![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Peter on January 13, 2003, at 23:17:29
Man! I feel like crawling out of this body. I'm so fed up with this crap. One med combo to the next, one year after the next, nothing working. My pdoc keeps on making promises.
It's been a few months now titrating the lamictal. My doc has been decreasing everything else at the same time, and my moods are worse than ever. After being up to 100mg zoloft for a few months, I started getting impulsive and drinking like a fish, etc...the same thing that's happened on every other SSRI I've been on after a few months. So, pdoc decided to get me off of it; he had me decrease slowly over many weeks to 50mg, but then he had me go from 50mg to nothing in 1 week. I've been off it now for 10 days, and I still feel like I'm dying: These crazy electric shock sensations keep going through my arms and legs and hands. I get throbbing headaches, body aches; I've been getting so depressed that sometimes I can't even lift my head up & I just sit there thinking about how distant 'reality' seems and how hopeless I am-like I'm gonna keep on going around these experimental drug trials but never reach any state where I could function in the world. I've been on 50mg lamictal for weeks, but when my doc told me to go up to 62.5 and then 75mg, I got more depressed and agitated and these wierd physical symptoms got worse. So I've been seeing this same doc since '97 and he insists I'm 'mild bipolar,' and keeps pushing anticonvulsants on me (and Lithium), and he can't seem to get it into his head that maybe the reason why none of them work is because they're not the right type of med for me! I've also been diagnosed w/ ADD + SP, and I take adderall (he just told me to drop 10mg off my 40mg dose-which seems like a lot at once), klonopin (3mg), depakote (went from 750mg to 250mg over a few weeks), ambien+temazepam for sleep. What I don't get is he doesn't seem to know what he's doing. I've had 3 other consultations over the years w/other doctors-they all tell me something different; one said I'm 'unspecified' bipolar, another said I'm not ADD, another said I'm not bipolar at all (no signs of mania or hypomania) but depressive anxiety is at the core of my illness. This last one I mentioned said I should get off the mood-stabilizers already and try a TCA-a class of antidepressant that might work well for me since the SSRI's don't (in the long run). Who am I supposed to listen to? I'm so sick of this. I asked my pharmacist for a list of meds I've taken since I started seeing this pdoc, and it's 8 pages long, fine print. I've never felt like such a lab rat in my life. Meanwhile I'm completely dysfunctional-I'm a musician and I can't play or compose anymore, can't get a job. I really don't know what to do; I'm at the end of my rope. I thought I'd either check into that Columbia-Cornell psychiatric evaluation program or go to another doc altogether and just leave this one I've been seeing for 7years once and for all. Has anyone heard of this guy Dr. James Kocsis in NYC? Another doctor gave his name to me as a suggestion to start fresh. Or Dr. Frank Miller in NYC? I don't know, I'm just miserable.
Posted by BekkaH on January 13, 2003, at 23:36:31
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
>and he can't seem to get it into his head that >maybe the reason why none of them work is >because they're not the right type of med for >me!
Hi Peter. I think that many, many patients are misdiagnosed and medicated with the wrong medicines. Since I've been here on PB, I've noticed that some people get seven or eight different diagnoses in as many months, depending on what drug they are on. Some doctors foolishly diagnose patients based on the patient's reactions to certain medications. A patient can have severe adverse reactions to meds. For example, some patients can act psychotic or they can become more depressed on a medicine and will be diagnosed on the basis of the reaction to the drugs rather than on who they really are.
>Has anyone heard of this guy Dr. James Kocsis in >NYC? Another doctor gave his name to me as a >suggestion to start fresh. Or Dr. Frank Miller )in NYC?
I know that James Kocsis is very good. He's at NY Hospital/Cornell. I've heard the name Frank Miller and I've heard he's good, but I can't remember in what context I heard this.
I certainly can sympathize with you. I'm not an M.D., but I think it's best to simplify, if possible. In the distant past, I was placed on multiple medications, and I was a total wreck. I'm one of those people with liver enzyme problems. I don't metabolize drugs well and I cannot tolerate "polypharmacy." The more I take, the worse I get, so much so that I used to end up in the ER on a regular basis due to hypertensive crises and all kinds of problems due to drug interactions. I don't know whether you fall into that category, but it's something to consider. I think it's always good to get a fresh approach and at least hear someone else's ideas, even if you don't switch doctors completely. I hope you feel better soon!!
Posted by Kar on January 14, 2003, at 0:12:38
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
Hey Peter. i can relate to that trapped feeling. Even when i'm feeling better for a spell i still feel that way. but unfortunately I can't trade this body in either. I've been working at this for years and had begun to feel at the end of my rope. Combo after combo, and sick of hearing from everyone else that something will work.
In a way it's good that you feel fed up...frustrated, disgusted...because I see thems as fighting words. I didn't hear you say, "it's over...that's it...there's no more help". i think we've all been there, probably many times...the lowest of the lows...knowing it will get better but worrying about the next one. "How long will this 'good' last?" "How can i change it?", "Why the hell won't something work like it seems to with everyone else?".
Is your doc leery about adding something as you titrate the Lamictal? It does seem logical that if you were this crappy and taking the Lamictal slowly, that adding something else just might lighten this mood up a little. My doc keeps stressing that it's not each drug and how it works alone, but the combo and how they work together. if you're feeling that bad he should treat this more aggressively. No need to wait any longer. Any talk of MAOI's?
I'm not working either and it sucks. As I said, even when I feel good I'm only cautiously optimistic because this is such a pattern that i don't trust that it will last.
Had you been working before? It may be a bad stretch for you now but you will get it back! I vote for leaving this doc. He sounds unsure and off target. i don't know what to tell you about which drug next. I'm sure someone will respond to that..There is an interesting algorithm site where you can plug in what drugs you've tried and concomitant symptoms and it gives the next recommended line of treatment. I think docs probably use it too. It might help you just to get some idea of where to go next. i found it really helpful although my doc is very on top of things. It's http://www.mhc.com/Algorithms/Depression/index.htHaven't heard of Kosis but that means nothing. Do you live in the tri state area? I'm in CT and have an awesome doc out of Yale. I also here that Donald Klein is superb. Don't know it he takes patients anymore but i think he's at Columbia. Ivan Goldberg's in the City too.
I am so sorry that you're feeling the way that you are. I think you should start fresh. Somneone new will have a fresh outlook and more ideas, I'm sure. this dude you have should not be having you suffer so much, no matter whether you are waiting for something to "kick in". We've all been there. Hang in.
"Patence is bitter but its fruit is sweet"
-Rousseubest, Karen
Posted by JohnL on January 14, 2003, at 4:27:50
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
If I were you I would forget about listening to different opinions from different doctors on what your condition should be called. Because in the end, what ends up working for you may likely be something that doesn't exactly fit the diagnosis. Actually, that is pretty obvious at this point, because everything that should have been appropriate for your symptoms wasn't.
I look at psychiatry a bit different than most. I try to gather clues from medication reactions as to what the real underlying problem is related to. Is it related to serotonin? dopamine? electrical? other? Zoloft has a cool slogan that actually describes my approach to choosing meds...."The more you know what's wrong the more you can do something to correct it." Clues from medication trials can help steer you into the right direction.
For example, in your case, mood stabilizers do not seem to be good choices. For whatever reason, they do not affect the chemistries in your brain that need to be affected.
Some meds have multiple actions at multiple receptors and also have a high percentage of success rates in the general public. One such med is Zyprexa. It is being shown to be effective for depression, mania, and bipolar. For doctors "in the know", Zyprexa is fast becoming a first line treatment instead of Lithium, Tegretol, Lamictal, or any of the others.
My doctor loves Zyprexa because he has a high percentage rate of success with it in a whole variety of different symptom clusters. I love it too. You could ask your doc for a combo of Prozac plus Zyprexa. Here's why:
1) The odds of it working are in your favor. I like good odds.
2) There is plenty of scientific evidence supporting it.
3) There is tons of anecdotal evidence supporting it.
4) Studies have shown that Prozac plus Zyprexa is far superior to either alone. Somehow they work in harmony to where the sum is greater than the parts.How many times to we hear of someone doing real good with Lamictal? Lithiu? Etc? Actually, not very often. But when you look at Zyprexa, it is much more common to hear all kinds of success stories.
The one drawback...potential weight gain, which tends to subside on its own after about 3 months.
So I would say don't fool around with the traditional stuff or the fancy stuff. Instead, go with a reliable common powerhorse...10mg to 20mg of Prozac plus 5mg to 10mg Zyprexa.
Just my opinion. But it could very likely save you months and years of further frustration.
JohnL
Posted by Ritch on January 14, 2003, at 9:07:31
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
> Man! I feel like crawling out of this body. I'm so fed up with this crap. One med combo to the next, one year after the next, nothing working. My pdoc keeps on making promises.
> It's been a few months now titrating the lamictal. My doc has been decreasing everything else at the same time, and my moods are worse than ever. After being up to 100mg zoloft for a few months, I started getting impulsive and drinking like a fish, etc...the same thing that's happened on every other SSRI I've been on after a few months. So, pdoc decided to get me off of it; he had me decrease slowly over many weeks to 50mg, but then he had me go from 50mg to nothing in 1 week. I've been off it now for 10 days, and I still feel like I'm dying: These crazy electric shock sensations keep going through my arms and legs and hands. I get throbbing headaches, body aches; I've been getting so depressed that sometimes I can't even lift my head up & I just sit there thinking about how distant 'reality' seems and how hopeless I am-like I'm gonna keep on going around these experimental drug trials but never reach any state where I could function in the world. I've been on 50mg lamictal for weeks, but when my doc told me to go up to 62.5 and then 75mg, I got more depressed and agitated and these wierd physical symptoms got worse. So I've been seeing this same doc since '97 and he insists I'm 'mild bipolar,' and keeps pushing anticonvulsants on me (and Lithium), and he can't seem to get it into his head that maybe the reason why none of them work is because they're not the right type of med for me! I've also been diagnosed w/ ADD + SP, and I take adderall (he just told me to drop 10mg off my 40mg dose-which seems like a lot at once), klonopin (3mg), depakote (went from 750mg to 250mg over a few weeks), ambien+temazepam for sleep. What I don't get is he doesn't seem to know what he's doing. I've had 3 other consultations over the years w/other doctors-they all tell me something different; one said I'm 'unspecified' bipolar, another said I'm not ADD, another said I'm not bipolar at all (no signs of mania or hypomania) but depressive anxiety is at the core of my illness. This last one I mentioned said I should get off the mood-stabilizers already and try a TCA-a class of antidepressant that might work well for me since the SSRI's don't (in the long run). Who am I supposed to listen to? I'm so sick of this. I asked my pharmacist for a list of meds I've taken since I started seeing this pdoc, and it's 8 pages long, fine print. I've never felt like such a lab rat in my life. Meanwhile I'm completely dysfunctional-I'm a musician and I can't play or compose anymore, can't get a job. I really don't know what to do; I'm at the end of my rope. I thought I'd either check into that Columbia-Cornell psychiatric evaluation program or go to another doc altogether and just leave this one I've been seeing for 7years once and for all. Has anyone heard of this guy Dr. James Kocsis in NYC? Another doctor gave his name to me as a suggestion to start fresh. Or Dr. Frank Miller in NYC? I don't know, I'm just miserable.
Peter, it sounds like pursuing the "depressive-anxiety" angle might be a good idea to me, IMO, especially if you haven't had any clearcut hypomanias. SSRI's sound bad because of the recurring substance abuse associated with them. Adderall can aggravate anxiety. The TCA idea might be a good one (with Klonopin). FWIW, desipramine has a history of *reducing* alcohol cravings for some (also helps ADD). ---Mitch
Posted by Peter on January 14, 2003, at 12:54:29
In reply to Re: Feel so awful I can't stand it anymore=Peter, posted by BekkaH on January 13, 2003, at 23:36:31
> Hi Peter. I think that many, many patients are misdiagnosed and medicated with the wrong medicines. Since I've been here on PB, I've noticed that some people get seven or eight different diagnoses in as many months, depending on what drug they are on. Some doctors foolishly diagnose patients based on the patient's reactions to certain medications. A patient can have severe adverse reactions to meds. For example, some patients can act psychotic or they can become more depressed on a medicine and will be diagnosed on the basis of the reaction to the drugs rather than on who they really are.
>
> Hi Bekka:
Thanks so much for the reassurance. I really agree with you on this; every time I'm diagnosed, much of how I'm feeling is based on my reactions to whatever meds I'm on at the time. That's why I never understood how these single -day, shockingly expensive consultations can give pdocs such a seemingly clear idea of diagnosis. I mean, every time I've gone for another consultation, I've been on like 5 different meds-and, of course, the reason I go to a consultation is because I feel awful-but who knows if I feel that way in the first place because of who I am or what I'm taking? I know what you mean. At least coming off of these other meds will simplify my cocktail so, ideally, I'd just be on lamictal-that way the doctor could tell how it affects me, but I don't care anymore what conclusions he can add to his little experiment chart about how effective drugs are-meanwhile, we're the gineau pigs he's testing all of them on! If I was hanging out in a little cage and just had to sit there, that's one thing. But there's so much hanging on our ability to function in this life, and I just don't think it's a way to live to keep becoming 'paralyzed' by all these medications. You know, I haven't experienced life without chemicals, whether illicit or prescribed, since I was 14 (I stopped the illcit drugs when I started meds at 21). And from then on, as you said, all the med switches have been done because of how I feel on whatever meds I was on at the time. Crazy world. But I gotta say, this sight is such a blessing and so are you. Thanks,
Peter
Posted by Peter on January 14, 2003, at 13:10:03
In reply to Hang in... » Peter, posted by Kar on January 14, 2003, at 0:12:38
> Hey Peter. i can relate to that trapped feeling. Even when i'm feeling better for a spell i still feel that way. but unfortunately I can't trade this body in either. I've been working at this for years and had begun to feel at the end of my rope. Combo after combo, and sick of hearing from everyone else that something will work.
> Yep.
> In a way it's good that you feel fed up...frustrated, disgusted...because I see thems as fighting words. I didn't hear you say, "it's over...that's it...there's no more help". i think we've all been there, probably many times...the lowest of the lows...knowing it will get better but worrying about the next one. "How long will this 'good' last?" "How can i change it?", "Why the hell won't something work like it seems to with everyone else?
> yeah, I guess it's better to be angry about it and motivated to do something about than to feel like giving up (although, in a wierd way, I feel like both!)
> Is your doc leery about adding something as you titrate the Lamictal? It does seem logical that if you were this crappy and taking the Lamictal slowly, that adding something else just might lighten this mood up a little. My doc keeps stressing that it's not each drug and how it works alone, but the combo and how they work together. if you're feeling that bad he should treat this more aggressively. No need to wait any longer. Any talk of MAOI's?
> Well, my pdoc will not even budge from his theories know matter how many people, even doctors, disagree with him. I've begged him for something for relief, ieven if just for the interim, and he keeps saying that my serotonin is already going all haywire from coming OFF other meds, so going ON another med would make this worse. What!?!? Baffling. Also, I've taken moclobemide in the past-that 'reversible' MAOI-I forgot what it's called now-but he put me on it before it was even released in this country-gee, that's comforting! Anyway, it didn't end up working-caused panic attacks, etc..As for the real MAOI's like Nardil or Parnate, I hear they're the best-BUT I'm really nervous about all the food restrictions. I'm afraid I'll eat something that has tyramine in it without my knowing it, and I'll go into shock. Do you have any experience taking an MAOI-if so, how do you deal with all the interactions with food and other meds?
> I'm not working either and it sucks. As I said, even when I feel good I'm only cautiously optimistic because this is such a pattern that i don't trust that it will last.
> I completely relate to that. In fact, I know that even though I feel sort of ok right now, at any point I can drop into the abyss again.
> Had you been working before? It may be a bad stretch for you now but you will get it back! I vote for leaving this doc. He sounds unsure and off target. i don't know what to tell you about which drug next. I'm sure someone will respond to that..There is an interesting algorithm site where you can plug in what drugs you've tried and concomitant symptoms and it gives the next recommended line of treatment. I think docs probably use it too. It might help you just to get some idea of where to go next. i found it really helpful although my doc is very on top of things. It's http://www.mhc.com/Algorithms/Depression/index.htHaven't heard of Kosis but that means nothing. Do you live in the tri state area? I'm in CT and have an awesome doc out of Yale. I also here that Donald Klein is superb. Don't know it he takes patients anymore but i think he's at Columbia. Ivan Goldberg's in the City too.
> That site sounds great-I'll check it out. And it's good to know this guy Kocsis has a good rep. I already left a message on his machine. You know, I had a consultation with Donald Klein-he only does consultations now. But it wqas so confusing because he's the one who hired my current pdoc who I'm having so much trouble with! So I know there were a lot of politics involved, because he kept on saying that the guy I'm going to is so great, etc. I call his circle the bipolar circle. They're all really smart, but they think anticonvulsants and lithium are the answers to everyone's problems and that everyone is, to some extent, bipolar. So he just said he 'thins' I'm BP, 'unspecified,' but not ADHD, while my pdoc says I am ADHD!
> I am so sorry that you're feeling the way that you are. I think you should start fresh. Somneone new will have a fresh outlook and more ideas, I'm sure. this dude you have should not be having you suffer so much, no matter whether you are waiting for something to "kick in". We've all been there. Hang in.
> I agree. Thank you so much for taking the time to encourage me. You hang in there too.
> "Patence is bitter but its fruit is sweet"
> -Rousseu
>
> best, Karen
>
>
Posted by Peter on January 14, 2003, at 13:21:39
In reply to Re: Feel so awful I can't stand it anymore, posted by JohnL on January 14, 2003, at 4:27:50
> I look at psychiatry a bit different than most. I try to gather clues from medication reactions as to what the real underlying problem is related to. Is it related to serotonin? dopamine? electrical? other? Zoloft has a cool slogan that actually describes my approach to choosing meds...."The more you know what's wrong the more you can do something to correct it." Clues from medication trials can help steer you into the right direction.
> I agree, but it's quite difficult to determine what's effecting you in what ways if you're taking 7 medications at the same time-don't you think?
> Some meds have multiple actions at multiple receptors and also have a high percentage of success rates in the general public. One such med is Zyprexa. It is being shown to be effective for depression, mania, and bipolar. For doctors "in the know", Zyprexa is fast becoming a first line treatment instead of Lithium, Tegretol, Lamictal, or any of the others.
>Yeah, I've heard a lot of good stuff about zyprexa, but my doc says he doesn't think I'd respond well to it. And when it comes down to it, he's the one who writes the prescriptions.
> My doctor loves Zyprexa because he has a high percentage rate of success with it in a whole variety of different symptom clusters. I love it too. You could ask your doc for a combo of Prozac plus Zyprexa. Here's why:
> 1) The odds of it working are in your favor. I like good odds.
> 2) There is plenty of scientific evidence supporting it.
> 3) There is tons of anecdotal evidence supporting it.
> 4) Studies have shown that Prozac plus Zyprexa is far superior to either alone. Somehow they work in harmony to where the sum is greater than the parts.
> Interesting; I've been on every SSRI with every stabilizer, and my pdoc has always blamed the SSRI for making me go ballistic after a few months, even when it's accompanied by AC's. But SSRI + novel antipsychotic I've never tried. He thinks that, since I've come off the zoloft, my receptors are fluctuating and unstable, and that starting another antidepressant would only worsen this serotonin instability-this makes no sense to me, but he will not budge from his theories, no matter how much torture I say I'm experiencing.
> The one drawback...potential weight gain, which tends to subside on its own after about 3 months.
> I don't care about that. I just want to feel ok enough to go outside of my apartment.
> So I would say don't fool around with the traditional stuff or the fancy stuff. Instead, go with a reliable common powerhorse...10mg to 20mg of Prozac plus 5mg to 10mg Zyprexa.
> I'll probably have to go to another pdoc to ask for this.
> Just my opinion. But it could very likely save you months and years of further frustration.
> Thanks for your time and advice. I'll see what I can do about it-sounds good to me.
Peter
Posted by Peter on January 14, 2003, at 13:26:25
In reply to Re: Feel so awful I can't stand it anymore » Peter, posted by Ritch on January 14, 2003, at 9:07:31
> Peter, it sounds like pursuing the "depressive-anxiety" angle might be a good idea to me, IMO, especially if you haven't had any clearcut hypomanias. SSRI's sound bad because of the recurring substance abuse associated with them. Adderall can aggravate anxiety. The TCA idea might be a good one (with Klonopin). FWIW, desipramine has a history of *reducing* alcohol cravings for some (also helps ADD). ---Mitch
> Thanks Mitch, I agree. My pdoc doesn't, but I do. I'll probably leave him and go to someone who does. BTW-is desipramine better than imipramine or the other TCA'a (don't know much about them? And are TCA's better than effexor, since it also affects Serotonin AND NE?
Thanks,
Peter
Posted by Peter on January 14, 2003, at 16:03:45
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
Posted by Peter on January 14, 2003, at 16:44:30
In reply to Just had pdoc appointment (nm), posted by Peter on January 14, 2003, at 16:03:45
Wierd, my whole message didn't show up. Anyway, this is the outome of my session today: At first, he tried to push more AC's on me (Tegretol-the only one I hadn't tried yet). But I said no way, I'm sick of AC's. So, he gave me 4 AD options: Effexor, Wellbutrin, a TCA, or Strattera. I tried Effexor years ago, but only for a short while, and I was always getting wasted so I never knew if it had a good or bad effect on me. But I do recall hearing a lot about effexor being the hardest to wean off of. Wellbutrin I tried a few years ago for a short stint, but I do remember it making me very agitated. Strattera is too new and I'm no longer comfortable taking brand new meds, I told him-even though he said he's pretty sure they'll market it as an antidepressant down the road. Whatever, I'm not into it now. So it was down to the TCA's, which is good, because the last pdoc I went to for a consultation immediately recommended that I try a TCA because my main problem is not bipolar but depressive-anxiety, and she said TCA's work great for that, especially in those for whom SSRI's don't work well. My doc said the TCA's usually have a lot of antocholinergic (sp?) side-effects, but that they could help me fall asleep if I take them once every night; this would thereby help me to come off the sleeping pills and even lower my klonopin a bit. So we decided on low-dose nortriptyline (Pamelor)(10mg to begin), since he said it probably has the least side-effects in it's class, and it affects serotonin as well as NE, instead of only NE. Desipramine affects only NE, and, though it is great for many, I believe I benefit from something that has some serotonergic activities, since the SSRI's did help me , if only temporarily. As for MAOI's, it was his partner who discovered their efficacy for social anxiety. But he said that, although they are terrific drugs, he doesn't think I'd be comfortable with my neuroses and apprehensions about the dietary cautions, etc. Nortriptyline will not directly help my SP, he said, but it could to the extent that my SP is tied to GAD, which it very well might be-I worry all the time. I hope I made the right choice! Thanks,
Peter
Posted by Ritch on January 14, 2003, at 22:42:54
In reply to Re: Feel so awful I can't stand it anymore » Ritch, posted by Peter on January 14, 2003, at 13:26:25
> > Peter, it sounds like pursuing the "depressive-anxiety" angle might be a good idea to me, IMO, especially if you haven't had any clearcut hypomanias. SSRI's sound bad because of the recurring substance abuse associated with them. Adderall can aggravate anxiety. The TCA idea might be a good one (with Klonopin). FWIW, desipramine has a history of *reducing* alcohol cravings for some (also helps ADD). ---Mitch
> > Thanks Mitch, I agree. My pdoc doesn't, but I do. I'll probably leave him and go to someone who does. BTW-is desipramine better than imipramine or the other TCA'a (don't know much about them? And are TCA's better than effexor, since it also affects Serotonin AND NE?
> Thanks,
> Peter
>Peter, I brought up desipramine specifically because it has been used with *some* success to reduce alcohol and cocaine cravings. There were some studies done many years back. Also, I tried it at just 10mg/day and had a very good anti-ADD response to it. I'm just med sensitive and I couldn't tolerate the blurred vision and mild tachycardia I got with it. However, you seem to be able to tolerate quite a bit of Adderall, so I thought it might be worth mentioning. I believe that it is generally contraindicated to take a stimulant and a TCA simultaneously, so you would have to ditch the Adderall and switch to the TCA for ADD problems. It just seems like (based on what you have reported), that serotonergic meds seem to aggravate your substance abuse problems. Desipramine doesn't have much serotonergic activity at all-it's mostly NE. You might ask your doc about that new one-Straterra. You *can* take a stimulant with that med from what I read in the drug monograph (in that case Ritalin was mentioned). There is another med that you might consider-odansentron (Zofran). There have been some recent reports about it reducing social anxiety and also *reducing* alcohol cravings as well.----Mitch
Posted by Ritch on January 14, 2003, at 23:04:54
In reply to Sorry-message didn't show up, posted by Peter on January 14, 2003, at 16:44:30
> Wierd, my whole message didn't show up. Anyway, this is the outome of my session today: At first, he tried to push more AC's on me (Tegretol-the only one I hadn't tried yet). But I said no way, I'm sick of AC's. So, he gave me 4 AD options: Effexor, Wellbutrin, a TCA, or Strattera. I tried Effexor years ago, but only for a short while, and I was always getting wasted so I never knew if it had a good or bad effect on me. But I do recall hearing a lot about effexor being the hardest to wean off of. Wellbutrin I tried a few years ago for a short stint, but I do remember it making me very agitated. Strattera is too new and I'm no longer comfortable taking brand new meds, I told him-even though he said he's pretty sure they'll market it as an antidepressant down the road. Whatever, I'm not into it now. So it was down to the TCA's, which is good, because the last pdoc I went to for a consultation immediately recommended that I try a TCA because my main problem is not bipolar but depressive-anxiety, and she said TCA's work great for that, especially in those for whom SSRI's don't work well. My doc said the TCA's usually have a lot of antocholinergic (sp?) side-effects, but that they could help me fall asleep if I take them once every night; this would thereby help me to come off the sleeping pills and even lower my klonopin a bit. So we decided on low-dose nortriptyline (Pamelor)(10mg to begin), since he said it probably has the least side-effects in it's class, and it affects serotonin as well as NE, instead of only NE. Desipramine affects only NE, and, though it is great for many, I believe I benefit from something that has some serotonergic activities, since the SSRI's did help me , if only temporarily. As for MAOI's, it was his partner who discovered their efficacy for social anxiety. But he said that, although they are terrific drugs, he doesn't think I'd be comfortable with my neuroses and apprehensions about the dietary cautions, etc. Nortriptyline will not directly help my SP, he said, but it could to the extent that my SP is tied to GAD, which it very well might be-I worry all the time. I hope I made the right choice! Thanks,
> PeterOh, so he tried nortriptyline? That is the most tolerable TCA I have ever taken (dirt cheap too!). It didn't work as well for ADD as desipramine did, but it was much easier to tolerate. Hey, I managed to take it (at varying dosages with other meds) for nearly a year or so (that says a lot!). I don't know if you will find this helpful or if it will work for you or not, but I found (last wintertime depression) that a low-dose combo of nortriptyline (10-20mg/day) and wellbutrin (75mg/day) worked out fairly well. The NT seemed to "neutralize" the agitation from the WB considerably. You might find that down the road you can add some WB to the NT without the agitation you had previously (*maybe*). YES, the nortriptyline does help a lot with GAD, and that brings down the social anxiety several notches. Now, you have me wondering about a retrial of low-dose NT with the tiny bit of Effexor I take. I don't want to be on stims for my ADHD, and I don't want to spend the bucks for the Straterra. NT worked well for ADHD, but I had to combine it (in my case-a tiny bit of Zoloft), but I wonder if I could throw it back in with a tiny bit of Effexor instead? Dont' know. I think you made a decent choice. OH, BTW, you got to wait on TCA's for sure. Two weeks minimum. You will cruise along and feel absolutely no benefit except maybe for some reduced anxiety, for quite a while and then they rapidly start kicking in (if they are going to). ---good luck, Mitch
Posted by linkadge on January 15, 2003, at 9:37:06
In reply to Re: Sorry-message didn't show up » Peter, posted by Ritch on January 14, 2003, at 23:04:54
It is just a matter of trial and error. I know it that sounds extremely cold, but I've been where you are, and now I can hardly recall those emotions.
Good Luck
Linkadge
Posted by polarbear206 on January 15, 2003, at 10:01:28
In reply to Re: Feel so awful I can't stand it anymore » Peter, posted by Ritch on January 14, 2003, at 22:42:54
> > > Peter, it sounds like pursuing the "depressive-anxiety" angle might be a good idea to me, IMO, especially if you haven't had any clearcut hypomanias. SSRI's sound bad because of the recurring substance abuse associated with them. Adderall can aggravate anxiety. The TCA idea might be a good one (with Klonopin). FWIW, desipramine has a history of *reducing* alcohol cravings for some (also helps ADD). ---Mitch
> > > Thanks Mitch, I agree. My pdoc doesn't, but I do. I'll probably leave him and go to someone who does. BTW-is desipramine better than imipramine or the other TCA'a (don't know much about them? And are TCA's better than effexor, since it also affects Serotonin AND NE?
> > Thanks,
> > Peter
> >
>
> Peter, I brought up desipramine specifically because it has been used with *some* success to reduce alcohol and cocaine cravings. There were some studies done many years back. Also, I tried it at just 10mg/day and had a very good anti-ADD response to it. I'm just med sensitive and I couldn't tolerate the blurred vision and mild tachycardia I got with it. However, you seem to be able to tolerate quite a bit of Adderall, so I thought it might be worth mentioning. I believe that it is generally contraindicated to take a stimulant and a TCA simultaneously, so you would have to ditch the Adderall and switch to the TCA for ADD problems. It just seems like (based on what you have reported), that serotonergic meds seem to aggravate your substance abuse problems. Desipramine doesn't have much serotonergic activity at all-it's mostly NE. You might ask your doc about that new one-Straterra. You *can* take a stimulant with that med from what I read in the drug monograph (in that case Ritalin was mentioned). There is another med that you might consider-odansentron (Zofran). There have been some recent reports about it reducing social anxiety and also *reducing* alcohol cravings as well.----Mitch
Peter,I'm glad your going the tricyclic route. Pamelor is probably the best one to try first in your situation. Just hang in there with the initial side effects. They will subside over time. I think it will really help you with your anxiety. PLEASE keep us up to date.
Be well soon!
Laura.
Posted by Phil on January 15, 2003, at 12:25:38
In reply to Feel so awful I can't stand it anymore, posted by Peter on January 13, 2003, at 23:17:29
I haven't read the other posts but if I was in New York, I'd see Dr. Ivan Goldberg. Here's a link to his site. He's not cheap but neither is misery.
http://www.psycom.net/depression.central.html
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.