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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 59. This is the beginning of the thread.
Posted by delna on November 15, 2009, at 7:38:46
I fear I have exhausted all possibilities...but I am still looking at my final options (although now I am fearing the worst)
I tried the Effexor (which was my last real hope post Parnate) and it made me sleep for 4 days straight through, barely waking up to eat. I know sleepiness is a side effect but this was just ridiculous and despite my 200mg Provigil. I am so, so sensitive to sedation and somehow with me, it never passes nor is it ever transient. Add on's will not help sedation because I take 'ad-ons' when i am on non-sedating drugs just to stay awake (400mg provigil, 300mg wellbutrin, 200mg caffeine.) I need the 'base' drug to be activating.
So I stopped the effexor.My last experience of Effexor was that it made me **really** high. But now the Lamictal (200mg) is blocking the switch, I assume.
My pdoc here said he wants to keep me 'slightly' hypomanic.(I'm not sure how he plans to do that as he is sick and won't be around for a week.) I think he was planning on using add-ons but if the 'base' drug is sedating me, no add-on will help (not even if ritalin is added to my already long list of ad-ons, from past experience).
I don't think he has any intention of touching the Lamictal dose, though.I have some questions. I hope someone can please help me with some of them.
Question 1) Do you think lowering the dose of Lamictal is an option so that I get a *slight* high from the effexor?. Or is it plain silly because highs come crashing down, don't they? My last one lasted 8 months on Effexor (minus a mood stabilizer)but yes, it came crashing down eventually. But that was an uncontrolled 'manic episode' so maybe this would be different....?
The other option is a totally non sedating AD like Prozac. However...Question 2) My anxiety is back with a bang (6-8mg Klonopin a day + 20mg inderall + today for the first time in 10 years, whiskey ), does that mean Prozac is out for me? I know Prozac can make anxiety much worse to begin with but then doesn't that settle down and finally Prozac acts as a anxiolytic? It's the only AD without sedation as a side effect so it seems like my final hope. Do you think it is worth a shot or does the anxiety never go?
My other option is to go to the States and go to one of the special hospitals for bipolar/ depression. I don't have insurance (travel insurance doesn't cover me) so I am not sure how much it would cost to be an inpatient. I tried looking it up but found nothing.
Question 3) Does anyone have a rough idea of cost of being an inpatient? Especially if you needed something funky like ECT or TMS?
Rosy Crucifiction came up with this list of the 'National Network of Depression Centers'* Columbia University
* Duke University
* Emory University
* Harvard Brigham & Womens Hospital
* Harvard Massachusetts General Hospital
* Harvard McLean Hospital
* Johns Hopkins University
* Stanford University
* University of California, San Francisco Langley Porter Psychiatric Institute
* University of Colorado Denver Comprehensive Depression Center
* University of Cincinnati-Lindner Center of HOPE
* University of Louisville
* University of Michigan Comprehensive Depression Center
* University of Pennsylvania
* University of Texas Southwestern Medical Center
* Weill Cornell Medical CollegeQ4) Can anyone recommend one or comment on any? Or alternatively recommend something completely different?
Q5)Is this option even worth a try since I seem to have run out of drugs anyway? Also I have been told by 2 pdocs (one was an ECT specialist) that I am not a good candidate for ECT either- I am unlikely to respond. (Why? I don't know)
Any suggestions would really help
Thanks so much
Very desperate
DPS: I also consulted a doc of internal medicine who having looked at all my reports (past and present) ruled out infections (active or occult)or deficiencies.
Posted by bulldog2 on November 15, 2009, at 9:57:56
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
> I fear I have exhausted all possibilities...but I am still looking at my final options (although now I am fearing the worst)
>
> I tried the Effexor (which was my last real hope post Parnate) and it made me sleep for 4 days straight through, barely waking up to eat. I know sleepiness is a side effect but this was just ridiculous and despite my 200mg Provigil. I am so, so sensitive to sedation and somehow with me, it never passes nor is it ever transient. Add on's will not help sedation because I take 'ad-ons' when i am on non-sedating drugs just to stay awake (400mg provigil, 300mg wellbutrin, 200mg caffeine.) I need the 'base' drug to be activating.
> So I stopped the effexor.
>
> My last experience of Effexor was that it made me **really** high. But now the Lamictal (200mg) is blocking the switch, I assume.
> My pdoc here said he wants to keep me 'slightly' hypomanic.(I'm not sure how he plans to do that as he is sick and won't be around for a week.) I think he was planning on using add-ons but if the 'base' drug is sedating me, no add-on will help (not even if ritalin is added to my already long list of ad-ons, from past experience).
> I don't think he has any intention of touching the Lamictal dose, though.
>
> I have some questions. I hope someone can please help me with some of them.
>
> Question 1) Do you think lowering the dose of Lamictal is an option so that I get a *slight* high from the effexor?. Or is it plain silly because highs come crashing down, don't they? My last one lasted 8 months on Effexor (minus a mood stabilizer)but yes, it came crashing down eventually. But that was an uncontrolled 'manic episode' so maybe this would be different....?
>
>
> The other option is a totally non sedating AD like Prozac. However...
>
> Question 2) My anxiety is back with a bang (6-8mg Klonopin a day + 20mg inderall + today for the first time in 10 years, whiskey ), does that mean Prozac is out for me? I know Prozac can make anxiety much worse to begin with but then doesn't that settle down and finally Prozac acts as a anxiolytic? It's the only AD without sedation as a side effect so it seems like my final hope. Do you think it is worth a shot or does the anxiety never go?
>
> My other option is to go to the States and go to one of the special hospitals for bipolar/ depression. I don't have insurance (travel insurance doesn't cover me) so I am not sure how much it would cost to be an inpatient. I tried looking it up but found nothing.
>
> Question 3) Does anyone have a rough idea of cost of being an inpatient? Especially if you needed something funky like ECT or TMS?
>
>
> Rosy Crucifiction came up with this list of the 'National Network of Depression Centers'
>
> * Columbia University
> * Duke University
> * Emory University
> * Harvard Brigham & Womens Hospital
> * Harvard Massachusetts General Hospital
> * Harvard McLean Hospital
> * Johns Hopkins University
> * Stanford University
> * University of California, San Francisco Langley Porter Psychiatric Institute
> * University of Colorado Denver Comprehensive Depression Center
> * University of Cincinnati-Lindner Center of HOPE
> * University of Louisville
> * University of Michigan Comprehensive Depression Center
> * University of Pennsylvania
> * University of Texas Southwestern Medical Center
> * Weill Cornell Medical College
>
> Q4) Can anyone recommend one or comment on any? Or alternatively recommend something completely different?
>
> Q5)Is this option even worth a try since I seem to have run out of drugs anyway? Also I have been told by 2 pdocs (one was an ECT specialist) that I am not a good candidate for ECT either- I am unlikely to respond. (Why? I don't know)
>
> Any suggestions would really help
>
> Thanks so much
>
> Very desperate
> D
>
> PS: I also consulted a doc of internal medicine who having looked at all my reports (past and present) ruled out infections (active or occult)or deficiencies.sounds like you need a doc right away. Is your sick p-doc available right for phone consultations? It's probably not good to start making changes on your own without the consultation of a professional. Sounds like depression is your worst enemy right now.
My two cents for what it's worth. I wouldn't have stopped the effexor since it worked before. At this point I wouldn't worry about the mania. Maybe start lowering the dose of lamictal as it may be blocking your ad from working and start again on the effexor. Maybe it's best to make on change at a time so things don't get muddled. See how fast you are allowed to lower the lamictal and reinstate the effexor for now. That way you can see if the lamicatal is the problem. Than possibly ritalin to combat fatigue if that doesn't work.
Will your New York p-doc help you ? If your only p-doc is not available you really need another doc to guide you. Also all that klonopin you are taking could be depressing and make you very tired.
Sounds like you might need inpatient care in the states to straighten this out. Without insurance that will be very expensive. You might be able to call and get prices.
But find a p-doc as soon as possible to talk to. You're not in a state of mind to arrange your med combos and don't give up.
Posted by Phillipa on November 15, 2009, at 10:37:55
In reply to Re: Dangerously close to the end of the road. Help, posted by bulldog2 on November 15, 2009, at 9:57:56
Delna they are all excellent hospitals. Emery does have a good psych dept and does lots of research. Parents aware of whats going on. I know the situation of Pdoc in NY but you say GP ruled out medical conditions? Can you get an infection control doc and also a neurologist there? Have you have MRI of brain. Delna please be safe and I do hope someone has more answers than me. It's a shame oh wait does Rosy Crucifiction have her babblemail on? If so you could write her? Love Phillipa
Posted by delna on November 15, 2009, at 10:53:50
In reply to Re: Dangerously close to the end of the road. Help, posted by Phillipa on November 15, 2009, at 10:37:55
> Delna they are all excellent hospitals. Emery does have a good psych dept and does lots of research. Parents aware of whats going on.
Yes, there are aware and around.
> I know the situation of Pdoc in NY but you say GP ruled out medical conditions? Can you get an infection control doc and also a neurologist there? Have you have MRI of brain.
I have seen so many neurologists here and in London - no answers whatsoever. I have had brain scans too- more than once. I have been been checked for every neurological condition including MS. nothing organic has ever been found.
> Delna please be safe and I do hope someone has more answers than me.
Thanks. will try..Thanks Phillipa
Love
D
Posted by delna on November 15, 2009, at 11:07:25
In reply to Re: Dangerously close to the end of the road. Help, posted by bulldog2 on November 15, 2009, at 9:57:56
Thanks for the reply.
My pdoc is v.sick with diabetic complications so I can't speak to him. Am being taken to some other guy in the morning. He may be useless for all I know. I have no hopes set on him at all.
I am not touching/playing with my drugs at the moment because its just become too scary. This anxiety has appeared from no where and is so extreme I just want to curl up and die.>
> Will your New York p-doc help you ?He has washed his hands off me. Heartbreaking for me, but sadly true
>Also all that klonopin you are taking could be depressing and make you very tired.
My anxiety is off the charts at the moment. I wouldn't mind being knocked out with some drug (or a sledgehammer) right now because it is so unbearable.
> Sounds like you might need inpatient care in the states to straighten this out. Without insurance that will be very expensive. You might be able to call and get prices.I will call, or get my parents to. i am afraid it will be way too expensive :(
> But find a p-doc as soon as possible to talk to. You're not in a state of mind to arrange your med combos and don't give up.Thanks. I won't mess with my combo and I'll try to hang in there
Love
D
Posted by SLS on November 15, 2009, at 11:09:38
In reply to Re: Dangerously close to the end of the road. Help » bulldog2, posted by delna on November 15, 2009, at 11:07:25
How did you respond to Paxil?
- Scott
Posted by delna on November 15, 2009, at 11:42:01
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 15, 2009, at 11:09:38
> How did you respond to Paxil?
>
>
> - ScottHi Scott
Thanks for the reply.
Paxil made me a zombie- really, really sleepy for the whole 2 years i was on it. My pdoc in London didn't realize sleepiness was a side effect so he sent me to a sleep lab.
Idiopathic hypersomnia was the best they could say (because though they initially suspected narcolepsy, I don't have ANY other symptoms of any sleep disorder). When I came off the Paxil, i realized it was that which was making me like a narcoleptic.It definitely got rid of my anxiety and OCD (like all SSRI/SNRIs do) but I sat in bed, stared at the walls and slept for the whole time I was on it. So I don't think it lifted my depression at all.
Love
D
Posted by Maxime on November 15, 2009, at 12:04:45
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
Hi
I don't have any answers for you I am afraid. It's a shame that you have to take so much Klonopin because that is bad for depression and adding to your tiredness. Have you ever tried as SSRI for anxiety. If I remember correctly you can't anti-psychotics.
Can you take a trip to come and see a specialist in the States or in London. It seems like your case is so complicated.
I just want you to know that you are in my prayers and I will be thinking of you.
Posted by delna on November 15, 2009, at 12:15:11
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Maxime on November 15, 2009, at 12:04:45
> Hi
>
> I don't have any answers for you I am afraid. It's a shame that you have to take so much Klonopin because that is bad for depression and adding to your tiredness. Have you ever tried as SSRI for anxiety. If I remember correctly you can't anti-psychotics.I respond well to SSRI's for anxiety but not depression.
> Can you take a trip to come and see a specialist in the States or in London. It seems like your case is so complicated.
Am trying to find out about coming to the States but the cost may be too high . But I just contacted my pdoc in UK and told her I want to come back and be admitted. I'm British and am covered by private insurance. although it's not as good as the states, its an option.
> I just want you to know that you are in my prayers and I will be thinking of you.
Thank you so much. It really means alot
Love
D
Posted by Maxime on November 15, 2009, at 12:18:06
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Maxime on November 15, 2009, at 12:04:45
Have you ever tried Lithium or Depokate for the depression?
Posted by delna on November 15, 2009, at 12:42:28
In reply to Re: Dangerously close to the end of the road. Help, posted by Maxime on November 15, 2009, at 12:18:06
> Have you ever tried Lithium or Depokate for the depression?
I replied to this but my post was 'eaten' Hmmm...
Anyway..
Sadly Maxime I have tried both and neither have helped at all. :(
Posted by ricker on November 15, 2009, at 12:46:19
In reply to Re: Dangerously close to the end of the road. Help » Maxime, posted by delna on November 15, 2009, at 12:15:11
> I respond well to SSRI's for anxiety but not depression.
>Hi delna, sorry to hear you are not doing well. Have you considered zoloft / nortriptyline? The zoloft at 50mg should help the anxiety and nortrip at 25/50 mg may help the depression? The mix would work similar to that of effexor? You could probably lower the clonazepam once the zoloft kicked in. Just a thought.
Best of luck, Rick
Posted by SLS on November 15, 2009, at 13:22:00
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
You are taking a good dosage of Lamictal (lamotrigine) to combine with Wellbutrin (bupropion). My doctor uses it every now and then and seems to like it. Wellbutrin can sometimes make anxiety worse, but you would know rather quickly whether or not you react that way. It is unlikely to make you sleepy.
What tricyclic antidepressants are available to you? I believe Prothiadin (dothiepin; dosulepin) is. It might be worth a try as it also helps with anxiety along with depression.
- Scott
Posted by delna on November 15, 2009, at 15:10:37
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 15, 2009, at 13:22:00
> You are taking a good dosage of Lamictal (lamotrigine) to combine with Wellbutrin (bupropion). My doctor uses it every now and then and seems to like it. Wellbutrin can sometimes make anxiety worse, but you would know rather quickly whether or not you react that way. It is unlikely to make you sleepy.
I haven't taken the Wellbutrin for a while now. Not since I stopped the Parnate anyway. I have no idea where this insane anxiety has suddenly come from (although anxiety is one of problems). Maybe it's simply because I have not been properly medicated for months now and have recently even withdrawn my lexapro (for the Parnate). I've just been taking my mood stabilizer and drugs I use purely for stimulation. Wellbutrin being one of them.
A couple of people had mentioned (or maybe it was only Phidippus) that my dose of Lamictal (or infact Lamictal at all) could be contributing to my depression. Do you think a slightly lower dose would allow the effexor to be more 'activating' ie (give me a mild high)? Would that be a bad thing?
Obviously I would never attempt doing that myself and definitely not in this state of complete anxiety but as a treatment option in the long term. Effexor with lower dose Lamictal + the add ons to combat sleepiness and allow me to be fully functional?
>
> What tricyclic antidepressants are available to you? I believe Prothiadin (dothiepin; dosulepin) is. It might be worth a try as it also helps with anxiety along with depression.Scott, I am so intolerant to sedation. Problem is I don't seem to get used to it as my body doesn't adapt to it. I have tried both imipramine and recently nortryptyline and nearly died- I mean i couldn't move or get out of bed.
Is one more likely to develop tolerance to TCA sedation than other drugs like SSRIs and APs? All the TCA's are available here, incidentally and are actually used as first line treatment.
>
>Thanks Scott,
Your input is always so very welcome.
Thanks a million
D
Posted by delna on November 15, 2009, at 15:15:50
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by ricker on November 15, 2009, at 12:46:19
> > I respond well to SSRI's for anxiety but not depression.
> >
>
> Hi delna, sorry to hear you are not doing well.Thanks Rick for your supportive words.
>Have you considered zoloft / nortriptyline? The zoloft at 50mg should help the anxiety and nortrip at 25/50 mg may help the depression?
Its the nortrip I have a problem with. I tried it aftter the Parnate (as a cover) but couldn't tolerate even 25mg taken at night. I was so sedated by it. Sedation is a huge problem with me.
>The mix would work similar to that of effexor? You could probably lower the clonazepam once the zoloft kicked in. Just a thought.
>
> Best of luck, Rick
>
>
>Thanks Rick, for the good wishes and for sharing your ideas. Much appreciated.
love
D
Posted by ricker on November 15, 2009, at 15:54:13
In reply to Re: Dangerously close to the end of the road. Help » ricker, posted by delna on November 15, 2009, at 15:15:50
Hi delna, I understand what you're saying about dropping the lamictal down to 150. Kinda like letting a little fuel out of the airplane for an easier lift-off. Just don't let too much out or you could end up flying too high, or crashing!! Maybe a potential move though when you discuss with your p/doc?
If the anxiety keeps up maybe moving back on to lexapro would help. I know it sure crushed my anxiety!Take care, Rick
Posted by SLS on November 15, 2009, at 16:04:01
In reply to Re: Dangerously close to the end of the road. Help » SLS, posted by delna on November 15, 2009, at 15:10:37
I have never heard of Lamictal preventing an antidepressant from producing a therapeutic effect. Some drugs can produce depression or make depression worse, though. However, I have not seen any reports of that happening with Lamictal. If anything, Lamictal can trigger mania or produce anxiety and insomnia. I guess the caveat with using psychotropic drugs is to expect the unexpected, as there can be such interindividual variability in brain organization. That is almost like saying that anything is possible, but not quite.
Desipramine is a TCA that is usually activating and alerting, although it can be sedating during the first few days. It is selective for norepinephrine (NE). Protriptyline is touted as being the most activating of the TCAs. I find the drug too anticholinergic. It also made my depression significantly worse. Of course, it works perfectly fine for some people.
Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?
- Scott
Posted by delna on November 15, 2009, at 16:40:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 15, 2009, at 16:04:01
> I have never heard of Lamictal preventing an antidepressant from producing a therapeutic effect. Some drugs can produce depression or make depression worse, though. However, I have not seen any reports of that happening with Lamictal. If anything, Lamictal can trigger mania or produce anxiety and insomnia. I guess the caveat with using psychotropic drugs is to expect the unexpected, as there can be such interindividual variability in brain organization. That is almost like saying that anything is possible, but not quite.
Ever since I added the Lamictal I have become the most sedate person around- perhaps lacking a personality as some feel. Also I do not go high at all. Before, even the smallest dose of an ssri (or increase in dose) would make me hypomanic. I realize Lamictal is not blocking the therapeutic effect of effexor- just curbing the benefit of a mild high which I think I desperately need.
> Desipramine is a TCA that is usually activating and alerting, although it can be sedating during the first few days. It is selective for norepinephrine (NE). Protriptyline is touted as being the most activating of the TCAs. I find the drug too anticholinergic. It also made my depression significantly worse. Of course, it works perfectly fine for some people.
>
> Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?I was planning on adding that to the Effexor instead of the wellbutrin. I need the serotonin element for the OCD but of course I can get that from any SSRI like lexapro which is totally non-sedating (but does not impact my depression at all). Do you feel Edronax is a good AD on it's own or only as effective as wellbutrin (which for me only serves as an add-on).
I was under the impression that Edronax was not as powerful an AD as effexor or maybe that was simply my misconception. What do you feel?
Sorry to be such a bother.Thanks again
Love D
Posted by delna on November 15, 2009, at 16:44:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by ricker on November 15, 2009, at 15:54:13
> Hi delna, I understand what you're saying about dropping the lamictal down to 150. Kinda like letting a little fuel out of the airplane for an easier lift-off. Just don't let too much out or you could end up flying too high, or crashing!! Maybe a potential move though when you discuss with your p/doc?
> If the anxiety keeps up maybe moving back on to lexapro would help. I know it sure crushed my anxiety!
>
> Take care, RickYay, exactly what I hoped to hear.;) Now I will run that by my pdoc to see if it is wise.
Thanks Rick
Posted by Phillipa on November 15, 2009, at 18:31:02
In reply to Re: Dangerously close to the end of the road. Help » ricker, posted by delna on November 15, 2009, at 16:44:41
Delna doing any better now? How did you spend your day? Love Phillipa
Posted by delna on November 15, 2009, at 20:15:44
In reply to Re: Dangerously close to the end of the road. Help, posted by Phillipa on November 15, 2009, at 18:31:02
> Delna doing any better now? How did you spend your day? Love Phillipa
Hi Phillipa,
Thanks for asking. Am just about to leave to see the new pdoc. Didn't sleep much last night. was quite disturbed. On babble a bit- some really helpful suggestions. Was also writing to my genius (but evil) pdoc in NYC to request him to reply about the abilify (and geodon).
BTW your day is my night. I am 12 hrs ahead of you guys in the US.
Love
D
Posted by Phillipa on November 15, 2009, at 20:39:25
In reply to Re: Dangerously close to the end of the road. Help » Phillipa, posted by delna on November 15, 2009, at 20:15:44
12 hours India and isn't Australia one day ahead 26 hours? Morning Delna good luck and you can do it I know you can!!!!!!!! Love Phillipa
Posted by delna on November 16, 2009, at 0:20:16
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Phillipa on November 15, 2009, at 20:39:25
> Morning Delna good luck and you can do it I know you can!!!!!!!! Love Phillipa
Hi,
The new pdoc was a total **freak**. Rude, arrogant and clueless.
He has made me feel more hopeless than ever. He basically told me there was no hope for me. He couldn't answer a single question of mine - simple ones like could I have an infection that may explain the fatigue.
He sent me out of the office so he could speak to my parents alone in which time he completely insulted my dad. Of course when I came back in, I bit his head off for sending me out.
Incidentally he didn't even know what abilify was (although it has been available here for years)
He also suggested ECT for me and when I told him that I had been told I was a poor candidate for ECT he said 'yes you are, but still have it anyway'.Now I feel worse. I just hope my pdoc in the US replies about Abilify.
Thanks everyone for the support.
Love D
Posted by emmanuel98 on November 16, 2009, at 2:33:27
In reply to Re: Dangerously close to the end of the road. Help » Phillipa, posted by delna on November 16, 2009, at 0:20:16
I did ECT last year and it didn't help me. But I know people whose lives have been turned around by ECT. Maybe it would help you. Why do you say you're a poor candidate for ECT?
> He also suggested ECT for me and when I told him that I had been told I was a poor candidate for ECT he said 'yes you are, but still have it anyway'.
>
> Now I feel worse. I just hope my pdoc in the US replies about Abilify.
>
> Thanks everyone for the support.
> Love D
>
Posted by delna on November 16, 2009, at 5:57:12
In reply to Re: Dangerously close to the end of the road. Help, posted by emmanuel98 on November 16, 2009, at 2:33:27
> I did ECT last year and it didn't help me. But I know people whose lives have been turned around by ECT. Maybe it would help you. Why do you say you're a poor candidate for ECT?
I have been told by 2 pdocs (including one ECT expert) that I am not a good candidate. I really don't know why. This guy today thought I was not a good candidate for anything...
Anyway, I am open to ECT but not here..... Investigating London or the US
TC
D
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