![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by JonW on March 18, 2002, at 20:47:20
Hello All,
My current psydoc is one of the best doctors I've worked with but we've yet to find solid ground so she had me set up an appointment with Michael Liebowitz in New York. I've prepared a list of symptoms and med reactions for Dr. Liebowitz, and I thought I would post it here as I am open to any input or advice from anyone. I was thinking I should try Nardil. In any case, has anyone else here been at the end of their rope (no pun intended...) and been helped by Dr. Liebowitz? I've posted my symptoms and meds below.
Thanks,
JonSYMPTOMS
Have great difficulty getting up in the morning / Feel worst in the morning.
Mood lability / instability.
Irritability.
Severe social phobia / “afraid to go to my mailbox” / rejection sensitivity.
Near panic attacks in certain social situations. / Anxiety in most social situations.
Startle easily -- phone rings, etc.
Like to drive very fast.
Like to take risks.
Like to drink a lot of alcohol -- gave it up.
Strong reaction to caffeine -- don't drink it.
Love sweets, bread, etc. / Eat in excess. / Plain tastes.
Interrupt people because I'm afraid of losing my current thought.
Start things but rarely finish them.
Obsessive tendencies / Perfectionistic.
Enjoy challenging/bothering/defying authority.
Mood cycles about once a week, also within the same day.
Eat late at night.
Drink a lot of water.
Have essential tremor.
Have no go power.
Feel better on sunny days.
Sleep more when depressed.
Sensitive to sounds / excitement.
Over sensitive / emotional / "Thin skin"
Headache.
As a child, weird sensations where the air smelled different.
Going on or off an anti-depressant makes me feel good.DEPAKOTE -- Like taking placebo, but a bit of an anxiolytic.
TRILEPTAL -- Pleasantly intoxicating. Somewhat helpful I suppose.
LAMICTAL -- Initially made me "high". Also made me more emotional (tears came more easily). Caused me to slur my speach and lose track of my thoughts.
TOPOMAX -- It made me very depressed. Oddly, it was sedating but agrevated my social anxiety at the same time.
NEURONTIN -- I like it a lot, but it gives me a pretty bad headache. It may make me a bit dysphoric but I can't tell anymore and it seems good for my anxiety. I take 100mg 3x/day. It also makes me more emotional like Lamictal (tears come easily).
MOCLOBEMIDE -- Gave me a pretty bad headache. When I first started this it made me "high" and things looked sharper.
PARNATE -- Durning the state after taking each pill my social anxiety was significantly less, much more so than any other pill. I was only on Parante for a number of days because the day was like a rollercoaster of euphoria and depression.
KLONOPIN -- This drug was very smooth and nice, but left me feeling drugged. It helped a little with social anxiety. This drug has always helped to calm the seas when things get rough. Unfortunately, it also makes me depressed if I take it long term.
ZOLOFT – Without mood stabilizers, this drug was amazing when I took it but lost its zing after a day or two (typical pattern for me). With mood stabilizers, no zing and plenty of agitation and irritability and fatigue to go around. The other SSRI trials were so long ago that this one may be most relevant.
LITHIUM -- One pill makes me very depressed very quickly.
SULPIRIDE -- One pill makes me very depressed very quickly.
AMISULPRIDE -- Makes me feel nice, like after drinking a beer. When I took 50mg 3x/day I woke up easily and refreshed the next morning. That never happened to me before.
ADRAFINIL -- Things looked even sharper when I took this than when I took moclobemide. I liked this drug except it was a pure headache, almost as bad as Wellbutrin.
SELEGILINE -- Initially made me "high" and then made me very depressed after a single dose.
GEODON -- Weird feeling like Buspar after taking it. It initially made me "high". It may have caused cycling.
ZYPREXA -- It took me 2 weeks to adjust to the drowsiness -- I was a zombie. Objectively, things improved somewhat around the time when this drug was added to the mix but sometimes I think it’s part of the problem.
WELLBUTRIN -- Initial jitters almost unbearable but went away after a week or so. Focus and memory seemed much sharper. Gave me a horrible headache that never went away (worst of all meds).
PAXIL -- Partial response for social phobia. No help physiologically. Made me very sleepy.
BUSPAR -- Was somewhat helpful for my anxiety physiologically, but did nothing for me otherwise. I also had a weird feeling a half-hour after each dose -- like I was about to blackout.
CELEXA -- Similar to Paxil.
PROZAC -- Made me feel too jittery, etc.
SERZONE -- Made me very drowsy and very jittery at the same time.
CONCERTA -- Aggrevates my anxiety.
ADDERALL -- Aggrevates my anxiety way too much but I like the way it makes me feel.
DEXADRINE -- After I took the first dose - Wow! along with some anxiety. Then, more anxiety and less Wow!. As it exits my system I get very depressed and suicidal. I can tolerate the spansule much better.
XANAX -- Possibily mood elevating, but Klonopin is much better for anxiety.
ARICEPT -- Made me depressed.
TOFRANIL, RITALIN, EFFEXOR RESPERDAL, GABATRIL, SEROQUEL -- I don't remember.
Posted by Hal on March 18, 2002, at 22:36:35
In reply to My Life So Far -- Expert Advice Needed...?, posted by JonW on March 18, 2002, at 20:47:20
Hey Jon,
I am from NYC, and from what I have read and heard Dr. Liebowitz kicks as*! Your in great hands! Nardil sounds like an decent option for you. I wish you the best of luck.
Hal
Posted by Mr.Scott on March 18, 2002, at 23:48:10
In reply to My Life So Far -- Expert Advice Needed...?, posted by JonW on March 18, 2002, at 20:47:20
Jon,
Let me preface my response by saying a few things:
Liebowitz is a god in the realm of anxiety disorders, and has conducted research that has altered the field over the last 20 or so years. I am not a doctor. And Finally, while several people have come close no one has ever described my very same symptoms to a tee in a post while describing their own struggles as you just have. So compelling is your story to me that I have come out a posting hiatus after getting frustrated and leaving.
If you haven't already been told you have characteristics of many disorders most closely aligned with atypical depression, and bipolar type II, as well as the poorly defined and little known about Axis II disorder Borderline Personality disorder. The latter may as Dr. Heller claims be a sort of epilepsy in the hypothalamus, and indeed you manifest some syptoms of temporal lobe epilepsy, or at least did as a child. At the same time you manifest some ADD/OCD traits, but my best guess is that the OCD while possibly neurological is really more of a way you've learned to cope with being so "out of control", and the ADD stuff is probably secondary to mood dysfunction. I have doubts that Nardil will be the boon you're looking for, but it's also quite possibly your best bet. My experience was that it rocked for a while and then pooped. It left a lot of side effects but possibly some anxiolytic effect. However, given it's inherent comlications and my penchant at the time for drinking alcohol I felt the risk/benefit ratio was not in my favor and I jumped ship. One the other hand it could be your best bet, in that if you are one who gets dysphoric easily from AD's and Lithium, Nardil might be a better fit if you can tolerate its other woes. Of all the traditional antidepresants (excluding Lamictal) it is the only one that is truly anticonvulsant. Most AD's and lithium lower the seizure threshold and if that is part of the problem they will make you worse.
Of course if I was working at a managed care company, or if I was a doctor who didn't want to get sued it would be much easier and perhaps appropriate to label you a bipolar variant Type II rapid cycling.
If I was able to control myself better I would do this, but I can't as I think I might be addicted to being hypomanic, and so despite repeated failure I keep trying to refind those awesome few weeks and months I used to be able to get off of AD's before they pooped on me. I would pursue a protracted course of anticonvulsants only(perhaps several simultaneously) and make sure that NO Antidepressants were within ten feet of you! Then only if that failed to resolve your depression I would consider trying Nardil.
The third option is to pick from your list the drugs that you felt kind of helped and you could tolerate...Do the psychotherapy thing and accept that this is you're burden to carry until the next great development in neuroscience comes to pass. It's not so bad you know...finally accepting certain things.
Anyways, if I've been too forward or inappropriate or suggestive let me know. Sometimes I offend people when I don't mean to. It's happened before on this very board.
Keep in touch on this. I wish you the best.Scott
Posted by David Smith on March 19, 2002, at 0:29:09
In reply to My Life So Far -- Expert Advice Needed...?, posted by JonW on March 18, 2002, at 20:47:20
That is quite a bit of medication , but then I have a pretty long list too. :-)
I don't see talk therapy listed along with your treatment. Perhaps it would be a good add on.
Posted by JonW on March 19, 2002, at 9:55:46
In reply to Re: My Life So Far -- Expert Advice Needed...? » JonW, posted by Mr.Scott on March 18, 2002, at 23:48:10
Hi Scott,
Well, let *me* say I'm honored in a dark, ironic sort of way :) -- it's nice to know we're not alone, but it sucks that we've suffered for so long... On that note, how are you doing? Have you found a brew of meds to justify the journey?
I look at the description of atypical depression and I say *that's me*! But 10 years and a laundry list of meds later, my problems are as bad as they've ever been. Why is psychiatry so complicated? Why am I so complicated? Blah. Blah. I'm Rambling.
I relate to being addicted to hypomania, although I'm not sure I experience full blown hypomania. My psydoc and I prefer the word "high" because it's friendlier to the bipolar spectrum. She insists that I should not be on any AD and that makes all the sense in the world. However, when I take an AD and suddenly my world is brighter and clearer and I love being alive, how can that be wrong? When you are depressed you'll do anything for a breath of fresh air no matter how short lived it may be, but I'm sure I don't have to tell you or anyone here that. I have been on just mood stabilizers, but so far to no avail. You had some good suggestions that I'll keep in mind when working with Dr. Liebowitz.
Thanks for your input,
Jonp.s. You weren't too forward or anything like that at ALL!
> Jon
>
> Let me preface my response by saying a few things:
>
> Liebowitz is a god in the realm of anxiety disorders, and has conducted research that has altered the field over the last 20 or so years. I am not a doctor. And Finally, while several people have come close no one has ever described my very same symptoms to a tee in a post while describing their own struggles as you just have. So compelling is your story to me that I have come out a posting hiatus after getting frustrated and leaving.
>
> If you haven't already been told you have characteristics of many disorders most closely aligned with atypical depression, and bipolar type II, as well as the poorly defined and little known about Axis II disorder Borderline Personality disorder. The latter may as Dr. Heller claims be a sort of epilepsy in the hypothalamus, and indeed you manifest some syptoms of temporal lobe epilepsy, or at least did as a child. At the same time you manifest some ADD/OCD traits, but my best guess is that the OCD while possibly neurological is really more of a way you've learned to cope with being so "out of control", and the ADD stuff is probably secondary to mood dysfunction. I have doubts that Nardil will be the boon you're looking for, but it's also quite possibly your best bet. My experience was that it rocked for a while and then pooped. It left a lot of side effects but possibly some anxiolytic effect. However, given it's inherent comlications and my penchant at the time for drinking alcohol I felt the risk/benefit ratio was not in my favor and I jumped ship. One the other hand it could be your best bet, in that if you are one who gets dysphoric easily from AD's and Lithium, Nardil might be a better fit if you can tolerate its other woes. Of all the traditional antidepresants (excluding Lamictal) it is the only one that is truly anticonvulsant. Most AD's and lithium lower the seizure threshold and if that is part of the problem they will make you worse.
>
> Of course if I was working at a managed care company, or if I was a doctor who didn't want to get sued it would be much easier and perhaps appropriate to label you a bipolar variant Type II rapid cycling.
>
> If I was able to control myself better I would do this, but I can't as I think I might be addicted to being hypomanic, and so despite repeated failure I keep trying to refind those awesome few weeks and months I used to be able to get off of AD's before they pooped on me. I would pursue a protracted course of anticonvulsants only(perhaps several simultaneously) and make sure that NO Antidepressants were within ten feet of you! Then only if that failed to resolve your depression I would consider trying Nardil.
>
> The third option is to pick from your list the drugs that you felt kind of helped and you could tolerate...Do the psychotherapy thing and accept that this is you're burden to carry until the next great development in neuroscience comes to pass. It's not so bad you know...finally accepting certain things.
>
> Anyways, if I've been too forward or inappropriate or suggestive let me know. Sometimes I offend people when I don't mean to. It's happened before on this very board.
>
> Keep in touch on this. I wish you the best.
>
> Scott
Posted by JonW on March 19, 2002, at 10:01:06
In reply to Re: My Life So Far -- Expert Advice Needed...? » JonW, posted by Hal on March 18, 2002, at 22:36:35
Thanks Hal,
It's great to hear you and Scott speak so well of him.
Jon
> Hey Jon,
>
> I am from NYC, and from what I have read and heard Dr. Liebowitz kicks as*! Your in great hands! Nardil sounds like an decent option for you. I wish you the best of luck.
>
> Hal
Posted by chiaratara on March 19, 2002, at 11:10:28
In reply to My Life So Far -- Expert Advice Needed...?, posted by JonW on March 18, 2002, at 20:47:20
hi there.
well, i don't know dr. l.; and, i only have experience with SSRIs. i am not sure how much help i will be, however your post was very compelling to me. it seemed to me that a lot of your symptoms could be characteristic of someone who is not clinically "depressed." i only know a few people who get out of bed and feel great. in fact, most people would like to sleep until noon and skip morning all together. i don't know one person who doesn't like to eat at night and go to bed with that full warm and fuzzy feeling. i drink lots of water and always related that to the fact that my mother would chase me around with cups of water when i was little because she thought it was good for me, and now i drink a ton of water and hate to be thirsty. i probably don't have enough posting space to touch on each symptom that you wrote, although i wish i could. my first impression of your symptoms is that you are too hard on yourself. i am glad that you are seeking out a professional that, according to previous posts, has such a good reputation because there are things, as with myself, that you should be able to work on and hopefully overcome. some of your symptoms struck me as being a unique part of your personality. i could eat all the sourdough bread in san francisco if given the chance; and if challenging authority was a crime, at the tender age of 26, which i am now, i would be in jail for life. my mother says that i have been really challenging authority ever since i was about 3 months old. i was even told by my pdoc that i would never make a good "employee" and that challenging authority meant that i thought outside the box and wasn't one to follow the crowd. take some of those symptoms and attribute them to being a complex and interesting person. you sound like one to me. ok, sorry for the longwinded post, something struck me in your initial post.
take care, tara
Posted by JonW on March 19, 2002, at 13:09:41
In reply to Re: My Life So Far -- Expert Advice Needed...?, posted by chiaratara on March 19, 2002, at 11:10:28
Hi Tara,
Thanks for your post. I picked out a compliment or two there and I appreciate it :) It's true, a lot of us here are a bit too hard on ourselves. Thanks for reminding me. I have to say, in the last six months I've been hospitalized twice and continue on disability. I have a family history of mental illness. My current psydoc and two others have diagnosed me with bipolar disorder and social phobia among other things. I have a real problem -- just like lupus or diabetes. I know you didn't mean to say it's all in my head, but I just wanted to make that clear.
It's interesting what you said about not making a good employee because you think outside the box and like to challenge authority... I get all excited just talking about that :) Anyway, back to earth, that's one theory why genes that cause bipolar disorder are still around. Just a little "bipolar" would make you creative, curious, a risk taker, and productive. However, with bipolar disorder you might be disorganized, have bad judgement, and racing thoughts.
If you identify with my symptoms and have any mood instability at all you might want to take a look at this site to see if you identify with any of these people:
http://www.bipolarworld.net/Phelps/phelpsask.htm
Thanks Again,
Jon> hi there.
>
> well, i don't know dr. l.; and, i only have experience with SSRIs. i am not sure how much help i will be, however your post was very compelling to me. it seemed to me that a lot of your symptoms could be characteristic of someone who is not clinically "depressed." i only know a few people who get out of bed and feel great. in fact, most people would like to sleep until noon and skip morning all together. i don't know one person who doesn't like to eat at night and go to bed with that full warm and fuzzy feeling. i drink lots of water and always related that to the fact that my mother would chase me around with cups of water when i was little because she thought it was good for me, and now i drink a ton of water and hate to be thirsty. i probably don't have enough posting space to touch on each symptom that you wrote, although i wish i could. my first impression of your symptoms is that you are too hard on yourself. i am glad that you are seeking out a professional that, according to previous posts, has such a good reputation because there are things, as with myself, that you should be able to work on and hopefully overcome. some of your symptoms struck me as being a unique part of your personality. i could eat all the sourdough bread in san francisco if given the chance; and if challenging authority was a crime, at the tender age of 26, which i am now, i would be in jail for life. my mother says that i have been really challenging authority ever since i was about 3 months old. i was even told by my pdoc that i would never make a good "employee" and that challenging authority meant that i thought outside the box and wasn't one to follow the crowd. take some of those symptoms and attribute them to being a complex and interesting person. you sound like one to me. ok, sorry for the longwinded post, something struck me in your initial post.
>
> take care, tara
Posted by JonW on March 19, 2002, at 18:19:13
In reply to Re: My Life So Far -- Expert Advice Needed...?, posted by David Smith on March 19, 2002, at 0:29:09
Hi David,
I've read books on cognitive therapy and have worked with a cognitive therapist in the past with very little success. I find cognitive therapy interesting... I wish it were more effective for me. Other forms of talk therapy tend to turn me off -- maybe I just haven't found the right therapist, though.
Thanks for the post,
Jon> That is quite a bit of medication , but then I have a pretty long list too. :-)
> I don't see talk therapy listed along with your treatment. Perhaps it would be a good add on.
Posted by Mr.Scott on March 19, 2002, at 21:26:58
In reply to Re: My Life So Far -- Expert Advice Needed...?, posted by JonW on March 19, 2002, at 9:55:46
Hello Jon,Well I had typed along winded response back but lost it navigating the new posting features. Just as well I supoose. I'm still riding the AD+Stimulant+benzo bandwagon. And while my experience of life is probably not normal and I'd prefer one pill to do the job instead of 5 or 6 at at constantly changing doses and times to take them, I've managed to keep my beast on a leash for now. I do drop off from time to time into severe depressions that are short lived, and I use the start stop method with antidepressants to keep myself generally high.
I'm currently defining myself as Atypical depression with bipolar tendencies, comorbid ADD, Anxiety disorders, personality disorders, etc.
I do keep thinking that maybe...Just Maybe if I took Lithium and Depakote and *Waited* 6-12 months, I'd be a brand new person and never have to change my cocktail again. But I'm so impatient and unable to tolerate unhappiness that I want someone else to show up on this board and say that is exactly what they did and it worked before I ditch the feel good pills.
I will say that my arch nemesis of psychiatric drugs is wellbutrin. It seems to directly activate the part of my brain that is causing all my problems.
Please make sure to let me know what goes down with Dr.Liebowitz. I'm interested for the both of us!
Warm Regards,
Scott
Posted by cybercafe on August 25, 2002, at 21:46:37
In reply to My Life So Far -- Expert Advice Needed...?, posted by JonW on March 18, 2002, at 20:47:20
> Mood lability / instability.
> Irritability.Is this bipolar or narcissistic personality disorder?
> Startle easily -- phone rings, etc.
hmmm.. is this "anxiety" or "adrenal fatigue"?
> Like to drive very fast.
> Like to take risks.Is this bipolar or narcissistic personality disorder?
> Strong reaction to caffeine -- don't drink it.
hmmm... a symptom of ADD?
> Love sweets, bread, etc. / Eat in excess. / Plain tastes.
hmmm... is this a symptom of adrenal fatigue or hypothyroidism?
> Interrupt people because I'm afraid of losing my current thought.
> Start things but rarely finish them.
> Obsessive tendencies / Perfectionistic.
> Enjoy challenging/bothering/defying authority.
> Mood cycles about once a week, also within the same day.Are these symptoms of bipolar or narcissistic personality disorder?
> Drink a lot of water.
hmm.. i think i drink a lot of water because i'm bored and poor :)
> Have essential tremor.
is this a symptom of high blood pressure?
> Sensitive to sounds / excitement.
> Over sensitive / emotional / "Thin skin"hmmm.. adrenal fatigue ? or just plain anxiety (more likely)?
> As a child, weird sensations where the air smelled different.
is this a tactile hallucination? or a simple partial seizure?
i get weird feelings in my head sometimes... perhaps like major electrical activity...
...oh well.. i know it's an old post... please don't beat me :(
Posted by paulk on September 22, 2002, at 3:24:57
In reply to Re: My Life So Far -- Expert Advice Needed...?, posted by cybercafe on August 25, 2002, at 21:46:37
Sounds like ADD first - I would hope your doc would try Dexedrine with a anti epileptic med combo.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.