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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 52. Go back in thread:
Posted by pseudoname on November 3, 2006, at 13:16:29
In reply to considering ECT, posted by pseudoname on November 2, 2006, at 11:39:50
Thanks to everyone who's responded to my post. It really means a lot to me. I knew that I could come to Babble and not worry about how pathetic I sounded. I really appreciate the support.
I am considerably less desperate now. I increased my buprenorphine dose from about 0.25 mg/day to 1.5 mg/day. That pulled me out of that headfirst hole I was in. (When I first started bupe last fall, it took 3 mg/day to get a sustained antidepressant response. Maybe there's a seasonal component to my depression and I just need to take more bupe in the fall & winter?)
Anyway, despite the restored antidepressant response, I still get pleasure out of nothing, so I'm still considering ECT, although I can't imagine how I could manage it logistically.
I want to reply to everyone individually (HUGS all around!), but I may not have time on this public terminal…
Posted by pseudoname on November 3, 2006, at 13:39:43
In reply to Re: considering ECT, posted by ronaldo on November 2, 2006, at 12:51:28
Hi, Alan! Nice to meet you. Thanks for your really thoughtful post.
> Isn't ECT a bit drastic, more like the very last resort?
I think I qualify for the last resort. I have tried an awful lot of drugs and therapies over the last 19 years. My only sustainably effective drug so far (buprenorphine/Subutex®) is only a partial relief at its best.
> Wouldn't changing your drug regime be a more positive alternative?
I'm certainly open to specific med suggestions. Maybe I could give Provigil a shot while I'm waiting. --With bupe! Heh heh. That'll make the drug regulators uneasy. (Not that I mind that) ;-)
Also, it's been a while since I've had an MAOI; I could try one of those again. But with a history of ZERO response to all classes of typical ADs, there's not a lot to work with.
> Another alternative would be to change your pdoc. A new pdoc might have some new ideas and a whole different approach.
I got my current pdoc because my last one insisted on ECT. I've called around a little and the popular new ideas suggested by pdocs around here is VNS, which I rule out for myself as far more drastic than ECT.
I'm not sure where I could get another pdoc with great new ideas. The nearby major university pdoc program is where they insist on ECT. Also, my current pdoc is one of the very few in my state who is willing to prescribe buprenorphine to a non-addict for depression; a daring approach, actually. (For lurkers/info: Subutex, an opioid, is mostly restricted in the U.S. to opioid addicts in recovery programs.)
> Good luck whatever you decide to do.
Thanks much. Likewise. So, you're a nurse?
Posted by pseudoname on November 3, 2006, at 13:42:40
In reply to Re: considering ECT, posted by blueberry on November 2, 2006, at 16:17:50
Hi, blueberry. I've really appreciated following your ECT experience here. And I'm glad it's working out for you.
> Though I've never heard of sexual side effects from ECT, I have them pretty fierce
If you don't mind my asking, what sort of sexual dysfunction are you experiencing from the ECT? I haven't heard of that, either. Thanks very much.
Posted by pseudoname on November 3, 2006, at 13:50:59
In reply to Re: considering ECT, posted by deniseuk190466 on November 2, 2006, at 16:37:51
> My heart bleeds for you.
Thanks, Denise. I loved reading that line.
> Your family sound so insensitive it makes me so angry
As Alan said in reference to my ECT-thinking, this is probably my depression talking. If I weren't depressed, I would probably ignore my family more or disregard their "bad" (i.e., less good) aspects. It's hard to do that when you're head-first in a mental drainage ditch, though. In comparison to many others, they could be a lot worse, I guess.
> What sort of business do you have? Is there no way that you can ask somebody just to manage things whilst you are in hospital.
I can't post what the business is, exactly, but I'm self-employed and work out of my home, with a small client base. If I can have a cell phone in the hospital, it's just *possible* I could manage it for a while, with luck...
> I'm in no way to offer advice I was ready to jump off a cliff last week [metaphorically]
I'm glad you didn't! Good ol' Zyprexa.
> I really hope you the ECT works for you if you did decide to go ahead with it.
Thanks.
Posted by pseudoname on November 3, 2006, at 14:00:34
In reply to Re: considering ECT, posted by ed_uk on November 2, 2006, at 14:51:05
Hi, Ed.
> Are you still taking a 'break' from the bupe or have you restarted it?
I went back on it a couple weeks ago at the very low 0.25 mg/day, which was mildly effective. Yesterday, just before posting my "desperate" post, I took 0.6 mg. Exactly 90 minutes later, I suddenly felt a *lot* better. So -- good news -- bupe still works. Just sometimes it takes more, apparently. I guess I've got to get used to that and try more when needed. There's still room for quite a bit more per day to reach the 3 mg/day originally prescribed last fall.
> Did you stop the Abilify?
I got the Abilify up to 20 mg/day for 5 days without any benefit whatsoever. I quickly tapered down with it and had been taking about 5 mg every other day. Yesterday was probably my last day of Abilify (5 mg), unless I get withdrawal problems.
Thanks *so much* for paying such interest to my case and remembering my details over the last year, Ed. It really warms my heart. You've been a great help.
Hoping you are well,
PN
Posted by pseudoname on November 3, 2006, at 14:01:56
In reply to Re: considering ECT, posted by lymom3 on November 2, 2006, at 12:28:18
Posted by deniseuk190466 on November 3, 2006, at 14:37:01
In reply to Thanks » deniseuk190466, posted by pseudoname on November 3, 2006, at 13:50:59
I'm glad you liked the line, have to admit, it's not my own :-)
Anyway, I still think your family should be more encouraging and supportive but then they don't know what it's like do they but I think if they really loved you then they would try and understand. My mum does try and understand with me and so does my one true friend left.
If you do go and ahead with the ECT then please keep us updated, it seems to have helped blueberry so maybe it will help you.
Just wondering if you have tried any of the antipsychotics, they have helped me and I'm not psychotic just get very very depressed and I don't know why.
Denise
Posted by blueberry on November 3, 2006, at 14:38:53
In reply to What sexual side effects? » blueberry, posted by pseudoname on November 3, 2006, at 13:42:40
ECT sexual side effects...great difficulty in getting and maintaining an erection, impossible to reach an orgasm. I've tried nearly any drug you can think of over the years, I've had plenty of sexual side effects, but nothing anywhere near as dramatic as ECT. Viagra has always worked for me in the past when I needed it, but it was useless against ECT.
Looking back with the benefit of hindsight, I would have avoided ECT bigtime unless my life was in danger from possible suicide. ECT can definitely work, but not without paying some costs, which I'm sure vary a lot from person to person.
I think ECT is a lot more attractive and should be considered when you are aware upfront to keep an eye out for strange things. Nobody ever told me strange things might happen, and thus I got caught offguard.
> Hi, blueberry. I've really appreciated following your ECT experience here. And I'm glad it's working out for you.
>
> > Though I've never heard of sexual side effects from ECT, I have them pretty fierce
>
> If you don't mind my asking, what sort of sexual dysfunction are you experiencing from the ECT? I haven't heard of that, either. Thanks very much.
Posted by ronaldo on November 3, 2006, at 14:40:12
In reply to Thanks » ronaldo, posted by pseudoname on November 3, 2006, at 13:39:43
> So, you're a nurse?
No. LOL. I was a student male psychiatric nurse for about 8 months. That's as far as I got...
...Alan
Posted by ed_uk on November 4, 2006, at 14:13:14
In reply to Re: What sexual side effects?, posted by blueberry on November 3, 2006, at 14:38:53
From your last post:
>Looking back with the benefit of hindsight, I would have avoided ECT bigtime unless my life was in danger from possible suicide.
I think it was blueberry. You seem to have completely changed. Before the ECT, your posts indicated severe depression, have you forgotten?
eg. not long ago, you posted..........
It was cold and raining. I walked to the beach, took my shirt off, laid in the sand I figured I would die of exposure. If I could just get through the shivering part, I would enter that part where you actually feel warm and numb close to the end. Not sure how much time went by, but I was shivering with intense convulsions. Something told me to get up and go home. Could hardly walk. Six inch steps, very drunk-like, shaking uncontrollably, delirious. Went to bed. Woke this morning still crying. Never in my life have I been this bad.
Posted by ed_uk on November 4, 2006, at 14:17:31
In reply to current meds » ed_uk, posted by pseudoname on November 3, 2006, at 14:00:34
Hello PN :)
>I went back on it a couple weeks ago at the very low 0.25 mg/day, which was mildly effective. Yesterday, just before posting my "desperate" post, I took 0.6 mg. Exactly 90 minutes later, I suddenly felt a *lot* better. So -- good news -- bupe still works. Just sometimes it takes more, apparently. I guess I've got to get used to that and try more when needed. There's still room for quite a bit more per day to reach the 3 mg/day originally prescribed last fall.
I didn't realise you were currently taking such a small dose PN. There is certainly room for an increase. I definitely think you should increase your bupe dose before you consider ECT. Once your on a higher dose of bupe, you can try some rare combinations.
>Thanks *so much* for paying such interest to my case and remembering my details over the last year, Ed. It really warms my heart. You've been a great help.
Aww thanks :)
((((PN))))
Love
Ed
Posted by Declan on November 4, 2006, at 18:24:15
In reply to current meds » ed_uk, posted by pseudoname on November 3, 2006, at 14:00:34
Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
If you can maintain an AD effect from bupe in the face of tolerance that would be great.
Posted by JahL on November 4, 2006, at 21:27:34
In reply to Bupe » pseudoname, posted by Declan on November 4, 2006, at 18:24:15
> Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
I had a marvellous response to Bupe. Unfortunately it lasted just a matter of days.
In contrast low-dose Methadone has gifted me with consistent, sustained AD effects for some 6 years now.
I recently had to stop taking it due to supply problems and experienced no withdrawal symptoms whatsoever. This may not the case with (ex-) heroin addicts who will typically take much higher doses, although my friends on Methadone are in the main satisfied with the help it provides.
My illness is highly responsive to any and all opioids.
J.
Posted by Declan on November 5, 2006, at 0:10:02
In reply to Re: Bupe, posted by JahL on November 4, 2006, at 21:27:34
Geez, I'm impressed that you could take it for 6 years and just stop. It's not like that for me.
But I agree with you about the AD effect of opioids.
Posted by linkadge on November 5, 2006, at 16:22:34
In reply to Re: Bupe » JahL, posted by Declan on November 5, 2006, at 0:10:02
Supposedly opiates induce similar electroencephalographic changes as do the TCA's in depression.
Posted by Phillipa on November 5, 2006, at 17:36:35
In reply to Re: Bupe, posted by linkadge on November 5, 2006, at 16:22:34
All I know is the first time a few months back I took a l percocet at night for pain presribed. I was laughing and my husband noticed. It was great as I haven't laughed in a long time. But I told the doc and he said you'll get addicted. Everythings addictive. Love Phillipa
Posted by Declan on November 6, 2006, at 1:10:48
In reply to Re: Bupe » linkadge, posted by Phillipa on November 5, 2006, at 17:36:35
(in another context)
I don't care if it's horse piss, it works.
Posted by pseudoname on November 6, 2006, at 11:20:56
In reply to Bupe » pseudoname, posted by Declan on November 4, 2006, at 18:24:15
> Is the AD effect completely swallowed by tolerance (as seems to be the case with methadone)?
In fact, there seems (for me) to be NO tolerance-development with buprenorphine to its antidepressant effects. Ironically, I think that's where I got into a problem: I was able, circa April-September, to take a much lower dose of bupe than I had previously required. Then, for the last couple months, when my depression was getting worse, I neglected to increase it back to what it was.
It may be that I don't experience tolerance to bupe because I don't get a buzz or high from it in the first place. It just removes the depressive agony and suicidal thoughts.
I also don't seem to get much if any tolerance to the mild but annoying side-effects (like mild cognitive fuzziness) at the higher doses, either.
I'm greatly relieved that bupe is still effective. As Ed notes, I had been taking a pretty small dose recently. I was trying to avoid the (as I say, mild but still annoying) side effects, and I started to consider myself a "0.3-per-day man". I wish there were a published set of guidelines for bupe's use as an AD.
In related news: My pdoc NEVER CALLED ME BACK about getting ECT. She was supposed to talk to the ECT clinic and then let me know who to call for an initial appointment. I even left another message with her answering service last Wednesday. Unless she's meanwhile been hospitalized herself, I think her silence is inexcusable! The only reason I'm keeping her on as my pdoc is that she's willing to prescribe bupe.
Posted by Crazy Horse on November 6, 2006, at 11:26:09
In reply to Re: considering ECT, posted by blueberry on November 2, 2006, at 16:17:50
> ECT can certainly work. For me I found 3 weeks of it to just about completely get rid of depression. There are other problems though...the forgetfulness from ECT is pretty intense. I find myself writing a lot of notes and reminders to myself which I never had to do before. Though I've never heard of sexual side effects from ECT, I have them pretty fierce, when no amount of any drugs ever gave me much problem. I've been doing 3 outpatient ECT sessions per week for 3 weeks, and now I am going to cut it back to just once a week for a while and see how that goes. All in all it seems like a very effective treatment, but I must admit the side effects of confusion and the sexual dysfunction side effects are pretty intense.
Trust me..those side effects will fade with time.
-Monte
Posted by pseudoname on November 6, 2006, at 12:17:22
In reply to Re: Bupe (no tolerance yet!) » Declan, posted by pseudoname on November 6, 2006, at 11:20:56
(I hadn't yet read this more detailed question when I replied before. Sorry if I'm writing too much; I'm a little lonely right now and I don't have internet access at home for the moment.)
> Do you find that after being on x amount of bupe you *lose* the AD effect, or is it maintained. There must be some doses anyway that are more optimal than others. And I suppose that once you move to a higher dose the AD effect off the lower dose has gone? The trouble with methadone is not the effect of methadone as such, but rather how you feel once tolerance has been achieved long term.
For me, a given dose-level of buprenorphine does not seem to lose its effect *due to tolerance*, even over months. The very low 0.25 mg/day I was on remained effective throughout the summer, for example. And if I take an unusually large dose for a few days, the amount *required* for me to get an AD effect does not seem to increase on subsequent days. But also, the AD effect itself doesn't get greater for me with a greater-than-needed dose.
I don't know why I need a larger dose now or last winter than I did during the summer. Given my overall history with bupe, I don't attribute it to tolerance.
My theory on my lack of typical opioid tolerance is due to the fact that I don't get a typical opioid buzz or high from the bupe even if I take a whole lot of it. Not even on my very first day, when I naively took waaaay too much.
But some people apparently do get an opioid buzz from bupe. (Anybody out there?) In those cases, they might develop a tolerance to that but maybe still not to an underlying antidepressant effect? Dunno.
At Dr Bob's presentation about Babble at the Toronto APA convention in May, we went around the room and the Babblers who were there summarized their experience with Babble. I told how I found out about bupe here and now try to help others on Babble learn about it. I'll bet the half-dozen pdocs in the audience were thinking, "Oh great! My patients will visit Babble and then demand that I give them addictive opiates."
But my experience (including this latest little drama) is that buprenorphine is a very safe and — if given a proper chance — enduringly effective antidepressant.
I do wonder, however, if Provigil or Adderall might help the mild cognitive fuzziness that can occur for me at doses above 2 mg/day. Anybody know?
Posted by ed_uk on November 6, 2006, at 13:52:40
In reply to more on buprenorphine tolerance, posted by pseudoname on November 6, 2006, at 12:17:22
Hi PN
Now you're on a higher dose of bupe, and are feeling better............what are your symptoms? ie. which symptoms does bupe leave untreated?
Ed
Posted by pseudoname on November 7, 2006, at 9:43:03
In reply to Re: more on buprenorphine tolerance » pseudoname, posted by ed_uk on November 6, 2006, at 13:52:40
Thanks for the question, Edski.
> what are your symptoms? ie. which symptoms does bupe leave untreated?
I don't do things, or *want* to do them. I don't read books, learn about new things, shower, clean my house, do bookkeeping, spend time with people, enjoy food, etc. Even things that are easy & presumptively pleasurable I have no interest in doing, and I don't enjoy them when I do force myself to do them. Even my fantasies end in indifference. Shall we call that *anhedonia*?
I also have some huge neurotic fears, obsessions, and intrusive thoughts centered around What Other People Think Of Me (chiefly that everyone hates my guts or finds me ridiculous & undeserving), but I suspect that if the anhedonia were cleared up, I could tackle those obsessive thoughts behaviorally / therapeutically / mindfully.
ECT might still help with the anhedonia, might it not? Or perhaps Provigil? Do you think an MAOI might have a different effect for me when I'm on buprenorphine than they did before? I got no response from several MAOI trials 10+ years ago. Don't opioids & MAOIs have an area of intersection in the brain?
Posted by Declan on November 7, 2006, at 11:18:37
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia? I can't see how ECT would give you any get up and go. Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Declan
Posted by ed_uk on November 7, 2006, at 14:34:20
In reply to good question » ed_uk, posted by pseudoname on November 7, 2006, at 9:43:03
Hi PN
Which tricyclic antidepressants have you tried? Perhaps one of the non-sedating tricyclics might help your anhedonia.
Ed
Posted by pseudoname on November 8, 2006, at 11:15:45
In reply to Re: good question, posted by Declan on November 7, 2006, at 11:18:37
Hi, Dek.
> Wouldn't it be more likely for ECT to help with intrusive thought processes than anhedonia?
My understanding from the ECT promotional literature is that it does NOT help with intrusive thoughts or schizophrenic symptoms or mania but does help with more classic depressive symptoms (when it helps at all).
> Which brings stimulants to mind. But if you take all that stuff you can end up simply feeling unwell, on top of whatever else you have.
Yeah. Does that happen even with Provigil? Does anyone know? I.e., does Provigil eventually result in tolerance and after-crash?
Then again, I can't see even my fruitcake pdoc prescribing BOTH an opioid and Provigil at the same time.
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