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Dr. Bob is Robert Hsiung, MD,
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Posted by floatingbridge on January 26, 2011, at 23:18:05
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by sigismund on January 26, 2011, at 16:09:07
Sigi, you have a great memory. I said that exactly about (my dear, sweet) dexedrine. I don't know. Dropping one life line for another. However, I am plain tired of the ssri/ssni trials that leave me nowhere. Cymbalta cut the pain--pretty amazing--but the s/e's were debilitating. I feel better at 20mg than 30mg--clearer head. It's been so long to be almost snri free. I had forgotten.
Ultram goes. I agree. Now regular
tramadol felt great--but my physiatrist freaked at the escalation. It kinda helped pain, but mostly my mood. Not at all like norco.Oh, for some reason I'm rambling.
I'm hoping this works:
Emsam
Lyrica
Xanax as needed or low daily doseCould that be the magic three?
Some doc in Stanford intimated that stims would not be out of the picture for me if I went to emsam or parnate. Best for 'existental depression' he said. I walked around for awhile feeling very sophisticated and French until I remembered it was a fancy way of saying 'you're screwed'.
I gotta get better. I have to help my son.
Hey Sigi, thanks for the input. Phillipa, you too.
Posted by sigismund on January 27, 2011, at 1:22:24
In reply to Re: umm. advice from anyone tracking/knows me? » sigismund, posted by floatingbridge on January 26, 2011, at 23:18:05
>Best for 'existental depression' he said
We're not quite as brisk as the British, but that wouldn't pass muster here, which is a great pity because I can do a reasonable number in existential depression. The trouble is the only doctors you can stand talking to have it too, and they have learned to do without. You have to swat up on ADHD. I mean, maybe not....I heard from a young friend that a very attractive 20yo young woman was prescibed Dexedrine because she felt down.
Posted by floatingbridge on January 27, 2011, at 2:13:03
In reply to Re: umm. advice from anyone tracking/knows me?, posted by sigismund on January 27, 2011, at 1:22:24
Sigi, I'm supposed to be sleeping now....
I didn't understand your post...swat up on adhd. I am a bit dense and sleepy, and just argued with my husband about meds and depression. He doesn't think I'm doing so bad because I'm not weeping uncontrollably; I'm telling him this depression feels different--flat, no motivation, no pleasure. He says I'm looking for a magic wand. I am.Please don't make fun of the existential part. After reading up on it, it explains my vulnerability to depression as a child. Besides, the term describes a large chunk of peoples' various depressions.
Off to bed. Thanks for writing.
Posted by SLS on January 27, 2011, at 2:24:55
In reply to umm. advice from anyone tracking/knows me?, posted by floatingbridge on January 24, 2011, at 17:30:55
> Cymbalta 30mg
> Dex about 60mg
> Xanax xr about 1.5mg
> Xanax 0-1.5/2.0 mg as needed
> Ultram 200mg
> Lithium 300mg
> Norco 10-30mg as neededI was thinking more like a combination of Nardil and either amitriptyline or nortriptyline. You would have to discontinue the Ultram and the Cymbalta in order to use a MAOI. It's nothing too fancy. I would like to hear others' opinions on this. Nardil is often used successfully for treating anxiety disorders.
You know, it is frustrating to have so few proven tools to work with for treating FM. I know a doctor who used sibutramine to treat FM. He claimed it was a miracle drug. Sibutramine is no longer available in the US. However, that it is a SNRI is interesting. I guess that's just a little more evidence that combining the reuptake of serotonin and norepinephrine might be something to try along with Lyrica. You could perhaps combine a SSRI with nortriptyline of desipramine. Desipramine isn't chosen as often.
You might want to add a tricyclic now. You could go with amitriptyline. It is a proven entity. Its daughter metabolite, nortriptyline, might be as effective, but has not investigated as often. The problem with amitriptyline is that it can produce sedation, weight-gain, somnolence, and anticholinergia as side effects. You could try NOR first, and go with AMI if necessary. People become tolerant of TCA side effects after prolonged treatment.
I do know one woman who was able to combine Nardil with doxepin. Doxepin can be calming and promote sleep, although I don't know how it affects sleep quality. It is a potent antihistamine.
And then there is trimipramine. This drug is atypical for a TCA. It does not inhibit the reuptake of neither NE nor 5-HT.It produces improvements in sleep architecture and can be calming. Although I don't know anyone who has combined trimipramine with a MAOI, it might be worth looking into. It is sometimes chosen for FM.
Add Lyrica and see how you react to it. You might then add a TCA after you are convinced that Lyrica is not making your depression worse.
That seems like such a mess, but no more complicated than what you are taking now.
What are your thoughts on these treatments?
- Scott
Posted by floatingbridge on January 27, 2011, at 14:04:07
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by SLS on January 27, 2011, at 2:24:55
Scott, you saying add a tca's to the lyrica before trying an maoi--if I read you correctly. I know my gp mentioned some you did as the next step (if Lyrica fails).
Nardil scares me. I do have some vanity. I don't mind being mildly overweight, but Nardil has a rep.
The d*mn FM skews everything. Grrrr.
Hmmm. Let me know if I read you right. I would try the tca's.
Thank you for your thoughts. They have me thinking.
Like trying effexor--which I tolerated years ago.... I was thinking the more stimulating Maoi's like emsam or parnate. Fatigue +anxiety :-O
fb
> > Cymbalta 30mg
> > Dex about 60mg
> > Xanax xr about 1.5mg
> > Xanax 0-1.5/2.0 mg as needed
> > Ultram 200mg
> > Lithium 300mg
> > Norco 10-30mg as needed
>
> I was thinking more like a combination of Nardil and either amitriptyline or nortriptyline. You would have to discontinue the Ultram and the Cymbalta in order to use a MAOI. It's nothing too fancy. I would like to hear others' opinions on this. Nardil is often used successfully for treating anxiety disorders.
>
> You know, it is frustrating to have so few proven tools to work with for treating FM. I know a doctor who used sibutramine to treat FM. He claimed it was a miracle drug. Sibutramine is no longer available in the US. However, that it is a SNRI is interesting. I guess that's just a little more evidence that combining the reuptake of serotonin and norepinephrine might be something to try along with Lyrica. You could perhaps combine a SSRI with nortriptyline of desipramine. Desipramine isn't chosen as often.
>
> You might want to add a tricyclic now. You could go with amitriptyline. It is a proven entity. Its daughter metabolite, nortriptyline, might be as effective, but has not investigated as often. The problem with amitriptyline is that it can produce sedation, weight-gain, somnolence, and anticholinergia as side effects. You could try NOR first, and go with AMI if necessary. People become tolerant of TCA side effects after prolonged treatment.
>
> I do know one woman who was able to combine Nardil with doxepin. Doxepin can be calming and promote sleep, although I don't know how it affects sleep quality. It is a potent antihistamine.
>
> And then there is trimipramine. This drug is atypical for a TCA. It does not inhibit the reuptake of neither NE nor 5-HT.It produces improvements in sleep architecture and can be calming. Although I don't know anyone who has combined trimipramine with a MAOI, it might be worth looking into. It is sometimes chosen for FM.
>
> Add Lyrica and see how you react to it. You might then add a TCA after you are convinced that Lyrica is not making your depression worse.
>
> That seems like such a mess, but no more complicated than what you are taking now.
>
> What are your thoughts on these treatments?
>
>
> - Scott
>
Posted by floatingbridge on January 27, 2011, at 17:47:06
In reply to Re: umm. advice from anyone tracking/knows me? » SLS, posted by floatingbridge on January 27, 2011, at 14:04:07
Upon rereading, besides being embarrassed by seeing all the typos and grammar bloops, I saw something about Lyrica worsening depression...? I didn't know this. I guess it a possible side to any treatment.
So far, I've tapered to about
Cymbalta 15mg
Ultram still 200mg. Should I take halves?
Dexedrine is at about 50. I'm hoping to give it up last. (My dear friend dexedrine. Sigh.)Can one change from one maoi to another w/o a washout? Say if Emsam is ineffective....
Posted by SLS on January 27, 2011, at 18:09:18
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by floatingbridge on January 27, 2011, at 17:47:06
> Upon rereading, besides being embarrassed by seeing all the typos and grammar bloops,
Yeah. I could hardly bring myself to read it.
:-)
> I saw something about Lyrica worsening depression...?
Yes. Some people like me react badly to Neurontin and Lyrica, both of which are ligands of the alpha-2-delta subunit of the voltage-gated calcium channel.
> I didn't know this. I guess it a possible side to any treatment.
Too many, I'm afraid.
> Can one change from one maoi to another w/o a washout?
No. Possible stroke.
> Say if Emsam is ineffective....
Let us hope that it isn't.
- Scott
Posted by Phillipa on January 27, 2011, at 19:13:18
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by floatingbridge on January 27, 2011, at 17:47:06
FB is husband supportive why weeping to be depressed? Have you taken him to any doc's appointments with you? Also on a positive note if 6mg of EMSAM works for you no dietary restrictions!!!! Love Phillipa ps plus supposed to be stimulating. Fingers and toes crossed!!!!
Posted by roscopeeco on January 29, 2011, at 3:57:03
In reply to umm. advice from anyone tracking/knows me?, posted by floatingbridge on January 24, 2011, at 17:30:55
Man...I am sorry you are feeling this way. Did you ever take Ultram or Dex alone or has it always been in combination with the other meds. I don't think polypharmacy is a tricky thing. I would reboot your program and start with a foundation. A medication that you know works.
Posted by floatingbridge on January 29, 2011, at 21:02:28
In reply to Re: umm. advice from anyone tracking/knows me?, posted by roscopeeco on January 29, 2011, at 3:57:03
Hi roscoepeeco,
Hey, thanks for your suggestion. How very sound and concise. And sensible. I think this is close to what Scott was saying if not the same. Thank you. I don't know where your med knowledge is from, but I certainly appreciate it--here and in other posts I've read.
So update is:
Cymbalta 10mg. (Too fast. Had supreme head-zaps. Went up close to 15 by adding some sprinkles. Better.)
Dex 45
Ultram 0 mg
Xanax XR 1.0 mg
Xanax as needed 0 mg
Lyrica 75mg x day
My pdoc wanted me to start Lyrica AFTER Cymbalta, which makes sense if you're a doctor, but as me and a mother, if Lyrica was going to help, why wait? I need help NOW. That said, despite the decrease in snri after at least, jeez, 12 years, my mood is alright. I just feel very wonky.
I am going to try for dex, lyrica, xanax, and extra therapy. Maybe? (Hope, Hope, Hope.) If my boat springs a leak, I'll try emsam.
Wish me luck, and I really appreciate ALL the input. You guys/gals are great.
fb
> Man...I am sorry you are feeling this way. Did you ever take Ultram or Dex alone or has it always been in combination with the other meds. I don't think polypharmacy is a tricky thing. I would reboot your program and start with a foundation. A medication that you know works.
Posted by floatingbridge on January 29, 2011, at 22:53:50
In reply to Re: umm. advice from anyone tracking/knows me?, posted by roscopeeco on January 29, 2011, at 3:57:03
Add a little norco. 10mg-20mg per day. That's still over the golden 3 rule.
Ultram not the same, though I like the idea of extended release...really, I had superior results from the same dose or less of generic ultracet. However, it never touched the deepest pain :(
A time released norco? But then, it probably wouldn't work as effectively either.
My physiatrist tries to prescribe whatever dosage in the least amount of pills. Says pill-popping, even when necessary creates a negative psychological template.
The psychology of pain is very interesting.
Posted by Conundrum on January 30, 2011, at 11:17:15
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by SLS on January 27, 2011, at 2:24:55
>
> I do know one woman who was able to combine Nardil with doxepin. Doxepin can be calming and promote sleep, although I don't know how it affects sleep quality. It is a potent antihistamine.
>
I was thinking the same thing, that doxepin is a sedating TCA. It is adrenergic so in theory it should help with pain, but its probably not as stimulating as desipramine which could interfere with sleep.I would imagine you could add an SSRI to it if it is not cutting it for depression and anxiety. An MAO wouldn't be a bad option either but I would imagine you would still need the TCA for pain so it might make sense to try a TCA alone first.
Just a thought.
Posted by Conundrum on January 30, 2011, at 11:19:33
In reply to Re: umm. advice from anyone tracking/knows me? » SLS, posted by floatingbridge on January 27, 2011, at 14:04:07
> Nardil scares me. I do have some vanity. I don't mind being mildly overweight, but Nardil has a rep.
You might gain weight on nardil, but it is possible to lose the weight you gain from nardil. I know because I've seen someone do it. If a med can get you out doing things then it might have a better impact on health than a med that does not work. Thats not saying parnate would not work. I Just wouldn't be to scared of Nardil.
Posted by floatingbridge on January 30, 2011, at 11:47:35
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by Conundrum on January 30, 2011, at 11:19:33
Thanks Conundrum for both pieces of advice. My gp mentioned doxepin right off as a possibly.
And thank you for the positive input on Nardil. I don't know. To me it has the big heavyweight, big guns reputation (again, to me), like it's the last stop on the transit line. Oh. I think I wrote the very same metaphor to you. Oh well.
Maybe aggregates of stories, David Foster Wallace most recently that it is for the suicidal. I'm more like Emily Dickenson, "without the courage to die" when I am in the deeps.Whatever it takes (in a sane, thought out manner) I suppose. I added Lyrica (I didn't want to wait a complete wash as
my doctor wanted...) 75x daily, and my mood's been good. I'll let the board know if it cuts the muster pain-wise.The past few days have been oddly alright. I tapered Cymbalta too fast yesterday and paid for it.
Thanks again. I'm not happy that you find yourself here, but I'm sure glad you're around.
Best to you and your day.
fb
Posted by ed_uk2010 on January 30, 2011, at 13:00:33
In reply to Re: umm. advice from anyone tracking/knows me?, posted by sigismund on January 27, 2011, at 1:22:24
>We're not quite as brisk as the British...
As brisk as the British Sigi?
Posted by floatingbridge on January 30, 2011, at 13:53:30
In reply to Re: umm. advice from anyone tracking/knows me? » sigismund, posted by ed_uk2010 on January 30, 2011, at 13:00:33
Hi ed, may I interupt you two's British /Aussie thing a moment?
Sigi, I understand your post more. You we not having fun at my expense :)
Ciao
Posted by ed_uk2010 on January 30, 2011, at 16:01:08
In reply to Re: umm. advice from anyone tracking/knows me? » ed_uk2010, posted by floatingbridge on January 30, 2011, at 13:53:30
> Hi ed, may I interupt you two's British /Aussie thing a moment?
Oooo I don't know about that.
Posted by floatingbridge on January 30, 2011, at 16:12:12
In reply to Re: umm. advice from anyone tracking/knows me?, posted by ed_uk2010 on January 30, 2011, at 16:01:08
ed, I hope that didn't come off badly. I like to read you and Sigi compare cultural notes. Truly best intentions. Please write and let me know.
fb
Posted by phillipa on January 30, 2011, at 18:42:31
In reply to Re: umm. advice from anyone tracking/knows me?, posted by ed_uk2010 on January 30, 2011, at 16:01:08
Ed best be nice to FB as she's a sweetheart!!! PJxx
Posted by sigismund on January 30, 2011, at 21:16:41
In reply to Re: umm. advice from anyone tracking/knows me? » ed_uk2010, posted by floatingbridge on January 30, 2011, at 13:53:30
No FB, I wasn't making fun of you. I'm not sure what is meant by existential depression. When I feel bad I like to read the historiography of the Holocaust and stuff like that. I was probably making fun of myself. The British can be pretty damned brisk. Not Ed, of course.
Posted by sigismund on January 30, 2011, at 21:26:45
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by sigismund on January 30, 2011, at 21:16:41
And there's some envy going on. I'd like some Dexedrine. Do me the world of good. And some paregoric for this flu. Australia has been taken over my PC Methodism. A politician's husband with a cozy job at the top of the bureaucracy was caught buying a single ecstasy tablet. His wife the politician was saddened and angered then appealed for privacy while they worked through their issues. The Premier was angered and saddened. We should find out in a few days if he needs counselling for substance abuse and untreated bipolar illness. Perhaps he was in the manic phase? The corruption of the government is neither here nor there. It's a fascinating farce.
Posted by creepy on January 31, 2011, at 8:46:30
In reply to umm. advice from anyone tracking/knows me?, posted by floatingbridge on January 24, 2011, at 17:30:55
My fibro pain came from my depression. Treating the depression (even with drugs that arent known as analgesics) has got rid of the pain for me.
Id imagine this is different for everyone though.
What about switching the lithium for an AED? Even lamictal is known for some pain relief.
desipramine was really good on my fibro pain when I was on it. ITs an old school NRI.
If you go off the cymbalta, there are other SSRI + NRI combos that have less side effect and weight gain, IMO.
I dont think youll get much mood stabilization out of lyrica. =(
Posted by ed_uk2010 on January 31, 2011, at 16:04:27
In reply to Re: umm. advice from anyone tracking/knows me? » ed_uk2010, posted by floatingbridge on January 30, 2011, at 16:12:12
> ed, I hope that didn't come off badly.
Not at all, no problem x
Posted by ed_uk2010 on January 31, 2011, at 16:06:13
In reply to Re: umm. advice from anyone tracking/knows me? » floatingbridge, posted by sigismund on January 30, 2011, at 21:16:41
>The British can be pretty damned brisk. Not Ed, of course.
Not as brisk as the weather.
Posted by sigismund on February 1, 2011, at 2:50:09
In reply to Re: umm. advice from anyone tracking/knows me? » sigismund, posted by ed_uk2010 on January 31, 2011, at 16:06:13
Not to hijack the thread but I managed to make a real improvement in my dysphoric fatigued state by adding 400mg SAMe in the morning to the agomelatine 25mg.
This is the end of the thread.
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