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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Quintal on April 19, 2008, at 14:04:39
I'm thinking of asking for it at my next appointment. I'd also like to ask for buprenorphine of course, but I doubt he'd wear it. I mentioned it in hospital though and he didn't seem all that perturbed by the idea, but told me not to bother with "those American drugs". I doubt bringing in the studies would make much difference, especially since they come from the internet. Anyway, lofepramine seemed like a good choice to add to my Lamictal because of my previous response to TCAs, that and it's mild side effect profile. I'm not sure what else to suggest since I've tried almost all of them and only a few have worked. The only new one on the market since then is Cymbalta and I'm very wary of it because I can't usually tolerate strongly serotenergic drugs, and the strong NA reuptake puts me off too - reboxetine was awful and Effexor made me suicidal, as well as causing a hell of a withdrawal syndrome. I suppose cyproheptadine would help offset some of the serotonin side effects though, if I actually get it.
The other big idea was to try Parnate again, but to be honest I'm wondering if I need such a powerful AD effect now I've got Lamictal on board, and if it's worth all the dietary/drug restrictions right now. I suspect it isn't. I was having a good response to tianeptine, but my supply ran out on Sunday and my mood has dropped somewhat since then. I'm also starting to feel much more uneasy in social situations. That all-pervading fear is starting to creep back in. About the only problem with tianeptine is that it's so expensive. I wonder if I could talk my pdoc into importing it for me on the NHS? A professor once offered to try and get hold of a supply of melatonin for me because it isn't available here, so maybe that's an option, but a very remote one.
I'm also considering Wellbutrin, but I'm wary of anything that could make me even more irritable or give me insomnia or anxiety. Also, it's only licensed for smoking cessation here and getting my pdoc to prescribe it off-label feels like too much of a pain in the *ss, especially considering it might not really be suitable for me. At the last appointment he said "We're not going back to the days where you're trying a new drug every month", so I have to be carfeul what I ask for. I'm on rations.
I'm not sure what to do. Maybe it's easier to list what I'm looking for and see what people suggest as fitting the bill?
* More energy and motivation. I feel lethargic, don't want to get out of bed on a morning, and I'm tired all the time.
* Something to help with anxiety. I suppose it's more generalized anxiety these days, with a bit of agoraphobia mixed in.
* Not to disturb sleep too much.
* Something to help sleep if possible (but not cause daytime sedation).
* Something 'rewarding' if possible, something that will tice me to get out of bed on a morning and take it.
* Help with neuropathic pain/fibromyalgia symptoms.
I'm currently taking 50mg lamotrigine and 50mg amisulpride (p.r.n.) with moderate results. Diagnosis Bipolar I and borderline personality disorder.
Q
Posted by Phillipa on April 19, 2008, at 16:20:18
In reply to Trying to coose an AD. Anyone tried lofepramine?, posted by Quintal on April 19, 2008, at 14:04:39
Q mind if I follow your thread? Seems we have quite a few of the same symtoms. Love Phillipa
Posted by undopaminergic on April 20, 2008, at 22:49:12
In reply to Trying to coose an AD. Anyone tried lofepramine?, posted by Quintal on April 19, 2008, at 14:04:39
>
> I'm not sure what to do. Maybe it's easier to list what I'm looking for and see what people suggest as fitting the bill?
>
> * More energy and motivation. I feel lethargic, don't want to get out of bed on a morning, and I'm tired all the time.
>You already have amisulpride. Take it 30-60 min. before you want to get up. If that's insufficient, add methylphenidate, and if that's insufficient switch to dextroamphetamine. Perhaps even modafinil would help, but I think it helps less with motivation and it brings greater risks of insomnia than the others.
> * Something to help with anxiety. I suppose it's more generalized anxiety these days, with a bit of agoraphobia mixed in.
>I recall that you can't get benzos. How about picamilon, phenibut or theanine (L-theanine)? Of these, I've only tried theanine, and found it to be a potent GABAergic agent at 1-2 grams. These are all pretty cheap if you buy them as powders.
> * Not to disturb sleep too much.
>
> * Something to help sleep if possible (but not cause daytime sedation).
>As stimulants wear off, drowsiness and lethargy often sets in, and this helps with sleep.
> * Something 'rewarding' if possible, something that will tice me to get out of bed on a morning and take it.
>Stimulants. Or memantine.
> * Help with neuropathic pain/fibromyalgia symptoms.
>How about morphine, plus memantine to prevent tolerance? Or maybe just codeine or tramadol?
Selegiline may be an alternative to the stimulants.
Posted by Quintal on April 21, 2008, at 6:15:11
In reply to Re: Trying to coose an AD. Anyone tried lofepramine?, posted by undopaminergic on April 20, 2008, at 22:49:12
>You already have amisulpride. Take it 30-60 min. before you want to get up. If that's insufficient, add methylphenidate, and if that's insufficient switch to dextroamphetamine. Perhaps even modafinil would help, but I think it helps less with motivation and it brings greater risks of insomnia than the others.
Amisulpride doesn't do much of anything any more, but I could try taking it in bed to see if that helps. I just took a dose this morning and I can't tell I've taken anything. Stimulants are very much restricted in the UK, and I can't see anyone prescribing them on the NHS, much less my psychiatrist. When I was in hospital he told me to stay away from stimulants, even MAOIs (which he considers stimulating). I tried adrafinil and it just made me spaced out and gave me brain fog. I have no trouble staying awake druing the day, so I doubt modafinil would be of that much use. I did ask for it years ago, but the pdoc refused "I'm not prescribing any kind of stimulant".
>I recall that you can't get benzos. How about picamilon, phenibut or theanine (L-theanine)? Of these, I've only tried theanine, and found it to be a potent GABAergic agent at 1-2 grams. These are all pretty cheap if you buy them as powders.
I tried picamilon a few times, but it didn't seem to have any effect. I've never tried phenibut, but I've heard tolerance develops rapidly. L-theanine didn't seem to do a great deal either, but I was taking benzos at the time.
>How about morphine, plus memantine to prevent tolerance? Or maybe just codeine or tramadol?
Morphine would probably help, but again, nobody is going to prescribe such a drug on the NHS. I think the NICE guidelines have advised that memantine is less suitable for prescribing because of the high cost. I'm already addicted to OTC codeine products, and have been for years. I've developed tolerance to them. Tramadol was very effective, but only for a short while until tolerance set in. I read an artricle once where lamotrigine had also been shown to prevent opioid tolerance.
>Selegiline may be an alternative to the stimulants.
I think I still have a a few boxes of it somewhere. It just made me feel wired and irritable. Parnate would probably be the only realistic alternative to stims (and it did have a very powerful stimulant effect the last time I tried it).
Q
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