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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by elbee on June 16, 2008, at 13:06:35
Hi,
I was wondering if anyone can weigh in on what drugs would be helpful for me. Also, if there's anyone who can help me understand what my problems are symptoms of or if they have similar symptoms that'd be great! I currently take zyprexa 7.5 and Lamictal 400 for BP1. I would probably not be changing these much.
I mostly have low energy and motivation. I have trouble getting started with anything. I also have a mental hangup about doing anything because I feel like first I must have the appropriate mind set or be mentally organized. It's hard to explain--maybe it's a little obsessive. Finally I ruminate a lot about negative things. I guess I'm also "rejection sensitive" and worry about people are judging me (but not in a psychotic sense).
I'm open to any drug. My psychiatrist said to think about luvox, anafranil (clomipramine), nardil, buspar, and zyprexa/prozac combination but she is open to other things.
Thanks so much!
Posted by Phillipa on June 16, 2008, at 13:20:55
In reply to Need Advice on Med Cocktail. Please help!, posted by elbee on June 16, 2008, at 13:06:35
Elbee try the luvox. Taken it for years. My brain likes it. Love Phillipa
Posted by elbee on June 16, 2008, at 13:41:38
In reply to Re: Need Advice on Med Cocktail. Please help! » elbee, posted by Phillipa on June 16, 2008, at 13:20:55
Hi Phillipa,
Thanks for the info. Could you tell me what it felt like to take luvox or how it made a difference?
I went ahead and started luvox--although I am a little worried because it's hard to sleep and it might make me a bit hypomanic. But I hope not. I've only tried it a few days.
Posted by Phillipa on June 16, 2008, at 19:55:53
In reply to Re: Need Advice on Med Cocktail. Please help! » Phillipa, posted by elbee on June 16, 2008, at 13:41:38
First time took it got to 250mg and felt great also had ativan on board. I asked if the reason I was getting up and feeling great at 6am was am I hypomanic? Pdoc said I just didn't know what it felt like to feel Good. Only lasted a few weeks but continue it low dose as off it can't function. Phillipa ps I got to bed at around 3am and up at ll am.
Posted by BRC on June 16, 2008, at 20:08:11
In reply to Need Advice on Med Cocktail. Please help!, posted by elbee on June 16, 2008, at 13:06:35
Prozac made my anxiety even worse. It was a very stimulating med to me. But I am sure you know (your doc. probably already told you) that each medication effects each one differently. And that is soooo. true.
When I first became ill with my problems I had never really taken any meds (except the usual antibiotic, etc.). But never anything that effected my mind or mood.
So, everytime I would hear that someone was doing so well on a particular med. I immediately wanted to switch and try what they were taking.
It took me a while to learn that you have to give each med its time. There is no magic pill (I thought there was). I assumed I would take this medication and in a few days to a week (like a medication treating a virus or the flu I would be totallly well).
Ten years later I am still struggling with my meds. But don't give up. I am soooooo. much better now than I was before. It may just take you and your doctor a little experimenting and adjusting. But you will eventually find the right cocktail.
Good luck, and forgive my spelling
BRC
Posted by elbee on June 16, 2008, at 20:38:44
In reply to Re: Need Advice on Med Cocktail. Please help!, posted by BRC on June 16, 2008, at 20:08:11
That's true. I guess I am kind of looking for a magic pill and your posting reminded me things are more complex than that.
Thanks!
Posted by SLS on June 17, 2008, at 4:55:25
In reply to Re: Need Advice on Med Cocktail. Please help!, posted by BRC on June 16, 2008, at 20:08:11
Hi.
I'm sorry that things have been so frustrating and painful for you. I must disagree, however, with your characterization of medication not producing a "magic pill". For me, there are magic pills. My depression is recalcitrant to psychotherapy because there really isn't that much going on in my mind that is depressogenic. I have been working on my mind along with my errant brain function for the past 25 years. I think my mind has been primed for the return of normal brain function, so really, all that is left to do is to remediate the abnormal brain function.
Even well-adjusted, self-actualized people can contract a biological mental illness. Simply taking one pill a day can return them to their lives of joy and fulfillment, where no amount of psychosocial therapy had.
"The brain determines the mind as the mind sculpts the brain."
There is an advantage to conceptualizing the brain and mind as separate phenomena. Of course, they both operate in tandem, and are inextricably linked. Each affects the other. Unfortunately, mental illness can be triggered by abnormal psychosocial stress if one's brain has been made vulnerable to decompensation because of genetics or congenital acquisition. Mental illness usually affects the way one thinks and feels. If this goes on long enough, one's psychodynamics can become as dysfunctional as their brain is. Psychotherapeutic modalities will be most effective in this regard.
So, yes, there are magic pills that can treat effectively a sick brain. No, these pills do not make a sick or challenged mind well. By themselves, pills do not process issues and deal with the stresses of life in general. Only people do.
- Scott
> Prozac made my anxiety even worse. It was a very stimulating med to me. But I am sure you know (your doc. probably already told you) that each medication effects each one differently. And that is soooo. true.
>
> When I first became ill with my problems I had never really taken any meds (except the usual antibiotic, etc.). But never anything that effected my mind or mood.
>
> So, everytime I would hear that someone was doing so well on a particular med. I immediately wanted to switch and try what they were taking.
>
> It took me a while to learn that you have to give each med its time. There is no magic pill (I thought there was). I assumed I would take this medication and in a few days to a week (like a medication treating a virus or the flu I would be totallly well).
>
> Ten years later I am still struggling with my meds. But don't give up. I am soooooo. much better now than I was before. It may just take you and your doctor a little experimenting and adjusting. But you will eventually find the right cocktail.
>
> Good luck, and forgive my spelling
>
> BRC
Posted by yxibow on June 17, 2008, at 14:56:35
In reply to Re: Need Advice on Med Cocktail. Please help!, posted by SLS on June 17, 2008, at 4:55:25
> So, yes, there are magic pills that can treat effectively a sick brain. No, these pills do not make a sick or challenged mind well. By themselves, pills do not process issues and deal with the stresses of life in general. Only people do.
I partially agree for some that a cocktail works -- but there is no magic bullet, and that can lead to magical thinking as well for some (unfortunately I wish I had a magic bullet but at the moment only Seroquel works somewhat for me).As for the polypharmacy, the Luvox if it is working is fine, the Lamictal can be boosted up to 600 from what I've heard at least one BP or BP borderline patient take. But its up to you and your doctor
-- Jay
Posted by SLS on June 17, 2008, at 15:33:14
In reply to Re: Need Advice on Med Cocktail. Please help! » SLS, posted by yxibow on June 17, 2008, at 14:56:35
> I partially agree for some that a cocktail works -- but there is no magic bullet,
Usually, a "magic bullet" means that one has found one treatment that works for everyone. This is clearly not the case. It is certainly not what I intended to say.
You and I are probably making the same mistake - projecting our own experiences to others. If you experienced what I am now experiencing, you would have not one iota of doubt that it is the result of the magic pills I take. They are magic for me, but certainly not for everyone. Antibiotics are also magic pills. However, there is not one single magic bullet that treats all pathogens.
Jay, your condition is extraordinarily intricate and seems to defy a simple paradigm of treatment. I really hope that you find your magic treatment, regardless of how much of it may be biological and how much it may be psychological.
- Scott
Posted by dcruik518 on June 17, 2008, at 21:42:20
In reply to Need Advice on Med Cocktail. Please help!, posted by elbee on June 16, 2008, at 13:06:35
> Hi,
>
> I was wondering if anyone can weigh in on what drugs would be helpful for me. Also, if there's anyone who can help me understand what my problems are symptoms of or if they have similar symptoms that'd be great! I currently take zyprexa 7.5 and Lamictal 400 for BP1. I would probably not be changing these much.
>
> I mostly have low energy and motivation. I have trouble getting started with anything. I also have a mental hangup about doing anything because I feel like first I must have the appropriate mind set or be mentally organized. It's hard to explain--maybe it's a little obsessive. Finally I ruminate a lot about negative things. I guess I'm also "rejection sensitive" and worry about people are judging me (but not in a psychotic sense).
>
> I'm open to any drug. My psychiatrist said to think about luvox, anafranil (clomipramine), nardil, buspar, and zyprexa/prozac combination but she is open to other things.
>
> Thanks so much!Hi Elbee,
Nice to meet you. Hope you're doing well.
I have to say: You don't really sound obsessive compulsive to me! The fact you ruminate a lot is not enough; it's common with most forms of depression, and sometimes has more to do with personality than illness. I've taken both Anafranil and Luvox and they both made me really groggy and dull and apathetic--not exactly what you want if you're having trouble getting started on things.
My guess is that you're more of a thinker than a doer, and may be a bit of a loner--an introvert, in other words. You also say you have rejection sensitivity and low energy and motivation. All that together sounds to me like Atypical Depression and/or Dysthymia, which is what I have, in addition to Social Phobia.
Nardil is sort of the gold standard for Atypicals/Dysthymics, but you may gain quite a bit of weight on it. However, the huge relief you may feel might easily be worth it, at least until you're back on your feet. Another possibility is mixing a stimulant like Adderall with a good social anxiety drug like Neurontin. The Adderall will help with your energy, motivation, concentration, and probably boost your mood some, and the Neurontin should take care of that "rejection sensitivity", possibly boost your mood a little more, and take away a lot of anxiety you may feel, especially concerning other people.
Best, D.R.C.
Posted by yxibow on June 18, 2008, at 5:01:00
In reply to Re: Need Advice on Med Cocktail. Please help! » yxibow, posted by SLS on June 17, 2008, at 15:33:14
> > I partially agree for some that a cocktail works -- but there is no magic bullet,
>
> Usually, a "magic bullet" means that one has found one treatment that works for everyone. This is clearly not the case. It is certainly not what I intended to say.
>
> You and I are probably making the same mistake - projecting our own experiences to others. If you experienced what I am now experiencing, you would have not one iota of doubt that it is the result of the magic pills I take. They are magic for me, but certainly not for everyone. Antibiotics are also magic pills. However, there is not one single magic bullet that treats all pathogens.
Yes, I think we tend at times to project our own experiences overlayed on others because that is where we have started from.
I guess I was trying to distinguish intrinsically going down the road of "magical thinking" and medication that will cure all magically. It wasn't to say that everyone has magical thinking, or that even I always have such a belief -- maybe its more a frustration or hope after time.
I was probably also projecting what had been told to me some time recently in specific, which I don't wish do go into as there has been various traumatic setbacks and catch-22s, that, yes to sum up in my reexplanation to myself, there is no magic bullet that will heal all my psychobiological trauma at once in 2008.And that's hard to accept -- because you want to work with what you knew you had and what you have now -- the future is never known of course, so why project to the infinite future?
Well that's depression and many years of illness -- but I repeat myself. I am progressing forward, and then off focus a bit, and then more forward -- that's the natural stage of things.
From what I believe your definition of magic, is more, I have an amazing set of medications that have worked for X years, and another one that have worked for Y years and they have made my functionality fantastic (or magically wonderful) as one wants to put it.
And that I think is just as healthy a view as anyone else's hope as well.
> Jay, your condition is extraordinarily intricate and seems to defy a simple paradigm of treatment. I really hope that you find your magic treatment, regardless of how much of it may be biological and how much it may be psychological.You're very perceptive about what may be going on with me -- not that you're diagnosing, but its the intrinsic insight (and I appreciate that insight), and you're right, it does defy a single paradigm of treatment. Thank you for wishing me future forward views on it.
I think regardless of the content, there may at least (this is hope projection I guess) be some people who also have conditions that have multiple angles of treatment because they are combined disorders, not clearly (NOS) specified. I wait to meet such people because there's so much I want to discuss -- some has to be factual, but a positive hope inside would really stir. Hope comes from within
--thanks
--tidings
Jay.
Posted by yxibow on June 18, 2008, at 14:36:06
In reply to Re: Need Advice on Med Cocktail. Please help! » yxibow, posted by SLS on June 17, 2008, at 15:33:14
> > I partially agree for some that a cocktail works -- but there is no magic bullet,
>
> Usually, a "magic bullet" means that one has found one treatment that works for everyone. This is clearly not the case. It is certainly not what I intended to say.
>
> You and I are probably making the same mistake - projecting our own experiences to others. If you experienced what I am now experiencing, you would have not one iota of doubt that it is the result of the magic pills I take. They are magic for me, but certainly not for everyone. Antibiotics are also magic pills. However, there is not one single magic bullet that treats all pathogens.
Yes, I think we tend at times to project our own experiences overlayed on others because that is where we have started from.
I guess I was trying to distinguish intrinsically going down the road of "magical thinking" and medication that will cure all magically. It wasn't to say that everyone has magical thinking, or that even I always have such a belief -- maybe its more a frustration or hope after time.
I was probably also projecting what had been told to me some time recently in specific, which I don't wish do go into as there has been various traumatic setbacks and catch-22s, that, yes to sum up in my reexplanation to myself, there is no magic bullet that will heal all my psychobiological trauma at once in 2008.And that's hard to accept -- because you want to work with what you knew you had and what you have now -- the future is never known of course, so why project to the infinite future?
Well that's depression and many years of illness -- but I repeat myself. I am progressing forward, and then off focus a bit, and then more forward -- that's the natural stage of things.
From what I believe your definition of magic, is more, I have an amazing set of medications that have worked for X years, and another one that have worked for Y years and they have made my functionality fantastic (or magically wonderful) as one wants to put it.
And that I think is just as healthy a view as anyone else's hope as well.
> Jay, your condition is extraordinarily intricate and seems to defy a simple paradigm of treatment. I really hope that you find your magic treatment, regardless of how much of it may be biological and how much it may be psychological.You're very perceptive about what may be going on with me -- not that you're diagnosing, but its the intrinsic insight (and I appreciate that insight), and you're right, it does defy a single paradigm of treatment. Thank you for wishing me future forward views on it.
I think regardless of the content, there may at least (this is hope projection I guess) be some people who also have conditions that have multiple angles of treatment because they are combined disorders, not clearly (NOS) specified. I wait to meet such people because there's so much I want to discuss -- some has to be factual, but a positive hope inside would really stir. Hope comes from within
--thanks
--tidings
Jay.
Posted by yxibow on June 18, 2008, at 14:39:06
In reply to Re: Need Advice on Med Cocktail. Please help! » SLS, posted by yxibow on June 18, 2008, at 14:36:06
Posted by elbee on June 18, 2008, at 22:43:38
In reply to Re: Need Advice on Med Cocktail. Please help!, posted by dcruik518 on June 17, 2008, at 21:42:20
Thanks D.R.C.,
You really gave my situation some thought and came up with some observations that were right on target. I am a thinker rather than a doer and the dysthymia/atypical depression sounds spot on.
I am going to see what I can rearrange regarding my meds. I want to try Nardil but my doc says it can't be combined with Zyprexa.
Thanks for the recommendations. How are you doing in general with your meds/diagnoses? Nice to meet you.
Posted by dcruik518 on June 19, 2008, at 11:41:04
In reply to Re: Need Advice on Med Cocktail. Please help! » dcruik518, posted by elbee on June 18, 2008, at 22:43:38
> Thanks D.R.C.,
>
> You really gave my situation some thought and came up with some observations that were right on target. I am a thinker rather than a doer and the dysthymia/atypical depression sounds spot on.
>
> I am going to see what I can rearrange regarding my meds. I want to try Nardil but my doc says it can't be combined with Zyprexa.
>
> Thanks for the recommendations. How are you doing in general with your meds/diagnoses? Nice to meet you.
>
>Hi Elbee,
Nice to meet you, too, and thanks for asking how I'm doing. I'm glad you found my post helpful.
Btw, I'm not sure why you can't take Zyprexa with Nardil; I know you can take other antipsychotics with it--for instance, risperidal.
For some reason, I've found that psychiatrists often make too much of this "rumination" thing, and immediately start thinking "OCD!" I actually think rumination is common with atypical depression, in which people tend to lie around a lot instead of doing things, because they feel this kind of lead paralysis, like just getting up and doing somehting would be a great effort. Therefore, the tend to get really introspective and mull over things, instead of focusing on activities or other people.
You might mention the following to you doctor and explain why they fit you.
The four main symptoms of "atypical depression"
1. extreme lack of energy/motivation
2. tendency to overeat and oversleep
3 it has last pretty much non-stop for at least 2 years.
4. rejection sensitivity, fear of criticism, social vulnerability, low self-esteem, etc.Anyway, I'm sure I'd be doing better right now if I were still on Nardil, but I really need to lose weight now, so I'm on other stuff. Right now I'm really taking more drugs than I probably need or should be taking, partly becauese I've been doing some experimentation with dopamine agonists normally used for Parkinson's disease, as these have recently shown promise for social anxiety and dysthymic disorders. The agonists I've been trying so far have been Bromocriptine and Requip. I also take Neurontin and Adderall, which together, work a little bit like Nardil, I think. I also take clonazepam for anxiety and trazadone for sleep. Sometimes when I'm really stressed out I will take Abilify for a few weeks, as it stops me from pulling out my hair, mainly my eyebrows and beard. (Strange, I know)
Anyway, I'm not doing as well as when I was on the Nardil and clonazepam and trazadone combo, but still pretty good.
Hope you find something soon that works really well for you. I suspect the Nardil will. Just remember to be patient with it. It can take up to six weeks before you really notice it.
BEst, DRC
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