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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by SLS on January 5, 2008, at 20:14:29
> Scott I am interested and was hoping you could answer a few questions for me?
> First, what meds are you taking and what doses? Do you take any specific supplements, vitamins, or minerals with them?
> The one med that really made the difference for you (I'm guessing it was Nardil?)...how many weeks did you wait for major improvements?
> Your doctor will use non-FDA meds. Cool. How the heck did you find such a doctor? Where do you live? I'm jealous. I didn't know a doctor could even legally consider using adrafinil, milnacipran or some others.
> Nice to see you Scott. I know you're enjoying a better life, but please keep your absences from here a little shorter, eh? :-)I have a feeling I'll be posting from time to time. Thank you so much for the stroking. :-) It is good for my self-esteem.
Here is my current treatment regime:Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
The only other pill that I gratefully force down my throat is a multi-vitamin. However, I might add some extra bioactive B-vitamins if I experience a plateau in my recovery.Please ask more questions. I'll answer the remainder of yours in a subsequent post.
:-)
- Scott
Posted by Phillipa on January 5, 2008, at 20:32:04
In reply to SLS Stuff., posted by SLS on January 5, 2008, at 20:14:29
Scott where and how did you find a doc that really listened to you and gained your confidence to go off label with so many meds and the fact that he can prescribe so many meds must be a very important person. No not looking for a name. Thank-you Scott. Love Phillipa
Posted by Maxime on January 7, 2008, at 2:21:25
In reply to Re: SLS Stuff. » SLS, posted by Phillipa on January 5, 2008, at 20:32:04
> Scott where and how did you find a doc that really listened to you and gained your confidence to go off label with so many meds and the fact that he can prescribe so many meds must be a very important person. No not looking for a name. Thank-you Scott. Love Phillipa
Phillipa, I think it's luck of the draw when it comes to psychiatrist. The one I have now will let me try anything because he knows that I know my body really well. I have been on so many combos that are contraindicated.
Find a pdoc who will prescribe an MAOI and you will be set.
Maxime
Posted by SLS on January 8, 2008, at 6:02:22
In reply to Re: SLS Stuff. » Phillipa, posted by Maxime on January 7, 2008, at 2:21:25
> > Scott where and how did you find a doc that really listened to you and gained your confidence to go off label with so many meds and the fact that he can prescribe so many meds must be a very important person.
Well, I don't know what criteria one would use to judge my doctor to be important, but he is sure important to me. Most of the treatment ideas came from me. He also became trusting enough of me such that he let me experiment to a moderate degree. It is through my own experimentation combined with his idea of using L-methylfolate (Deplin) that has produced such a robust antidepressant effect.
Like you told Phillipa, it was a lucky find. I did collect a few names by asking other psychiatrists and mental health professionals for suggestions. My doctor's name kept coming up.
- Scott
Posted by ny2bk on January 8, 2008, at 6:22:34
In reply to SLS Stuff., posted by SLS on January 5, 2008, at 20:14:29
Happy to see you back,while i missed ya not being here,i was still happy as i had a gut feeling your abscense was due to a remission state you were making numero uno priority.Again why i knew this i dont know,but glad i was right.
Im about to follow your regimine with some slight differeances,however main similiarity will be the maoi parnate and the tca Noratrip..
Sorry early forgot spelling.Anyhow being on both mentioned maois,and knowing there effects,can you give me an idea on a starting dose of the combo,should they be taken togther as part of a cocktail,etc...
If i can provide any info to help you answer that for me please let me know.
Just for fyi the combo itself will include,Klonopin as needed not to exceed a mg at most
nuerontion however id like to give this up
possably xyremHowever id like my primary med parnate to have a addition which allows me to cut back on most others.Thanks
> > Scott I am interested and was hoping you could answer a few questions for me?
>
> > First, what meds are you taking and what doses? Do you take any specific supplements, vitamins, or minerals with them?
>
> > The one med that really made the difference for you (I'm guessing it was Nardil?)...how many weeks did you wait for major improvements?
>
> > Your doctor will use non-FDA meds. Cool. How the heck did you find such a doctor? Where do you live? I'm jealous. I didn't know a doctor could even legally consider using adrafinil, milnacipran or some others.
>
> > Nice to see you Scott. I know you're enjoying a better life, but please keep your absences from here a little shorter, eh? :-)
>
> I have a feeling I'll be posting from time to time. Thank you so much for the stroking. :-) It is good for my self-esteem.
>
>
> Here is my current treatment regime:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> Deplin 7.5mg
>
>
> The only other pill that I gratefully force down my throat is a multi-vitamin. However, I might add some extra bioactive B-vitamins if I experience a plateau in my recovery.
>
> Please ask more questions. I'll answer the remainder of yours in a subsequent post.
>
> :-)
>
>
> - Scott
>
Posted by deniseuk190466 on January 8, 2008, at 17:00:09
In reply to SLS Stuff., posted by SLS on January 5, 2008, at 20:14:29
Scott,
It's good to see that you still lurk occasionally, I often think about you as inspite of your illness you have always managed to be able to impart really good, reassuring advice and wisdom to others on this board.
Glad you are still doing well.
I have been writing to somebody who suffers from Bipolar disorder but has been in the grip of mainly depression for the last two years. He has tried tricyclics amongst many other drugs to no avail. The tricyclic made him really irritable and angry so he tells me.
If you have any suggestions for him (based on your own experiences) then please let me know.
Denise
Posted by SLS on January 9, 2008, at 19:25:40
In reply to Re: SLS Stuff., posted by deniseuk190466 on January 8, 2008, at 17:00:09
Hi Denise.
Thanks for the well-wishes.
All I can say is that it is hard to believe. It doesn't compute with me to be on my way to wellness. It feels almost surreal that my odyssey should come to a happy conclusion.
> It's good to see that you still lurk occasionally, I often think about you as inspite of your illness you have always managed to be able to impart really good, reassuring advice and wisdom to others on this board.
I think I'm "rusty". I'm flattered that you should think such things of me. Thanks.
Is there more information you can add?
Which MAOIs has he tried? Results?
Tricyclics are generally contraindicated for bipolar disorder. They have the highest rate of producing a manic reaction. That explains what your friend has experienced. It sounds like he had a drug-induced mixed-state mania or manic dysphoria. Irritability and/or episodes of rage are the hallmark symptoms of this condition.
I think that Wellbutrin + Lamictal + Deplin might produce some improvement. Should there be no improvement, adding Lexapro would be one alternative if he can tolerate it. Very important is to understand that Lexapro can produce anxiety at the 2-week mark, but this usually dissipates by the end of week 3. If necessary, add Abilify or Geodon.
Of course, MAOIs are good choices for bipolar disorder. Conventional wisdom points to using Parnate as a first choice. All of the aformentioned drugs are available to combine with an MAOI except for Lexapro. In my estimation, there is no safe dose of an SSRI or SNRI to combine with an MAOI.
- Scott
>
> Glad you are still doing well.
>
> I have been writing to somebody who suffers from Bipolar disorder but has been in the grip of mainly depression for the last two years. He has tried tricyclics amongst many other drugs to no avail. The tricyclic made him really irritable and angry so he tells me.
>
> If you have any suggestions for him (based on your own experiences) then please let me know.
>
>
> Denise
>
Posted by SLS on January 10, 2008, at 6:06:15
In reply to Re: SLS Stuff., posted by ny2bk on January 8, 2008, at 6:22:34
Hi.
> Happy to see you back,while i missed ya not being here,i was still happy as i had a gut feeling your abscense was due to a remission state you were making numero uno priority.Again why i knew this i dont know,but glad i was right.
Thanks.
Yes. When I left in November, 2006, I was dismayed at how many people had developed a negative reaction to the premise that antidepressant drugs were effective to treat depression. It was a critical time for me, and I was not disposed to putting out fires anymore. My posture now will probably be different, posting less frequently and more directly.
> Im about to follow your regimine with some slight differeances
I wish everyone with treatment-resistant affective disorders could respond to the same regime.
> however main similiarity will be the maoi parnate and the tca Noratrip..
What exactly are the differences?
> Sorry early forgot spelling.Anyhow being on both mentioned maois,and knowing there effects,can you give me an idea on a starting dose of the combo,should they be taken togther as part of a cocktail,etc...
Yes. Conventional wisdom is that both Parnate and nortriptyline be started together or have the TCA on board first. However, I have added one to the other both ways without a problem.
Maybe...
Start:Parnate 20mg
nortriptyline 10-25mg
Week 2:Parnate 30mg
nortriptyline 25-50mg
Week 3:Parnate 40mg
nortriptyline 50-75mg
Week 4:
Parnate 40mg
nortriptyine 75mg
If no response, increase Parnate to 60mg
If no response, increase Parnate to 80mg
If no response, increase nortriptyline to 100mg
If no response, get blood test for nortriptyline level. Increase dosage if necessary.
> Just for fyi the combo itself will include,
>
> Klonopin as needed not to exceed a mg at mostI like that idea. Klonopin actually has mood-stabilizing properties.
> nuerontion however id like to give this up
I agree.
> possably xyrem
Why?
I hope I answered your questions. You can ask more if you'd like. If I don't know the answer to any of them, I'll tell you or research it.
Get well.
- Scott
Posted by deniseuk190466 on January 10, 2008, at 15:07:34
In reply to Re: SLS Stuff. » deniseuk190466, posted by SLS on January 9, 2008, at 19:25:40
Scott,
Thanks for getting back to me. Please don't disappear from this site for good. Although I've sort of given up on God I used to pray for you (and others every night). Maybe, he/she/it was listening after all :-).
Don't want to use you as some sort of sounding board but as you yourself suffer from Bipolar and have an awful lot of experience with medications thought you might be able to suggest something.
Anyway, my US pen pal has tried the following, in his words below, he has also told me that Nardil is the only drug which gave him substantial relief but had unbearable side affects, that Wellbutrin gave him a lot of energy but then stopped doing anything, Zyprexa didn't do much and just made him put a lot of weight on (typical, unless you smoke like me). He is now on Selegeline which helps his mood a bit Seroquel which helps him sleep but which he thinks dampens his mood and makes him tired and he has been abilify but for some reason came off that. He has also had ECT which didn't help.
He has good days and bad (in bed all day) days and he is still unable to work. Although he does seem to like to go out and socialise now and again.
"Prozac gives me unmanagable anxiety attacks. Lithium has side-effects I forget, and didn't seem to do anything. Nardil, I probably mentioned. Lamictal, I forget - don't think it did anything. Effexor was a side-effect nightmare, and I wish they banned it outright. Zoloft, they didn't bother with, as it's not powerful, and Paxil was a waste of my time.Sadly, my drug list is about 3.5 times the size of yours. I've been on 32 meds, plus or minus a few. Some were to deal with side effects. The majority were AD's and some anti-psycotics type meds".
Thanks....Denise
Posted by Phillipa on January 10, 2008, at 22:41:19
In reply to Re: SLS Stuff. » ny2bk, posted by SLS on January 10, 2008, at 6:06:15
Scott was prescirbed 7.5 mg of Deplin today with the same luvox and valium. Should it be taken morning or night as pdoc not that familiar with it as said I was her first patient to put on it. Called it kind of a brain food and said it boosts ad's and also being used for Alzheimers. Can you add anything? Would be grateful. Love as always Phillipa
Posted by SLS on January 11, 2008, at 6:55:18
In reply to Re: SLS Stuff. » SLS, posted by Phillipa on January 10, 2008, at 22:41:19
Hi Phillipa.
> Scott was prescirbed 7.5 mg of Deplin today with the same luvox and valium.
What is he being treated for?
> Should it be taken morning or night
I take mine in the morning. Deplin seems to be alerting in some people. Deplin does not reach its peak blood level until several weeks after beginning therapy.
> as pdoc not that familiar with it as said I was her first patient to put on it. Called it kind of a brain food
I still consider Deplin a drug. It does not occur naturally in human food stuffs, so I'm not sure one could call it a food, regardless of its categorization.
With the possible exceptions of flatulence and possibly headache, I know of no other side effects of Deplin. I don't think we will know the full range of its therapeutic activity and side effects until it has been used for awhile.
The antidepressant response to Deplin seems to follow a pattern. One can experience a brief period of a mild increase in energy during the first week. This disappears quickly. 4-8 weeks later, the true antidepressant response emerges.
- Scott
Posted by Phillipa on January 11, 2008, at 12:49:07
In reply to Re: SLS Stuff. » Phillipa, posted by SLS on January 11, 2008, at 6:55:18
Scott thank-you so very much. Love Phillipa
Posted by Phillipa on January 11, 2008, at 18:30:43
In reply to Re: SLS Stuff. » SLS, posted by Phillipa on January 11, 2008, at 12:49:07
Well picked up my bottle of Deplin today so tomorrow the full pill. Nothing so far good or bad. The pharmacy read out a large chain doesn't have it in their system I guess cause in info said to go to deplin.com. And there's a coupon on deplin site and saved 1/3 on the script with it as my insurance is not good. Pharmacist said I'd be getting a card in the mail for furture prescriptions always with the money off. I have Medicaire. Phillipa
This is the end of the thread.
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