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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 Meri-Tuuli on May 14, 2006, at 10:05:58
Okay so the moclobemide I had tentatively pinned my hopes on, didn't work out. It seems I'm allergic to it.
The pdoc is ringing me tomorrow to discuss getting something else. Now, he was actually asking me what I would like to try next....I thought he was the one who knew what to prescribe not me! But hey, I guess its good I've got an open minded pdoc.
I've tried:
prozac - anxiety levels through the roof
effexor - Didn't like
celexa - hated: apathic, slept too much, couldn't concentrate, tired all the time
reboxetine - quite liked, but got bad acne + my periods stopped.
wellbutrin - too much anxiety and got rash (allergic?)
moclobemide - rash due to an allergic reaction?
St John's wort - pretty good, but somehow not 'strong' enoughSo I guess I'm now looking at the TCAs. Argh! Basically, I am constrained by two things;
I live in the UK and here it is impossible for me to get MAOIs, benzos, and stimulants, and antipyschotics and exotic regimens of polypharmacy, or so it seems.
Secondly, I seem to be pretty med sensitive, and need lower end dosages. And even then I get loads of side effects so god knows what a TCA would be like for me. Plus I have no problem sleeping, I tend to sleep too much, particulry on serotonic meds.
I suffer plain depression. Its kind of like a blah, no-motivation, apathetic, fatigued and completely joyless depression.
So basically, whats left to try??????
If I had the means to self medicate with illict drugs I probably would. I would like to try a stimulant. But, that would never happen here.
Argh!
Posted by ed_uk on May 14, 2006, at 10:49:32
In reply to Utterly hopeless - whats left to try? Please help, posted by Meri-Tuuli on May 14, 2006, at 10:05:58
Hi Meri
I'd go for lofepramine (Gamanil). It is a non-sedating TCA which usually has mild side effects. I used to take it myself.
It comes as scored 70mg tablets. They are difficult to cut in half - don't chop a finger off!
Ed x
Posted by Meri-Tuuli on May 14, 2006, at 11:55:22
In reply to Re: Utterly hopeless - whats left to try? Please help » Meri-Tuuli, posted by ed_uk on May 14, 2006, at 10:49:32
Hi Ed again!
Thanks for the suggestion. Looks like an very interesting med, and pretty kind on the side effects side.
What would you say the main (in real life - not the drug leaflet style!) side effects were?
Is it relatively 'safe' drug to take? I always worry when I read in the drug leaflet things about those poor people who got 'heptatic impairment' and liver diease etc.
Anyway how long wash out do I need? Any ideas??
I've read only a couple of days, but that somehow seems 'wrong'!How does it work exactly? I just read it affects noradrenaline. Noradrenlinic drugs seem to work for well for panic for me. Although my friends say I become mean on them.
Anyway, thanks again,
Kind regards
Meri
Posted by SLS on May 14, 2006, at 11:55:53
In reply to Re: Utterly hopeless - whats left to try? Please help » Meri-Tuuli, posted by ed_uk on May 14, 2006, at 10:49:32
> I'd go for lofepramine (Gamanil). It is a non-sedating TCA which usually has mild side effects. I used to take it myself.
What do you use as a source of information regarding which drugs are available in the BNF?
I think lofepramine is an ideal first choice of TCA in this case because desipramine can be alerting. However, I was wondering whether or not nortriptyline was also available. What about maprotiline? I know maprotiline can be nasty in terms of side effects, but it is one of the drugs I have not yet tried.
- Scott
Posted by Meri-Tuuli on May 14, 2006, at 12:10:56
In reply to Re: Utterly hopeless - whats left to try? Please h » ed_uk, posted by SLS on May 14, 2006, at 11:55:53
Hi Scott,
> What do you use as a source of information regarding which drugs are available in the BNF?
I use the online BNF: http://www.bnf.org/bnf/
> I think lofepramine is an ideal first choice of TCA in this case because desipramine can be alerting.I don't think desipramine is available in the UK.
>However, I was wondering whether or not nortriptyline was also available.Yes its available. I was thinking of trying until Ed suggested the lofepramine.
>What about maprotiline? I know maprotiline can be nasty in terms of side effects, but it is one of the drugs I have not yet triedFor me, I wouldn't like to try it (I don't need sedating, and rashes seem to be bit of a problem!) but its avaiable here in the UK.
I hope you're doing alittle better??Kind regards
Meri
Posted by ed_uk on May 14, 2006, at 13:11:23
In reply to Re: Utterly hopeless - whats left to try? Please h, posted by Meri-Tuuli on May 14, 2006, at 11:55:22
Hi Meri
>What would you say the main (in real life - not the drug leaflet style!) side effects were?
The most common side effects are flushing, increased sweating, elevated heart rate, dry mouth (usually mild), constipation, insomnia, urinary hesitancy in men and occasionally headaches, drowsiness and dizziness.
My side effects were increased sweating and elevated heart rate. Didn't notice anything else.
>Is it relatively 'safe' drug to take?
Yes, except in people with coronary heart disease because it increases the heart rate. Hepatitis is a rare side effect.
>Anyway how long wash out do I need? Any ideas??
From moclobemide? Two days is fine.
>How does it work exactly?
It is predominantly an NE reuptake inhibitor.
Ed x
Posted by ed_uk on May 14, 2006, at 13:15:47
In reply to Re: Utterly hopeless - whats left to try? Please h » ed_uk, posted by SLS on May 14, 2006, at 11:55:53
Hi Scott
>BNF
Meri beat me to it!
>However, I was wondering whether or not nortriptyline was also available.
It is, yes: Allegron. Desipramine (Pertofran) was discontinued in the UK over 10 years ago. Pdocs tend to prefer lofepramine over nortriptyline because it's less dangerous in overdose.
>What about maprotiline?
Yes, but it's almost never used. The brand name in the UK is Ludiomil.
Ed
Posted by Phillipa on May 14, 2006, at 13:21:02
In reply to Re: Utterly hopeless - whats left to try? Please h » SLS, posted by ed_uk on May 14, 2006, at 13:15:47
Ludiamil I took it once and it made me totally out of it. I felt like I was sleeping but never fell asleep. One dose was all I took. Was working then. Love Phillipa
Posted by ed_uk on May 14, 2006, at 13:23:33
In reply to Re: Utterly hopeless - whats left to try? Please h » ed_uk, posted by Phillipa on May 14, 2006, at 13:21:02
Ludiomil can cause a lot of drowsiness at first!
Ed xx
Posted by SLS on May 14, 2006, at 13:25:35
In reply to Re: Utterly hopeless - whats left to try? Please h » SLS, posted by Meri-Tuuli on May 14, 2006, at 12:10:56
> > What do you use as a source of information regarding which drugs are available in the BNF?
> I use the online BNF: http://www.bnf.org/bnf/Does it cost anything to register?
> > I think lofepramine is an ideal first choice of TCA in this case because desipramine can be alerting.
> I don't think desipramine is available in the UK.I'm sorry. I guess I didn't make myself clear. Lofepramine is a prodrug. Although the lofepramine molecule itself is basically inactive, its metabolite, desipramine, is. You are basically taking desipramine when you take lofepramine.
> >However, I was wondering whether or not nortriptyline was also available.
> Yes its available. I was thinking of trying until Ed suggested the lofepramine.If one drug fails, sometimes the other one works.
> I hope you're doing alittle better??
I guess. My mental state is tenuous. I have thought about suicide a few times this week.
Thanks for asking.
- Scott
Posted by ed_uk on May 14, 2006, at 13:33:57
In reply to Re: Utterly hopeless - whats left to try? Please h » Meri-Tuuli, posted by SLS on May 14, 2006, at 13:25:35
Hi Scott
>Does it cost anything to register?
No it's free :)
Ed
Posted by Meri-Tuuli on May 14, 2006, at 14:10:12
In reply to Re: Utterly hopeless - whats left to try? Please h » Meri-Tuuli, posted by SLS on May 14, 2006, at 13:25:35
Hello again,
> I'm sorry. I guess I didn't make myself clear. Lofepramine is a prodrug. Although the lofepramine molecule itself is basically inactive, its metabolite, desipramine, is. You are basically taking desipramine when you take lofepramine.
I see!! I guess I read your first post wrong! Nevermind. Well thats good if its alerting.
> If one drug fails, sometimes the other one works.
I've never been on a TCA. So I guess lofepramine would be the first choice in my case.
> I guess. My mental state is tenuous. I have thought about suicide a few times this week.
Yeah me too :( I try and tell myself that life is an adventure, a journey - you know, its not the desination that matters, but the journey. Doesn't really help! Oh well.
Sigh. I wish we could all get better! I'm slowly begining to accept that my life will be a lifelong struggle against depression. Which is quite frightening considering I'm nearly 26! Thing is, I don't know whether to give in to it, and tailor my life to be as depression-free as possible (if that makes sense) ie don't do a masters, anything out of my comfort zone, don't get a 'professional' job etc. Or whether I should just try and if I crash and burn a few times, then so be it. At least I would have had a decent shot at something. And I would never wonder 'what if'. At the moment, I'm on course to be a lecturer's wife, which as 'comfortable' as it sounds, isn't really what I would want out of life. Oh well.
Anyway take care.
Kind regards
Meri
Posted by pseudoname on May 14, 2006, at 15:35:35
In reply to Utterly hopeless - whats left to try? Please help, posted by Meri-Tuuli on May 14, 2006, at 10:05:58
> I live in the UK and here it is impossible for me to get MAOIs, benzos, and stimulants, and antipyschotics and exotic regimens of polypharmacy, or so it seems.
Are UK stimulants impossible? What do they give kids diagnosed with ADHD? If they do prescribe methylphenidate or other stims for it, can you find some ADHD symptoms in yourself? I'm not suggesting you fake anything, just that we all have attention problems that can be honestly highlighted in the right context — especially us no-motivation, apathetic depressives.
Since a stim's helpfulness can be judged very quickly, maybe it'd be worth considering an attempt to get one?
If not, Meri, good luck with lofepramine. I'm just thinking out loud.
> It comes as scored 70mg tablets. They are difficult to cut in half - don't chop a finger off!
I love my little $4 tablet splitter! It's the only way I can cut my tiny Subutex doses. http://www.hearmore.com/ProdImages/67015.jpg
Posted by Meri-Tuuli on May 14, 2006, at 16:10:44
In reply to stimulants hard to get in UK? » Meri-Tuuli, posted by pseudoname on May 14, 2006, at 15:35:35
Hi PN!
> Are UK stimulants impossible? What do they give kids diagnosed with ADHD?
Under 16s with ADHD don't seem to have problems getting it. Although it seems that there aren't nearly as many kids here with ADHD than in the US. I reckon its underdiagionsed, particulary in females. But honestly, after 16, who knows? I suppose if you were diagnosed at a young age and kept with the same docs etc and then grew up and your symptoms were the same, then it'd be okay. But I've never heard of an adult being dignosed with ADHD for the first time. You know, as in, they've had it since childhood, but it just never got diagnosed til they were much older.
>If they do prescribe methylphenidate or other stims for it, can you find some ADHD symptoms in yourself? I'm not suggesting you fake anything, just that we all have attention problems that can be honestly highlighted in the right context — especially us no-motivation, apathetic depressives.
Yeah, I know exactly what you mean. I could probably find alot of ADHD symptoms in me. Even my friends joke about it. The thing about getting into trouble because you said stuff before thinking -- I thought it was me being rude and tactless!! Actually, I'm desperate to try stims. Sadly I really don't think my pdoc (as amenable as he is) would let me try a stim. I've only seen him once, and at the moment, I'm trying to build up my trust with him. You know what I mean? If the drug we try next doesn't work, then I probably will suggest a stim. Yeah, I once did an online ADHD test and I was off the scale.
I honestly don't know what they do with ADHD people here in the UK, particulary adults. I suspect that there is a vast swave of people underdiagnosed with it, who are in all likeihood self medicating with things or illict drugs. I've never ever met an adult with ADHD here. Or rather, one that has offically been diagnosed as one.I honestly don't know why UK docs/pdocs are so anti stimulants. Seriously, their eyes would pop out if I asked for a stim. Still, I might anyway. One UK poster managed to get dexerine from a pdoc- but since then, he's been struck off.
Ed_uk would probably be better able to comment on stims vs the UK.
Its the same story for benzos too.
It really makes me mad that people here can't get access to the drugs that might help them.
> If not, Meri, good luck with lofepramine. I'm just thinking out loud.
Thanks!
Kind regards
Meri
Posted by Phillipa on May 14, 2006, at 19:51:24
In reply to Re: Utterly hopeless - whats left to try? Please h » Phillipa, posted by ed_uk on May 14, 2006, at 13:23:33
Ed I wish it had been drozziness it was like a space cadet out of it totally. And I had to take care of pts. then. I really don't know I did it that day. Love Phillipa
Posted by patrickhh on May 16, 2006, at 15:07:50
In reply to Utterly hopeless - whats left to try? Please help, posted by Meri-Tuuli on May 14, 2006, at 10:05:58
You might try a mood stabilizer like lithium. Often times when people have reactions like you do to antidepressants they may have some soft bipolar signs. Adding lithium is worth a shot. Even if you don't have any bipolar signs, in literature it's the most tried and true augmenting agent.
Posted by Declan on May 17, 2006, at 1:07:28
In reply to Utterly hopeless - whats left to try? Please help, posted by Meri-Tuuli on May 14, 2006, at 10:05:58
Hey Merri
You might not so much be med sensitive as reactive/allergic. The meds you have reacted to positively are stimulating (I think). I found 75mg/d moclobemide as stimulating as I could easily hack. So what does that leave you with, assuming you can't get Parnate in the UK? Desipramine?
Declan
Posted by Meri-Tuuli on May 20, 2006, at 8:45:28
In reply to Re: Utterly hopeless - whats left to try? Please h » Meri-Tuuli, posted by Declan on May 17, 2006, at 1:07:28
Hi Declan,
Sorry I didn't notice your post for ages! And I've been super busy - my mother is staying for a while, and I find it super draining. Anyway,
Yeah, you can get parnate, but I don't want the food restrictions (I'm paranoid anyway about poisening myself as it is, let alone taking a drug that could actually mean you poisen yourself!) plus the pdoc I'm seeing says they're not much good - which I know isn't true, but well, I guess I have to try and 'work with him' as much as possible, if you know what I mean.
Anyway actually you can't get despiramine here, but you can get lofepramine which apparently breaks down into despiramine in your body (or so I understand!)
Yeah, I rather wish moclobemide worked out. I liked the feeling of being energised. The pdoc reckoned I got an inflammation of those tiny capilaries which was what caused the red spots/rash. I wonder how he could make that diagnosis, considering he never saw the spots!!
I have a complete lack of enery and zero motivation and blah feeling. Its awful. Anyway. I need a stimulant!
Kind regards
Meri> Hey Merri
> You might not so much be med sensitive as reactive/allergic. The meds you have reacted to positively are stimulating (I think). I found 75mg/d moclobemide as stimulating as I could easily hack. So what does that leave you with, assuming you can't get Parnate in the UK? Desipramine?
> Declan
Posted by Meri-Tuuli on May 20, 2006, at 8:58:57
In reply to Re: Utterly hopeless - whats left to try? Please h, posted by Meri-Tuuli on May 20, 2006, at 8:45:28
Posted by whitelab on May 23, 2006, at 16:02:37
In reply to Re: Utterly hopeless - whats left to try? Please h, posted by Meri-Tuuli on May 20, 2006, at 8:45:28
Don't give up yet. I've gone almost a year before feeling horrible while the doctors fiddled with drugs and dosages, but they finally got right.
Have you tried Wellbutrin (bupropion)? And I mean a good slug of it--300 to 450 mg/d. It tends to be pretty energizing, as well as being a good antidepressant for most people.
--woof!
This is the end of the thread.
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