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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by floatingbridge on January 26, 2010, at 0:43:15
Well, after all the hoopla I put myself through, the consult wad just an ordinary 90 minutes with a (very smart, with-it) psych / pharmacologist.
After checking in a variety of ways for any hint of hypomania/mania--my husband, unaccustomed to these questions, was a valuable, objective source--the doc sees 'double
depression'. Only last month did I ask Meltingpot what that was....No quibble with ptsd--just inquired about flashbacks, dreams, intrusive thoughts. (No real med protocol for that yet he said)
O.K. Let's cut to the chase:
Before going to the maoi's (which is what I sensed he was most interested in) he suggested trials of lithium and remeron before washing out.He wad jazzed about emsam--I think he participated in research trials.
TMs is possible--though labor intensive.
4-5 days for 6 weeks for best result. Is it
like a reset button? I asked. He actually looked sad for a second. No, he said. Guess I'm still hoping for a magic wand....At first I was dissappointed; my husband liked him, and he could tell I was....
After awhile, this is what came to me:
The consult confirmed my instincts as to treatment--and he said I was a 'dopamine responder'. (I had not used the word dopamine once.) Dopamine is not currently addressed by newer anti-
depressants. He mentioned mirapex and requip and expressed small faith in their efficacy as add-ons for MD.His plan reconfirmed that my own pdoc is quite competent if cautious.
He said we should know on a few weeks if the lithium and/or remeron work. Hopefully he will work with my doc if a washout becomes necessary; I think he'd move it along more quickly.
Sigh. No magic wands. But you already knew that.
fb
Posted by janejane on January 26, 2010, at 4:02:52
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
Thanks for the report, fb. So you're a dopamine responder? I remember reading past threads on babble discussing dopaminergic strategies so you might want to do a search if you haven't already. I really thought there were more drugs that addressed it. I do know that tyrosine and phenylalanine are the amino acid precursors. (I saw you were asking about DLPA in another thread. It's a form of phenylalanine that not only produces dopamine, but endorphins as well.) Mucuna pruriens is an herb that is also supposed to increase DA. (There are some anecdotal reports about it in the archives. As I recall, it can enhance one's sense of well-being.) Sorry I can't be of help with the med stuff. I'm sure others will be along soon to comment. Glad to hear your consult went more smoothly than Peanut's.
Posted by SLS on January 26, 2010, at 6:41:21
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
> he suggested trials of lithium and remeron before washing out.
Logical.
How much lithium?
- Scott
Posted by floatingbridge on January 26, 2010, at 9:42:48
In reply to Re: consult results » floatingbridge, posted by janejane on January 26, 2010, at 4:02:52
Thanks Janejane,
I'd have been disappointed if I had traveled very far--good to have my instincts confirmed--not bad for a non-science major--thanks to babble, really.
I'm not sure about the precursors you mention--about 30 days? Hmmmm. Don't know how to fit in a trial. I had
read dosages in a book, UltraMind, and have some on hand, though I've forgotten my research :-DHerbs, I haven't looked into-- I just keep downing the ones from my Chinese
practitioner--but they address different issues. Will file the ones you mention--Thanks for the helping hand,
fb
Posted by janejane on January 26, 2010, at 9:56:19
In reply to Re: consult results » janejane, posted by floatingbridge on January 26, 2010, at 9:42:48
fb, where did you get 30 days for aminos? My understanding is that you would probably notice a difference pretty quickly. I think the same is true of mucuna. I also forgot to mention that fish oil is supposed to boost DA, though you probably already know about that one.
Posted by floatingbridge on January 26, 2010, at 10:07:41
In reply to Re: consult results » floatingbridge, posted by SLS on January 26, 2010, at 6:41:21
Ummm. You think I would have asked....
My own doc had said 600 per day. I feel that's too high. Read a bit last night and worried-- serum levels and toxicity. Maybe those will be non-issues at my dose.
Frankly, I want to start lower. I'll find out more about recommended dosages and
order of trials when I see my own doc next week. Right now, I'm inclined to try the remeron first.How is your adderall trial so far?
Thanks, Scott,
fbOh, I wanted to mention to you that my non-response to abilify seemed to further suggest a need for dopamine. Anyways, he was a booster of maoi's as effective because of their non-selectivity and action on dopamine. And, in my case, he feels some people really do need stimulants--guess I'm fortunate to have fallen into the hands of my own doc.
My, am I going on.
> > he suggested trials of lithium and remeron before washing out.
>
> Logical.
>
> How much lithium?
>
>
> - Scott
Posted by floatingbridge on January 26, 2010, at 10:08:50
In reply to Re: consult results, posted by floatingbridge on January 26, 2010, at 10:07:41
Posted by floatingbridge on January 26, 2010, at 10:17:07
In reply to Re: consult results » floatingbridge, posted by janejane on January 26, 2010, at 9:56:19
There you are :-D
Didn't the 30 days come from Colorado's thread. I would imagine supplements might take a bit--at least for some.
I gulp fish oil daily-- we all do here. My husband felt the effects that week. (He's quite healthy--knock on wood!) Didn't know about DA affect. Hmmmm.
Good morning,
fb
Posted by Phillipa on January 26, 2010, at 11:20:02
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
Fb I skipped the rest for now so it's remeron and lithium for you and this hits dopamine? I will be back after eating breakfast yes slept again. One hour? For some reason I'd thought it was an all day venture? Love Phillipa
Posted by Phillipa on January 26, 2010, at 12:20:43
In reply to Re: consult results » floatingbridge, posted by Phillipa on January 26, 2010, at 11:20:02
FB back and read since I'm not good with neurotransmitters at all what's the connection with lithium and why lithium and the remeron? Love Phillipa
Posted by floatingbridge on January 26, 2010, at 14:14:30
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
Don't worry about rocking the boat.
fb
Posted by inanimate peanut on January 26, 2010, at 17:25:02
In reply to opinions, information welcome, posted by floatingbridge on January 26, 2010, at 14:14:30
Hi fb,
I'm glad your consult went relatively well, and I think it's actually a good thing that it confirmed the competence of your doc. I think it's a good thing that you're trying a couple more things before wash-out-- hind-site is 20/20 and I now wish that I had done the same. Sorry I can't help with the dosage questions on lithium and remeron, as I was on lithium for bipolar (so on 1200-- far more than you would need) and didn't get a chance with the remeron. Overall, just wanted to pop in and say I'm glad you're relatively happy with the consult and that I wish you the best in the lithium and remeron trials. I'm sure you'll keep us posted :-)
Posted by bleauberry on January 26, 2010, at 17:25:46
In reply to consult results, posted by floatingbridge on January 26, 2010, at 0:43:15
Dopamine responder? Well, that makes sense, based on a verbal inventory of history and symptoms which he did. Not to rain on the party, but in the real world, the only way to know if someone is a dopamine responder or not is to try that route and see what happens.
The quickest method I know of is called the Methyphenidate challenge. Ritalin is a quick way to see if the DA/NE route is on the right track or not.
I'm puzzled by the Remeron. It does have some indirect effect of boosting the firing of NE, indirectly stimulates dopamine a little bit, but does nothing to increase levels of either. Based on scientific studies, it does not actually increase levels of any neurotransmitters. First and foremost, it is one of the planet's most potent antihistamines.
In combo with Pristiq it would be an updated California Rocketfuel, claimed to be a potent antidepressant cocktail. It has been with a few people here. In the STAR*D study, it wasn't very impressive. But then, at that stage of the game, it was a very difficult sample population of multidrug failure patients.
Lithium low dose makes sense no matter what the AD is. No guarantees, but it makes sense. I like that it is a natural substance. Doses as low as 100mg to 300mg can be felt. I swear, when I tried 100mg a few years ago, it felt like amphetamines. Higher doses felt like benzos. But that's just me. Everyone is different. Few treatments have as much history and track record as lithium.
A low dose ssri (preferably Prozac) with brand name extended release Ritalin makes sense to me. And if the diagnosis is double depression with a suspicion of dopamine responder, the one and only monotherapy I know of that fits that bill perfectly is Savella.
Common doses of Remeron include 15mg and 30mg. Some go up to 45mg. I've heard of doses as high as 90mg. I found 3mg to 7.5mg to be profoundly more sedating than higher doses. It felt like the NE stimulation was beginning in the 7.5mg range, but absent below that. Just how it felt. I can tell from what my tinnitus tells me. Expect some sedated drugged days in the beginning. It will mostly pass as the body adjusts to the antihistamine effect.
I'm very happy you had an encouraging meeting. I think something good will come from it.
Posted by floatingbridge on January 27, 2010, at 12:43:40
In reply to Re: consult results, posted by bleauberry on January 26, 2010, at 17:25:46
Thanks, BB. I am already taking dexadrine--I was hoping to reduce or remove it....
I feel cautious about NE because of my response to strattera and raynaud's.
Remeron is such a weird beast according to wiki. We'll see--I think that is an attempt to reduce anxiety (and boost the AD effect).
I think I'll try low dose lithium first--though it scares me--and I have thyroid issues.
Not feeling to great today; optimism definitely flagging. I might re-examine savella.
Thanks again Bleauberry!
fb
Posted by floatingbridge on January 27, 2010, at 12:44:49
In reply to Re: opinions, information welcome, posted by inanimate peanut on January 26, 2010, at 17:25:02
Nice to see you again.
Posted by Phillipa on January 27, 2010, at 21:41:56
In reply to Re: consult results » bleauberry, posted by floatingbridge on January 27, 2010, at 12:43:40
This is the end of the thread.
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