->
World J Biol Psychiatry. 2005;6(1):57-9.Links
Citalopram plus reboxetine in treatment-resistant obsessive-compulsive disorder.
Fontenelle LF, Mendlowicz MV, Miguel EC, Versiani M.Anxiety and Depression Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. leofontenelle@hotmail.com
While serotonin reuptake inhibitors (SRIs) are the first-line treatment of obsessive compulsive disorder (OCD), as many as 40-60% of patients fail to respond to adequate trials with these drugs. In this study, we describe the case of a patient with an SRI-resistant OCD who was successfully treated with a combination of citalopram (a selective SRI) and reboxetine (a selective noradrenaline reuptake inhibitor (SNRI)). This report suggests that future studies accessing the efficacy of the SRI SNRI combination in treatment resistant OCD are needed.
here is a negative result showing desipramine didn't help->
Addition of desipramine to serotonin reuptake inhibitors in treatment- resistant obsessive-compulsive disorderLC Barr, WK Goodman, A Anand, CJ McDougle and LH Price
Clinical Neuroscience Research Unit, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, USA.OBJECTIVE: The purpose of this study was to determine whether combined treatment with a selective serotonin reuptake inhibitor (SSRI) and a norepinephrine reuptake inhibitor, desipramine, effectively reduces obsessive-compulsive symptoms in patients who do not respond to SSRIs. METHOD: In a double-blind study, desipramine or placebo was added for 6 or 10 weeks to the treatment of 30 patients with obsessive-compulsive disorder whose symptoms were refractory to SSRI treatment (fluvoxamine, fluoxetine, or sertraline) alone. RESULTS: There were no significant differences between the adjunctive desipramine and placebo groups in obsessive-compulsive or depressive symptoms. CONCLUSIONS: These data suggest that clomipramine's possibly superior efficacy in the treatment of obsessive-compulsive symptoms may not stem from its capacity to inhibit reuptake of norepinephrine
Also i think it might be relevant that clomipramine has a metabolite with NRi properites so while not quite the same it does have some NRI affect, and it is considered the gold standard (although high side effecty). There seems to be a disjunct in that people either respond to desipramine or to nortryptaline, i wonder if that is why desip didn't help in that last study.
i was going to babblemail you but it seems you've got it turned off
-d/r
Posted by crittercuddler on December 18, 2008, at 18:39:59
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by desolationrower on December 18, 2008, at 13:51:29
d/r
Thank you so much for that link on OCD augmenting strategies and for the abstracts. :-)
I will turn my babble mail on. I am sure others won't mind being able to see all of this though. It is helpful.
So, do you still take inositol? I ordered mine from www.bulknutrition.com. I searched for a while for other sites to buy from or brands, but came up pretty much empty handed. I couldn't find a better price than that site. I hope their product is good. Have you heard about inconsistencies between brands or anything?
Yeah, some drug names are funny. Dr. Phelps calls Abilify "smarmy". He even puts it in little letters on his website.
My OCD has changed over the 14 years I have had it. Obsessions that I had issue with when I was a teenager don't mostly don't bother me anymore. My OCD therapist says that is not uncommon, although I have a hard time understanding how they ever went away without me doing any ERP for them. I sure wish my current ones would go away. Of course if that happened they would just be replaced with new, different ones... and they are all crippling in their own way.
I am glad your OCD tendencies never turned into full blown OCD.
Yes, the young brain is amazing. Well, the brain is amazing period. I have lamented the fact that I didn't get diagnosed and treated sooner.
Well, my head is killing me.
Thank you again. I will keep everyone updated.
Posted by crittercuddler on December 26, 2008, at 18:50:23
In reply to Re: SSRI insomnia, restlessness, poor concentration, posted by crittercuddler on December 18, 2008, at 18:39:59
I should mention....
For those who are familiar with my other threads and how I can't tolerate an SSRI at all anymore, I have to say that I forgot to mention this important bit of info....
I was able to tolerate Lexapro for a month when I took it with Gabapentin. I didn't have any of the problems that I have with activation, insomnia, restlessness, muscle jerking. It was a mini-miracle. So, I guess you are wondering why I stopped it? Well, my depression was not improving after one month. I am aware that OCD symptoms take longer to respond and respond at higher doses, but depression I would think should have been getting better by that point. I took 10mg for 3 weeks and then 15mg for one week. I think depression should have responded to that dose. All it really seemed to do was take the edge off my suicidal desires.
I feared staying on it too long and having to wean off of it so I only gave it a month. I have weaned off of it before after just 2 weeks and had withdrawal symptoms which weren't nice. But, at four weeks, knowing this, I still quit cold turkey. Big mistake. Duh.
I often wonder if I should have stuck it out. It has been the most success I have had in 3 years of trying to tolerate an anti-depressant. I tried the Gabapentin along with Zoloft this fall to see if I could replicate the results and I could not. I was activated despite the Gabapentin.
If I take Gabapentin alone I feel drunk, blank, and out of it. That would be with a 300mg dose. If I take it with an anti-depressant that feeling goes away.
I don't want to take Gabapentin though because it works on GABA. That is another reason why I stopped the Lexapro/Gabapentin combo. I am scared/hesitant to take anything that has an effect on GABA afte my benzo experience. I know Gabapentin works differently, but still.
The good news was that I stopped the Gabapentin for a week before stopping the Lexapro and I did fine, no activation.
This was in July, which was my first month benzo free. (I completed my taper June 15)
This is the end of the thread.
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