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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by kavinsky99 on February 16, 2014, at 20:27:06
In reply to Re: Advice on which medication is best for my case, posted by Tomatheus on February 16, 2014, at 18:40:53
Blood tests have all returned ok. I'll try looking up with my GP what else I should look for.
Just ordered supplements, including zinc and vitamin D3. Vitamin B usually makes me more agitated so I'll avoid that meanwhile. However, I'll give inositol a try.
Posted by Tomatheus on February 16, 2014, at 21:40:58
In reply to Re: Advice on which medication is best for my case » Tomatheus, posted by kavinsky99 on February 16, 2014, at 20:27:06
Kavinsky,
Thank you for your reply. I do want to say that I recommend exercising caution when taking supplements, especially if you're also taking psychiatric medications (or any kinds of medications, for that matter). Check for interactions, and if at all possible, run things by a medical professional before starting a supplement.
Regarding vitamin D3, I have reason to at least suspect that it may take some time -- six months or more, from what I've read -- before you really notice the vitamin's long-term effects. This may be due to the vitamin's long half-life in the body, which one recent study found to be even longer than previously thought (Mocanu & Vieth, 2013). Vitamin D3 may help with both mood and cognition, as it boosts the expression of the tyrosine hydroxylase gene (which helps to synthesize dopamine, norepinephrine, and adrenaline) and also boosts the activity of the enzyme choline acetyltransferase (which helps to synthesize acetylcholine).
Good luck, and be well.
Tomatheus
==
REFERENCE
Mocanu, V., & Vieth, R. (2013). Three-year follow-up of serum 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density in nursing home residents who had received 12 months of daily bread fortification with 125 micograms of vitamin D3. Nutrition Journal, 12, 137. Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874673/
Posted by Phillipa on February 17, 2014, at 8:52:37
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
I also didn't remember other posts by you in the past. Welcome back. Not that I want to see you not feeling well. Hope you find some good ideas here. Phillipa
Posted by kavinsky99 on February 17, 2014, at 10:01:32
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by Phillipa on February 17, 2014, at 8:52:37
Hello. I only posted here once or twice in the past. I'll try becoming more active here, as I feel I have a lot of experience with medication and treatments for psychiatrical disorders, amongst other issues people with these conditions usually also go through.
Posted by Hugh on February 17, 2014, at 11:37:12
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
For your PTSD, you might try the beta blocker propranolol. This quote is from The Atlantic:
He and his colleagues administered propranolol 75 minutes before the reactivation of frightening memories in 40 patients. "It really did wonders," he told me. "After six sessions, 70 percent of patients no longer met the clinical criteria for PTSD."
The whole article is here:
This story about using propranolol to treat PTSD was shown on 60 Minutes several years ago:
Part one: http://www.youtube.com/watch?v=AhK0EX4G018&feature=related
Posted by Zyprexa on February 18, 2014, at 21:04:33
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
Not sure if you were taking those doses of zyprexa. There are no pills in any of those strengths. If you were taking those doses they are really low. Or were you really taking 5mg, 10mg,20, and 40mg. If so that is a lot. Were you taking generic zyprexa, or brand? I find that generic zyprexa is very light on weight gain.
Also I suggest perphenazine, which has no weight gain. Calming, and helps sleep. It is similar to zyprexa, but different.
Just wanted to say that I have a lot of similar problems as you. I am ptsd, schizo affective.I will say zyprexa is the single most effective med I've taken. 16y now. I also take perphenazine, zoloft and wellbutrin.
Posted by Chris O on February 19, 2014, at 9:33:12
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
Hey, Kavinsky:
Wow, that was a wonderfully comprehensive description of your situation. I am impressed by your powers of self reflection and analysis. I wish that I had the magic bullet for all of your symptoms, but I am still struggling so much myself that all I can offer is my empathy. I just want to say, with respect to your final summary at the bottom (I copied it below), I can totally relate (or, at least on some level, I can relate)! Mine is more on the anxiety side (with fear of homelessness; inability to care for myself being chief among them), but I struggle with endlessly intrusive worries that prevent me from living in the present. I really hope you find something (or some combination of things) that work. Have you tried rTMS (Transcranial Magnetic Stimulation)? Is that available where you live? In the US, a new form of TMS, Deep TMS (I think developed in Israel), apparently is showing some promise, as well. I am going to see my psychiatrist in a couple of weeks to try a combination of the TCA nortriptylene and the beta blocker propranolol in the coming weeks. I have low hopes, but still struggle so much that I have to keep trying. I just took a bottle of curcumin supplements for a month (inspired by a recent story that said curcumin had comparable antidepressant power to Prozac), but to no avail. Whatever you decide to do, I hope it provides you with some relief! God knows we all deserve it.
Sincerely,
Chris"Depression;
anxiety;
negative critical thoughts that "talk to me" in my mind;
intrusive flashbacks that pop up constantly;
overall agitation;
insomnia;
I wish to see improved:
Overall cognition (bad memory, poor concentration, difficulty to (re)learn even the simplest things, poor criativity, difficulty forming sentences sometimes);
focus: both on the big picture in life projects, and on the ability to actually read a line on a text book and be able to absorb it. I have an impulsive and frenzied attitude towards life, I rarely finish anything I start and keep trying new things all the time.;
ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen."
Posted by bleauberry on February 19, 2014, at 19:15:06
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
Well, honestly, this probably won't be the answer you were looking for, and I apologize in advance, but I do not feel that the kind of gains you are looking for are going to come from medications. I mean, my fight with all that stuff was so long I forgot, what, 20 years, 30 years, every psych med on the planet except nardil, ect failed.
So anyway, it was never psychiatric the whole time. It only looks that way. The problem is somewhere else in the body, basically poisoning the brain from within. You know how a person can lose some or all control of their thinking and behavior under the influence of alcohol? Well, it's sort of like that. The toxins from within, such as heavy metals or lyme-like, cause the person not to be drunk, but to feel the exact emotions you described.
The depression and all the other stuff, there isn't anything wrong with your brain, there isn't a chemical imbalance. What there is, is something providing continuous abuse. In my experience, that usually falls in the category of toxic accumulation, such as heavy metals, or hidden infection, lyme estimated to be 9 times more common than we think.
If your treatment were to maintain what you already have, but add new arms and legs to it that directly target hidden inflammations, hidden infections, and toxicity, I think the outcome in a year or two would be light years ahead of psychiatric medications alone. They are only attempting to control the symptoms, the end result, but meanwhile the target is missed and we wonder why we don't get better.
These are my opinions only.
Posted by kavinsky99 on February 20, 2014, at 3:53:11
In reply to Re: Advice on which medication is best for my case, posted by Hugh on February 17, 2014, at 11:37:12
> For your PTSD, you might try the beta blocker propranolol. This quote is from The Atlantic:
>
> He and his colleagues administered propranolol 75 minutes before the reactivation of frightening memories in 40 patients. "It really did wonders," he told me. "After six sessions, 70 percent of patients no longer met the clinical criteria for PTSD."
>
> The whole article is here:
>
> http://www.theatlantic.com/health/archive/2012/02/ending-the-nightmares-how-drug-treatment-could-finally-stop-ptsd/252079/
>
> This story about using propranolol to treat PTSD was shown on 60 Minutes several years ago:
>
> Part one: http://www.youtube.com/watch?v=AhK0EX4G018&feature=related
>
> Part two: http://www.youtube.com/watch?v=0rJ-NLSyS_w&NR=1Going to look into that later, Hugh, as most of my anxiety symptoms are actually physical and not mental. (Dizzyness, muscle tension, teeth grinding, fast heartbeats, shakyness, coldsweats, the works)
Does propranolol cause hypotension, thoufh? i have a 12/8 blood pressure usually.
Posted by kavinsky99 on February 20, 2014, at 4:13:46
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by Chris O on February 19, 2014, at 9:33:12
> Hey, Kavinsky:
>
> Wow, that was a wonderfully comprehensive description of your situation. I am impressed by your powers of self reflection and analysis. I wish that I had the magic bullet for all of your symptoms, but I am still struggling so much myself that all I can offer is my empathy. I just want to say, with respect to your final summary at the bottom (I copied it below), I can totally relate (or, at least on some level, I can relate)! Mine is more on the anxiety side (with fear of homelessness; inability to care for myself being chief among them), but I struggle with endlessly intrusive worries that prevent me from living in the present. I really hope you find something (or some combination of things) that work. Have you tried rTMS (Transcranial Magnetic Stimulation)? Is that available where you live? In the US, a new form of TMS, Deep TMS (I think developed in Israel), apparently is showing some promise, as well. I am going to see my psychiatrist in a couple of weeks to try a combination of the TCA nortriptylene and the beta blocker propranolol in the coming weeks. I have low hopes, but still struggle so much that I have to keep trying. I just took a bottle of curcumin supplements for a month (inspired by a recent story that said curcumin had comparable antidepressant power to Prozac), but to no avail. Whatever you decide to do, I hope it provides you with some relief! God knows we all deserve it.
>
> Sincerely,
> Chris
>
> "Depression;
>
> anxiety;
>
> negative critical thoughts that "talk to me" in my mind;
>
> intrusive flashbacks that pop up constantly;
>
> overall agitation;
>
> insomnia;
>
> I wish to see improved:
>
> Overall cognition (bad memory, poor concentration, difficulty to (re)learn even the simplest things, poor criativity, difficulty forming sentences sometimes);
>
> focus: both on the big picture in life projects, and on the ability to actually read a line on a text book and be able to absorb it. I have an impulsive and frenzied attitude towards life, I rarely finish anything I start and keep trying new things all the time.;
>
> ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen."
Sadly, TMS isn't available here. And if it is, I doubt my insurance will ever cover it! hahaI can totally relate to the fear of going homeless or not be able to care for yourself. Although, I have to say I don't actually fear it or care much about it. I have a very "blah" attitude towards the future, being overly-rational about most things. My anxiety is usually towards the past, not future. I'm sure you won't be homeless, though, as I can see you're an intelligent person. I don't know you, but if the cause of your fear are the impairments psychiatrical conditions cause, then I wouldn't worry. Medication nowadays can improve almost anything.
Find the right medication that works, has the least side effects and hope it keeps going for you as long it can. Psychiatrical medication requires constant tweaking on doses, combinations and switching similar types, because the previous one stopped working or started to cause bad side effects. It's sad we have to go through this hassle.I hope that combination of meds works for you. I haven't tried Nortryptiline yet, although I always had a hunch it would be great for me. I got it prescribed for herniated disc pain once, but didn't took it to avoid interactions. TCAs, with Nortryptline specially, seem to be the best antidepressants/anxiolytics. Although their side effect profile can be quite scary.
Haven't tried propranolol, but I'm also interested. As Hugh posted here, it seems great for PTSD symptoms.
Posted by kavinsky99 on February 20, 2014, at 4:19:22
In reply to Re: Advice on which medication is best for my case, posted by bleauberry on February 19, 2014, at 19:15:06
> Well, honestly, this probably won't be the answer you were looking for, and I apologize in advance, but I do not feel that the kind of gains you are looking for are going to come from medications. I mean, my fight with all that stuff was so long I forgot, what, 20 years, 30 years, every psych med on the planet except nardil, ect failed.
>
> So anyway, it was never psychiatric the whole time. It only looks that way. The problem is somewhere else in the body, basically poisoning the brain from within. You know how a person can lose some or all control of their thinking and behavior under the influence of alcohol? Well, it's sort of like that. The toxins from within, such as heavy metals or lyme-like, cause the person not to be drunk, but to feel the exact emotions you described.
>
> The depression and all the other stuff, there isn't anything wrong with your brain, there isn't a chemical imbalance. What there is, is something providing continuous abuse. In my experience, that usually falls in the category of toxic accumulation, such as heavy metals, or hidden infection, lyme estimated to be 9 times more common than we think.
>
> If your treatment were to maintain what you already have, but add new arms and legs to it that directly target hidden inflammations, hidden infections, and toxicity, I think the outcome in a year or two would be light years ahead of psychiatric medications alone. They are only attempting to control the symptoms, the end result, but meanwhile the target is missed and we wonder why we don't get better.
>
> These are my opinions only.I'm quite healthy physically (despite some things left over by all the medication they used to force down on me, including everything obesity related). I eat well, exercise, don't live in a overly-poluted place. However I agree that anything physical can be synergistical or the cause for mental issues.
Posted by Hugh on February 21, 2014, at 10:22:26
In reply to Re: Advice on which medication is best for my case, posted by kavinsky99 on February 20, 2014, at 3:53:11
> Does propranolol cause hypotension, thoufh? i have a 12/8 blood pressure usually.
I have fairly low blood pressure -- usually about 105/65. I've taken beta blockers for years (propranolol, atenolol, nebivolol) for mitral valve prolapse and anxiety. I have to take a really high dose before they make me feel dizzy. Even if propranolol drives your blood pressure too low, you'd only have to put up with it for six sessions to do your PTSD some good.
Neurofeedback might do your depression, anxiety, PTSD and ADHD a lot of good. A wonderful book about neurofeedback is A Symphony in the Brain by Jim Robbins. Another thing that might help you is TRE (Tension and Trauma Releasing Exercises).
Posted by jono_in_adelaide on February 22, 2014, at 19:27:43
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
Could I suggest a high dose SSRI (escitalopam 20mg or sertaline 200mg each morning, Effexor 300mg each morning) with mirtazapine 45mg at night. For the intrusive thoghts, I found risperidone 1mg at night very helpful as well.
There are many other cocktails that could help you - the main thing is, dont give up
Posted by phidippus on February 23, 2014, at 17:31:49
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
>I have neverending, repetitive, intrusive and crippling thoughts of bad moments or things that I've been through. Sometimes memories, other times the memories "insert themselves" in the moment/current task I'm on, projecting a critic voice.
This is 'Pure O' OCD - intrusive and recurrent thoughts, not PTSD.
>I feel very, very anxious all the time. I feel like most of the time I'm in an extreme hurry and feel unable to just be in the moment...it actually causes a bit of frenzied behavior that is not only unpleasant, but very irrational. I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present.
Bipolar mania can present with a lot of anxiety. Describing your behavior as frenzied points to hypomania.
What about your obsessions? Do you think maybe they could be causing a lot of the anxiety?
>I also have panic attacks daily if I'm not on the right medication.
That would be an AD or a benzo.
>I have it all: frustration and anger...a temper...insomnia...And when anxious/depressed, my energy feels neverending.
You used the above words to describe your depresssion, but they sound more like me to be the symptoms of a bipolar mixed state
> ADHD: I am very restless. - VERY -. I can't keep my mind on one subject/task for too long. I usually find myself doing a thousand things at once.
I think these are indications of a bipolar disorder, rather than an ADHD.
>I notice when I find myself in a calm environment where I have to focus, my mind tends to drift to dark places. The bad memories/intrusive thoughts come down like thunder. I usually feel desperation coming when I can't find distractions, as I know my mind will be at the mercy of my horrible thoughts and feelings.
This is kind of how OCD works.
>I find it hard to read books, follow plots or study something. It's actually very hard, and it's concerning me a lot.You're concentration problems seeem far more severe than thoe found in ADHD.
>This gives me quite a strong genetic and behavioral reason to develop bipolar disorder.
You probably already are bipolar.
> Lexapro...Intensified irritability and feeling of neverending energy.
Triggered manic symptoms.
>Zoloft...Felt very motivated, chatty, full of self confidence and somewhat agressive.
Triggered mania
>Helped calming my mind from the bad negative thoughts. After that, I just started feeling very, very relaxed. No apathy, almost no physical symptom of depression/anxiety, rarely the bad racing thoughts came up. Felt like my mind was "moving" again, able to be in the moment and think and feel new things.
Probably triggered a manic cycle that then led to a depressive cycle which was treated. Had you continued to take it, more mania would've been triggered.
> Buspar...Seemed to give me an even worst boost to physical energy and cause a LOT (and I mean A LOT) of anger.
Triggered mania
> Effexor XR...When I got on the 150mg dose, I turned out to be very, very irritable and hostile, fighting with my girlfriend for no reason.
triggered mania
>lithium, of which I took 75mg to 900mg daily. By far, the medication I most enjoy and would never be without it.Good. I hope you stay on it to treat your bipolar symptoms. As long as you stay on the Lithium, you should be able to take an antidepressant to treat your OCD symptoms. I'd recommend Luvox, Viibryd or Clomipramine, though there are many other SSRIs available.
Eric
Levels my mind just enough to feel somewhat normal every odd day. And I feel the longer I take, the better I do/feel overall.
>
>
> Now, for a conclusion, I would like your input for medications that best and safely fit my diagnosis/possible comorbities, according to my issues, that I will describe here in a more objective manner:
>
> My main goal is to seek relief for all the symptoms described above, but while retaining a few capacties or gaining new ones:
>
> I wish to see obliterated:
>
> Depression;
>
> anxiety;
>
> negative critical thoughts that "talk to me" in my mind;
>
> intrusive flashbacks that pop up constantly;
>
> overall agitation;
>
> insomnia;
>
> I wish to see improved:
>
> Overall cognition (bad memory, poor concentration, difficulty to (re)learn even the simplest things, poor criativity, difficulty forming sentences sometimes);
>
> focus: both on the big picture in life projects, and on the ability to actually read a line on a text book and be able to absorb it. I have an impulsive and frenzied attitude towards life, I rarely finish anything I start and keep trying new things all the time.;
>
> ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
>
>
>
> I appreciate any input. Be it medication, behavior change or technique, natural supplementation or anything.
>
> Sincerely grateful.
>
>
>
>
>
Posted by kavinsky99 on February 24, 2014, at 6:12:43
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 23, 2014, at 17:31:49
> >I have neverending, repetitive, intrusive and crippling thoughts of bad moments or things that I've been through. Sometimes memories, other times the memories "insert themselves" in the moment/current task I'm on, projecting a critic voice.
>
> This is 'Pure O' OCD - intrusive and recurrent thoughts, not PTSD.
>I think it might be both, really. I have more vivid and emotionally intense memories sometimes, as if I'm truly reliving stuff. The not-official diagnosis being called CPTSD fits me more than Pure O and simple PTSD, though I don't exclude Pure O. I don't really obsess about anything else other than my traumas (the more severe ones), also. Don't know if that matters.
> >I feel very, very anxious all the time. I feel like most of the time I'm in an extreme hurry and feel unable to just be in the moment...it actually causes a bit of frenzied behavior that is not only unpleasant, but very irrational. I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present.
>
> Bipolar mania can present with a lot of anxiety. Describing your behavior as frenzied points to hypomania.
>
Could be hypomania, or could be just stress induced brain changes. People who suffer too much stress end up with poor impulse control, lack of attention, chronic anxiety and a lot of symptoms that mimic mania. It would explain why I never have euphoric mania, just severe excitability with behaviors and symptoms more likely on the anxiety spectrum.
> What about your obsessions? Do you think maybe they could be causing a lot of the anxiety?
>They definetely do. And one thing fuels the other... However, I'm noticing that doing something concrete and real about it is making me feel better. I'm filling complaints and opening law suits, and that is being as good as medication honestly.
> >I also have panic attacks daily if I'm not on the right medication.
>
> That would be an AD or a benzo.
Yeah, those work good. However, I've been taking less benzos since they tend to cripple my memory really badly. I'm taking tianeptine, now. Best anxiolytic I've ever had, and a great mood enhancer too. Just feel plain "normal", not too much of anything, and still feeling different when situation requires (unlike SSRIs, which tend to put me on a constant mood regardless of what I'm doing).>
> >I have it all: frustration and anger...a temper...insomnia...And when anxious/depressed, my energy feels neverending.
>
> You used the above words to describe your depresssion, but they sound more like me to be the symptoms of a bipolar mixed state
>
What I tried to describe is more like extreme anxiety/stress with depression being a consequence, that tends to be brief. But I don't exclude the possibility of being a bipolar mixed state, and it makes me sad that I never had euphoric mania! haha> > ADHD: I am very restless. - VERY -. I can't keep my mind on one subject/task for too long. I usually find myself doing a thousand things at once.
>
> I think these are indications of a bipolar disorder, rather than an ADHD.
>
Yeah, I don't think I have actual ADHD. But a lot of difficulties and behaviors that mimic it, but like you said, more severe.> >I notice when I find myself in a calm environment where I have to focus, my mind tends to drift to dark places. The bad memories/intrusive thoughts come down like thunder. I usually feel desperation coming when I can't find distractions, as I know my mind will be at the mercy of my horrible thoughts and feelings.
>
> This is kind of how OCD works.
>
>
> >I find it hard to read books, follow plots or study something. It's actually very hard, and it's concerning me a lot.
>
> You're concentration problems seeem far more severe than thoe found in ADHD.
>
I think so, too. Poor focus, really bad memory. Sometimes I tend to have a really incoherent approach to things, a lot of confusion. I don't know if it's a symptom, effect of the current meds I'm taking or consequence of so much antipsychotic use during childhood and adolescence. Even on the smallest doses, APs make this specific problem far, FAR worse.But, I'm finding that, lately, simply having a "quieter" mind if making it all easier. More focus, better memorization, I approach things without having to try to shutdown my brain due to a string of negative thoughts and emotions. That is making me able to develop skills again.
> >This gives me quite a strong genetic and behavioral reason to develop bipolar disorder.
>
> You probably already are bipolar.
>
Could be. Anxiety related stuff is definetely separated from this in cause, though they interact with each other.> > Lexapro...Intensified irritability and feeling of neverending energy.
>
> Triggered manic symptoms.
>
That seems to happen more on the beginning of SSRIs. More or less the same between all of them:t They make me feel good the first 2 doses, then move to slight apathy and the host of physical side effects, then I get this boost in
energy and get way too confident. Then a more severe form of bluntness of emotion/though and apathy kicks in.> >Zoloft...Felt very motivated, chatty, full of self confidence and somewhat agressive.
>
> Triggered mania
>
Like Lexapro, only the first month or so was like that. After that, I started to feel really low but that could be other medications I was taking). Then it made me quite "leveled". No depression, no anxiety. And I felt like my mind was "learning" again. Being able to see and enjoy new things. Sadly I had to quit Zoloft due to side effects.
> >Helped calming my mind from the bad negative thoughts. After that, I just started feeling very, very relaxed. No apathy, almost no physical symptom of depression/anxiety, rarely the bad racing thoughts came up. Felt like my mind was "moving" again, able to be in the moment and think and feel new things.
>
> Probably triggered a manic cycle that then led to a depressive cycle which was treated. Had you continued to take it, more mania would've been triggered.
>
Think it's worth the shot to try again, to see if mania is triggered? Is there anything such as a "test for mania" in those who already might suffer from it? Like a medication you can take to trigger mania ONLY if you are succetible to it naturally, and not just from medications.> > Buspar...Seemed to give me an even worst boost to physical energy and cause a LOT (and I mean A LOT) of anger.
>
> Triggered mania
>
Like SSRIs, that was during the beginning. After that, it was much like a "soft" SSRI. I quit due to dizzyness it was causing, though.> > Effexor XR...When I got on the 150mg dose, I turned out to be very, very irritable and hostile, fighting with my girlfriend for no reason.
>
> triggered mania
>
I spent a month on the 75mg range, with apparent no effect (just physical side effects) and some minor relaxation. Then moved to 150mg, and that made me a little more relaxed and I was sleeping better. I felt more in peace overall, but some stimulus seemed too intense. 150mg is the dosage that starts kicking in norepinephrine reuptake inhibition. A lot of people get irritable with norepinephrine being increased, and that might have been the cause. It wasn't feeling angry all the time or anything that's just exagerated and feels like a "switch was on", it was more like being upset by little things, which isn't normal for me. But I don't think in this case, it was mania being triggered, as I felt overall very tranquil.
It seems that Effexor on the higher dosage range is one of the medications that are most likely to trigger mania. I'm really curious about trying it again to be sure that I'm bipolar. However, as I said above, I'm not sure it would trigger mania ONLY in those who already are prone to have it naturally.
Mirtazapine at 45mg (more norepinephrine release) caused the same irritability as Effexor 150mg did, by the way (even concurrent with 900mg lithium).>
> >lithium, of which I took 75mg to 900mg daily. By far, the medication I most enjoy and would never be without it.
>
> Good. I hope you stay on it to treat your bipolar symptoms. As long as you stay on the Lithium, you should be able to take an antidepressant to treat your OCD symptoms. I'd recommend Luvox, Viibryd or Clomipramine, though there are many other SSRIs available.
>
Lithium was prescribed for the effects it has on repairing damage caused by stress. The longer I take it, the better I feel overall.
And I was taking lithium during the experiences with the other medications. Lithium, bromazepam and alprazolam were the only constants during my entire treatment.Be it bipolar, anxiety, brain damage from stress or all three together, I think lithium is my best bet.
However, I do need something else for anxiety and focus. Lithium doesn't hold back severe anxiety and the improvement in focus isn't noticeable, although it keeps me quieter and
Tianeptine is being absolutely great for all 3 and it's also good for stopping glutamate damage and increasing brain plasticity, so I've read. However, it tends to be addicting and it might stop working. So I don't wanna bet it all on that.I've read Seroquel might be good for bipolar depression and reversing cognitive dysfunction (that is more present in bipolar II). What do you think?
> Eric
>
>
>
> Levels my mind just enough to feel somewhat normal every odd day. And I feel the longer I take, the better I do/feel overall.
> >
> >
> > Now, for a conclusion, I would like your input for medications that best and safely fit my diagnosis/possible comorbities, according to my issues, that I will describe here in a more objective manner:
> >
> > My main goal is to seek relief for all the symptoms described above, but while retaining a few capacties or gaining new ones:
> >
> > I wish to see obliterated:
> >
> > Depression;
> >
> > anxiety;
> >
> > negative critical thoughts that "talk to me" in my mind;
> >
> > intrusive flashbacks that pop up constantly;
> >
> > overall agitation;
> >
> > insomnia;
> >
> > I wish to see improved:
> >
> > Overall cognition (bad memory, poor concentration, difficulty to (re)learn even the simplest things, poor criativity, difficulty forming sentences sometimes);
> >
> > focus: both on the big picture in life projects, and on the ability to actually read a line on a text book and be able to absorb it. I have an impulsive and frenzied attitude towards life, I rarely finish anything I start and keep trying new things all the time.;
> >
> > ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
> >
> >
> >
> > I appreciate any input. Be it medication, behavior change or technique, natural supplementation or anything.
> >
> > Sincerely grateful.
> >
> >
> >
> >
> >
>
>
Posted by phidippus on February 24, 2014, at 18:01:55
In reply to Re: Advice on which medication is best for my case, posted by kavinsky99 on February 24, 2014, at 6:12:43
>I don't really obsess about anything else other than my traumas (the more severe ones), also. Don't know if that matters.
All you kneed to have is one obsession (mine is suicide).
>I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present.
It sounds more like hypomania, which can include high levels of anxiety.
> Could be hypomania, or could be just stress induced brain changes.
The area of the brain most susceptible to changes brought about by stress is the hippocampus-it can shrink, causing memory impairments, cognitive problems, etc.
>It would explain why I never have euphoric mania
I'm Bipolar I and rarely have euphoric manias.
>I'm noticing that doing something concrete and real about it is making me feel better.
Distraction and structure help alleviate OCD symptoms.
> What I tried to describe is more like extreme anxiety/stress with depression being a consequence, that tends to be brief.
You'r still describing a mixed state :) Bipolar II presents exactly the way you describe. The stress/anxiety component is the mania.
>it makes me sad that I never had euphoric mania! haha
Even when I had a euphoric state it was laced with god awful amounts of anxiety.
> Sometimes I tend to have a really incoherent approach to things, a lot of confusion.
Do you experience a lot of racing thoughts?
>Even on the smallest doses, APs make this specific problem far, FAR worse.
If you do have the slightest bit of ADHD, it could axplain why APs make these symptoms worse.
> That seems to happen more on the beginning of SSRIs. More or less the same between all of them:t They make me feel good the first 2 doses, then move to slight apathy and the host of physical side effects, then I get this boost in
> energy and get way too confident. Then a more severe form of bluntness of emotion/though and apathy kicks in.Sounds like they destabilize your mood quite a bit. If you were on 1200mg of Lithium and say, 20 mg Lexapro, it wouldn't be such an issue.
> Think it's worth the shot to try again, to see if mania is triggered?What's worth trying is one of these antidepressants that worked for you .with the lithium.
>Is there anything such as a "test for mania" in those who already might suffer from it?
Not really. A manic response to any antidepressant is a good indicator you are truly bipolar
> Mirtazapine at 45mg (more norepinephrine release) caused the same irritability as Effexor 150mg did, by the way (even concurrent with 900mg lithium).
900 mg of Lithium might not be enough.
>
>Lithium was prescribed for the effects it has on repairing damage caused by stress.Does it help with your anxiety?
>I think lithium is my best bet.
I think so, too and indicates to mee you are bipolar. HOWEVER, Lithium is not going to help with the intrusive and recurrent thoughts - you need an AD to treat those, so I encourage you to find an SSRI that works well with the lithium.
> However, I do need something else for anxiety and focus.
You can always try Vyvanse, which will help with concentration and may even help your OCD/PTSD.
> I've read Seroquel might be good for bipolar depression and reversing cognitive dysfunction (that is more present in bipolar II). What do you think?
Seroquel is not so good for cognitive dysfunction-it is more likely to cause it.
> > > I wish to see obliterated:
> > >
> > > Depression;Lithium helps depression.
Any serotegenic antidepressant could help
Wellbutrin
Rilutek
> > > anxiety;
TCAs, SSRIs, Gabitril, Benzodiazapines, Keppra, 5ht1a agonists, many APs can be helpful.
> > > negative critical thoughts that "talk to me" in my mind;
APs are good for intrusive thoughts. If its an OCD thing, SSRIs can be helpful. CBT and DBT.
> > > intrusive flashbacks that pop up constantly;
Prazosin
> > > overall agitation;
Lithium, APs, serotogenic drugs
> > > insomnia;
Gabitril, Seroquel, Rozerem, Lunesta, Ambien, Clonidine, Mirtazapine, Trazodone.
> > > I wish to see improved:
> > >
> > > Overall cognitionKeppra, LAtuda, MEmantine, Riluzole
> > > focus
Vyvanse, Concerta
> > > ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
Zen Buddhism
Eric
Posted by kavinsky99 on February 24, 2014, at 19:08:14
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 24, 2014, at 18:01:55
> >I don't really obsess about anything else other than my traumas (the more severe ones), also. Don't know if that matters.
>
> All you kneed to have is one obsession (mine is suicide).
>
> >I still don't know if it's pure anxiety or a type of hypomania where anxiety is very present.
>
> It sounds more like hypomania, which can include high levels of anxiety.
>
> > Could be hypomania, or could be just stress induced brain changes.
>
> The area of the brain most susceptible to changes brought about by stress is the hippocampus-it can shrink, causing memory impairments, cognitive problems, etc.
>
> >It would explain why I never have euphoric mania
>
> I'm Bipolar I and rarely have euphoric manias.
>
> >I'm noticing that doing something concrete and real about it is making me feel better.
>
> Distraction and structure help alleviate OCD symptoms.
>
> > What I tried to describe is more like extreme anxiety/stress with depression being a consequence, that tends to be brief.
>
> You'r still describing a mixed state :) Bipolar II presents exactly the way you describe. The stress/anxiety component is the mania.
>
> >it makes me sad that I never had euphoric mania! haha
>
> Even when I had a euphoric state it was laced with god awful amounts of anxiety.
>
> > Sometimes I tend to have a really incoherent approach to things, a lot of confusion.
>
> Do you experience a lot of racing thoughts?
>
I do have true racing thoughts when I'm very anxious, specially during a panic attack. Other times, I don't have RACING thoughts per se, but very attention consuming, endless mind chatter that I can't control and often give up and just "dialogue" with. I have the odd day where I'm literally consumed by "flashbacks" and inner dialogue. I wouldn't say these thoughts are racing, as I actually feel my mind goes slower in those days (along with extreme fatigue), but they are intense and run on a chain, like my mind is on a track and all I can do is wait for the ride to be over (when I sleep or pop a benzo).
> >Even on the smallest doses, APs make this specific problem far, FAR worse.
>
> If you do have the slightest bit of ADHD, it could axplain why APs make these symptoms worse.
>
Yeah, APs are great for managing anxiety (in lower doses. higher doses seem to worsen it) and agitation, but create an specific kind of restlessness that is a lot like true ADHD. Nothing sinks in, nothing feels rewarding, nothing gets caught in my mind. So I keep doing random stuff and moving around.
>
>
> > That seems to happen more on the beginning of SSRIs. More or less the same between all of them:t They make me feel good the first 2 doses, then move to slight apathy and the host of physical side effects, then I get this boost in
> > energy and get way too confident. Then a more severe form of bluntness of emotion/though and apathy kicks in.
>
> Sounds like they destabilize your mood quite a bit. If you were on 1200mg of Lithium and say, 20 mg Lexapro, it wouldn't be such an issue.
>
Don't know if I could tolerate 1200mg of lithium well. 900mg was causing a few bothersome side effects. Now I'm at 600mg, but I do miss how well it worked at 900mg.
> > Think it's worth the shot to try again, to see if mania is triggered?
>
> What's worth trying is one of these antidepressants that worked for you .with the lithium.
>
Well, I'd have to go up to 1200mg then.
But I'm using tianeptine and feeling as stable as I have ever been, on 3mg to 6mg daily dose along with 600mg lithium.
> >Is there anything such as a "test for mania" in those who already might suffer from it?
>
> Not really. A manic response to any antidepressant is a good indicator you are truly bipolar
>
> > Mirtazapine at 45mg (more norepinephrine release) caused the same irritability as Effexor 150mg did, by the way (even concurrent with 900mg lithium).
>
> 900 mg of Lithium might not be enough.
>
> >
> >Lithium was prescribed for the effects it has on repairing damage caused by stress.
>
> Does it help with your anxiety?
>
It does, but not enough to keep it under control, specially when it gets too bad. I feels as if lithium is just "cementing" a solid layer of tranquility and overall good functioning in my mind. The more I use lithium, the less excitable I am in general. On or off the lithium, I can see severe changes on how I react to just about anything. For the best, in general. I do notice lithium "dulls" certain impulses and interests I used to have, that made me a more fun and outgoing person. Lithium is turning me into a more quiet person, that finds comfortable to just not care much about things.> >I think lithium is my best bet.
>
> I think so, too and indicates to mee you are bipolar. HOWEVER, Lithium is not going to help with the intrusive and recurrent thoughts - you need an AD to treat those, so I encourage you to find an SSRI that works well with the lithium.
>
Actually, that's why my doctor prescribed me originally and it was the best medication I took regarding the never ending mind chatter and intrusive thoughts. Serotonergic ADs help too, of course. Sadly, I usually can't tolerate SSRI/SNRI side effects (really bad ones tend to appear after a few months), so I end up discontinuing them. Doctor suggested Clomipramine for the intrusive thoughts, I haven't tried it yet due to the anti-cholinergic effects being possibly harmful to my already bad cognition. What do you think of TCAs, at a low dose? Their side effect profile scares me, but their efficacy and how they can be helpful on neuropathic pain keep me curious.> > However, I do need something else for anxiety and focus.
>
> You can always try Vyvanse, which will help with concentration and may even help your OCD/PTSD.
>
I think Vyvanse isn't available in my country yet. Isn't it a stimulant? Stimulants and other dopaminergic drugs aren't a good option for me, as they worsen the agitation and anxiety a lot.> > I've read Seroquel might be good for bipolar depression and reversing cognitive dysfunction (that is more present in bipolar II). What do you think?
>
> Seroquel is not so good for cognitive dysfunction-it is more likely to cause it.
>
As will most APs, right? Damn you, dopamine...
> > > > I wish to see obliterated:
> > > >
> > > > Depression;
>
> Lithium helps depression.
>
> Any serotegenic antidepressant could help
>
> Wellbutrin
>
> Rilutek
>
Rilutek, did not know it could work for depression.
Wellbutrin worsened my anxiety and agitation a lot. I took 450mg for 2 years, and it slowly increased my symptoms of anxiety, depression and the possible bipolar II to a point where I was having anxiety attacks every 45 minutes (all of them were pretty negligible before it and I never had panic attacks before). So any doctor usually rule out dopaminergic drugs.> > > > anxiety;
>
> TCAs, SSRIs, Gabitril, Benzodiazapines, Keppra, 5ht1a agonists, many APs can be helpful.
>
Never tried TCAs. What do you think of them? You think low dose of any of them could be effective for anxiety and neuropathic pain, without harm to cognition or other more bothersome side effects?SSRIs are so unreliable. Every two weeks or so my mood and side effect profile seem to shift to something else.
Gabitril's description makes it sound a lot like Gabapentine. Gabapentine made me dumber than a box of rocks. Rocks with a relentless death wish, too. Same goes to Topamax. That's why I'm weary of trying any mood stabilizer (though I haven't touched the better ones for anxiety/depression/bipolar, like Lamictal, Tegretol, Trileptal). Keppra isn't very popular in my country, but I think we have it. i'm going to look into that one better before I comment on it.
APs make me apathetic, impulsive, ADHD, dysphoric (not in the dysphoric mania sense. just extremely miserable and angry/sad at life), dumb and obese. But they work for what they're intended, though! I'll try one of these again when I have the time to deal with serious side effects and sleep 12-15 hours a day.
> > > > negative critical thoughts that "talk to me" in my mind;
>
> APs are good for intrusive thoughts. If its an OCD thing, SSRIs can be helpful. CBT and DBT.
>
The intrusive, repeating thoughts are by far the worst symptom of all. I don't know if they're the cause of a symptom or both, but they literally cripple my ability to live. For all that I do, unwanted negative thoughts pop up.900 Lithium + 30mg mirtazapine + 1mg risperidone or 600mg lithium + 50mg Zoloft + 6mg bromazepam were the best combos for that. However, Zoloft, risperidone, bromazepam and mitazapine tend to worsen my cognition.
> > > > intrusive flashbacks that pop up constantly;
>
> Prazosin
>
I never tried beta and alpha blockers. I'll look into it.> > > > overall agitation;
>
> Lithium, APs, serotogenic drugs
>
> > > > insomnia;
>
> Gabitril, Seroquel, Rozerem, Lunesta, Ambien, Clonidine, Mirtazapine, Trazodone.
>
> > > > I wish to see improved:
> > > >
> > > > Overall cognition
>
> Keppra, LAtuda, MEmantine, Riluzole
>
Can these drugs and nootropic drugs cause an increase on intrusive thoughts? I'm scared of trying even choline supplements, and insted of finding more ability to memorize better and focus on studying, I'll just have more ability to bring back and focus on the garbage already on my mind.> > > > focus
>
> Vyvanse, Concerta
>
Stimulants might not be a good idea for me.> > > > ability to "be in the moment", with no judgement coming from my own mind. to just relax and enjoy myself, letting life happen.
>
> Zen Buddhism
>
Not sure if you're joking, but it made me laugh.
hahahaha
> Eric
Posted by LostBoyinNC45 on February 24, 2014, at 19:18:47
In reply to Advice on which medication is best for my case, posted by kavinsky99 on February 16, 2014, at 17:02:18
Ive found asking "what meds should I take?" is a bad question to ask on a message board populated by lay people, non MDs. While I dont have a very high opinion of psychiatry and psychiatrists, they are, unfortunately the "experts" on psychopharmacology.
You would be best off asking a good psychiatrist offline what medication would be best for you. I have found discussing medications with anonymous strangers on a forum such as this leads to confusion, wild tangent discussions that lead off to suggestions of strange, off label medications that do nothing for mental illness. You need to keep in mind that many of the people who post on these boards regularly are prescription medication junkies and want to take anything that is not nailed down.
It is critical to have a good psychiatrist if your problems are severe. There are a lot of bad psychiatrists out there (probably the majority fit into the "poor" category). Finding a decent one can take time and be frustrating. Years can go by before you find someone who seems competent and not abusive or callous about your situation.
Also, some areas of the country simply have more "good" psychiatrists than other areas. Generally, metro areas and cities that are "college towns" with large Universities and medical schools will have the better shrinks. As financial incentive is the main motivation to be a MD these days, most MDs prefer to live in metro areas where there is more money, generally.
Eric
Posted by kavinsky99 on February 25, 2014, at 4:57:34
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by LostBoyinNC45 on February 24, 2014, at 19:18:47
> Ive found asking "what meds should I take?" is a bad question to ask on a message board populated by lay people, non MDs. While I dont have a very high opinion of psychiatry and psychiatrists, they are, unfortunately the "experts" on psychopharmacology.
>
> You would be best off asking a good psychiatrist offline what medication would be best for you. I have found discussing medications with anonymous strangers on a forum such as this leads to confusion, wild tangent discussions that lead off to suggestions of strange, off label medications that do nothing for mental illness. You need to keep in mind that many of the people who post on these boards regularly are prescription medication junkies and want to take anything that is not nailed down.
>
> It is critical to have a good psychiatrist if your problems are severe. There are a lot of bad psychiatrists out there (probably the majority fit into the "poor" category). Finding a decent one can take time and be frustrating. Years can go by before you find someone who seems competent and not abusive or callous about your situation.
>
> Also, some areas of the country simply have more "good" psychiatrists than other areas. Generally, metro areas and cities that are "college towns" with large Universities and medical schools will have the better shrinks. As financial incentive is the main motivation to be a MD these days, most MDs prefer to live in metro areas where there is more money, generally.
>
> EricIndeed, good psychiatrists are hard to find. I'm happy with mine though.
Getting input from medication users is valuable, nonetheless. Good way to gwyba glimpse from what to really expect, even though everyone reacts differently to medications. Good way to know off-label medication that seemed to work, too. Prescribers don't usually jump to those soon in treatment.
Thanks for your help and advice.
Posted by phidippus on February 26, 2014, at 18:12:31
In reply to Re: Advice on which medication is best for my case » phidippus, posted by kavinsky99 on February 24, 2014, at 19:08:14
> I do have true racing thoughts when I'm very anxious, specially during a panic attack.
I imagine the racing thoughts cause a lot of anxiety that then leads to panic.
>endless mind chatter that I can't control and often give up and just "dialogue" with.
I get the same nonsense at night when I'm trying to sleep. In some ways we have dissociated from the 'voices' inside our heads, making it out to be completely intrusive.
>I have the odd day where I'm literally consumed by "flashbacks" and inner dialogue.
What do you do to cope with these thoughts? Do you ever have fun with them?
> Yeah, APs are great for managing anxiety (in lower doses. higher doses seem to worsen it)
APs have that double edge: moderate doses can aleviate OCD symptoms and large doses can worsen them.
>but create an specific kind of restlessness that is a lot like true ADHD.
This is a side effect of neuroleptics called akathisia.
>Nothing sinks in, nothing feels rewarding, nothing gets caught in my mind.
That's what happens when dopamine is supressed.
> But I'm using tianeptine and feeling as stable as I have ever been, on 3mg to 6mg daily dose along with 600mg lithium.That's good. Are you still having symptoms you'd like to treat?
>I do notice lithium "dulls" certain impulses and interests I used to have, that made me a more fun and outgoing person.
This effect goes away after awhile.
>Doctor suggested Clomipramine for the intrusive thoughts, I haven't tried it yet due to the anti-cholinergic effects being possibly harmful to my already bad cognition.
When I took clomipramine I hardly noticed the impact to my cognition, rather I'd say it was improved because so much of the intrusive and recurrent thinking got cleared up, thus uncluttering my brain.
>What do you think of TCAs, at a low dose?
Clomipramine is the only TCA that makes a real impact on OCD symptoms and its not useful at a low dose-i took 300 mg alongside 1200 mg of lithium.
>dopaminergic drugs aren't a good option for me, as they worsen the agitation and anxiety a lot.
Try Strattera - its a norepenephrine reuptake inhibitor that can help improve motivation and focus.
> > Seroquel is not so good for cognitive dysfunction-it is more likely to cause it.
> >
> As will most APs, right? Damn you, dopamine...Not necessarily. Latuda has been shown to improve cognition.
> Rilutek, did not know it could work for depression.
A couple studies show it is efficacious in the treatment of ocd and bipolar depression
>Never tried TCAs. What do you think of them?
I've only taken imipramine and clommipramine. I had a good, clean experience with them. Imipramine felt a little sludgy, though.
>You think low dose of any of them could be effective for anxiety and neuropathic pain, without harm to cognition or other more bothersome side effects?
I think so, the problem is OCD seems to only respond to high doses of antidepressants.
> SSRIs are so unreliable. Every two weeks or so my mood and side effect profile seem to shift to something else.
Well, are you taking them without the lithium?
>Keppra isn't very popular in my country, but I think we have it. i'm going to look into that one better before I comment on it.It works great for OCD and improves cognition. Its also an adequate mood stabilizer. Good dosage range was 2000-3000 mg.
>I'll try one of these again when I have the time to deal with serious side effects and sleep 12-15 hours a day.
Remember! A moderate dose of AP should suffice-and more importantly don't take without a serotogenic antidepressant on board!
> The intrusive, repeating thoughts are by far the worst symptom of all. I don't know if they're the cause of a symptom or both, but they literally cripple my ability to live.
You're fighting the thoughts tooth and nail. Maybe you just need to accept that you have these thoughts. Have you ever done any ACT?
> 900 Lithium + 30mg mirtazapine + 1mg risperidone or 600mg lithium + 50mg Zoloft + 6mg bromazepam were the best combos for that. However, Zoloft, risperidone, bromazepam and mitazapine tend to worsen my cognition.
Try Brintellix + Latuda + Lithium
> I never tried beta and alpha blockers. I'll look into it.
They're studying Prazosin as an agent f0r treating OCD.
> > Keppra, LAtuda, MEmantine, Riluzole
> >
> Can these drugs and nootropic drugs cause an increase on intrusive thoughts?They all decreased intrusive thoughts for me.
>Focus on the garbage already on my mind.
Maybe you can pick through it and find something useful.
Eric
ps. where are you from?
Posted by kavinsky99 on February 26, 2014, at 19:10:49
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 26, 2014, at 18:12:31
> > I do have true racing thoughts when I'm very anxious, specially during a panic attack.
>
> I imagine the racing thoughts cause a lot of anxiety that then leads to panic.
>
More like the other way around. I think the physical anxiety sets in before the mind gets affect, on a course of a few days (with poor sleep nights in between). But without lithium or antidepressants (any I've tried), I usually tend to have not RACING, but constant endless mind chatter every day. Specially upon waking up. Mornings seem to be the worst part of my day regarding mood, thoughts and anxiety. Feels like my mind was busy thinking the same old traumas over and over again. Oddly, I also tend to wake up with a song BLASTING in my head, and stuck as the other thoughts. I wouldn't say they're racing thoughts, just repetitive, relentless and extremely attention draining. Everything feels like second-priority compared to them, according to my brain.
They're unpleasant in nature, mostly based on memories of bad things that happened and ruminations regarding them.> >endless mind chatter that I can't control and often give up and just "dialogue" with.
>
> I get the same nonsense at night when I'm trying to sleep. In some ways we have dissociated from the 'voices' inside our heads, making it out to be completely intrusive.
>
Yes, exactly. They're not MY thoughts. It's like my mind is playing to me a radio station. And it's very loud, with bad reception and it only plays the top 25 list of worst moments in my life.> >I have the odd day where I'm literally consumed by "flashbacks" and inner dialogue.
>
> What do you do to cope with these thoughts? Do you ever have fun with them?
>
I don't cope. I literally just try to not think. Other activites or "distractions" seem to actually worsen them. Benzodiazepines or really sit down quiet trying not to think is the best way to avoid it.> > Yeah, APs are great for managing anxiety (in lower doses. higher doses seem to worsen it)
>
> APs have that double edge: moderate doses can aleviate OCD symptoms and large doses can worsen them.
>
Yeah, from what I've read, higher doses tend to release norpepinephrine. I'm not sure that's why, but a lot of people get bad anxiety symptoms at higher doses of APs. And feel very sedated at the same time... Quite an unconfortable feeling.> >but create an specific kind of restlessness that is a lot like true ADHD.
>
> This is a side effect of neuroleptics called akathisia.
>
Yeah. Not able to sit, not able to lie down, not able to focus on anything. Just keep walking for no reason around the house. Terrible.> >Nothing sinks in, nothing feels rewarding, nothing gets caught in my mind.
>
> That's what happens when dopamine is supressed.
>
For depressed, anxious and bipolar people, is dopamine suppression the key-effect for the benefits received from APs? Never read anything about APs + Stimulants. Gonna check that out.
>
> > But I'm using tianeptine and feeling as stable as I have ever been, on 3mg to 6mg daily dose along with 600mg lithium.
>
> That's good. Are you still having symptoms you'd like to treat?
>
If things continue as good as they are as I increase tianeptine, then I'll just need to improve cognition and find something to sleep better. Currently using mirtazapine "crumbs" and I sleep great.
But I have to say, with depression and anxiety beat and the bad thoughts losing space on my mind, I'm noticing I'm living more freely, with more attention being given to studying. Gonna give time for tianeptine and then I'll see what I can do about my current awful cognitive performance.> >I do notice lithium "dulls" certain impulses and interests I used to have, that made me a more fun and outgoing person.
>
> This effect goes away after awhile.
>
Yeah. Today after my first dose of tianeptine, I felt a little TOO happy. Odd for me. Chatted more and interacted with teachers at my class.
By the way, it's nothing like mania.> >Doctor suggested Clomipramine for the intrusive thoughts, I haven't tried it yet due to the anti-cholinergic effects being possibly harmful to my already bad cognition.
>
> When I took clomipramine I hardly noticed the impact to my cognition, rather I'd say it was improved because so much of the intrusive and recurrent thinking got cleared up, thus uncluttering my brain.
>
That's good to know. If tianeptine fails, I'll try clomipramine.> >What do you think of TCAs, at a low dose?
>
> Clomipramine is the only TCA that makes a real impact on OCD symptoms and its not useful at a low dose-i took 300 mg alongside 1200 mg of lithium.
>
Well, if it's good for my brain, screw my heart. He had it easy enough.> >dopaminergic drugs aren't a good option for me, as they worsen the agitation and anxiety a lot.
>
> Try Strattera - its a norepenephrine reuptake inhibitor that can help improve motivation and focus.
>
I'm definetely curious about those. Never tried a single Norepinephrine Reuptake Inhibitor before.
> > > Seroquel is not so good for cognitive dysfunction-it is more likely to cause it.
> > >
> > As will most APs, right? Damn you, dopamine...
>
> Not necessarily. Latuda has been shown to improve cognition.
>
For non-schizophrenics? usually APs improve their cognition, but people with schizophrenia can have really bad cognitive skills.> > Rilutek, did not know it could work for depression.
>
> A couple studies show it is efficacious in the treatment of ocd and bipolar depression
>
> >Never tried TCAs. What do you think of them?
>
> I've only taken imipramine and clommipramine. I had a good, clean experience with them. Imipramine felt a little sludgy, though.
>
I wish I could try the norepinephrine ones first... I suffer from really bad nerve pain on my spine. Don't know if that worsens anxiety and OCD, though.> >You think low dose of any of them could be effective for anxiety and neuropathic pain, without harm to cognition or other more bothersome side effects?
>
> I think so, the problem is OCD seems to only respond to high doses of antidepressants.
>
The anxious "circuit" in the brain is a bitch.> > SSRIs are so unreliable. Every two weeks or so my mood and side effect profile seem to shift to something else.
>
> Well, are you taking them without the lithium?
>
Yeah. Only one I took without lithium was Lexapro. I don't know if it was it or clonazepam that put me on such a bad mood. (By the way, benzos usually make me very agressive and depressed. I find it odd how most people like them for the good mood it gives.).
> >Keppra isn't very popular in my country, but I think we have it. i'm going to look into that one better before I comment on it.
>
> It works great for OCD and improves cognition. Its also an adequate mood stabilizer. Good dosage range was 2000-3000 mg.
>
What kind of side effects you had it on it?
> >I'll try one of these again when I have the time to deal with serious side effects and sleep 12-15 hours a day.
>
> Remember! A moderate dose of AP should suffice-and more importantly don't take without a serotogenic antidepressant on board!
>
Why is it important to have a serotonergic antidepressant on board? Thought APs usually had serotonergic properties of their own.> > The intrusive, repeating thoughts are by far the worst symptom of all. I don't know if they're the cause of a symptom or both, but they literally cripple my ability to live.
>
> You're fighting the thoughts tooth and nail. Maybe you just need to accept that you have these thoughts. Have you ever done any ACT?
>
Never had ACT. Honestly, therapy retraumatizes me even subconsciouslly. But I don't think I can have an approach to it that will solve them that isn't "real". I'm already taking care of that, though... Meaning I'm sueing a couple of places.
>
>
> > 900 Lithium + 30mg mirtazapine + 1mg risperidone or 600mg lithium + 50mg Zoloft + 6mg bromazepam were the best combos for that. However, Zoloft, risperidone, bromazepam and mitazapine tend to worsen my cognition.
>
> Try Brintellix + Latuda + Lithium
>
> > I never tried beta and alpha blockers. I'll look into it.
>
> They're studying Prazosin as an agent f0r treating OCD.
>
> > > Keppra, LAtuda, MEmantine, Riluzole
> > >
> > Can these drugs and nootropic drugs cause an increase on intrusive thoughts?
>
> They all decreased intrusive thoughts for me.
>
> >Focus on the garbage already on my mind.
>
> Maybe you can pick through it and find something useful.
>
> Eric
>
> ps. where are you from?
Posted by kavinsky99 on February 26, 2014, at 20:15:35
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 26, 2014, at 18:12:31
and I'm from Brazil.
Forgot to say it on the previous message.
Posted by phidippus on February 26, 2014, at 22:41:42
In reply to Re: Advice on which medication is best for my case, posted by kavinsky99 on February 26, 2014, at 19:10:49
>I wouldn't say they're racing thoughts, just repetitive, relentless and extremely attention draining. Everything feels like second-priority compared to them, according to my brain.
You can't distract?
> They're unpleasant in nature, mostly based on memories of bad things that happened and ruminations regarding them.
Therapy is going to help you most with this issue.
> I don't cope. I literally just try to not think.
How's that working out?
>Other activites or "distractions" seem to actually worsen them.
Why do you think that is?
> For depressed, anxious and bipolar people, is dopamine suppression the key-effect for the benefits received from APs?
Well, schizophrenics benfit from the dopamine antagonism and certain seraotonin antagonism. While bipolar folk get the best benefit from seratonin antagonism as well as the dopamine antagonism. But now a days, a lot of the atypicals feature 5ht1a agonism, whicch helps with depression.
> I wish I could try the norepinephrine ones first... I suffer from really bad nerve pain on my spine. Don't know if that worsens anxiety and OCD, though.
You and me both. I've never tried something that boosts norepenephrine.
>By the way, benzos usually make me very agressive and depressed.
this is called a paradoxical effect. happens to me with certain benzos as well - Xanax is the worst. Last time I took it I had full blown ideations of bashing my son's head in.
> What kind of side effects you had it on it?
Some sedation. Sometimes a depressed mood.
> Why is it important to have a serotonergic antidepressant on board?
When you have OCD, their are depletions of serotonin in certain parts of the brain. If you take an AP, those depletions worsen, making symptoms worse. Treating OCD with a serotogenic drug corrects the serotonine imbalance in the brain, easing the symptoms of OCD. Often, dopaminergic transmission is defective in the brains of people with OCD resulting in a surplus of dopamine. That's why APs are also used to treat OCD-the trick being that if you use too much AP, too much serotonin gets antagonized and symptoms worsen. Just enough AP corrects dopamine levels.
>Thought APs usually had serotonergic properties of their own.
They antagonize way more serotonine receptors than they agonize.
>Honestly, therapy retraumatizes me even subconsciouslly.
That's kind of the point of therapy with OCD - ERP (exposure and ritual prevention). You are exposed to the thing that causes you anxiety systematically until it no longer causes you anxiety.
Eric
Posted by kavinsky99 on February 27, 2014, at 6:53:15
In reply to Re: Advice on which medication is best for my case » kavinsky99, posted by phidippus on February 26, 2014, at 22:41:42
> >I wouldn't say they're racing thoughts, just repetitive, relentless and extremely attention draining. Everything feels like second-priority compared to them, according to my brain.
>
> You can't distract?
>
More brain activity = more bad thoughts. Distractions are worse.> > They're unpleasant in nature, mostly based on memories of bad things that happened and ruminations regarding them.
>
> Therapy is going to help you most with this issue.
>
Therapy is likely to increase it, since most of my problems stems from being forced into therapy and the bad experiences associated with it.
Right now my mind is blasting angry thoughts at my last therapist (who was a crook), imagining what to say at the audience we'll have when the licensing board finds the time. (Can't sue this one. No evidence to show.)> > I don't cope. I literally just try to not think.
>
> How's that working out?
>
Better than anything. If I *try* to do something about it, I'm just feeding/agreeing with people in my head and it makes me feel worse, opening a cascade of bad thoughts.> >Other activites or "distractions" seem to actually worsen them.
>
> Why do you think that is?
>
As I said earlier, i'm guessing brain activity in general makes it worse. Anything that makes me think or stimulates me, worsens them. Staying still trying not to think is the best thing next to meds.
> > For depressed, anxious and bipolar people, is dopamine suppression the key-effect for the benefits received from APs?
>
> Well, schizophrenics benfit from the dopamine antagonism and certain seraotonin antagonism. While bipolar folk get the best benefit from seratonin antagonism as well as the dopamine antagonism. But now a days, a lot of the atypicals feature 5ht1a agonism, whicch helps with depression.
>
Even a little dopamine antagonism makes me worse regarding ADHD symptoms, apathy and lack of motivation. Very low doses of APs and moderate doses of SSRIs are sure to cause it.
> > I wish I could try the norepinephrine ones first... I suffer from really bad nerve pain on my spine. Don't know if that worsens anxiety and OCD, though.
>
> You and me both. I've never tried something that boosts norepenephrine.
>
I've used mirtazapine. Releases norepinephrine
instead of causing reuptake, so it's not good for pain. However, it's great for mood and motivation.
Reuptakers are going to be my next attempt. Either a pure NRI or a norepinephrine targetting TCA.> >By the way, benzos usually make me very agressive and depressed.
>
> this is called a paradoxical effect. happens to me with certain benzos as well - Xanax is the worst. Last time I took it I had full blown ideations of bashing my son's head in.
>
Yeah. Each benzos has it's own flavor regarding that. Lexotanil (bromazepam) seems to be the one benzo that is more likely to cause good feelings, according to myself and other people from forums.
Xanax and Klonopin seem to have bad depressive rebounds for a lot of people.> > What kind of side effects you had it on it?
>
> Some sedation. Sometimes a depressed mood.
>
> > Why is it important to have a serotonergic antidepressant on board?
>
> When you have OCD, their are depletions of serotonin in certain parts of the brain. If you take an AP, those depletions worsen, making symptoms worse. Treating OCD with a serotogenic drug corrects the serotonine imbalance in the brain, easing the symptoms of OCD. Often, dopaminergic transmission is defective in the brains of people with OCD resulting in a surplus of dopamine. That's why APs are also used to treat OCD-the trick being that if you use too much AP, too much serotonin gets antagonized and symptoms worsen. Just enough AP corrects dopamine levels.
>
Never made a connection to the serotonin antagonism from APs and how I feel awfully depressed with them. True, the antagonism outweighs the agonism.One day I might try low dose APS again. 0.25mg risperdal wasn't so bad.
My next step is to stabilize tianeptine. Then I'm going to try out supplements before more medication. What are your thoughts on supplements? I'm trying to look for something less invasive than / good add-on to medication.
By supplements I mean isolated aminoacids, herbal extracts, etc..> >Thought APs usually had serotonergic properties of their own.
>
> They antagonize way more serotonine receptors than they agonize.
>
> >Honestly, therapy retraumatizes me even subconsciouslly.
>
> That's kind of the point of therapy with OCD - ERP (exposure and ritual prevention). You are exposed to the thing that causes you anxiety systematically until it no longer causes you anxiety.
>
Not the reason, though. I truly *HATE* the whole concept. Maybe from being exposed to such a bad side of it, in awful ways. But honestly, I don't want nothing to do with it. It's important, more effective and healthier to just manage on my own. Most of my intrusive thoughts are therapists and psychiatrists talking to me in my head.I don't remember if I mentioned on the original post, but I was forced on therapy my entire life. And man, even after becoming an adult and seeking on my own, my experiences with it were bad. I don't think Brazil has good schools forming competent, ethical therapists. It's amazing the ammount of crazy people (not really crazy, as in having a psychiatrical disorder. that wouldn't be bad. More in being maladjusted, weird, unhappy, unethical, etc..).
If I ever feel inclined to learn about it, I'll just study it on my own. CBT/DBT seems interesting.
> Eric
Posted by phidippus on February 27, 2014, at 15:03:41
In reply to Re: Advice on which medication is best for my case » phidippus, posted by kavinsky99 on February 27, 2014, at 6:53:15
> Therapy is likely to increase it, since most of my problems stems from being forced into therapy and the bad experiences associated with it.
I'm sorry you've had bad experiences with therapy. There are good therapists out there, however, who's practices are ethical and effective.
> Right now my mind is blasting angry thoughts at my last therapist (who was a crook)
Call and leave him a message with all your thoughts about him.
>If I *try* to do something about it, I'm just feeding/agreeing with people in my head and it makes me feel worse, opening a cascade of bad thoughts.
Thinking or trying not to think about it probably causes equal amounts of stress. The bad thoughts are going to leak out no matter how hard you try to suppress them.
>As I said earlier, i'm guessing brain activity in general makes it worse.
It is true that stress worsens the symptoms of OCD.
>Staying still trying not to think is the best thing next to meds.
Which takes up just as much energy and is quite litrerally, is impossible. You can't think of nothing.
> One day I might try low dose APS again. 0.25mg risperdal wasn't so bad.
Try one with 5ht1a agonism. Perhaps you won't get as depressed and apathetic.
>What are your thoughts on supplements?
Inositol is good for OCD. N-acetylcysteine is good for both OCD and bipolar disorder. Glycine is good for OCD.
>Most of my intrusive thoughts are therapists and psychiatrists talking to me in my head.
You should make them quack every time they talk. Then you'll just have a bunch of ducks squawking in your head.
Here's a good book to read: http://www.amazon.com/The-Imp-Mind-Exploring-Obsessive/dp/0452283078
Eric
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