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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk on December 14, 2004, at 10:54:20
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 10:48:26
Hi Mattias,
I think it would be best go back down to 30mg/day mirtazapine and make sure your doctor gives you an appointment as soon as possible. I'd discuss the moclobemide at your next appointment.
Could you go to a different psychiatrist?
Regards,
Ed.
Posted by tensor on December 14, 2004, at 10:54:28
In reply to I second Ed..., posted by Racer on December 14, 2004, at 10:43:54
Hi Racer,
It started when i went from 15mg to 30mg, two weeks ago. And one week ago, i further increased to 45mg. I have no problems with 15mg. And in the past i've been on 30mg for years, but back then it helped, so.. I don't know, maybe this restlessness is good and one can be productive if the drug works, but it's living hell if it doesn't.
It has to start working soon if it's going to, because i can't stand this, i'm climbing the walls here./Mattias
Posted by ed_uk on December 14, 2004, at 10:56:39
In reply to Re: I second Ed... » Racer, posted by tensor on December 14, 2004, at 10:54:28
..... or maybe even go back down to 15mg.
Posted by tensor on December 14, 2004, at 11:09:37
In reply to Re: Restlessness, posted by ed_uk on December 14, 2004, at 10:56:39
Hi Ed,
Yes, i could step down to 30mg. But then i will never know if it's 45mg that would have helped. As i wrote earlier, can i double or triple my benzo dose for a few weeks and then step down to 'normal' dose without the risk of being addicted to a higher dosage? Because i might be able to cope with another week if sedated enough.
Weird logic i know.
Yes, i will meet a new physician soon, and i can barely wait to that appointment./Mattias
Posted by ed_uk on December 14, 2004, at 11:17:33
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 11:09:37
Hi Mattias,
I think it would be best to reduce the dose back down to 30mg because the restlessness might not decrease over time. I think that the next option for you would be to try a different antidepressant. You could always return to mirtazapine in the future if you were desperate but it is unlikely to come to that, you'll probably find a more effective treatment :-)
It's unlikely that you'll feel better at 45mg if you feel so restless.
Which benzo do you take? What dose?
Regards,
Ed.
Posted by tensor on December 14, 2004, at 11:38:15
In reply to Re: Restlessness, posted by ed_uk on December 14, 2004, at 11:17:33
Hi Ed,
I usually take 2mg of clonazepam, but have been taking 4, 6 and 8mg daily the last two weeks. Mostly 4mg. Yeah, you're probably right, the only benefit with 45mg is that it puts me to sleep at night in a more definit way than at 30mg.
Isn't it really annoying when a fine working combo suddendly stops working without any obvious reason? I mean, why? Then you desperately trying to get them to work again by increasing the dosage, can't remember when that worked, then after changing back and forth you end up(in best cases) with another combo that works for six months or maybe twelve months and then.. it starts all over again.
Btw, how many of you guys are sick-listed? I am.Kind regards,
Mattias
Posted by ed_uk on December 14, 2004, at 11:47:07
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 11:38:15
Hi :-)
Taking 45mg isn't worth it if you have to take so much clonazepam to deal with the side effects :-(
For me, antidepressants always take absolutely ages to work but they don't seem to stop working. Still get the side effects though.
>Btw, how many of you guys are sick-listed? I am.
I don't know. I'm a lazy student who ought to be studying but can't be bothered (SSRI).
Best Wishes,
Ed.PS. Are you wanting to try moclobemide next?
Posted by tensor on December 14, 2004, at 12:06:33
In reply to Re: Restlessness » tensor, posted by ed_uk on December 14, 2004, at 11:47:07
Hi
May i ask you which AD's you are currently taking?
Yes, i would like to try moclobemide, maybe in combination with trimipramine as the finnish dr. suggested(do you have experience of that drug?) and i will bring it up at next appointment. I actually mentioned moclobemide to the psychiatrist that i last talked to but she said it will be a decision between me and my next pdoc. The reason i'm switching pdoc is it that the one i talked to was here only temporarily. And i haven't got my 'own' pdoc since i came back from Sweden where i studied. I was a lazy student too, you see :). Well, lazy because of the depressions that kept me from keeping up with my studies so i decided to quit(cold turkey :))./Mattias
Posted by ed_uk on December 14, 2004, at 12:29:09
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 12:06:33
Hi Mattias :-)
I take citalopram and lofepramine...
Citalopram 60mg/day (Cipramil in UK and Finland/Celexa in US).
Lofepramine (Gamanil in UK/Tymelyt in Sweden/ not sure about Finland/not available in US).
You were a student? What subject? Do you think you'll go back when you're feeling better? I dropped out of college but I went back after a year. How old are you btw? I'm 20, I do Pharmacy.
I think the Aurorix is worth a try. You could add the trimipramine (Surmontil) if the Aurorix was inadequate on its own or if it caused insomnia. I've never taken Surmontil myself... although Surmontil is an antidepressant it's used mainly for insomnia in England.
Regarding antidepressants, I don't know what else to suggest because I don't know your symptoms or what you've tried before. Please will you tell me :-)
I'm naturally lazy but SSRIs make me worse. I take the Cipramil mainly for anxiety and obsessive compulsive disorder. The lofepramine is better for my depression.
Regards,
Ed.PS. Hope your new psych is good!
Posted by tensor on December 14, 2004, at 12:59:47
In reply to Re: Restlessness, posted by ed_uk on December 14, 2004, at 12:29:09
Hi Ed,
> You were a student? What subject? Do you think you'll go back when you're feeling better? I dropped out of college but I went back after a year. How old are you btw? I'm 20, I do Pharmacy.
Yes, i studied electrical civil engineering at KTH. I'm 27 so i believe my days as a student are over, it's sad. Well, the age maybe doesn't matter but i know that the risks are high for a relapse, it have happended before. And i can't move to Sweden back and forth as my mood swings, it's not practically nor economically defendable. I also feel better being 'home'. You study pharmacy, that must be practical knowledge when suffering from mental illness. You can outskill your pdoc when it comes to drugs :)
> I think the Aurorix is worth a try. You could add the trimipramine (Surmontil) if the Aurorix was inadequate on its own or if it caused insomnia. I've never taken Surmontil myself... although Surmontil is an antidepressant it's used mainly for insomnia in England.
> Regarding antidepressants, I don't know what else to suggest because I don't know your symptoms or what you've tried before. Please will you tell me :-)Sure, i suffer from depression(atypical?), anxiety and social phobia. I've tried:
Seronil(fluoxetine)
Effexor
Remeron
Seroxat(paroxetine)
Anafranil(clomipramine)
Edronax
Buspar
Zoloft
it should be all, can't remember exactly.
> I'm naturally lazy but SSRIs make me worse. I take the Cipramil mainly for anxiety and obsessive compulsive disorder. The lofepramine is better for my depression.So how are you doing now, is it under control? Can you study?
> PS. Hope your new psych is good!
Thanks!
/Mattias
Posted by vwoolf on December 14, 2004, at 13:09:22
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 11:38:15
I'm not officially sick listed but I work much less than I should. I'm a company director, which enables me to schedule my own time, but the temptation is always to do less than I should. I have found that by forcing myself to keep physically active (walking and dancing) , my energy levels rise and I can then work more. I would never have believed it, but it's true. I've always been an intellectual night owl, and for me exercise was very low on my list of priorities. Now I try to make sure I do something every day.
Posted by ed_uk on December 14, 2004, at 13:15:26
In reply to Re: Restlessness » ed_uk, posted by tensor on December 14, 2004, at 12:59:47
Hi Mattias,
If you do suffer from atypical depression you could benefit from a classical MAOI such as phenelzine (Nardil) or tranylcypromine (Parnate).
I'm not sure whether these drugs are on the market in Finland, if they are not you could probably get a pharmacy to order them for you if you had a prescription. Ted Brosnan, who you may have come across on babble, lives in Norway and he has recently found a psychiatrist who is willing to prescribe an MAOI. Apparantly, his doctor will need to get 'permission' to precribe an MAOI and the pharmacy will need to order it for him. I don't know how it works in Finland though, it would make sense to try Aurorix first and then consider the option of a traditional MAOI if the Aurorix didn't help.Some people on my course are much older than you. You are still young! Couldn't you go to University in Finland?
All the best,
Ed.
Posted by tensor on December 14, 2004, at 13:36:53
In reply to Re: Atypical depression, posted by ed_uk on December 14, 2004, at 13:15:26
> Hi Mattias,
>
> If you do suffer from atypical depression you could benefit from a classical MAOI such as phenelzine (Nardil) or tranylcypromine (Parnate).
> I'm not sure whether these drugs are on the market in Finland, if they are not you could probably get a pharmacy to order them for you if you had a prescription. Ted Brosnan, who you may have come across on babble, lives in Norway and he has recently found a psychiatrist who is willing to prescribe an MAOI. Apparantly, his doctor will need to get 'permission' to precribe an MAOI and the pharmacy will need to order it for him. I don't know how it works in Finland though, it would make sense to try Aurorix first and then consider the option of a traditional MAOI if the Aurorix didn't help.Yeah, aurorix feels more safe also. I'm not sure how they use MAOI here, it has never been suggested to me. That is also something i will take up with my pdoc.
> Some people on my course are much older than you. You are still young! Couldn't you go to University in Finland?Yes, i could but the distance to Stockholm is less than to closest university in Finland, i live in the little island called Aaland which is located between Finland and Sweden, you see. So it's a boat trip anyway. So i can't really commute, i'll have to move. We do have a local institute of technology which i've attended three years(B.Sc.) before i moved. I didn't get a diploma because i was going to Sweden for a M.Sc. diploma. I have to say i feel very reluctant to go back to my old school. That if something would make feel like a complete failure. I know the teachers there.
Btw, i recently started my own company in electronics. Will see how that works out. I do have a regular job daytime, but for now i'm sick listed.Kind regards,
Mattias
Posted by ed_uk on December 14, 2004, at 13:51:38
In reply to Re: Atypical depression » ed_uk, posted by tensor on December 14, 2004, at 13:36:53
Hi Mattias,
I have never known anyone from Aaland before! I like it how there are people on babble from all around the world.
I know how you mean about going back somewhere after you've left. I went to a different place after I left college.
Good luck with your company :-) Keep us updated! ...Don't forget to ask your new psych about MAOIs, your doctor might look shocked at the suggestion and tell you that they haven't been used for decades but it could be worth persisting because some people really benefit.
All the best,
Ed.
Posted by jay on December 14, 2004, at 20:05:01
In reply to This horrible depression, posted by tensor on December 14, 2004, at 10:26:12
This is just me....but I found Zoloft to be, especially after on it for awhile, the absolute worst med I have ever taken. (And I've taken pretty much all of the a.d.'s available here in Canada) It caused major, major crying spells, lack of energy, internal restlessness, and I have my worst memories in my entire *life* on that med. Now, it may just be me, but I found you have to try around some of the different SSRI's because they are not all the same. Prozac has been horrible to many people, but I have NO problems taking it.
It will take awhile and many, many med trials to find a right combo, but don't give up. I have started taking 5-10 mg\s of Ritalin 4 or so times a day, and being a small dose, it adds just a nice little 'boost' to my mood...but nothing overpowering or addictive. Benzos are good too...use them until you feel better, as they will *not* hurt you...they are very safe. Likely best until you find a combo that helps.
P.S. Have you tried slightly lowering your doses of Remeron and Zoloft, and taking them both at bedtime? Some people take SSRI's before bed too...while some need to take them in the morning.
Best wishes,
Jay
Posted by Mistermindmasta on December 14, 2004, at 23:43:19
In reply to This horrible depression, posted by tensor on December 14, 2004, at 10:26:12
> Hi,
>
> this feeling of restlessness without the energy to even take a shower or take a short walk is driving me mad. I don't know if it's the depression itself, but merely the s/e of the increase of the remeron to 45mg/d that causes this. I'm bored to death, but can't relax and, for e.g., watch a movie and just laying in my sofa, can't concentrate.
> My heart is pumping faster than usual, bad sleep, problably because i take 100mg of zoloft daily. So what shall i do, every day is just another wait for the next. I will have to stick to my benzos at least they calm me down, but i don't want get addicted to a higher dose. How long can take a three time higher dose and the step down to normal without being 'caught'?
> I know this is the core problem with depression, so you all probably feel the same. But this restlessness, is it due to increased norepinephrine?
>
> Thanks for being here guys.
>
> /MattiasThe way I understand it, restlessness usually comes from dopaminergic underactivity of the nigrostriatal (motor areas) tract. This most often occurs from the use of neuroleptics which antagonize dopamine receptors non-specifically. You wouldn't need that antagonism in the motor areas of the brain (if you were taking a neuroleptic), you'd need it other areas... it's quite an unfortunate side effect. Anyway, my point is that any number of pathyways could lower dopamine levels in the motor areas enough to cause restlessness. I think that SSRI's are able to do this through too much activity at a specific serotonin receptor that innervates the motor area thus reducing dopamine activity. I'm not sure how Rememeron does this, but I suppose norepinephrine could be involved.
I just want to tell you that when I took prochlorpromazine (I think that's the name) for nausea a few years ago, the restlessness / boredom that came with it was absolutely the worst experience of my life. It was indescribably horrible, and I hope you aren't experiencing the same degree of discomfort, because I'd be tossing all those meds out the window if you felt like I did. I was supremely tired, but I was so uncomfortable that I couldn't sleep a wink. I got zero sleep in the 3 days I took it, and ended up having to punch my legs because the pain in my legs felt better than the restlessness. Wow, that was bad.
So good luck. If you're willing to stick it out with the Remeron, I hope the restlessness subsides... if you're going to lower the dose, then I'm happy for you, because I know exactly how you're feeling, and the sooner it's relieved, the better.
Posted by tensor on December 15, 2004, at 0:04:35
In reply to Re: This horrible depression, posted by Mistermindmasta on December 14, 2004, at 23:43:19
Hi and thanks for your reply,
in addition to remeron i also take 100mg of zoloft. How do you think this affect dopaminergic underactivity?
Kind regards,
Mattias
Posted by Mistermindmasta on December 15, 2004, at 0:24:37
In reply to Re: This horrible depression » Mistermindmasta, posted by tensor on December 15, 2004, at 0:04:35
> Hi and thanks for your reply,
>
> in addition to remeron i also take 100mg of zoloft. How do you think this affect dopaminergic underactivity?
>
> Kind regards,
> Mattias
Well, I've read that SSRI's can cause a 50% drop in dopaminergic activity in the nigrostriatal tract. That's enough to cause the restlessness you describe. I'm trying to find exactly which serotonin receptor SSRI's cause this effect act, but I can't find much info.Prozac can induce what they call "Extrapyramidal-Induced Dysphoric Reaction", from inhibition of dopamine in the nigrostriatal tract, which they actually think is what causes suicide and aggression from prozac. I'm sure Zoloft could cause a similar reaction in susceptible people at high enough doses.
It seems like a very valid possibility that the combo of Remeron and Zoloft is effecting your dopamine levels in the nigrostriatal zone negatively. Less dopamine = less GABA, so that's what the benzo's calm you down. They oppose the effects that an SSRI might have.
I'm thinking that a dopamine agonist would quell your restlessness symptoms better than a benzo but that's sort of uncharted territory I think. DA agonists are used for restless legs sydrome, which also results from too little dopamine activity in that same pathway. I haven't ever heard of using DA agonists for SSRI induced EPS, but theoretically it makes sense.
Posted by ed_uk on December 15, 2004, at 6:35:26
In reply to Re: This horrible depression, posted by Mistermindmasta on December 15, 2004, at 0:24:37
Hi,
I'd just like to say that the worst that I have ever felt in my life was when I took chlorpromazine. It was torture in its purest form. Why is it that akathisia is so underated, textbooks often make it sound so mild and insignificant. I saw an article describing the effects of the AP droperidol in healthy psychologists and psychiatrists. After being given 5mg, one of them had to be admitted to a psych ward as an emergency because of profound distress and suicidal ideation. I think it could be beneficial for all psychiatrists who underate akathisia to be given a 10mg shot of Haldol so that they could experience the fun for themselves!
Ed.
Posted by ravenstorm on December 15, 2004, at 20:17:54
In reply to Re: I hate akathisia » Mistermindmasta, posted by ed_uk on December 15, 2004, at 6:35:26
Remeron somehow increases dopamine in the frontal cortex.
Posted by croy32 on December 19, 2004, at 10:21:26
In reply to Re: Atypical depression » ed_uk, posted by tensor on December 14, 2004, at 13:36:53
Sorry about my ignorance, but can anyone tell me exactly what "atypical depression" is? I can't get a satisfying explanation on the web.
My doc keeps saying "you are very atypical." Does he mean I am very atypically depressed? Or is he referring to the extremely unusual sensitivity I have to all but a few medications? Or is this one and the same. I've been described as "exquisitely sensitive"
Posted by polarbear206 on December 19, 2004, at 10:39:48
In reply to Re: Atypical depression, posted by croy32 on December 19, 2004, at 10:21:26
> Sorry about my ignorance, but can anyone tell me exactly what "atypical depression" is? I can't get a satisfying explanation on the web.
>
> My doc keeps saying "you are very atypical." Does he mean I am very atypically depressed? Or is he referring to the extremely unusual sensitivity I have to all but a few medications? Or is this one and the same. I've been described as "exquisitely sensitive"
Go to Dr. Ivans "Depression Central" web site. Scroll down to atypical depression. Loads of info on this.
Posted by jclint on December 19, 2004, at 11:28:02
In reply to Re: Atypical depression, posted by croy32 on December 19, 2004, at 10:21:26
Hi Croy. 'Atypical depression' is a lazy label for a depression which has contrastic symptoms to 'regular' (melancholic) depression - therefore not a 'typical' depression. For example, atypical depression often includes over-eating and over sleeping, while regular depression includes under-eating and under-sleeping. Its ironic that its called atypical, as many believe its more common than 'typical'...
But whatever you want to call it, it is quite different to some types of depression, and as Ed pointed out, some meds are more suited to this type, like MAOIs apparently.
There's lots of other symptoms like social isolation etc that I can't recall in detail. But I'm sure someone will clarify it.
Posted by banga on December 19, 2004, at 14:15:39
In reply to Re: Atypical depression, posted by jclint on December 19, 2004, at 11:28:02
You got some references above from other people in terms of what "atypical depression" is....just wanted to add that it sounds like you'll have to clarify with your pdoc in terms of what he meant saying you "atypical" --did he mean to refer to atypical depression, or was he/she rferring o something else-response to drugs etc. It doesn't sound like he was very clear about it
Posted by Ktemene on December 20, 2004, at 6:03:54
In reply to Re: Atypical depression, posted by croy32 on December 19, 2004, at 10:21:26
> Sorry about my ignorance, but can anyone tell me exactly what "atypical depression" is? I can't get a satisfying explanation on the web.
>
> My doc keeps saying "you are very atypical." Does he mean I am very atypically depressed? Or is he referring to the extremely unusual sensitivity I have to all but a few medications? Or is this one and the same. I've been described as "exquisitely sensitive"
I have never heard that there was any special connection between atypical depression and sensitivity to medications. Atypical depression is usually recognized as a subtype of depression, although there is some controversy about it. There is a nice discussion of the features of atypical depression in an issue of Current Psychiatry from last year. The following is the URL:
http://www.currentpsychiatry.com/2003_04/0403_depression.asp
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