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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by bob on February 16, 2000, at 18:43:20
*****
First, a note to all the old-fogey babblers who've been asking about me. Deb Richards and Noa have been passing on your thoughts and concerns. I really appreciate all the mental/spiritual energy sent my way the last two months. It's helped lighten the darkness considerably.... and hi to all the newbies out there ... glad you found us
*****When last I was here, I was trying wellbutrin to augment my nortriptyline. It was part of the diaster that put me out of commission. Since then, I've been trying nortriptyline alone (for depression--I'm still on the clonazepam for panic) at therapeutic dosages. 125mg at 5PM is the most I can tolerate if I'm going to wake up the next morning (yes, I eventually do wake up in the PM).
The change? Luvox, perhaps.
I've had it suggested to me as a med to potentiate the nortrip. I'd appreciate hearing from anyone who has tried Luvox with a TCA (or at all).
Seeing the pdoc on Monday. Time to make a change.
bob
Posted by torchgrl on February 17, 2000, at 0:25:59
In reply to Time for (another) change, posted by bob on February 16, 2000, at 18:43:20
No advice on the Luvox (one of the last unknowns for me, too), but just wanted to say that it's good to have you around again, Bob!
Posted by bob on February 17, 2000, at 16:23:10
In reply to Re: Time for (another) change, posted by torchgrl on February 17, 2000, at 0:25:59
> No advice on the Luvox (one of the last unknowns for me, too), but just wanted to say that it's good to have you around again, Bob!
Me and my goofy subject lines.
Thanks, torchgrl =^) It's very nice to be back.
Posted by Phil on February 17, 2000, at 18:08:15
In reply to Should have mentioned this is about Luvox advice, posted by bob on February 17, 2000, at 16:23:10
Bob, Luvox was the one that sent me to the ER with tachycardia. Of course, nothing else is working either so at least I got out of the house.
Phil
Posted by bob on February 17, 2000, at 18:11:47
In reply to Re: Should have mentioned this is about Luvox advice, posted by Phil on February 17, 2000, at 18:08:15
> Bob, Luvox was the one that sent me to the ER with tachycardia. Of course, nothing else is working either so at least I got out of the house.
Tachycardia? Great. My GP has regularly included an EKG whenever I'm in the neighborhood ever since I've been on nortriptyline.
Hmm ... since it was my girlfriend who suggested the combo, maybe I'd better check to see if she's taken out any life insurance policies on me lately ... ;^)
Posted by Noa on February 17, 2000, at 18:48:00
In reply to Re: Should have mentioned this is about Luvox advice, posted by bob on February 17, 2000, at 18:11:47
You guys...I love the sick humor.
Posted by Cam W. on February 18, 2000, at 20:58:50
In reply to Re: Should have mentioned this is about Luvox advice, posted by Noa on February 17, 2000, at 18:48:00
> You guys...I love the sick humor.
bob - I don't know if this fits in, but I have read several articles stating that nortripyline loses its efficacy during maintainance therapy (a poop-out kind-of-thing). We had several long term nortriptyline users who were decompensating and the dose kept being raised.(eg both were at 175mg nortriptyline at bedtime). One we put on Celexa and Clozaril for a very refractory, psychotic/suicidal depression and he is now functioning at the best level I have seen him in years. The other was switched to Effexor (with some seriously debilitating side effects for 2 weeks) and by the time we got her to 300mg XR once in the morning, she was out of the house, going downtown by herself and actually smiling sometimes. It makes you wonder about notriptyline over the long-term. Nortriptyline had remitted both these people initially and they were remitted for about a year to two years, each. This isn't proof of loss of efficacy, but it has me wondering. (Could have been wrong antidepressant for these people over long-term; disease course changed; could be due to their body's physiology changing or many other factors.) I just thought I'd throw my $.02 in. - Cam W.
Posted by S. Suggs on February 19, 2000, at 4:49:52
In reply to Time for (another) change, posted by bob on February 16, 2000, at 18:43:20
> *****
> First, a note to all the old-fogey babblers who've been asking about me. Deb Richards and Noa have been passing on your thoughts and concerns. I really appreciate all the mental/spiritual energy sent my way the last two months. It's helped lighten the darkness considerably.
>
> ... and hi to all the newbies out there ... glad you found us
> *****
>
> When last I was here, I was trying wellbutrin to augment my nortriptyline. It was part of the diaster that put me out of commission. Since then, I've been trying nortriptyline alone (for depression--I'm still on the clonazepam for panic) at therapeutic dosages. 125mg at 5PM is the most I can tolerate if I'm going to wake up the next morning (yes, I eventually do wake up in the PM).
>
> The change? Luvox, perhaps.
>
> I've had it suggested to me as a med to potentiate the nortrip. I'd appreciate hearing from anyone who has tried Luvox with a TCA (or at all).
>
> Seeing the pdoc on Monday. Time to make a change.
>
> bobBob, I just added T3 to my Parnate. In so doing, I've done some research which seems to indicate that it (T3) augments tca's. Of course the PDR would lable this an interaction. Run it by your doc, could end up lowering your dose of pamelor as an end result as well. Just a suggestion, blessings to you,
S. Suggs
Posted by quilter on February 19, 2000, at 20:18:39
In reply to Re: Time for (another) change, posted by S. Suggs on February 19, 2000, at 4:49:52
> > *****
> > First, a note to all the old-fogey babblers who've been asking about me. Deb Richards and Noa have been passing on your thoughts and concerns. I really appreciate all the mental/spiritual energy sent my way the last two months. It's helped lighten the darkness considerably.
> >
> > ... and hi to all the newbies out there ... glad you found us
> > *****
> >
> > When last I was here, I was trying wellbutrin to augment my nortriptyline. It was part of the diaster that put me out of commission. Since then, I've been trying nortriptyline alone (for depression--I'm still on the clonazepam for panic) at therapeutic dosages. 125mg at 5PM is the most I can tolerate if I'm going to wake up the next morning (yes, I eventually do wake up in the PM).
> >
> > The change? Luvox, perhaps.
> >
> > I've had it suggested to me as a med to potentiate the nortrip. I'd appreciate hearing from anyone who has tried Luvox with a TCA (or at all).
> >
> > Seeing the pdoc on Monday. Time to make a change.
> >
> > bob
>
> Bob, I just added T3 to my Parnate. In so doing, I've done some research which seems to indicate that it (T3) augments tca's. Of course the PDR would lable this an interaction. Run it by your doc, could end up lowering your dose of pamelor as an end result as well. Just a suggestion, blessings to you,
>
> S. SuggsI had good luck many years ago with augmenting a TCA (surmontil) with T3 (cytomel). I had more than 6 years of remission on that regime. I sure wish that would happen again! I missed you too, Bob. Glad you're back.
Posted by bob on February 20, 2000, at 2:31:57
In reply to Re: Time for (another) change, posted by quilter on February 19, 2000, at 20:18:39
Thanks Cam, SSuggs, & quilter for the tips (and the welcome backs).
Quite frankly, I'm still surprised I've been here for more than one quick visit. Mid-December hit me with my worst depressive episode in at least a decade and I ain't out of the woods yet. But I guess this place can be more addictive than xanax (and definitely more therapeutic, even after habituating to it).
Cam, 2.5 years of trying SSRIs pretty much demonstrated that I'm a non-responder to them wrt my depression. As I mentioned elsewhere, zoloft did a nice job of handling some OCD-like behaviors, but other than a manic response to it the first time I was on it, zoloft, prozac, and paxil have done little good (or, in paxil's case, some harm). SSRIs have also had a rather disconcerting effect on my cholesterol levels, and my GP doesn't want me on them any longer (yeah, even though he's put me on lipitor to knock it back down ... I still have an extra 50 pounds courtesy of zoloft to take off before he'll consider taking me off that). My pdoc has had me try augmenting with wellbutrin (prozac, wellbutrin, and perphenazine put me in the ER), lithium, and finally nortriptyline. The nortrip worked so well I asked to go off the SSRI (zoloft, again, at the time) and just try monotherapy with a TCA. At the time I was only on 75mg/day of the nortrip (I also take clonazepam 1mg/d for PD). I saw almost no drop in function from ditching the zoloft. We tried bringing wellbutrin back in, but it was making me highly irritable (as always ... before trying the prozac/wellbutrin combo, I was on wellbutrin alone, and I had some near psychotic reactions to it ... that's how I got on the perphenazine as well, to chill out the beast that wellbutrin likes to bring out in me). I think this last trial with wellbutrin was a contributing factor in what triggered this latest depressive episode as well.
Since then, I've gone up to 125mg/d of the nortrip. I was hoping to get up to 150/d, but I've been fighting drowsiness from it that had me literally falling asleep on my feet when I first increased my dosage. That's pretty much worn off as much as I can expect, so depending on my chat with my pdoc, I may go up the extra 25mg.
The problem I'm having is not having a "normal" baseline for comparison. I've been depressed since childhood, so I have a hard time judging where I'm "at". Particularly with this last episode -- every time it feels I take one step forward, I feel like I fall back five.
I'm not saying that the nortrip is loosing its efficacy -- rather the opposite, I believe. You know that warning about giving a severely depressed person medication for the first time...if he's suicidal, he just might find the energy to do something about it? Other than that one manic episode (where I blew right by this suicide-enabling level of affect), I now realize that in 2.5 years of drug therapy I'm only now getting up to that state of mind. The medication is finally working well enough to make me care, and caring about the condition I'm in and how it affects those around me hurts worse than just about anything I've ever experienced.
And since I mentioned it first--no, I'm nowhere near suicidal. The novelty of caring has somewhat ruled that out. Mostly, though, I'm enjoying the self-inflicted pain too much. Like I've said elsewhere, I don't use razors for my self-mutilation since I do my cutting from the inside out.
Anyway, my mood continues to improve on the nortrip, but I still have a long, bad stretch of road out in front of me and I sure ain't moving all that fast down it. I have enough sanity to not want to spend another two months or more in this frame of mind, so I need something to give the nortrip a boost.
I guess that's where the T3 can come in, instead of Luvox. My pdoc has mentioned it before, when we were trying to decide between it and lithium as an augmentor. I guess my test results and the normal thyroid function they showed made him/us forget about the T3 option. Thanks SSuggs & quilter for reminding me.
cheers
bob
This is the end of the thread.
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