![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Vincent_QC on March 11, 2009, at 8:43:42
It seem that everytime I switch for another AD, especially from a category into another one, I experience not stable mood and a decrease level of energy +motivation, got into a more deep depression mood, my social anxiety is worse than ever and I experiences more panic attack, especially concerning my heart who make me a lot anxious since a while...too much hypertension or high pulse rate...it's seem that i'm hypervigileant about these symptoms now and I can't focus on other things...
I take a couple of hours reading old threads about TCA's, since my PDoc begin to explore that category of AD's and try them on me...and I discover that they are not very helpfull with the social anxiety, especially when a depression and others comorbidities are presents...Thanks to Elizabeth, someone who seem to not be anymore a member of the babble forum...
I knonw that Scott point out the fact that the side-effects of TCA's decrease with time, but I can't handle them like I can't handle the SSRI's or the SRNI's or the Wellbutrin or the Remeron or anything else...I just feel worse each time I try a newer med from the 90's and more... I just don't seem to answer or improve on any meds using on-label or off-label for social anxiety with comobordities...that's make me a treatment resistant for SAD.
So I don't see why I will try to stick on the TCA's, if they make my heart and my head completly f*ck up...having to wait more than 12 or 16 weeks before I see an improve, and I assume a MINIMAL improvement, is not the kind of things I call to be a succeesfull story.
Since I was introduce into the world of TCA's, with the most potent SRI one (Clomipramine), I have to deal with newer sources of high stress, that stress is caused by the weight gain, who continue to affect me even if I totally stop any TCA's since more than 5 days, extra daytime sedation, regain of insomnia and vivids dreams, and the incredible decrease in my interests and motivation, I just feel like i'm surviving, not living...I don't have a life for now...nothing interest me, I just want to eat, sleep and I don't care about anything. I don't even call back my Psychologist since I miss my last appointment with her last week, so I will be probably push out of my CTB therapy because I miss more than 2 appointments since I begin it and my lovely PDoc is on vacation for I don't know how many times and no other PDoc seem to take his place during that period of time. Such a big deal...
Reading old post about TCA's, especially Elizabeth posts back from 2001 make me realise that no TCA'S alone will help me to improve my social anxiety and my general anxiety level...I suppose the sedative effect as well as the weight gain and the heart effect (high pulse rate on me) will be just another major issue and even with time, those side-effects will never disepear or decrease...like the side-effects of the newer drugs never decrease on me with time...
So, i'm leave alone with my little Valiums pills who don't work on me anymore...20mg/day or 30mg/day seem to be the same, so forget the Gaba-ergic effect on me of others off-label products like Vigabatrin, they only one I never try on that category (Neurontin, Lyrica...) or the return on the Nardil...
So what will be my next move??? First, I think avoiding TCA's will be a more great solution for me, at least I will be able to move my *ss a little bit more at daytime, maybe start dieting and loose my winter weight gain (50 pounds), stop smooking (help my heart) and do some exercices (help my heart also...).
I will never be able to be on a rocket fuel combo like Scott, I mean something like Parnate with a TCA on the top of it, or Ritalin with Parnate for more energy and more motivation and increase interest and focus in my life. The PDoc I have his strict on this rules...never blend dangerous meds together...and avoid all possible interraction...
The more I think about my situation and the more I think that the Marplan will be the good solution, I just have to be patient and wait for the answer from Health Canada.
I also think that I will do my 14 days washout period ( I already have 4 days done) and ask to be put back on the Parnate at a very low dosage and stay at this small amount for a while, since not everyone need to be on a super high dose of the Parnate to feel more great, I assume for me the 20mg dose is the acceptable limits between improvements and side-effects... At this dose, I don't have a lot of daytime sedation, no BP problems, no high pulse rate and no weight gain or orthostatic hypotension... I just feel physically tired, that's what I was experienced last december, if I can recall...
In the meantime, if the Marplan is approved for me, I will jump into that boat... I think the MAOI will be my only way to escape that never ending circle, since I only partially answer to that kind of meds, especially the Parnate...and a partial answer is better than any No answer on newer meds who seem to be not very good anyway on the SAD, since it's my main problem and all the others problems are linked to it...
That's my thoughts of the day... I don't think the Surmontil or Doxepin solution will be a lot helpfull, I already feel exhausted, I don't need more weight gain or sedation to get more well...I already having some Seroquel who take care of my insomnia at night and that's enought histaminic effects on my body...I still not sure if fast weight gain I experienced since 2 months is cause by the Seroquel or the TCA's...who know...
It's seem that I lost another 2 years of my life trying differents meds and combo who never works anyway... and changing 1$ for 4 quarters is the same no???
So for now, a lot of coffee at daytime and Valium seem to be my only solution, until the lovely PDoc be back from his vacation...I will make it clear with him, no more TCA's...why stick on something who is just more dirty than newer meds? TCA's are just not helpfull in SAD, that's it, like the SSRI's or the SRNI's seem to be also not effective as well for SAD...even if they can help on others comorbidities like depression ...but since that's not my main problem, I don't think working around those problems will resolve the BIG one...
Negative maybe but true...
Posted by SLS on March 11, 2009, at 9:03:35
In reply to TCA not good for SAD+GAD+lack motivation/energy, posted by Vincent_QC on March 11, 2009, at 8:43:42
What are your feelings about going on a monoamine oxidase inhibitor (MAOI)? After being on them for years, I can say that once the side-effects disappear after a few months, they are very clean drugs. In my experience, they are more tolerable than TCAs or SRIs. Just start at a low dosage and move up slowly to avoid orthostatic hypotension and minimize other side effects as they emerge.
- Scott
Posted by Phillipa on March 11, 2009, at 10:01:52
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by SLS on March 11, 2009, at 9:03:35
Vincent didn't you try Parnate not long ago? I'm not sure thought I read that. Phillipa
Posted by desolationrower on March 11, 2009, at 10:33:36
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by Phillipa on March 11, 2009, at 10:01:52
i was actually going to make a post about TCAs, when i get my thoughts in straight line.
it seems your medical problems make it harder to stay on a medicine. i really think the very best thing you could do is work with your therapist to find some physical exercice that you enjoy, whether basketball league, frisbee, biking, weight lifiting, whatever. its always a good idea, but i think it would really help make medicines more tolerable for you.
also, are you on an ace inhibitor, i made a thread and it seems applicable here? they can be helpful for pre-diabetic, hypertensive, etc., especially the younger white male patient. i'm not sure exactly waht your health is at but something to consider, and theres some evidence they might positivly effect mood, as well as health.
also vitamin d3 and vitamin k2, maybe i've said those before. i doubt you have enough unless you're taking gelcaps now.
good luck yo, it sucks to go through meds that don't seem to help much
-d/r
Posted by mav27 on March 11, 2009, at 10:45:18
In reply to TCA not good for SAD+GAD+lack motivation/energy, posted by Vincent_QC on March 11, 2009, at 8:43:42
Yep they suck for SAD ect
I'll be giving it up later today when i see my PDOC, i'm pretty much fed up with trying any medication anymore, i'm so over it all.
Posted by Vincent_QC on March 11, 2009, at 12:37:56
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by SLS on March 11, 2009, at 9:03:35
> What are your feelings about going on a monoamine oxidase inhibitor (MAOI)? After being on them for years, I can say that once the side-effects disappear after a few months, they are very clean drugs. In my experience, they are more tolerable than TCAs or SRIs. Just start at a low dosage and move up slowly to avoid orthostatic hypotension and minimize other side effects as they emerge.
>
>
> - ScottHi Scott!
I hope you are in the good way for a remission ;-)To answer fast to your question, I was on the Nardil 75 mg for almost 3 months in january 2007...at this dosage, I was ok, no side-effects on my heart, no high BP or orthostatic hypotension...but also no improves on my SAD, as well as the GAD or panic disorder or anything else...at the times, I Was more active and I was walking almost 2 hours a day, so I never notice any weight gain on them and the food to avoid was not annoying me and I never experience a hypertensive crisis...But the Doc at the time decide to up the dosage to 90mg to see if I will answer more well...and "bingo", the hypotension orthostatic kick in, I had never experienced that kind of feeling before so I just decide to drop the Nardil cold turkey after being on it for almost 3 1/2 months with the 2 weeks at 90mg... I was affraid of the hypotension...who in fact is not dangerous...
I was put on Parnate last december...see small improves at 20mg, wanted to up the dosage too fast, endep up at 40mg with hypertension problem, hypertensives crisis without food interractions, had to use the safety pills often (Apo-Nifed 10mg), had several episodes of orthostatic hypotension at night, one time I fainted when I wanted to go to the bathroom and I had photophobia also, very sensible to light...at the same time the hypotension was often blend with hypertension...my heart totally dislike the Parnate... I stop it after one month...I was tired but not the normal fatigue, it was a physical fatigue, I assume it was caused by the heart problems...I also find the Parnate to be A LOT sedative...and I had to drink a lot of coffee to be able to move my *ss on it (40 mg)... I stop it cold turkey in the begining of january...and after a washout period I was put again back on the Nardil, change my minds and be put on Manerix, find it not usefull and full of SSRI's side-effects (increase migraines, agited with sedation at the same time), so another washout period and the PDoc decide to try the Clomipramine on me...on term of side-effects it was not too bad...exception goes to the strange goose bumps and chills that I had almost everytimes...with a lot of sedation as well, gain weight that never ending even after I stop it, and I was sweating like never before...On the Parnate, I was always cold, something very uncommon for me, I always leave my windows open a little bit at night in my bedroom...even if it's
-20 celsius outside...So you see, it's why the PDoc fill up some papers and send them to Health Canada, to become avaible to a special programm access for meds who are not avaible in the Canada but that we can import here... The Marplan is the next option...but we have to wait for a positive answer before and it's a long process...
It's why I ask myself a lot of questions now... In my head it's clear that the idea to be put again on a TCA's is not a valid option anymore, and I have to be honnest with myself and see that the only positive answer I got from an AD was from the Parnate, so i'm a positive candidate for this kind of meds...still don't know if the Nardil will be finished to worked at 90 mg on me, since I drop it at the 90mg dose after only 2 weeks...
Should I give another try to the Parnate and stay at 20mg, the dosage who don't give to me hypotension or hypertension??? The 30mg dose make me a lot tired physically and also orthostatic hypotension who put me asleep all day long...the 20mg dose is ok...Maybe i'm someone who can't take huge amount of drugs...or maybe I have a poor metabolisme that's make the drug to be more strong than on someone else??? Still don'T know what to think since I was before on huge amount of Zoloft and Lexapro with Ritalin or Wellbutrin on the top of that...mean that I was able to have high dosage of meds without any side-effects...so mean that my metabolism maybe not the implied in the whole process...
The return on the Parnate at a low dose is a temporary solution and I really hope the Marplan will be approved for me...I really need to try it...
Well what do you think of this? Did I miss something to not trying others TCA's since the Clomipramine fail and make me a lot too anxious and anti-social...and the Nortryptiline make my heart racing at the speed of light... I suppose the others who have dual-action will not be more usefull on me and on the SAD? Even if I wait 3 months and that I increase slowly the dosage to avoid side-effects??? So much questions... One thing is sure, I don't want to end-up on a TCA's who will just give to me daytime sedation, weight gain and a lot of others strange side-effects that never fade-away...and taking them ALONE, not as an addition to another med make the possible helpfull action on the SAG and GAD less possible no???
Well, thanks for any comments or recommandations you can make to me!!! I Appreciate that!
Have a nice day!
VIncent ;-)
Posted by Vincent_QC on March 11, 2009, at 12:55:05
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by desolationrower on March 11, 2009, at 10:33:36
> i was actually going to make a post about TCAs, when i get my thoughts in straight line.
>
> it seems your medical problems make it harder to stay on a medicine. i really think the very best thing you could do is work with your therapist to find some physical exercice that you enjoy, whether basketball league, frisbee, biking, weight lifiting, whatever. its always a good idea, but i think it would really help make medicines more tolerable for you.
>
> also, are you on an ace inhibitor, i made a thread and it seems applicable here? they can be helpful for pre-diabetic, hypertensive, etc., especially the younger white male patient. i'm not sure exactly waht your health is at but something to consider, and theres some evidence they might positivly effect mood, as well as health.
>
> also vitamin d3 and vitamin k2, maybe i've said those before. i doubt you have enough unless you're taking gelcaps now.
>
> good luck yo, it sucks to go through meds that don't seem to help much
>
> -d/r
Hi -d/r...
Hummm, that's true, my physical condition is not very good at the moment. I don't exercise, I don't eat a lot and when I eat it's not good food, I have an anemia problem who seem to persist even with iron pills and intravenous iron treament I recieve each month, I smooke a lot, I have insomnia at night...and the list goes on... Nothing to make me a good and healtly guy... I had also before morbid obesity problem and a gastric by-pass...but even when I was at a high weight, I was in good shape, I was exercices a lot, do a lot of bicycle and walked a lot also...What you mean by ace inhibitor??? I don't know this...
For the Vitamins...the D3 and the K2...they are liposolubs vitamins no??? My gastric by-pass work with a malabsorbtion, mean that I have a short intestine and the part where the fat is digest and transform into others substances in the blood and fat tissue don't work anymore...I take huge amount of fat solubes vitamins everyday (Vit D - 50 000 units, Vit A - 30 000 units, Iron pills - 1200 mg/day, 2 Xtra strenght centrum pills, and calcium - 1500 mg/day... I have blood test often and all my vitamins level are at the lowest limit of the acceptable level...but my iron is low and my hemoglobine level as well as my vitamin K level is too low...
Diabetic is common in my familly, my mom is a type 1 diabetic...my dad do hypertension (take Avapro 60mg each day)...so genetic is also not very good in my familly...
I also have a lot of bad habits to stop...cigarettes (more than 20 a day), no physical exercise, high fat meal and craving for sweet things, coffee... but that's hard to move on and change is lifestyle when you are not feeling good and you don't have any energy to do a step in the good direction...
well, thanks for your help...just explain a little bit more what is the ace inhibitor... ;-)Have a nice day!
Vincent :-)
Posted by Vincent_QC on March 11, 2009, at 13:12:35
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by mav27 on March 11, 2009, at 10:45:18
> Yep they suck for SAD ect
> I'll be giving it up later today when i see my PDOC, i'm pretty much fed up with trying any medication anymore, i'm so over it all.Hi Mav!
Can I know what AD you use now??? I'm a little bit lost...Did you try any MAOI's before?I have a family Doctor who is also a specialist on the anxiety disease and he follow me since more than 14 years... He always refuse to try any TCA's on me, telling me they was not good at all and not helpfull for SAD... He is use to treat resistant treatments people with MAOI's like The Nardil but not the Parnate...and he don't like the Manerix and short acting MAOI like that one...Anyway, he was out of solution for me last year so it's why I ended up at the psychiatric hospital with a PDoc...funny cause the PDoc I had at first was a more young one, so he was not used to treat people with old drugs and was always refering the newer drugs as the only good things in the world, especially the Lexapro (Cipralex)...claim it was the best AD in the world, the more easy to take, no side-effect...bla bla bla...That's all false of course...I never had a more bad experience than the one I had with the Lexapro...Anyway, I remember he had a lot of appointments with the representative peoples of the pharmaceutical compagny who produce the Cipralex(Lexapro) drug...I think he was push by this compagny...anyway...he quit his job and the other PDoc I have now is more open minded and his used to treat people with old drugs...especially the Parnate and the TCA's...but that's not really helping me more to be follow by a PDoc, no ones find a newer solution for me, the Parnate was MY idea...The TCA's was my idea also...That's seem that I'm the one who decide what to try and what will be the next med to try also...The PDoc seem to be not usefull...sometimes I feel like I know more things than him in fact...the same apply with my familly doctor...anyway...I feel trap in the same never ending circle, they all return to the 0 case... When you fall into the second try of a med, that's sign that you almost do all the list of the possibilities to treat and cure you...
Give me some news of you ok...and I hope your appointment this afternoon will be ok!!!
Take care!
Vincent ;-)
Posted by mav27 on March 11, 2009, at 13:29:01
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » mav27, posted by Vincent_QC on March 11, 2009, at 13:12:35
> > Yep they suck for SAD ect
> > I'll be giving it up later today when i see my PDOC, i'm pretty much fed up with trying any medication anymore, i'm so over it all.
>
> Hi Mav!
> Can I know what AD you use now??? I'm a little bit lost...Did you try any MAOI's before?
>
> I have a family Doctor who is also a specialist on the anxiety disease and he follow me since more than 14 years... He always refuse to try any TCA's on me, telling me they was not good at all and not helpfull for SAD... He is use to treat resistant treatments people with MAOI's like The Nardil but not the Parnate...and he don't like the Manerix and short acting MAOI like that one...Anyway, he was out of solution for me last year so it's why I ended up at the psychiatric hospital with a PDoc...funny cause the PDoc I had at first was a more young one, so he was not used to treat people with old drugs and was always refering the newer drugs as the only good things in the world, especially the Lexapro (Cipralex)...claim it was the best AD in the world, the more easy to take, no side-effect...bla bla bla...That's all false of course...I never had a more bad experience than the one I had with the Lexapro...Anyway, I remember he had a lot of appointments with the representative peoples of the pharmaceutical compagny who produce the Cipralex(Lexapro) drug...I think he was push by this compagny...anyway...he quit his job and the other PDoc I have now is more open minded and his used to treat people with old drugs...especially the Parnate and the TCA's...but that's not really helping me more to be follow by a PDoc, no ones find a newer solution for me, the Parnate was MY idea...The TCA's was my idea also...That's seem that I'm the one who decide what to try and what will be the next med to try also...The PDoc seem to be not usefull...sometimes I feel like I know more things than him in fact...the same apply with my familly doctor...anyway...I feel trap in the same never ending circle, they all return to the 0 case... When you fall into the second try of a med, that's sign that you almost do all the list of the possibilities to treat and cure you...
>
> Give me some news of you ok...and I hope your appointment this afternoon will be ok!!!
>
> Take care!
>
> Vincent ;-)Yeah i'm lucky to have found a really nie pdoc after 10 years, he lets me try what i want and even some things that are totally not what a doc would expect to work in my case. I'm on imipramine which i decided to retry but it is causing severe blood pressure problems, the same ones i have with the maoi;s but not as bad as i'm not fainting on imipramine. It's making me really agitated though and given me a bad temper.
So far the best thing that has helped is sodium volroate, i'm not bipolar at all and i only asked him if i could try it because i couldn't think of anything else new to try and since i had seen people complain about it making them drowsy and other negative things i thought i would try it because i seem to react the opposite to everyone else on a medication. Sure enough the stuff gave me a lot of mental energy and a slight pick me up but not quite enough to lift the depression, so it's helped with mental energy but not body energy so i still feel really lethargic all the time which is kind of really annoying now that my brain wants to get out and about but not my body.
I was hoping the imipramine would help with the depressed mood and lack of energy in my body but it's just royally stuffing my heart around.
Posted by myco on March 11, 2009, at 18:29:13
In reply to TCA not good for SAD+GAD+lack motivation/energy, posted by Vincent_QC on March 11, 2009, at 8:43:42
Vince...please don't take offense to this at all ok. How come you have such a problem sticking to meds. It's because your med sensitive is it? I think so based on what I know of you. Seems like you may want to just stick it out as long as you can...you are already feeling bad...so a couple weeks or months to evaluate a med properly seems logical to me no? I'm sure youve had doctors force feed you this idea though. Again no offense please...just asking about your med sensitivity
myco
Posted by Vincent_QC on March 11, 2009, at 19:44:25
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » Vincent_QC, posted by myco on March 11, 2009, at 18:29:13
> Vince...please don't take offense to this at all ok. How come you have such a problem sticking to meds. It's because your med sensitive is it? I think so based on what I know of you. Seems like you may want to just stick it out as long as you can...you are already feeling bad...so a couple weeks or months to evaluate a med properly seems logical to me no? I'm sure youve had doctors force feed you this idea though. Again no offense please...just asking about your med sensitivity
>
> mycoHi Myco!
I'm not offensed don't worry...lolI'm sensitive to meds who have side-effects on the heart, but not to others meds...I always give to all the meds I try at least a 3-4 months of times to see what happen.
I was on the Paxil for almost 4 years at a high dose ( 60mg, 2 blue pills day...) and I see no improves but I gain more than 150 pounds on it!!! If you don't believe me, I Can send you some pictures at 18 yo and pictures of me 5 years later, after I stop the Paxil... The SSRI's as well as the TCA's make me fat, even if I get a gastric by-pass to loose all the weight I get from this kind of drugs... I always think that I will never be again fat but I was wrong... Since October 2007, I begin to gain weight again, after more than 6 years without getting any weight, even if I was not eating well or exercises a lot at some points...Now I have to do DIET again...and STRICT diet because the regular ones like Weight watchers don't work, I have to do strict diet like 600 calories/day of whey protein with tons of supplements vitamins...if not, I don't loose a pound...
I also give a long try to the Celexa without any improve and with no side-effect except the weight gain, it was before my gastric by-pass also.
I also give to the Zoloft two differents tries, one before my gastric surgery, no improve at all just another weight gain as usual and a second try in the winter of 2008, I also try the PRozac for almost 4 months and I gain weight also for a total of 55 pounds that I gain from October 2007 to april 2008... from 175 pounds to 230 pounds...
Others side-effects often include sedation, lack of motivation and energy with worsing panic disorder and agoraphobia...and yes, I often stay on a AD who make me worse at the begining, just to see if with time it will turn to be helpfull but that's never happen...
Now it's seem that I have also a body dismorphic problem...relatively close to OCD... I give a long try to drugs like Gabapentin, Topamax who make me think like an idiot, I try for a long times differents antipsychotics drugs who make my hands shake and worse my state... I get addicted to almost all the benzos drugs that exist, the worse are of course the short half-life like the Xanax...i'm now addicted to the Valium, can't stop them...
I admit that I drop out some drugs faster than the other ones...Lyrica, Trazodone, Parnate, Manerix (not effective anyway) and of course the Clomipramine and the Nortryptiline who almost killed me...
If I stop a med cold turkey, it's because I know it can be dangerous for me, the goal is not to feel more bad and to be a total mess...the main goal is at least to have some side-effects that equal the ratio of improves I get from a med...a med with no side-effect don't exist, but you have to admit than when the heart is linked to the side-effects, you don't play that dangerous game of staying on that med and maybe die of an heart attack...
Posted by desolationrower on March 12, 2009, at 5:38:06
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » desolationrower, posted by Vincent_QC on March 11, 2009, at 12:55:05
> > i was actually going to make a post about TCAs, when i get my thoughts in straight line.
> >
> > it seems your medical problems make it harder to stay on a medicine. i really think the very best thing you could do is work with your therapist to find some physical exercice that you enjoy, whether basketball league, frisbee, biking, weight lifiting, whatever. its always a good idea, but i think it would really help make medicines more tolerable for you.
> >
> > also, are you on an ace inhibitor, i made a thread and it seems applicable here? they can be helpful for pre-diabetic, hypertensive, etc., especially the younger white male patient. i'm not sure exactly waht your health is at but something to consider, and theres some evidence they might positivly effect mood, as well as health.
> >
> > also vitamin d3 and vitamin k2, maybe i've said those before. i doubt you have enough unless you're taking gelcaps now.
> >
> > good luck yo, it sucks to go through meds that don't seem to help much
> >
> > -d/r
>
>
> Hi -d/r...
> Hummm, that's true, my physical condition is not very good at the moment. I don't exercise, I don't eat a lot and when I eat it's not good food, I have an anemia problem who seem to persist even with iron pills and intravenous iron treament I recieve each month,interesting, couple reasons might be inflammatory IL6 which also involved in depression, and folate/12 deficiency, i assume you take those?
>I smooke a lot, I have insomnia at night...and the list goes on... Nothing to make me a good and healtly guy... I had also before morbid obesity problem and a gastric by-pass...but even when I was at a high weight, I was in good shape, I was exercices a lot, do a lot of bicycle and walked a lot also...
so you used to excercise, but haven't been?
> What you mean by ace inhibitor??? I don't know this...
its for high blood pressure, protect from harms of high blood sugar. you have a number of risk factors, i think you said you had high blood pressure, at least off the parnate.
> For the Vitamins...the D3 and the K2...they are liposolubs vitamins no??? My gastric by-pass work with a malabsorbtion, mean that I have a short intestine and the part where the fat is digest and transform into others substances in the blood and fat tissue don't work anymore...I take huge amount of fat solubes vitamins everyday (Vit D - 50 000 units, Vit A - 30 000 units, Iron pills - 1200 mg/day, 2 Xtra strenght centrum pills, and calcium - 1500 mg/day... I have blood test often and all my vitamins level are at the lowest limit of the acceptable level...but my iron is low and my hemoglobine level as well as my vitamin K level is too low...
>hm, wow. ok first off it might not even be the right kind of vitamin d, prescription kind is D2. if you are being checked for D level, hopefully its working enough...for that and vitamin k, you could get those "Twinlab Vitamin D3 1000 + K2"
tabs you take sublingually, that wouldn't have the absorbtion problem. also i guess if vitamin A is low, its not a problem, but really getting it in carotenoid form, and letting body convert the amount it needs is better, vitamin A can cause depression...Accutane is a form of vitamin A used for acne and it causes depression. i'd want to see if there are carotenoid supplements to take instead, but at minimum get your vitamin D level up...also if you aren't adding magnesium (citrate)and zinc...lots of people find that helpful for anxiety and sleep, if you are deficient i'm sure that is making things worse...b12 deficiecy will do that too> Diabetic is common in my familly, my mom is a type 1 diabetic...my dad do hypertension (take Avapro 60mg each day)...so genetic is also not very good in my familly...
yeah, avapro is an ARB which is almost the same thing as ace inhibitor, sounds like you have lots of risk factors for heart problems.
> I also have a lot of bad habits to stop...cigarettes (more than 20 a day), no physical exercise, high fat meal and craving for sweet things, coffee... but that's hard to move on and change is lifestyle when you are not feeling good and you don't have any energy to do a step in the good direction...
>
>
> well, thanks for your help...just explain a little bit more what is the ace inhibitor... ;-)
>
> Have a nice day!
>
> Vincent :-)cheers
-d/r
Posted by Vincent_QC on March 12, 2009, at 14:49:40
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » Vincent_QC, posted by desolationrower on March 12, 2009, at 5:38:06
interesting, couple reasons might be inflammatory IL6 which also involved in depression, and folate/12 deficiency, i assume you take those?
Hummm, not sure what I got tested with my last blood test...I know my thyroid was tested (T3, T4), the B6, B12, iron level (I have anemia around 10 of iron, we need more than 14 to be at the acceptable limit) and my hemoglobin is low also but thats related to the fact that each time I go to the bathroom I lost a lot of blood (profound hemorrhoids that I got ligatured every 2 months or so...I need a least 5 or 6 ligatures of hemoroid before the blooding will stop) so its why I take 1200mg of iron each day and also I have one monthly treatment of intravenous iron...others things was also tested but nothing negative was find, I ask my Pdoc to include everything who can be linked to depression, lack of motivation, interest and anxiety of course...so I suppose he know everything to be tested ...if not can you told me exactly what I should ask to my Pdoc to be test next time??? I will print the list and bring it to him...we will see if I got everything tested, it will be very nice from you do do this for me! Thanks in advance!!!
so you used to excercise, but haven't been?
Exactly, before my gastric-by-pass and even if I had morbid obesity, I was very active, I had a hard work (working as a help-cook in a high class restaurant in a big hotel), always do a lot of bicycle at summer, sometimes more than 300km in all my summer ( I had a counter kilometers installed on my bicycle)...Yes, I agree that in my teenager years I was not active, but I was not eating a lot also, I was always on diet...I begin to diet at the age of 8 years old...I Was already fat... and already with an avoidance personality with a lot of anxiety at school and no friends...everything was already in place for the social anxiety disease but nobody at school or even my parents see this happening...it was not a disease back then... it was only my fault anyway, I was the one who was not good...I Was the one who always defy the authority...At school it was crazy as hell, I always avoid public place and the cafeteria... I always had medical papers to not going to my physical education class because I was not choose in the teams and often the others childs was yelling at me about the fact that I was just a fat kid thats worth nothing, that I was a big and fat and not usefull, a piece of sh*t, that I was just a bullet for them, things like this...you know kids are very cruel together anyway...I was just lacking the capacity to answer to them and defend myself... I begin to avoid all the sports, in particulary team sports games (baseball, soccer, football, volleyball)...and I jump into the drugs early, around 12 years old, I start smoking weeds, cigarettes, I was doing hard drugs like LSD, cocaine to loose some weight, PCP, things like that...everything to be able to avoid the reality and to be able to continue to live a normal life and ignore the others kids... I developp a boulimia problem and a BDD problem around the same period of time between 12 -18 years old...I was felling guilty because I was eating guilty to be fat, so it was a big problem for me...and you now understand why I dont like a lot sports and why I dont want to continue to gain weight...and why the TCAs are not good for me...The Clomipramine start in me intense craving for food, I just cant stop eating and sometimes its goes to a so high level that I begin to have pain in my stomach and my intestine because with the gastric by-pass I cant eat a lot....one meter of intestine and a small stomach dont help a lot, and the more I eat, the more often I go to the bathroom and the more often I lost blood and I feel more and more over concerned with my weight and I feel more and more guilty about the weight I gain... that's a never ending circle... I dont want to have another surgery...I get two of them, the first for the gastric by-pass and another one to repair a hernia that reappear one year later, I need to have the hernia repair another time but thats so painful that I think I will wait and make it at the same time I will get my extra skin remove (plastic surgery)....
Anyway, in 2005 I move into a bigger city to start a new program at the university and a new life...and walking was my main transport to go to the university and work on the weekend. I always walk and avoid the public transport system in that big city, it was my daily exercise, more than 1 ½ hours of fast walk with heavy bag, with my laptop and tons of books and things like that...I suppose its why I never gain weight on the Nardil or any others meds I was put on between 2005 and october 2007...(Topamax, Gabapentin, Effexor-Xr, Remeron, Zyprexa, Risperdal, Seroquel at high dose, Lyrica (short try) and the list goes on...
The heart problem happened just when I start the Parnate, before my blood pressure was low, around 100/60 with a pulse of 70... so the genetic is a questionable issue but not to be exclude...now I always have a BP around 135-140/80 and 90-100 pulse rate... I stop the Parnate and it seem that the HBP stay on and never return to my normal...
its for high blood pressure, protect from harms of high blood sugar. you have a number of risk factors, i think you said you had high blood pressure, at least off the parnate.
hm, wow. ok first off it might not even be the right kind of vitamin d, prescription kind is D2. if you are being checked for D level, hopefully its working enough...for that and vitamin k, you could get those "Twinlab Vitamin D3 1000 + K2"
tabs you take sublingually, that wouldn't have the absorbtion problem. also i guess if vitamin A is low, its not a problem, but really getting it in carotenoid form, and letting body convert the amount it needs is better, vitamin A can cause depression...Accutane is a form of vitamin A used for acne and it causes depression. i'd want to see if there are carotenoid supplements to take instead, but at minimum get your vitamin D level up...also if you aren't adding magnesium (citrate)and zinc...lots of people find that helpful for anxiety and sleep, if you are deficient i'm sure that is making things worse...b12 deficiecy will do that too
Ok, no I never take any meds for my high blood pressure since it a new problem...and I was put two times on the acutane and I never get depress because of it. The first time was in 2005...at the time, depression was not one of my problem, I had a lot of energy back then...SAD was my only one problem, and in 2006 I do another 4 months treatment of acutane and nothing to complain also...it was ok... I know that its linked to depression but I dont think its related to my problem...The Vit D I take is a huge amount of regular D...not D2 or D3... In fact, its only avaible as a prescription med, 50 000 units of vitamin D can be dangerous for a normal person....I never see a Vit D2 or D3 bottle in the OTC products at the drugstore... My vitamin D level is tested three times a year and is ok...I suppose the huge amount of 50 000 units each day make the level good in my blood...I try a lot of vitamins mixtures...I never find them helpfull...Omega-3 with high level of EDA for depressive problems (very expensive), Vitamins B complex for stress, I had also try 5HTP as well as others naturals products for the mental problems...I cant remember everything but I try a lot of them trust me...thats never help me..
The blood testing I had to do three times a year is done by the hospital where I got my gastric by-pass...its the most complete blood test as far as the vitamins levels concern... As I was asking before, just give me the complete list of what I need to test that is related with anxiety or depression and I will get those tested and I will give the result to you..maybe we will be able to work out a list of OTC naturals vitamins that I can buy and take daily...??? It can be more easy for me like this...and of course its if you have the time to do this for me...
Well thats all for today...I used all the concentration I had to answer to your message...You are really nice to help me !!!
Take care of you and we talk more later, and if I dont answer well to something just told me it... I lack a lot of focus since a while and my english is not very good sometimes...
Thanks again!
Vincent ;-)
Posted by desolationrower on March 15, 2009, at 0:46:04
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » desolationrower, posted by Vincent_QC on March 12, 2009, at 14:49:40
hey yeah remind me in a few days, to respond
-d/r
Posted by Vincent_QC on March 15, 2009, at 6:16:30
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy, posted by desolationrower on March 15, 2009, at 0:46:04
> hey yeah remind me in a few days, to respond
>
> -d/rHi d/r...Hummm remind to you what exactly? The list of the things I have to get tested in my blood?...
Posted by Phillipa on March 15, 2009, at 19:01:54
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » desolationrower, posted by Vincent_QC on March 15, 2009, at 6:16:30
Vincent just a guess thinking d/r may mean remind him to respond to your post. Just a thought. Love Phillipa
Posted by desolationrower on March 29, 2009, at 2:09:42
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » desolationrower, posted by Vincent_QC on March 12, 2009, at 14:49:40
hey vincent.
these are things i'd be interested in, arrange to some degree with most improtant at top. its waht i can think of as being worth checking, though please keep in mind this is the kind of thing an MD can hlep with, and i do'nt know much about bypass surgery and its effects, or obesity sequelae (although ive read a lot about preventing weight gain). and test could be expensive if not covered with insurance, although seeing how treatment resistant you are, looking around for problems in less likely places seems worth it. but i will write a list, of things that might be abnormal and cause problems, and maybe something will show up that your doctor will be able to treat. also i'm not 100% on which tests are needed, for some systems there are multiple tests, and you may only need some of them to check for a problem, but further tests to know what is causing the problem. i think they usually come in combination 'panels'.
also, while i am thinking about it, i think it might be quite helpful if you used nicotine patches/lozenge to reduce smoking. have you tried this? also smokers withdrawal from nicotine at night, if you wake up and smoke right away, it might be causing sleep problems, and a patch worn at night might help.
check for sure, 25-Hydroxy vitamin D (it should includes concentration of total 25OHD, 25OHD2, and 25OHD3)
i think you said you do get tested for vitamin A? i think keeping an eye on this. but while most people i would say, take beta-carotene, there was a study indicating beta-c supp with smoking increases cancer risk. and eating more veggies (with a bit of olive oil on top, same time of day as taking fishoil and other oils) might not work as well with bypass, although its never a bad idea. getting d, A, and w-3 from cod liver oil would probably be a good idea, for a cheap source since you sound deficient in both? and getting lutein and zanthaxin(sp) woudl be good, important for eye health. also, taking vitamin K, while not useful psychiatricaly that i know, is good for health, epscially with the risk factors you have, i think you should definatly take that too.ANd vitamin E in multis is not good quality, get gelcap type mixed tocotrienol/tocopherol (there are 4 each-8total). that probably won't help psychiatric things, but good for health. it might be testable, but maybe wait till you get things worked out and can make some diet improvements to go about testing everything like that.
not sure i'd bother with something like b12 test, just get those methylcobalimin lozenges and take one a day. but also getting folate is important too, but you are getting enough of that? probably would show up on blood tests for aneamia.
also do you take mineral supplements? ca, mg, zn especially. citrate forms and zinc gluconate is good. actually you know if its me i'd probably end up taking a few things like that, a trace mineral, b-vitamin complex, etc, instead of a multivitamin, to be sure i got the most absorbable form. of course it makes it more of a hasle to have more containers of pills to take everyday, and they don't do much good if you don't take them then because its so complicated. i think these are more helpful for good health, but also i think while not going to have antidepressant effect on their own, will improve response, when all the different things are there, and your health is better. but there should be good values, it can be complicated, but shouldn't be too expensive.
i think you said you had thyroid (not just TSH, but t3 and t4 check out, and it was ok?) if so, i wouldn't bother rechecking unless it was borderline
should be checked: hormones
testosterone, free, total
estradiol, progesterone
maybe dhea, prolactin, dht, fsh & lh, those seem to be included most of the time with other hormone panels.
should be checked: some kind of cortisol/DSM suppression. maybe include Aldosterone and Renin, crh, and/or acthmaybe show something:CYTOKINE PANEL - IL1b, IL6, IL8, TNF alpha. these tend to be disturbed with depression, but they usually aren't a specific disease, or treatable. but might be useful to know, since you are kind of lost for ideas.
if you know something isn't working, like you are iron deficient, you should really try to get that to normal range: i don't know if you need to take a larger dose, or add vitamin C, or try eating red meat (might reduce appetite a bit more than protein shake, though pick lean)? (oh also while mentioning, probably would be good to eat some skim yoghurt with 'live active cultures'(not pasteurized after the bacteria grow), with various bacteria strains. the stoneyfield yoghurt is the one i get, there is probably different brands for you.) I really don't know in context of the bypass. but if you have something like that, doctor should be getting it to normal. otherwise how does it help to test?
hm that was long and disorganized, ask me if that didn't make sense. obviously we need someone here who has a large prescription for dexedrine to organize.
also you said you walked a lot before? maybe get a dog to take out for a walk in the park would be good, get out of the hosue, a reason to chat up people, etc.
-d/r
Posted by Vincent_QC on March 29, 2009, at 9:16:20
In reply to Re: TCA not good for SAD+GAD+lack motivation/energy » Vincent_QC, posted by desolationrower on March 29, 2009, at 2:09:42
> hey vincent.
>
> these are things i'd be interested in, arrange to some degree with most improtant at top. its waht i can think of as being worth checking, though please keep in mind this is the kind of thing an MD can hlep with, and i do'nt know much about bypass surgery and its effects, or obesity sequelae (although ive read a lot about preventing weight gain). and test could be expensive if not covered with insurance, although seeing how treatment resistant you are, looking around for problems in less likely places seems worth it. but i will write a list, of things that might be abnormal and cause problems, and maybe something will show up that your doctor will be able to treat. also i'm not 100% on which tests are needed, for some systems there are multiple tests, and you may only need some of them to check for a problem, but further tests to know what is causing the problem. i think they usually come in combination 'panels'.
>
> also, while i am thinking about it, i think it might be quite helpful if you used nicotine patches/lozenge to reduce smoking. have you tried this? also smokers withdrawal from nicotine at night, if you wake up and smoke right away, it might be causing sleep problems, and a patch worn at night might help.
>
> check for sure, 25-Hydroxy vitamin D (it should includes concentration of total 25OHD, 25OHD2, and 25OHD3)
> i think you said you do get tested for vitamin A? i think keeping an eye on this. but while most people i would say, take beta-carotene, there was a study indicating beta-c supp with smoking increases cancer risk. and eating more veggies (with a bit of olive oil on top, same time of day as taking fishoil and other oils) might not work as well with bypass, although its never a bad idea. getting d, A, and w-3 from cod liver oil would probably be a good idea, for a cheap source since you sound deficient in both? and getting lutein and zanthaxin(sp) woudl be good, important for eye health. also, taking vitamin K, while not useful psychiatricaly that i know, is good for health, epscially with the risk factors you have, i think you should definatly take that too.
>
> ANd vitamin E in multis is not good quality, get gelcap type mixed tocotrienol/tocopherol (there are 4 each-8total). that probably won't help psychiatric things, but good for health. it might be testable, but maybe wait till you get things worked out and can make some diet improvements to go about testing everything like that.
>
> not sure i'd bother with something like b12 test, just get those methylcobalimin lozenges and take one a day. but also getting folate is important too, but you are getting enough of that? probably would show up on blood tests for aneamia.
>
> also do you take mineral supplements? ca, mg, zn especially. citrate forms and zinc gluconate is good. actually you know if its me i'd probably end up taking a few things like that, a trace mineral, b-vitamin complex, etc, instead of a multivitamin, to be sure i got the most absorbable form. of course it makes it more of a hasle to have more containers of pills to take everyday, and they don't do much good if you don't take them then because its so complicated. i think these are more helpful for good health, but also i think while not going to have antidepressant effect on their own, will improve response, when all the different things are there, and your health is better. but there should be good values, it can be complicated, but shouldn't be too expensive.
>
> i think you said you had thyroid (not just TSH, but t3 and t4 check out, and it was ok?) if so, i wouldn't bother rechecking unless it was borderline
>
>
> should be checked: hormones
> testosterone, free, total
> estradiol, progesterone
> maybe dhea, prolactin, dht, fsh & lh, those seem to be included most of the time with other hormone panels.
>
>
> should be checked: some kind of cortisol/DSM suppression. maybe include Aldosterone and Renin, crh, and/or acth
>
> maybe show something:CYTOKINE PANEL - IL1b, IL6, IL8, TNF alpha. these tend to be disturbed with depression, but they usually aren't a specific disease, or treatable. but might be useful to know, since you are kind of lost for ideas.
>
>
>
> if you know something isn't working, like you are iron deficient, you should really try to get that to normal range: i don't know if you need to take a larger dose, or add vitamin C, or try eating red meat (might reduce appetite a bit more than protein shake, though pick lean)? (oh also while mentioning, probably would be good to eat some skim yoghurt with 'live active cultures'(not pasteurized after the bacteria grow), with various bacteria strains. the stoneyfield yoghurt is the one i get, there is probably different brands for you.) I really don't know in context of the bypass. but if you have something like that, doctor should be getting it to normal. otherwise how does it help to test?
>
> hm that was long and disorganized, ask me if that didn't make sense. obviously we need someone here who has a large prescription for dexedrine to organize.
>
> also you said you walked a lot before? maybe get a dog to take out for a walk in the park would be good, get out of the hosue, a reason to chat up people, etc.
>
> -d/rHi d/r!!!!
MAny thanks!!!! I ask you in another post this morning about this blood test!!! I will print this and ask this to my family doctor... I Still don'T know what he will be able to do with the results...
First, don't worry for inssurance...it's cover here...all the test are cover...100%...
Yeah, the by-pass is not the one who have in the USA...it's a unique one... that part of the intestine who was by-pass that's more than 5/6 of the intestine... I have 1 meter of fonctionnal intestine on the 6 avaible meters...make a total of 4 hours of digestive system....compare of the normal 12 hours for a normal person... so if a med have a peak plasma level of 6 hours... forget it...that's sure I will not absord it at 100%... any XR release are out of question...or I need to crush them...but the question is to know if the med will survive the gastric acid???
Here a link for the a picture of the surgery...you will see how it's working now inside...
http://www.amlfc.com/Pages/Congres_med_amb/13e-2006/images/jette15.gif
Ok for the list of Vitamins I Take each day, it'S all good vitamins...don't know the forms of them...if it's sulfate or anything else...I take what they give to me...it's high level of vitamins not avaible OCT, you need a prescription to get them... some of them are so high they can be toxic for a normal person: Vit A 30 000 Units day, Vit D 50 000 units, B6 50mg, B12 1000mg, Calcium 1200mg, Iron 1200mg, Vit K ??? liquid form... Once a month treatment Venofer... I take also some meds... Flagil (antibiotics, larger specter, for my intestine) 10 days/month..., Cotazym (help to digest the food)... I eat plenty of yogourt with bacteria as well as taking a pills with naturals nacterias...20 millions inside a small pills, 10 differents sources of bacterias I think...it's expensives, 60 $ for a small 60 pills bottle...and I never trust naturals products...they never help me...in fact, I feel more puffed...and I have a lot of gazzzzzz....sorry!!! lol The yogurt I eat is the brand "Activia"... a good one...
One example...I take huge amount of Vitamine D each day ... one pill of 50 000 units by day... that's a level who is toxic for a normal person... sometimes, my blood test come out with a result of a just to the acceptable limit of vitamie D level!!! Vitamie D is fat lipid absorbation vitamine...mean that it's absorbed in the first part of the intestine... Too bad, it's the part of my intestine who was removed first... All the fat I eat end in the toilet...and trust me... whan I write it ...that's true!!!! I don't talk about the color (orange...lol) and the odour...lol.... It was worst the first couple of years...now that's ok...I think over the time, the rest of the intestine adapted itself to the situation and it's probably why I begin to gain weight again since a little while...
A patch ? At the same time than I smooke at daytime? Hummm no...I dont trust this... At night it's ok ... but for now, I dont see the interest of using a patch at night time because I sleep 3 hours in one shoot...normal for me... Cigarettes never disturb my sleeps anyway... (What I don't write it in the public board is that I stop smooking this week but I don't wanted to put pressure on me... I have already buy my 14 box of patches on my desk already...they wait for me...
For the exercies...I start the gym this week also... I Wait the money in the middle of the week... My mom buy some clothes for going to the gym...a good start...yeah I know..i'm 33yo and my mom pay for me!!! I'm shy but what can I do...
Anemia here...you point it out...lol My iron level is low... 10 the last time, I need at least 14 to be at the acceptable limit...and my hemoglobin level is low also...90...something like this...my saturation level is low also... my vitamine K level is also low...it's why I take large amount of it in liquid form... I have one intraveanous treatment of iron each month (Venofer)... and I take 1200 mf of oral iron pills... but no Vitamin C...I will buy Vit C to take at the same time...good idea... For the anemia, it's related to blood that I loost every day by a place that I will not write here...you can ask me in privacy!!! lol That's complicated...like me...
IF I succeed to do this 2 things ( Gym + Stop smooking) in the same week it will be so great for me...I mean for my level of self-esteem...
For the cigarettes smooke, I force myself to wait more and more before I Smooke another one...last night I watched the TV and I was almost 5 hours without smooking one...a miracle...for me...and when I go out at night with my friend, who stop last year, I also don'T smooke...I respect him...if we walk outside and I want to smooke, I take care of doing it behind him... I can imagine how it can be hard to stop... He had a hard time and I know I Will have hard time... but I Can...my dad stop cold turkey...after more than 50 years of smooking...2 packs a day...and it'S now more than 10 years now...he never smooke again...he never talk about it also...
So for the exercise you have your answer...no dog...the gym will be my solution!!! I will go with my best friend... alone it's more hard for me...I will be less shy...
So , another time, thanks for everything d/r!!!!
Loves!!!
VIncent ;-)
This is the end of the thread.
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