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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by SLS on September 22, 2006, at 7:29:30
In reply to Re: Nortriptyline » SLS, posted by tensor on September 22, 2006, at 7:03:37
> Hi SLS,
>
> When i have had my relapses i raised the dose with 25mg almost immediately, from then it took only a few days to recover. It has been several months between each relapse so i have given each dosage an adequate amount of time. The thing is, when it works, my mood, motivation and energy is really good. Probably better than i have ever been without meds, including childhood(no, it's not hypomania.).Nortriptyline is a good drug. Dirt cheap too.
It just takes a little more finesse to arrive at the right dosage. Most people respond to 75-100mg.
Fortunately, you had the latitude to experiment to find your optimum dosage. Perhaps Lamictal would stabilize you and obviate your need to continually raise your dosage.
- Scott
Posted by Meri-Tuuli on September 22, 2006, at 11:28:12
In reply to Re: Nortriptyline, posted by SLS on September 22, 2006, at 7:29:30
Hei!
Minun asun Turuassa nyta!
I can't 'a' with 'dots' on my computer...(any mac users out there who know how this is done...? I can get all sorts of symbols ß®©§å just not 'a' with dots!)
Anyway, I'm really sorry I can't help you with your questions, but well.
I'm going to try out the mental healthcare around these parts soon, I've just not got round to doing it yet....do you know if CBT is popular round here?
Kind regards
Meri-Tuuli
Posted by tensor on September 22, 2006, at 14:08:57
In reply to Re: Nortriptyline, posted by SLS on September 22, 2006, at 7:29:30
> Fortunately, you had the latitude to experiment to find your optimum dosage. Perhaps Lamictal would stabilize you and obviate your need to continually raise your dosage.
Well, i haven't found my optimum dosage yet(?), i'm still climbing upwards, started with 75mg and now i'm taking 175mg, is it gonna stop? There's was a lot of discussing about mood stabilizers over a year ago, lamictal was of them, but i ended up with lithium as an augmentor to zoloft and remeron, it did nothing. We pushed the blood level beyond the unipolar range and into the bipolar, so to speak. I quit lithium and switched from zoloft to nortrip about one and a half years ago and this is where i am now.
I have these relapses with a about one to three months interval, sometomes i get away with boosting with buspar a few days(often works great), but other times like now i need to raise my nortrip dosage. I haven't worked since tuesday and i "need" to be in shape to monday.Any input on this appreciated.
/Mattias
Posted by ed_uk on September 22, 2006, at 14:24:35
In reply to Nortriptyline, posted by tensor on September 22, 2006, at 1:16:16
Hi Mattias
Given that you're on a high dose of nort, perhaps you should have an ECG, especially if you're planning on raising the dose further.
Ed
Posted by tensor on September 22, 2006, at 14:28:39
In reply to Moikka! :o), posted by Meri-Tuuli on September 22, 2006, at 11:28:12
Hej Meri-Tuuli!
So you live in Turku now, are you studying? I see a person who is both a pdoc and therapist, she has her own reception so it's not for free, she charge me 70e for 45min. I'm not going to the mental healthcare because the pdoc i used to see there thinks lithium is the only substance that can help me.
I really don't know about any CBT's in Turku but i think there's a private hospital known as Pulssi, but try the free healthcare first.And the dots you asked about, first go to this page: http://www.lookuptables.com/
Scroll down to "Extended ASCII Codes", as you see, every character has its own code, for example Ä has the code 142. So when you are using a keyboard without åÅäÄöÖ, you can input them like this, hold down [Alt] button, wkile keeping it down type 142, release the button and the character "Ä" will appear. This works with PCs, i'm not sure with MAC.Kind Regards,
Mattias
Posted by tensor on September 22, 2006, at 14:40:08
In reply to Re: Nortriptyline » tensor, posted by ed_uk on September 22, 2006, at 14:24:35
Hi Ed, it's been awhile :-)
>Given that you're on a high dose of nort, perhaps you should have an ECG, especially if you're planning on raising the dose further.
That's not a bad idea, i will suggest that when i see her at tuesday, i'm also going to take a blood test next week. You know what i've been through, given the frequent relapses that i've had since i started with nortrip, has it always been a too low dosage? I wonder what causes it, and what can be done to prevent it. First i'm going to see what the level of nortrip is at 175mg.
So, how is it going for you, are you still taking lofepramine? Selegiline? Are you studying or are you working? If you charged people 1e for every advice you give, you would rich by now..
Kind regards,
Mattias
Posted by SLS on September 22, 2006, at 14:53:30
In reply to Re: Nortriptyline » SLS, posted by tensor on September 22, 2006, at 14:08:57
> > Fortunately, you had the latitude to experiment to find your optimum dosage. Perhaps Lamictal would stabilize you and obviate your need to continually raise your dosage.
>
> Well, i haven't found my optimum dosage yet(?), i'm still climbing upwards, started with 75mg and now i'm taking 175mg, is it gonna stop?Perhaps you are a rapid-metabolizer. Yes, getting a blood-level is certainly a good idea. Let us know what it is. At 175mg, most people would be beyond the therapeutic window. So, yes, there is a ceiling, and you may have reached it.
I would not compare Lamictal to lithium. Lamictal exerts antidepressant effects that go beyond mood stabilization. Also, its mood stabilization effects are likely derived from a different mechanism of action from lithium. You just can't lump all the mood-stabilizers together as a class.
What was your response to Wellbutrin?
- Scott
Posted by tensor on September 22, 2006, at 16:15:35
In reply to Re: Nortriptyline » tensor, posted by SLS on September 22, 2006, at 14:53:30
Hi,
the results from the up coming blood test is going to take awhile, first i want to stay at 175mg for at least a week, then it takes 5-6days to get results from the lab, anyway i will let you know. One(of many) problem with ever increasing doses is that it's very difficult falling asleep, once i sleep i sleep to the morning. But since i started with 150mg, a couple of months ago, i need to take zopiclone to fall asleep. It works most of the time, but gives me a bit of hangover, making it even more difficult getting up in the morning; halflife is to long. However, the use of zopiclone must be transient, it's enough taking one BZD(clonazepam 2mg).
Lamictal.. i thought fish oil would be enough to stabilize my mood :-) I haven't thought about mood stabilizers for awhile, if it can stop my frequent relapses i'm gonna try it.
I have never tried Wellbutrin, here in the nordic region it is only indicated for treating smoking cessation. I'm not convinced enough to fight for it. If you meant zoloft, it worked very well together with remeron but suddenly stopped working completely, we pushed the doses to 45mg remeron and 150mg zoloft at which point the akathisia was unbearable and there was no sign of improvement.Kind regards,
Mattias
Posted by zeugma on September 22, 2006, at 18:41:07
In reply to Re: Nortriptyline » SLS, posted by tensor on September 22, 2006, at 14:08:57
sometomes i get away with boosting with buspar a few days(often works great)>>
buspar works best when taken over a long period of time.
-z
Posted by tensor on September 23, 2006, at 4:27:31
In reply to Re: Nortriptyline » tensor, posted by zeugma on September 22, 2006, at 18:41:07
> buspar works best when taken over a long period of time.
Yes i know, but it is something i have found out myself. It seems to boost noradrenaline, if i feel somewhat depressed and i take 10-20mg of buspar at bedtime i often wake up very energized. Exactly the same feeling as when you are taking a too high dose of e.g. remeron, edronax or nortrip. This probably works on a very few people. Sometimes i take buspar prior to sex to counteract the sexual s/e of nortrip, this also often works fine. I do only take buspar p.r.n.
/Mattias
Posted by SLS on September 23, 2006, at 6:18:08
In reply to Re: Nortriptyline » zeugma, posted by tensor on September 23, 2006, at 4:27:31
> > buspar works best when taken over a long period of time.
>
> Yes i know, but it is something i have found out myself. It seems to boost noradrenaline, if i feel somewhat depressed and i take 10-20mg of buspar at bedtime i often wake up very energized. Exactly the same feeling as when you are taking a too high dose of e.g. remeron, edronax or nortrip. This probably works on a very few people. Sometimes i take buspar prior to sex to counteract the sexual s/e of nortrip, this also often works fine. I do only take buspar p.r.n.
Buspar (buspirone) is metabolized extensively into 1-PP. 1-PP is a NE alpha-2 autoreceptor antagonist just like Remeron and yohimbine. This mechanism produces an increase in the synthesis and release of norepinephrine. I mention yohimbine because it is sometimes suggested as an aid to counteract sexual dysfunction and, before the availability of Remeron, was sometimes suggested in the treatment of treatment-resistent depression.
- Scott
Posted by tensor on September 23, 2006, at 11:28:07
In reply to Re: Nortriptyline, posted by SLS on September 22, 2006, at 6:17:23
Hi Scott,
> I respond best to 100mg of nortriptyline. I think my blood level is 123 ng/ml. It is in combination with Lamictal. Unfortunatly, it only produces about a 15% improvement, but it gets me out of bed.
Based on my situation, would you recommend me adding lamictal to remeron and nortrip? Should i make any changes in my current dosage first? If you happen to have some good links about lamictal and recurring unipolar depression, please let me know, need to arm myself with some good articles before my appointment with my pdoc.
/Mattias
Posted by Meri-Tuuli on September 23, 2006, at 15:14:52
In reply to Re: Moikka! :o) » Meri-Tuuli, posted by tensor on September 22, 2006, at 14:28:39
Hei!
Well, 70e for 45mins is pretty okay, by my reckoning. Yes, I'm a student in Turku now! I rather like Turku, sure its no Helsinki, but its nice. And very safe! And pretty cheap too.
Anyway, because I'm a student I get the free student healthcare thing, complete with 'mental healthcare counselling' whatever that means, although I do intend to try it out! Yeah after mental healthcare starved UK, Finland is turning out to be a breath of fresh air! Well at least according to the info in the healthcare guides. My goodness, its full of 'mental healthcare' lines, Crisis prevention numbers and such. In the UK equivalent student guides, where might be a number for 'student support services' if you're lucky. Certainly no mental healthcare!!!
Anyway.
I can't actually get the a with dots using your method, muct be a mac thing. I do, however, get swedish å as in Åland! :o)
Meri-Tuuli
Posted by tensor on September 23, 2006, at 16:11:56
In reply to Re: Moikka! :o) » tensor, posted by Meri-Tuuli on September 23, 2006, at 15:14:52
Hej,
yes 70e is okay, and i have an insurance that covers it all, so for me it's free. I'm beginning to feel the effects of the higher dose of nortrip, not much of mood improvement but i feel the restlessness is coming, along with muscle weakness, fatigue etc. I have felt this way before, high doses of noradrenergic drugs that just give side effects; akathisia. It's like the fuel is there, but no spark.
You are studying something in environment, right?I have an idea about the dots, i write them here so you can copy and paste whenever you need to :-)
å Å ä Ä ö ÖMattias
Posted by ed_uk on September 23, 2006, at 16:15:26
In reply to Re: Nortriptyline » ed_uk, posted by tensor on September 22, 2006, at 14:40:08
Hi Mattias
Nice to hear from you :)
I'm not on lofepramine anymore, just citalopram. I'm working now - I never went back to uni. I hope you can find a dose of nort which gives you consistent relief.
Regards
Ed
Posted by tensor on September 23, 2006, at 17:54:04
In reply to Re: Nortriptyline » tensor, posted by ed_uk on September 23, 2006, at 16:15:26
Hi Ed,
> I'm not on lofepramine anymore, just citalopram.
How does it work for you?
>I'm working now - I never went back to uni.
ok, how is it with your energy and motivation, any plans going back to uni?
>I hope you can find a dose of nort which gives you consistent relief.I honestly don't think i will.
/Mattias
Posted by SLS on September 24, 2006, at 8:24:20
In reply to Lamictal » SLS, posted by tensor on September 23, 2006, at 11:28:07
> > I respond best to 100mg of nortriptyline. I think my blood level is 123 ng/ml. It is in combination with Lamictal. Unfortunatly, it only produces about a 15% improvement, but it gets me out of bed.
> Based on my situation, would you recommend me adding lamictal to remeron and nortrip? Should i make any changes in my current dosage first? If you happen to have some good links about lamictal and recurring unipolar depression, please let me know, need to arm myself with some good articles before my appointment with my pdoc.
Here a few listings of abstracts on Medline involving unipolar depression.
My doctor has found Wellbutrin + Lamictal to be particularly effective. I really don't know what to recommend to you regarding your present treatment. You may have reached a dead-end of sorts. However, I would not abandon it without adding Lamictal first. You might try to add the Lamictal now and leave it in place as you try other things if it becomes necessary.I think you should first establish a therapeutic dosage of nortriptyline based upon blood levels. You will need to remain at any one dosage for 10 days before testing. You can begin the Lamictal as you do this. Use the starter pack that they offer for bipolar patients. If unavailable, you can get the 25mg tablets to start with and use the following titration schedule if you are not taking Depakote. If you are taking Depakote, divide the dosages in half.
25mg x 2 weeks
50mg x 2 weeks
100mg x 1 week
* 150mg x 1 week
200mg - target dosage* I stuck the 150mg in there. I am rather conservative. You can skip it if you want. It does not appear in the manufacturer's recommendations:
http://www.rxlist.com/cgi/generic/lamotrigine_ids.htm
What is the Remeron doing for you at 15mg?
- Scott
Posted by tensor on September 24, 2006, at 10:22:59
In reply to Re: Lamictal » tensor, posted by SLS on September 24, 2006, at 8:24:20
Hi Scott, thanks for the links!
>You might try to add the Lamictal now and leave it in place as you try other things if it becomes necessary.
I think that's a good idea, if you change more than one thing at a time, one has no idea what caused what.
> I think you should first establish a therapeutic dosage of nortriptyline based upon blood levels. You will need to remain at any one dosage for 10 days before testing. You can begin the Lamictal as you do this.
Yes, the sooner the better, the titration will take some time.
> 25mg x 2 weeks
> 50mg x 2 weeks
> 100mg x 1 week
> * 150mg x 1 week
> 200mg - target dosage
>
> * I stuck the 150mg in there. I am rather conservative. You can skip it if you want. It does not appear in the manufacturer's recommendations:Thanks for the dose schedule.
>What is the Remeron doing for you at 15mg?
Remeron was the first AD i responded to, about 8 years ago, i have tried to remove it a few times but i have always ended up continuing taking it, it's like it's needed in the background. I don't know how i would respond to a discontinuation now. Anyway, it's only 15mg.
I hope i can reduce the nortrip dosage down to a more normal level, or better still, remove it, if lamictal gives me some AD effect. It will be interesting to hear what my pdoc has to say about lamictal at tuesday./Mattias
Posted by Meri-Tuuli on September 24, 2006, at 11:05:38
In reply to Re: Moikka! :o) » Meri-Tuuli, posted by tensor on September 23, 2006, at 16:11:56
Hei
>It's like the fuel is there, but no spark.
Yes when I tried reboxetine, thats exactly how I felt. Energy and things, but no motivation or desire to actually do anything about it.
> You are studying something in environment, right?
Well I'm actually studying geology, under the title of a masters in 'environmental science' -- there's alot of overlap.
Thanks for the charactors!!
I have often wondered why people take out health insurance here. I mean, the public hospitals and things (I'm led to believe) are much better than in the UK for example - so why bother with health insurance? I mean, you get all the health services here for free anyway don't you? Or is there something I'm missing?
I have to say I do really like it here. I don't want to move! I think I might have to become fluent in Finnish before I can find a job, post studies through.
Meri-Tuuli
BTW how did it work out with your boat this (very nice!) summer?
Posted by tensor on September 24, 2006, at 14:44:28
In reply to Re: Moikka! :o) » tensor, posted by Meri-Tuuli on September 24, 2006, at 11:05:38
Hej,
> Well I'm actually studying geology, under the title of a masters in 'environmental science' -- there's alot of overlap.
Interesting, i have a friend who is a rock driller, when we party, the only thing he talks about, is his job. :-) He is really into geology.
> Thanks for the charactors!!
np :-)
> I have often wondered why people take out health insurance here. I mean, the public hospitals and things (I'm led to believe) are much better than in the UK for example - so why bother with health insurance? I mean, you get all the health services here for free anyway don't you? Or is there something I'm missing?Because it's often long waiting time to public hospitals, private receptions and docs can help you quicker, but that's something you have to pay for yourself. To further complicate this, you may then apply for compensation at FPA/KELA who will then pay 60% of the costs. If you have health insurance, they(the insurance company) will pay for the remaining 40%.
Another thing is the meds, they can be pretty expensive, with insurance, just send a copy of your prescriptions and the receipts to the insurance company and they compensate for all costs, money back right to your bank account. Imagine how fast i earn back the premium when i go to the pharmacy, they are not getting rich on me, so to speak. :-)
Another thing is hospitalization, there's a fee for each day you stay, not much but..> I have to say I do really like it here. I don't want to move! I think I might have to become fluent in Finnish before I can find a job, post studies through.
> BTW how did it work out with your boat this (very nice!) summer?
Really good, I actually relaunched it today after some engine adjustments, there's plenty of time left for boating before the ice sets.
Posted by Dr. Bob on September 25, 2006, at 0:28:30
In reply to Re: Moikka! :o) » tensor, posted by Meri-Tuuli on September 23, 2006, at 15:14:52
> I can't actually get the a with dots using your method, muct be a mac thing.
On a Mac, it's two steps, first option-u, then a.
Bob
Posted by Meri-Tuuli on September 25, 2006, at 5:46:46
In reply to Re: Moikka! :o) » Meri-Tuuli, posted by tensor on September 24, 2006, at 14:44:28
Sorry to be a pain (asking you all these questions!) but is there a 'set fee' for the prescriptions? Like in the UK we only pay about £6.50 for each script of medication the pharmacy give us. Is this the same here in Finland? Or does the cost of medication vary? And will KELA pay anything towards the cost? And if so, how expensive is pyschiatric medication??
Glad to hear your boat is going well! Yes, its pretty warm still here, isn't it! Yesterday was around 20ºC!
And once you get bitten by the geology bug, there's no stopping you! Hence your friend talking about it all the time...most people go 'hmmm....rocks.....yeah' and then talk to someone else!!!!!!
Kind regards
Meri-Tuuli
Posted by Meri-Tuuli on September 25, 2006, at 5:52:41
In reply to Re: the ä with dots, posted by Dr. Bob on September 25, 2006, at 0:28:30
Posted by tensor on September 25, 2006, at 6:50:59
In reply to Re: Moikka! :o) » tensor, posted by Meri-Tuuli on September 25, 2006, at 5:46:46
> Sorry to be a pain (asking you all these questions!)
you're not a pain :-)
but is there a 'set fee' for the prescriptions? Like in the UK we only pay about £6.50 for each script of medication the pharmacy give us. Is this the same here in Finland? Or does the cost of medication vary? And will KELA pay anything towards the cost? And if so, how expensive is pyschiatric medication??
Never heard of a set fee. At the pharmacy you pay what the drugs cost, older drugs are cheap, newer ones can be pretty expensive. However, FPA/KELA cover alot of the costs, you need to get the FPA/KELA card and show it to the pharmacist. I'm not really sure about cover rates, because the only thing i do is handing over the prescriptions and reciepts to the insurance company, who compensate 100%. You can find information at http://www.kela.fi/in/internet/suomi.nsf?Open
>Hence your friend talking about it all the time...most people go 'hmmm....rocks.....yeah' and then talk to someone else!!!!!!LOL, kind of true, but when he's drunk and he is telling you a story you've heard twenty times, it gets a bit boring. He really likes his job, that's for sure.
BTW, have you tried lyrica? What dose? (I need to bring up some medical stuff so we won't be directed to the social board) LOL!
Kind regards,
Mattias
Posted by Meri-Tuuli on September 25, 2006, at 9:31:34
In reply to Re: Moikka! :o) » Meri-Tuuli, posted by tensor on September 25, 2006, at 6:50:59
Ah, I see, yeah I need to get the FPA/KELA card, my mother was talking about that...... trouble is, despite having Finnish nationality, my lingo doesn't match my nationality status....!
Its quite clever of the Finnish government, making you claim things back from KELA. In the UK we really just take it for granted that all of our medications cost £6.50 (c 9€/9$)and things like that. Although you can't claim from the NHS things that you do privately.
Anyway I think, unless I'm mistaken, just talking about the costs of medication, etc is enough for it to stay on the meds board....
But I've never tried Lycria.
Thanks for the help! Tack/tag?! (I think!)
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