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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Tepiaca on November 26, 2005, at 16:16:25
My best days in the last 5 years have been
when I stop abruptly a med. Wait for 1 week
and then I restarted again the med.
I did this sometimes with Nardil and It was so great, more great than any other drug. I remember that I though I finally have found the solution to my problem. However this effect lasts only for 7 or 10 days.
THIS IS THE ONLY THING THAT HAS PUT ME INTO A
NORMAl LEVEL OF LIFE.
Do you think If I do this more times, my brain its gonna get used and soon or later this trick is gonna stop working .In august, I stop abruptly Nardil. Then I start and stop taking Seroquel for about 1 month ( 2 days on and 2 day off), I felt very well.
I dont know how safe is to do this with an AP
What do you think that it would be the best drug to this?
I AM SERIOUSLY THINKING TO DO THIS WITH NARDIL.
Has anybody tried this? I heard Scott was doing this with a TricyclicPlease give me some advice. What is the best way to do this.
Tep
Posted by willyee on November 26, 2005, at 16:34:34
In reply to A desperate alternative, posted by Tepiaca on November 26, 2005, at 16:16:25
Maybe its not a trick,perhaps the drug/drugs are workingbest on you when in moderation,and going off it a while doesent nexxasrly mean ur not medicated.
The dosage recomendations on these drugs are as fimbys as there explained methoed of actions and theorys of why they work.
Theres not way they can apply to everyone,ive read about people who took partial prozac tab once a week,every individual is different,go for what works i say.
Posted by iforgotmypassword on November 26, 2005, at 19:09:12
In reply to Re: A desperate alternative, posted by willyee on November 26, 2005, at 16:34:34
it was definately from stopping abruptly, feeling and drive were fading back into me, but then the were gone in days. ugh. don't know what the brain does in that scenario. maybe we should be trying tianeptine? that may cause catecholamine overload and anxiety... maybe it should be tried with a beta blocker? oh god i don't know. for all we know it could have been a hypomanic response, but for us hypomania is the closest we'll ever get to feeling again. i don't know i'm probably totally of the mark.
Posted by blueberry on November 26, 2005, at 20:05:54
In reply to A desperate alternative, posted by Tepiaca on November 26, 2005, at 16:16:25
I've had this happen a lot, not from stopping a med suddenly, but from decreasing the dose suddenly. It works with any of the SSRIs, TCAs, or st johns wort for me. But alas, the good effects only last 2 or 3 days. I know what hypomania feels like, and it isn't that. It is just a nice normal awakening feeling.
I often wonder if maybe there are two scenarios to treat depression...one is to surround the receptors with a stationary thick pool of neurotransmitters, and the other is to have a fresh flowing stream of neurotransmitters. I think when we stop or drop a dose, that stream kicks into action.
Like you said, I think tianeptine sounds like a good possible way to go for any of us that experience this phenomenon.
Posted by iforgotmypassword on November 26, 2005, at 21:09:48
In reply to A desperate alternative, posted by Tepiaca on November 26, 2005, at 16:16:25
Posted by Phillipa on November 26, 2005, at 23:07:24
In reply to Re: A desperate alternative, posted by blueberry on November 26, 2005, at 20:05:54
Want to follow this Thread. Thanks , Fondlly, Phillipa
Posted by SLS on November 27, 2005, at 9:54:19
In reply to A desperate alternative, posted by Tepiaca on November 26, 2005, at 16:16:25
Hi.
:-)
> My best days in the last 5 years have been
> when I stop abruptly a med.This is an all-too-familiar story for me.
I have had this happen upon the discontinuation of several tricyclics and Nardil. More recently, it happened upon abruptly discontinuing imipramine while continuing the Nardil that I had been taking in combination. It was the closest I came to feeling normal in over 15 years.
This phenomenon is sometimes called a discontinuation rebound improvement.
I, too, have been thinking about putting together a plan of alternating between medications in an attempt to provoke this type of reaction. Right now, I am taking Parnate and nortriptyline. Unless something better comes along, I am looking at switching from the Parnate to Nardil. From there, I can perhaps first d/c the nortriptyline and restart it and then follow with Nardil. I don't know.
In general, "pulsing" the same drugs over and over is probably counterproductive and tends to set up for treatment-resistance. However, once you are already treatment-resistant, what else is there?
I once had a marvelous response to initiating Lamictal monotherapy after an abrupt discontinuation of Nardil.
I have actually become manic upon the abrupt discontinuation of some antidepressants, always in association with an MAOI. This probably is more common with Nardil than it is with Parnate.
What exactly is the treatment strategy you are thinking of employing?
- Scott
Posted by ace on November 28, 2005, at 7:59:11
In reply to Re: A desperate alternative, posted by Phillipa on November 26, 2005, at 23:07:24
Posted by ace on November 28, 2005, at 8:00:29
In reply to A desperate alternative, posted by Tepiaca on November 26, 2005, at 16:16:25
TEP.....raise Nardil to 105-135mg
Posted by med_empowered on November 28, 2005, at 8:26:34
In reply to Re: A desperate alternative » Tepiaca, posted by ace on November 28, 2005, at 8:00:29
hey! sorry you're having a rough time. Trust me, though--whatever you're feeling, odds are someone here at the board has felt it, too.
Anyway, like one poster said, it seems like something like tianeptine would be ideal to create that kind of feeling. My guess would be that you could create something kind of similar if you used an SSRI with a serotonin antagonist...docs like APs for this, but it seems like BuSpar would work just fine, if you can tolerate it. It seems like for some people adding BuSpar makes SSRIs more tolerable (less sexual dysfunction, faster response, better response, less akathisia and anxiety). My wild, UN-educated guess would be that BuSpar's serotonin antagonism, combined with *mild* D2 antagonist/agonist action helps counteract the apathy you see with SSRIs by allowing you the benefits of increased serotonin (from the SSRI) while also keeping the serotonin system going at the usual pace, and also preventing too much dampening of the dopamine end of things. Like I said though, thats just a guess. My own experiences with BuSpar were so-so, but I took it for anxiety.
Posted by iforgotmypassword on November 28, 2005, at 14:28:25
In reply to Re: A desperate alternative, posted by med_empowered on November 28, 2005, at 8:26:34
probably another reason why remeron+effexor works so well. ugh.
Posted by Pfinstegg on November 28, 2005, at 18:50:08
In reply to Re: A desperate alternative, posted by med_empowered on November 28, 2005, at 8:26:34
I've taken tianeptine for nearly a year, now, and think it's an excellent drug. It is sort of mild, and without side-effects, but, the longer I take it, the more effective it seems. All the research I've been able to find on it point to a really good neuroprotective profile. I also take Cytomel, fish oil, and all the vitamins. I still have major things I'm dealing with in therapy, but I really do like the feeling of a "floor" under me, which tianeptine has provided- and I also really appreciate feeling normal again sexually, and not feeling anhedonic or apathetic. I'd be so happy if tianeptine were available here! (US)
Posted by Sarah T. on November 29, 2005, at 2:21:28
In reply to Tianeptine, posted by Pfinstegg on November 28, 2005, at 18:50:08
Hi Pfinstegg,
How many milligrams of Tianeptine do you take? I tried it a few years ago. I ordered it a few times, but I did not experience the improvement that you have. I did have very strange food cravings while on that med! I craved salty meat --the saltier, the better. The very thought of it now makes me feel kind of ill, but I do remember eating a lot of corned beef while on Tianeptine. I have no explanation for those cravings. The cravings stopped when I stopped taking the medication.
Posted by Pfinstegg on November 29, 2005, at 8:39:57
In reply to Re: Tianeptine » Pfinstegg, posted by Sarah T. on November 29, 2005, at 2:21:28
I take the reglar recommended dose:12.5 mg. three times a day. I haven't experienced any cravings for salty things, as you did. Maybe someone else could comment on that. Do you think it helped at all?
Posted by SLS on November 29, 2005, at 9:06:16
In reply to Re: Tianeptine » Sarah T., posted by Pfinstegg on November 29, 2005, at 8:39:57
Hi Pfinstegg.
I'm glad you are walking on solid ground. I remember what that feels like. It doesn't instantaneously evaporate all of your problems, but rather, allows you the mental energy and cognitive resources to process them. I felt empowered during my remission. Because I was undeterred from doing the work necessary, I processed a great many issues and lived a very happy and rewarding life - all 6 months of it.
> I take the reglar recommended dose:12.5 mg. three times a day.
How much does that cost you?
$$$
- Scott
Posted by Pfinstegg on November 29, 2005, at 9:25:21
In reply to Re: Tianeptine, posted by SLS on November 29, 2005, at 9:06:16
Hi Scott..it cost $3.30 per day at the dosage I take, and being unapproved here, my pdoc can't prescribe it, so none of it is covered by insurance.
Did you have a pretty good response to it for six months, and then did that stop?
Posted by SLS on November 29, 2005, at 10:34:50
In reply to Re: Tianeptine » SLS, posted by Pfinstegg on November 29, 2005, at 9:25:21
Hi.
> Hi Scott..it cost $3.30 per day at the dosage I take,
Thanks. That's pretty cheap.
> Did you have a pretty good response to it for six months, and then did that stop?
Sorry for the misunderstanding. I have never tried tianeptine.
In 1987, I was placed on a combination of Parnate + desipramine. It was the only treatment that ever brought me into a true remission. Unfortunately, I became manic after 6 months. Both drugs were discontinued. I relapsed into depression 2 months later. The doctor was adamant about not restarting both drugs in combination again. He tried Prozac first because it had just been approved. He then tried Parnate monotherapy for which I was only partially responsive. Being a "good patient", I did not question his decision to avoid the treatment that had been the only one ever to work well. By the time another doctor retried the Parnate + desipramine combination, I was no longer responsive to it. So, here I am.
- Scott
Posted by Pfinstegg on November 29, 2005, at 11:06:57
In reply to Re: Tianeptine » Pfinstegg, posted by SLS on November 29, 2005, at 10:34:50
Oh, I'm sorry to hear that. Just from remembering your posts over the past few years, I think you have tried a lot of other combinations as well. Would you be thinking of combining a low dosage of a mood stabilizer, or low dosage AP, and EMSAM when it comes out? Maybe EMSAM first, and then cautious add-ons if needed?
I think that when people have suffered with depression for a long time- whether it is unipolar, bipolar or atypical- and have taken a lot of medication, we need to treat our brains as gently as possible- for example, with as low amounts of medication as possible, good supplements and vitamins, exercise of whatever type and meditation. And therapy, of course, also. In addition to the original mood disorder, we may have added on additional medication-influenced neurotransmitter dysregulations.Dopamine deficiencies get mentioned, but there may be many other things going on at the same time which we don't know about. I see this subject coming up here, from time to time, but it's clear that there aren't full answers yet. It's something I am always keeping in mind,now, when I have a pdoc visit.
Posted by SLS on November 29, 2005, at 19:40:32
In reply to Re: Tianeptine » SLS, posted by Pfinstegg on November 29, 2005, at 11:06:57
Hi Pfinstegg.
This is what I am currently taking:
Parnate 80mg
nortriptyline 100mg
Keppra 1000mg
Abilify 10mg
Is there a particular depressive subtype that seems most treatable with rTMS?I have what appears to be a severe bipolar depression. It appears most like atypical unipolar depression. Anergia, psychomotor retardation, impaired memory and concentration, and anhedonia are most prominent. In addition, I am hypercortisolemic and a DST non-suppressor.
Do you happen to know what percentage of motor threshold your treatments apply?
My doctor disappointed me today. He is still too afraid of "playing" with MAOIs in combination with TCAs. I wanted to switch from Parnate to Nardil, but he would want me to discontinue the nortriptyline to do so. He also suggested that I consider VNS. He gave me a video to watch regarding the procedure, which I haven't viewed yet. I am not real big on the idea - at least not yet.
In the meantime, I am still trying to get a hold of mifepristone. The players don't seem to be playing on the same ballfield. The people responsible for making this thing happen seem to be vague on what needs to be done. When the dust settles, I might have to commit to spending $2000 for an 8 day treatment.
I am seriously thinking about trying the rTMS sooner than later.
Thanks for all of your input.
- Scott
Posted by Pfinstegg on November 29, 2005, at 22:11:07
In reply to Re: Tianeptine » Pfinstegg, posted by SLS on November 29, 2005, at 19:40:32
Hi Scott..thank you for bringing me up to date on your current medications. It helps me know much more about your situation. I know VNS has been approved, but I am, personally, more skeptical about it than I am about TMS. Mark George has treated a small group of people with severe bipolar- one TMS treatment per week for a year- which resulted in really good remissions while the treatment was going on. I'm sorry that I don't have the reference handy but I think it's easy to find on Medline. I have a more atypical type of unipolar depression, but am very fortunate that it is responsive to TMS as given by Dr. Hutto in Atlanta. He gives it at a percentage of the motor threshold: I started at 65%, and now get 75% when I go for "boosters"- always to the left frontal area. In addition, the other things i have been doing have resulted in an overall lessening in the severity of the depression.
If you explore the TMS literature, which I expect you already have, you will find that it does lower 24-hour cortisol levels, and often reverses DST non-suppression (it does that for me, but only for a short time). If it works (50% chance), it only does so for a short period of time (with Dr, Hutto's patients, they come back for retreatment as often as every three weeks, or, at the other end of the range, every six months). The research on it is very encouraging- citing a lot of neuroprotective benefits, and there does not seem to be any harm- unless you have a seizure disorder, or metal in your skull. When (if?) it's approved, i plan to make it a regular part of my health care here at home. After a lot of exploration, Dr. Hutto and I think that 4-6 treatments every two months would probably be the best protocol.
If you decide to give it a try, please let me know. I would love to know if it works for you! For my initial series of treatments, I had 10 treatments before I felt much benefit, and then had another 5 as "insurance". Now, people are usually given two treatments per day, so that you can receive 20 in two weeks if you want/need them; often 10 are enough.
This is the end of the thread.
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