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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Maxime on October 10, 2005, at 14:40:35
Hi Scott. I value your input and knowledge very much. I know that you have been through so many meds like I have plus you are one smart guy.
So I am in a deep suicidal depression. I am unable to get up everyday. My cognitive ability has declined. The plan is to return to prozac and add Sulprimide from the UK to the mix. What do you think of this plan. Do you think I should try to add the Sulprimide to the Parnate first or just go straight to Prozac. Prozac and Parnate are the only 2 ADs that have given me any relief.
I know I am going to lactate on the sulprimide, but we shall see.
I am so desperate Scott. I keep falling deeper into depression. The black hole doesn't haven't an end.
How are you doing? Are you having any good days? I hope so. I truly do.
Thanks Scott. Take care. :-)
Hugs from Maxime
Posted by Maxime on October 10, 2005, at 15:05:31
In reply to SLS? Your input please., posted by Maxime on October 10, 2005, at 14:40:35
Or anyone else who has some insight I would like to hear your thoughts.
Maxie
> Hi Scott. I value your input and knowledge very much. I know that you have been through so many meds like I have plus you are one smart guy.
>
> So I am in a deep suicidal depression. I am unable to get up everyday. My cognitive ability has declined. The plan is to return to prozac and add Sulprimide from the UK to the mix. What do you think of this plan. Do you think I should try to add the Sulprimide to the Parnate first or just go straight to Prozac. Prozac and Parnate are the only 2 ADs that have given me any relief.
>
> I know I am going to lactate on the sulprimide, but we shall see.
>
> I am so desperate Scott. I keep falling deeper into depression. The black hole doesn't haven't an end.
>
> How are you doing? Are you having any good days? I hope so. I truly do.
>
> Thanks Scott. Take care. :-)
>
> Hugs from Maxime
Posted by linkadge on October 10, 2005, at 16:09:28
In reply to Re: and Ed and Link too or anyone else.... » Maxime, posted by Maxime on October 10, 2005, at 15:05:31
Parnate helped me for the first little while, then it turned ugly on me. I just was paranoid, and my mood was very dark.
I got off of it, and for some strange reason I almost felt euphoric for a few months.
I would not hesitate to change it if you are feeling this way.
Not sure what to recomend, since I don't know what you've tried.
Linkadge
Posted by blueberry on October 10, 2005, at 17:59:08
In reply to SLS? Your input please., posted by Maxime on October 10, 2005, at 14:40:35
I know you were requesting help from SLS, so please forgive me for butting in. Just wanted to say I think sulpiride is a good choice. Amisulpride, which is very similar, started working fast for me a few years ago. I think fast is what you need. I think your doctor should think in terms of "fast", like sulpiride, zyprexa, ritalin, adderall, at least until other meds have a chance to take hold. Gotta get you out of that awful hole quickly and worry about longterm later.
Posted by Maxime on October 10, 2005, at 19:30:47
In reply to Re: and Ed and Link too or anyone else...., posted by linkadge on October 10, 2005, at 16:09:28
WOW! Link, you are the FIRST person I have heard of who had trouble with Parnate after being on it for a while. Most people can just stay on it for life.
I am really glad you posted your experience. I don't feel so alone in my experience now.
((( Link)))
Maxime
> Parnate helped me for the first little while, then it turned ugly on me. I just was paranoid, and my mood was very dark.
>
> I got off of it, and for some strange reason I almost felt euphoric for a few months.
>
> I would not hesitate to change it if you are feeling this way.
>
> Not sure what to recomend, since I don't know what you've tried.
>
>
>
> Linkadge
>
Posted by Maxime on October 10, 2005, at 19:34:52
In reply to Re: SLS? Your input please., posted by blueberry on October 10, 2005, at 17:59:08
Hey I made a second post asking for help from anyone with insight ... thank you for your input. I can't take Zyprexa or Ritalin. I have a prescription for Adderall XR that I can't afford. I am going to go for the the Sulpiride. I need something that will brighten my mood.
You are not butting in at all. All input and advice is welcome. This forum is about sharing and helping. I appreciate your taking the time to post.
Maxime
> I know you were requesting help from SLS, so please forgive me for butting in. Just wanted to say I think sulpiride is a good choice. Amisulpride, which is very similar, started working fast for me a few years ago. I think fast is what you need. I think your doctor should think in terms of "fast", like sulpiride, zyprexa, ritalin, adderall, at least until other meds have a chance to take hold. Gotta get you out of that awful hole quickly and worry about longterm later.
>
Posted by Phillipa on October 10, 2005, at 19:38:18
In reply to Re: SLS? Your input please. » blueberry, posted by Maxime on October 10, 2005, at 19:34:52
Maxie, Scott posted a few days ago that he would be gone for a few weeks. Didn't say where. Fondly, Phillipa
Posted by linkadge on October 10, 2005, at 20:55:59
In reply to Re: and Ed and Link too or anyone else.... » linkadge, posted by Maxime on October 10, 2005, at 19:30:47
No, the truth is that parnate was not too good for me.
Personally I think the MAOI's must be overhyped.
Although if it is working for you then it is not overhyped.
In the end, I just found my mood was very dark. I was almost psychotic, it felt like god was watching me all the time.
Plus, I had a spontanious hpyertensive crisis that laned me in ER, no wrong foods, I was confused.
Don't let med classifications rule you, they are only guidlines. I know a guy who failed multiple ECT, and then went into remission on St. John's wort, so go figure !Linkadge
Posted by Maxime on October 11, 2005, at 11:12:15
In reply to Re: SLS? Your input please. » Maxime, posted by Phillipa on October 10, 2005, at 19:38:18
> Maxie, Scott posted a few days ago that he would be gone for a few weeks. Didn't say where. Fondly, Phillipa
Oh thanks Phillipa. I didn't see that post as I am not able to read everything right now. I know that Scott goes though rough times as well and I figured that he was having one of those times.
Hugs,
Maxie
Posted by Maxime on October 11, 2005, at 11:14:24
In reply to Re: and Ed and Link too or anyone else...., posted by linkadge on October 10, 2005, at 20:55:59
Yup, you just never know. We are all so different. I mean Nardil wasn't good for me.
Link, you are such a sweetie. I just want to say that I am sorry you are having such a hard time PLUS you are having to worry about your mom. You are a special person.
Hugs,
Maxime
> No, the truth is that parnate was not too good for me.
>
> Personally I think the MAOI's must be overhyped.
>
> Although if it is working for you then it is not overhyped.
>
> In the end, I just found my mood was very dark. I was almost psychotic, it felt like god was watching me all the time.
>
>
> Plus, I had a spontanious hpyertensive crisis that laned me in ER, no wrong foods, I was confused.
>
>
> Don't let med classifications rule you, they are only guidlines. I know a guy who failed multiple ECT, and then went into remission on St. John's wort, so go figure !
>
>
>
> Linkadge
Posted by SLS on October 11, 2005, at 13:21:20
In reply to SLS? Your input please., posted by Maxime on October 10, 2005, at 14:40:35
Hi Maxime.
I agree with Blueberry. I think adding a drug for immediate palliative relief makes sense. Blueberry mentioned the ones I would have suggested. I am partial to Zyprexa. I think it is a good drug to help bring someone out of the anxious catastrophic state that produces suicidality.
Since you are already on Parnate, I would look to optimize its use and build a regime around it. The sulpiride might be worth exploring. When I tried it, I was not on any antidepressants. It provided significant relief for a few days before it pooped-out on me. Dosages of 50-100mg were suggested to me when sulpiride is to be used as an antidepressant. Some people will go higher, but I don't think there is any real data to demonstrate a dose-response curve.
If you haven't already tried adding Lamictal to Parnate, I would consider doing so. Of course, lithium is still the drug with the most established track record as an augmentor of Parnate. That might be because it has been around the longest and studied the most. It may not really be the best, but it does work.
If it were me, these are the things I would consider doing:
1. Add Zyprexa 5-10mg
2. Increase Parnate dosage to over 100mg
3. Add Lamictal 200mg and/or lithium 300-600mg
4. Add nortriptyline 75mg or desipramine 200mg
Of course, you might already have tried these things and have been without success.I wouldn't know where to place the sulpiride. I think it makes sense to try, but you might want to optimize your mood as much as possible with these other things first. Some people use S-AMe for temporary relief. I really don't think it would interact adversely with the Parnate. Adderall might be worth considering, but it might help for only three days or so.
I still think that Zyprexa is a good anti-suicide drug that might be the very first thing for you to try. You can use it temporarily while waiting for the sulpiride to arrive. However, I would not wait to treat the suicidality. Even Klonopin might help, but I still favor the Zyprexa.
Before discontinuing the Parnate, see if your doctor would be willing to go with adding a TCA. Unless he has personal experience with using any of the others, I would recommend either nortriptyline or desipramine. These two avoid the dangers of serotonin syndrome and are milder in terms of side effects.
Just take one thing at a time. Immediate relief should be your priority at this juncture. I would recommend Zyprexa. If it works really well at preventing suicidal states, and you are not happy with its potential weight gain, you can try crossing over to either Seroquel or Abilify. I would probably add Abilify 10mg to the Zyprexa for two weeks, and then discontinue the Zyprexa. This will help you avoid the discomfort of any akathisia-like phenomena that Abilify might produce as a startup side-effect.
- Scott
Posted by SLS on October 11, 2005, at 13:36:20
In reply to Re: SLS? Your input please., posted by SLS on October 11, 2005, at 13:21:20
Hi Maxime.
I saw in one of your earlier posts that you experienced a persistent improvement with Adderall. Also, it seems that you are under some financial constraints to be able to buy medications. Go with what you know works. I still think it would be a great investment of your time to add a TCA. They are cheap.
- Scott
Posted by ed_uk on October 11, 2005, at 15:57:14
In reply to SLS? Your input please., posted by Maxime on October 10, 2005, at 14:40:35
Hi Maxie,
Why not add Abilify to Parnate? Sulpiride causes hyperprolactinemia very frequently!
~Ed xx
Posted by Maxime on October 11, 2005, at 23:30:51
In reply to Re: SLS? Your input please. » Maxime, posted by ed_uk on October 11, 2005, at 15:57:14
I'm a little overwhelmed with all the suggestions. Here is what I will be trying. Adding a small amount of Prozac to the Parnate and sulprimide. I didn't know you could take Prozac and Parnate together, but I can take 10 mg or so.
I don't think I can afford the Abilify. Despramine makes me lactate when I go above 75 mg. Zyprexa makes me want to eat the fridge. Seroquel= a lactating zombie. Lamictal= more depression.
God I am really confused now with all the options mentioned. But hey,I asked.
Maxime
Posted by Maxime on October 12, 2005, at 9:06:05
In reply to Re: SLS? Your input please., posted by SLS on October 11, 2005, at 13:21:20
Thanks Scott.
Zyprexa scares me since I was on it twice and I gained weight so quickly and of course I lactated. Seroquel ... lactate. Abilify, I would have to ask my Pdoc to get it from England and I just realised that I wouldn't be able to afford it.I've been wanting to get my prolactin level tested to see if it's naturally high. However, I use Thorazine once a week or so to help me sleep so that would scew the results.
When I increase the Parnate over 100 I get severe headaches which is a sign of hypertension, although I have never taken my BP. But it makes me really dizzy too. I could try again and see what happens.
Lamictal worsens my depression.
I am allergic to Nortrip.
I can only take 25-50 mg of Desipramine before I start to lactate. I have actually been taking it for 3 weeks now with the Parnate.
Sigh.
Maybe I will try to increase the Parnate. Someone has a BP cuff where I am living. I can see if it really does increase it or if the headache is non BP related.
Thanks Scott. I hope you are doing alright.
Hugs,
Maxime> Hi Maxime.
>
> I agree with Blueberry. I think adding a drug for immediate palliative relief makes sense. Blueberry mentioned the ones I would have suggested. I am partial to Zyprexa. I think it is a good drug to help bring someone out of the anxious catastrophic state that produces suicidality.
>
> Since you are already on Parnate, I would look to optimize its use and build a regime around it. The sulpiride might be worth exploring. When I tried it, I was not on any antidepressants. It provided significant relief for a few days before it pooped-out on me. Dosages of 50-100mg were suggested to me when sulpiride is to be used as an antidepressant. Some people will go higher, but I don't think there is any real data to demonstrate a dose-response curve.
>
> If you haven't already tried adding Lamictal to Parnate, I would consider doing so. Of course, lithium is still the drug with the most established track record as an augmentor of Parnate. That might be because it has been around the longest and studied the most. It may not really be the best, but it does work.
>
> If it were me, these are the things I would consider doing:
>
> 1. Add Zyprexa 5-10mg
> 2. Increase Parnate dosage to over 100mg
> 3. Add Lamictal 200mg and/or lithium 300-600mg
> 4. Add nortriptyline 75mg or desipramine 200mg
>
>
> Of course, you might already have tried these things and have been without success.
>
> I wouldn't know where to place the sulpiride. I think it makes sense to try, but you might want to optimize your mood as much as possible with these other things first. Some people use S-AMe for temporary relief. I really don't think it would interact adversely with the Parnate. Adderall might be worth considering, but it might help for only three days or so.
>
> I still think that Zyprexa is a good anti-suicide drug that might be the very first thing for you to try. You can use it temporarily while waiting for the sulpiride to arrive. However, I would not wait to treat the suicidality. Even Klonopin might help, but I still favor the Zyprexa.
>
> Before discontinuing the Parnate, see if your doctor would be willing to go with adding a TCA. Unless he has personal experience with using any of the others, I would recommend either nortriptyline or desipramine. These two avoid the dangers of serotonin syndrome and are milder in terms of side effects.
>
> Just take one thing at a time. Immediate relief should be your priority at this juncture. I would recommend Zyprexa. If it works really well at preventing suicidal states, and you are not happy with its potential weight gain, you can try crossing over to either Seroquel or Abilify. I would probably add Abilify 10mg to the Zyprexa for two weeks, and then discontinue the Zyprexa. This will help you avoid the discomfort of any akathisia-like phenomena that Abilify might produce as a startup side-effect.
>
>
> - Scott
Posted by SLS on October 12, 2005, at 13:03:53
In reply to Re: SLS? Your input please. » SLS, posted by Maxime on October 12, 2005, at 9:06:05
Hi Maxime.
It must be frustrating for you to receive so many suggestions that you have already tried and failed with.
Have you ever tried taking Mirapex or Requip?
Which mood-stabilizers have you tried so far?
- Scott
Posted by ed_uk on October 12, 2005, at 14:03:31
In reply to Re: SLS? Your input please., posted by Maxime on October 11, 2005, at 23:30:51
Hi Maxie,
>I didn't know you could take Prozac and Parnate together
YOU CAN'T. NOT UNDER ANY CIRCUMSTANCES! It's lethal.
~ed
Posted by Maxime on October 12, 2005, at 18:21:47
In reply to WARNING » Maxime, posted by ed_uk on October 12, 2005, at 14:03:31
That what I thought. I think he is prescribing the 10 mg pills or the liquid so that I can take just a small amount. He said he has other patients use the combo. He's 80 years old, I guess he has seen a lot of contraindications used.
Maxime
> Hi Maxie,
>
> >I didn't know you could take Prozac and Parnate together
>
> YOU CAN'T. NOT UNDER ANY CIRCUMSTANCES! It's lethal.
>
> ~ed
Posted by Maxime on October 12, 2005, at 18:33:54
In reply to Re: SLS? Your input please. » Maxime, posted by SLS on October 12, 2005, at 13:03:53
Hi Scott, no it's not frustrating because how can others know how many things I have tried. I haven't tried Requip or Mirapex.
Mood Stabilisers:
Topomax= psychosis on two occasions
Lamictal= increased depression
Depakote=Rash
Lithium=always toxic no matter what. Have tried several times.
Tegretol = Could not take side effects. Really tried to stick it out but it made me throw up and really dizzy.
Neurotin=pitting edema
Klonopin which I take at night
Trileptal which I take 450 mg at nightI haven't tried Geodon.
I think that covers everything.
Maxime
> Hi Maxime.
>
> It must be frustrating for you to receive so many suggestions that you have already tried and failed with.
>
> Have you ever tried taking Mirapex or Requip?
>
> Which mood-stabilizers have you tried so far?
>
>
> - Scott
Posted by SLS on October 13, 2005, at 11:18:44
In reply to Re: SLS? Your input please. » SLS, posted by Maxime on October 12, 2005, at 18:33:54
Trileptal is a good drug. I responded to it briefly. I have also had limited success with Keppra. Keppra might be worth a quick trial. You could remain on the other drugs you are taking. Dosages between 1000mg and 2000mg are recommended.
I forgot to ask about Parlodel (bromocriptine) along with the Mirapex and Requip. All three drugs are dopamine receptor agonists that can potentially help with depression, but also can also eliminate the lactation produced by other drugs. Unfortunately, there don't seem to be very many people for whom these drugs continue to improve depression for more than 6 months. After some period of time, a sizeable percentage of people experience the onset of somnolence or "sleep attacks". Still, it might be interesting to see if you respond to one of these drugs to be used as an augmentor of the others you take.
As has been suggested, Prozac is not a safe drug to mix with MAOIs. Although some of the traditional contraindications of MAOI drug combinations have been found to be safe, that of SSRIs and other SRIs is not. Serotonin syndrome is bound to occur. Worse still is the use of Prozac as an experiment. With a half-life of over a week, the sequalae of its combination with an MAOI would last days, not hours. When I experimented with an SRI and Parnate, I chose Effexor for its short half-life. If I were to experience a serotonin syndrome reaction, I was hoping it would be minor and short lived. The result of taking a single small 10-15mg dose of Effexor along with Parnate was indeed an episode of serotonin syndrome during which I was completely delirious and unable to rise out of bed for lack of muscle control. It lasted for about an hour.
How does one night's total sleep deprivation affect you?
- Scott
Posted by Maxime on October 13, 2005, at 18:13:22
In reply to Re: SLS? Your input please. » Maxime, posted by SLS on October 13, 2005, at 11:18:44
Scott - i can't respond now but will soon. i'm barely here.
m.
> Trileptal is a good drug. I responded to it briefly. I have also had limited success with Keppra. Keppra might be worth a quick trial. You could remain on the other drugs you are taking. Dosages between 1000mg and 2000mg are recommended.
>
> I forgot to ask about Parlodel (bromocriptine) along with the Mirapex and Requip. All three drugs are dopamine receptor agonists that can potentially help with depression, but also can also eliminate the lactation produced by other drugs. Unfortunately, there don't seem to be very many people for whom these drugs continue to improve depression for more than 6 months. After some period of time, a sizeable percentage of people experience the onset of somnolence or "sleep attacks". Still, it might be interesting to see if you respond to one of these drugs to be used as an augmentor of the others you take.
>
> As has been suggested, Prozac is not a safe drug to mix with MAOIs. Although some of the traditional contraindications of MAOI drug combinations have been found to be safe, that of SSRIs and other SRIs is not. Serotonin syndrome is bound to occur. Worse still is the use of Prozac as an experiment. With a half-life of over a week, the sequalae of its combination with an MAOI would last days, not hours. When I experimented with an SRI and Parnate, I chose Effexor for its short half-life. If I were to experience a serotonin syndrome reaction, I was hoping it would be minor and short lived. The result of taking a single small 10-15mg dose of Effexor along with Parnate was indeed an episode of serotonin syndrome during which I was completely delirious and unable to rise out of bed for lack of muscle control. It lasted for about an hour.
>
> How does one night's total sleep deprivation affect you?
>
>
> - Scott
Posted by Maxime on October 14, 2005, at 15:17:42
In reply to Re: SLS? Your input please. » SLS, posted by Maxime on October 13, 2005, at 18:13:22
Keppra. Keppra was the med I was thinking of in as a mood stabiliser. I haven't tried it.
I am going to ask my pdoc about bromocriptine. I haven't taken the Prozac yet. I don't even have it yet. I don't think I want to take after what you and Ed have said.
I think I am just going to throw all my meds out the window and just wither up until I die.
I like that plan the best. I am at the end of my rope and something has happened in real life that has just pushed me over the edge. I just can't take it anymore.
Thanks for your help Scott. I appreciate it.
Maxime
> Scott - i can't respond now but will soon. i'm barely here.
>
> m.
>
>
> > Trileptal is a good drug. I responded to it briefly. I have also had limited success with Keppra. Keppra might be worth a quick trial. You could remain on the other drugs you are taking. Dosages between 1000mg and 2000mg are recommended.
> >
> > I forgot to ask about Parlodel (bromocriptine) along with the Mirapex and Requip. All three drugs are dopamine receptor agonists that can potentially help with depression, but also can also eliminate the lactation produced by other drugs. Unfortunately, there don't seem to be very many people for whom these drugs continue to improve depression for more than 6 months. After some period of time, a sizeable percentage of people experience the onset of somnolence or "sleep attacks". Still, it might be interesting to see if you respond to one of these drugs to be used as an augmentor of the others you take.
> >
> > As has been suggested, Prozac is not a safe drug to mix with MAOIs. Although some of the traditional contraindications of MAOI drug combinations have been found to be safe, that of SSRIs and other SRIs is not. Serotonin syndrome is bound to occur. Worse still is the use of Prozac as an experiment. With a half-life of over a week, the sequalae of its combination with an MAOI would last days, not hours. When I experimented with an SRI and Parnate, I chose Effexor for its short half-life. If I were to experience a serotonin syndrome reaction, I was hoping it would be minor and short lived. The result of taking a single small 10-15mg dose of Effexor along with Parnate was indeed an episode of serotonin syndrome during which I was completely delirious and unable to rise out of bed for lack of muscle control. It lasted for about an hour.
> >
> > How does one night's total sleep deprivation affect you?
> >
> >
> > - Scott
>
>
Posted by Maxime on October 14, 2005, at 15:18:59
In reply to Re: SLS? Your input please. » Maxime, posted by SLS on October 13, 2005, at 11:18:44
Oh and a night of no sleep has no effect on me. I can go a few night without sleep.
Maxime
Posted by SLS on October 14, 2005, at 16:48:04
In reply to Re: SLS? Your input please. » SLS, posted by Maxime on October 14, 2005, at 15:18:59
> Oh and a night of no sleep has no effect on me. I can go a few night without sleep.
You just want to make things more difficult on me!
:-)
I'm still thinking...
- Scott
Posted by Maxime on October 14, 2005, at 17:09:20
In reply to Re: SLS? Your input please. » Maxime, posted by SLS on October 14, 2005, at 16:48:04
> > Oh and a night of no sleep has no effect on me. I can go a few night without sleep.
>
> You just want to make things more difficult on me!
>
> :-)
>
> I'm still thinking...
>
>
> - Scott
>((((Hugs))))
Maxime
This is the end of the thread.
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