![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 54. Go back in thread:
Posted by Cecilia on August 20, 2008, at 0:26:13
In reply to The stakes are too high., posted by SLS on August 19, 2008, at 8:11:07
There are many different types of side effects. I could care less if a med decreases my libido, which is already zero, and I am already fat, with very painful health problems as a result, so while I don't want to gain any more weight, I would be willing to if an antidepressant actually worked; it would mean a shorter and more physically painful life, but a short period of less emotional pain before I died would be worth it. I think of side effects in terms of "can I function with this?". I could not function with Effexor unless I wanted to spend my entire life within 2 feet of the bathroom, and yes, I started at the smallest possible dose. I could not function with the severe eye pain of Emsam or Nardil. Some meds I have given up on before the magic six weeks and others I have forced myself through a trial despite horrible side effects but it has nothing to do with any theories, just what I can stand. Some of the trials I have forced myself through have been basically self punishment for being depressed. My pdoc, who is supposed to be an expert on treatment resistant depression has long since run out of ideas and could care less, just tells me to try therapy again, when I have already spent a fortune on useless therapy. I stand in awe of the high doses of meds that you are able to tolerate, Scott, but everybody's metabolism is different. Nobody wants to be depressed and we are all doing the best we can. Cecilia
Posted by SLS on August 20, 2008, at 5:08:11
In reply to Re: The stakes are too high., posted by Cecilia on August 20, 2008, at 0:26:13
Hi Cecilia.
> There are many different types of side effects. I could care less if a med decreases my libido, which is already zero, and I am already fat, with very painful health problems as a result, so while I don't want to gain any more weight, I would be willing to if an antidepressant actually worked; it would mean a shorter and more physically painful life, but a short period of less emotional pain before I died would be worth it. I think of side effects in terms of "can I function with this?". I could not function with Effexor unless I wanted to spend my entire life within 2 feet of the bathroom, and yes, I started at the smallest possible dose. I could not function with the severe eye pain of Emsam or Nardil. Some meds I have given up on before the magic six weeks and others I have forced myself through a trial despite horrible side effects but it has nothing to do with any theories, just what I can stand. Some of the trials I have forced myself through have been basically self punishment for being depressed. My pdoc, who is supposed to be an expert on treatment resistant depression has long since run out of ideas and could care less, just tells me to try therapy again, when I have already spent a fortune on useless therapy.
> I stand in awe of the high doses of meds that you are able to tolerate,
Don't be. My lack of sensitivity is probably an index of treatment resistance because of my exposure to many different drugs. I didn't get that way overnight, to be sure.
I'm sorry that 12.5mg of Effexor was intolerable for you. The first antidepressant I tried was imipramine. The doctors at Columbia Presbyterian started me at 10mg and had me increase the dosage very slowly. Yes, I had side effects at 50mg, but I was able to get up to 450mg after a few months. I am probably a rapid metabolizer of P450 D26 enzyme. Still, most people tolerated 150-200mg.
> Scott, but everybody's metabolism is different. Nobody wants to be depressed and we are all doing the best we can.
Understood.
I am fortunate that my doctor and I work collaboratively. I do present him with ideas and data, some of which I owe to Psycho-Babble.
I really don't care how people get well, as long as the treatment is inherently safe.
As I said in my first post, I realize that I am projecting onto others my own success. I figure someone ought to.
- Scott
Posted by Cecilia on August 20, 2008, at 6:47:40
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 5:08:11
I am glad that you finally had success and hope it lasts. It's just that from my experiences with lower doses I can not begin to imagine taking the high doses of Nortriptyline and Nardil you take. I have learned the hard way to always always start with the quarter of the smallest tablet available, with some like Wellbutrin and Nortriptyline I worked up over many many months. I was counting out beads on Cymbalta, could never make it up to a therapeutic dose. Some people really ARE med sensitive. I have also learned the hard way that due to my anxiety I can not tolerate anything with norephineprine. Interesting that going through so many trials made you more able to tolerate meds, with me it's been the opposite. Some meds that were tolerable (though not helpful) on a first trial were unbearable on a second. Who knows what all these meds have done to my brain. I think my depression is secondary to my anxiety, which is probably secondary to genetic factors and a lousy childhood. Anyway, just felt hurt by the implication that people don't get better because they aren't willing to put up with side effects, when I had been through SO many horrible ones. But of course I understand that everyone is different, I am so constantly amazed at people giving up effective meds because of loss of libido, so incredibly jealous of them for actually finding a med that works with what to me is a meaningless side effect but what is obviously a deal breaker for them. But obviously that is their right, everybody has different priorities in life. Cecilia
Posted by Hygieia's Bowl on August 20, 2008, at 7:33:13
In reply to Re: The stakes are too high. » Hygieia's Bowl, posted by atmlady on August 19, 2008, at 22:18:53
Hey There Ms. atm
> I agree with you, Hy.
I am so very pumped as I rarely get an agreement. ; )
I am slowly realizing I am allowing the posted experiences of a few to cloud how I preceive and evaluate the manner in which folks are going about their treatment plans and maybe, just maybe, I'm not seeing the forest for the trees.
I wish you the very best in your quest. I've been doing well for some years now and it's a wonderful thang.
Posted by SLS on August 20, 2008, at 8:03:35
In reply to Re: The stakes are too high. » SLS, posted by Cecilia on August 20, 2008, at 6:47:40
Don't get mad at me for trying.
Something I read recently demonstrated that, for certain drugs, more is better when it comes to a starting dosage to avoiding side effects. Prozac and Geodon are examples. Prozac at 20mg is probably less problematic than at 5mg. At lower dosages, it can be anxiogenic, at higher dosages it becomes anxiolytic and antidepressive. The same thing has been shown to be true of Geodon. It is less problematic at 40mg than it is at 20mg. I wonder if Abilify follows a similar pattern. I also wonder if at lower dosages, Effexor is more dopaminergic relative to serotonin and norepinephrine and more likely to produce a nausea that lingers.
With Abilify, I started at 20mg. I had very little problem with agitation, restlessness, or anxiety. The doctor who managed me was pretty smart.
Anyway, I am still on your side, even if my current positive outlook becomes annoying.
Any chance of mixing Wellbutrin with Lamictal?
- Scott
Posted by Justherself54 on August 20, 2008, at 11:32:39
In reply to Re: The stakes are too high. » Hygieia's Bowl, posted by atmlady on August 19, 2008, at 22:18:53
I'm not as articulate as some who post but here goes..I noticed in one of you posts you had put med sensitive in quotes. I consider my self med sensitive or side effect sensitive and so does my pdoc. I have had cease med trials early but have given some a fair trial despite some grim side effects. It just becomes a matter of how much you are willing to tolerate.
Despite a weight gain of 20 pounds on an already obese body I stuck with Nardil, even though it caused awful urinary problems. I had to have a potty downstairs as I'd never made it up the stairs. Going out was a lovely challenge. I had the drunken sailor walk, my typing looked like I had developed severe dyslexia. Oh, and the clincher which make my pdoc pull me off it..projectile vomiting in my sleep...nothing like waking up choking every night.
I'm on parnate right now, waiting for it to give me some partial benefit as I've put in so much time giving it a "fair trial", despite the fact I clench my back muscles so badly at night I wake up with my back arched and completely off the mattress. I have fibromyalgia and it's playing havoc with it.
On the flip side, amitriptaline got one day's trial as it knocked me out cold for 12 hours. So did nortriptaline.
Effexor made me want to hang off the ceiling like a scared cat. Wellbutrin made me a non-functioning zombie.
Paxil, Zoloft, Lexapro were great, except they all quit working within 6 months to a year and also added 60 pounds. I was quite slim and attractive at one time, now I feel like a beached whale.
I won't even go into the mood stabilizers.
We all have different tolerances for this meds. I read the posts where someone has achieved remission and I'm so happy for them. For me, when I achieve remission, I have to simply enjoy it while it lasts, because for me, it never does.
And when I read posts where someone has gained a ton of weight on these meds, my heart bleeds for them, as being obese not only affects your health, it also adds to your depression and erodes your self esteem.
One has to be careful when achieving remission, as you feel you've won the battle...in my experience when I've achieved remission, it's just a cease fire until the next battle begins and I'm pretty scared as I'm just about out of ammunition.
I don't blame my doctor, the drug companies, my childhood nor myself, it is what it is..
I come to babble as I don't feel so alone, as there are many who are dealing with constant failed med trials. Who am I to say anyone hasn't given some of them a fair trial. We each have our own unique makeup and perhaps some are in just too fragile a state to cope with heavy side effects.
Posted by Bob on August 20, 2008, at 12:12:32
In reply to Re: The stakes are too high., posted by bulldog2 on August 19, 2008, at 14:58:23
> As I stated in another post I believe in diet and exercise to be as healthy as I can be on my own. While I'm in good shape for my age and my blood tests also come back as wonderful that has not innoculated me from panic attacks, anxiety and depression. I believe some of this is genetic as some in my immediate family had some of these mental disturbances. So one would have to be naive to believe that eating well and exercising will make one immune from mental disease. For those with situational anxiety or depression there maybe hope to conquer your mental issues with diet and exercise if an improper life caused them to begin with. However those with mental disease with genetic roots or early childhood trauma are unlikely to eat or exercise their way out of mental illness anymore than you correct a faulty heart valve with exercise.
> I myself am not in remission and I take full responsibilty for it. I have aborted numerous drug trials because of the inabilty to tolerate sides. But I realize i pay a price for this decision in that my life is not as full as it could be.
I wouldn't be too hard on yourself for not being in remission or feeling that side effects are intolerable. There are, after all, two sides to the issue in this post.There really are people who's quality of life is so reduced from side effects that the meds are only technically tolerable, just like someone who hasn't eaten in three days could technically choose to not eat a plate of food sitting in front of them.
Although we have to be careful about choosing meds based on our theories, all the treatments are based on theories that are in the end, disconcertingly similar in many cases.
Posted by Bob on August 20, 2008, at 12:17:55
In reply to Re: The stakes are too high., posted by Cecilia on August 20, 2008, at 0:26:13
> There are many different types of side effects. I could care less if a med decreases my libido, which is already zero, and I am already fat, with very painful health problems as a result, so while I don't want to gain any more weight, I would be willing to if an antidepressant actually worked; it would mean a shorter and more physically painful life, but a short period of less emotional pain before I died would be worth it. I think of side effects in terms of "can I function with this?". I could not function with Effexor unless I wanted to spend my entire life within 2 feet of the bathroom, and yes, I started at the smallest possible dose. I could not function with the severe eye pain of Emsam or Nardil. Some meds I have given up on before the magic six weeks and others I have forced myself through a trial despite horrible side effects but it has nothing to do with any theories, just what I can stand. Some of the trials I have forced myself through have been basically self punishment for being depressed. My pdoc, who is supposed to be an expert on treatment resistant depression has long since run out of ideas and could care less, just tells me to try therapy again, when I have already spent a fortune on useless therapy. I stand in awe of the high doses of meds that you are able to tolerate, Scott, but everybody's metabolism is different. Nobody wants to be depressed and we are all doing the best we can. Cecilia
Excellent post, Cecelia. I too am amazed at what Scott and some others on this board are able to tolerate, when in some cases for me, practically any one of the meds in their cocktail would present severe problems for me. It's odd to find oneself in a position of envy (for lack of a better term) of someone who can take large cocktails of AD's.
Posted by Bob on August 20, 2008, at 12:24:42
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 8:03:35
> Don't get mad at me for trying.
>
> Something I read recently demonstrated that, for certain drugs, more is better when it comes to a starting dosage to avoiding side effects. Prozac and Geodon are examples. Prozac at 20mg is probably less problematic than at 5mg. At lower dosages, it can be anxiogenic, at higher dosages it becomes anxiolytic and antidepressive. The same thing has been shown to be true of Geodon. It is less problematic at 40mg than it is at 20mg. I wonder if Abilify follows a similar pattern. I also wonder if at lower dosages, Effexor is more dopaminergic relative to serotonin and norepinephrine and more likely to produce a nausea that lingers.
Scott, have you come across any articles in the med literature that you might be able to point me two about the differing responses at different doses?
>
> With Abilify, I started at 20mg. I had very little problem with agitation, restlessness, or anxiety. The doctor who managed me was pretty smart.Isn't it difficult to say with certainty why you responded the way you did to Abilify since you already had a number of meds on board which would be producing significant anxiolytic effects, and thus fighting any restlessness you might have otherwise gotten from Abilify?
>
> Anyway, I am still on your side, even if my current positive outlook becomes annoying.
>
> Any chance of mixing Wellbutrin with Lamictal?
>
>
> - Scott
>
>
>
Posted by SLS on August 20, 2008, at 12:33:14
In reply to Re: The stakes are too high. » SLS, posted by Bob on August 20, 2008, at 12:24:42
Hi Bob.
Are All Atypical Antipsychotics Equal for the Treatment of Cognition and Affect in Schizophrenia?Chairperson: Stephen M. Stahl, MD, PhD; Faculty: Herbert Y. Meltzer, MD; Jonathan M. Meyer, MD; Lili C. Kopala, MD, FRCPC
Copyright © 2004 The Center for Health Care Education, LLC"Are All Atypical Antipsychotics Equal for the Treatment of Cognition and Affect in Schizophrenia?"
A symposium held at the Hilton New York in New York, New York, on May 2, 2004.
Stephen Stahl:"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Scott
Posted by SLS on August 20, 2008, at 12:35:10
In reply to Re: The stakes are too high. - SLS, posted by Justherself54 on August 20, 2008, at 11:32:39
> I noticed in one of you posts you had put med sensitive in quotes. I consider my self med sensitive or side effect sensitive and so does my pdoc.
Your point is well taken, and I do apologize.
- Scott
Posted by SLS on August 20, 2008, at 12:38:38
In reply to Re: The stakes are too high. - SLS, posted by Justherself54 on August 20, 2008, at 11:32:39
Posted by B2chica on August 20, 2008, at 13:01:21
In reply to Re: The stakes are too high. » Hygieia's Bowl, posted by atmlady on August 19, 2008, at 22:18:53
that's what i want, the perfect AD. but what is that?
i ask myself am i asking/looking for trouble when i venture out and try new meds. when im 'getting by with my old standby zyprexa.
then i think and remember the few months of how i was on a combo way back of zyprex and wellbutrin.
zyprexa gets me to sea level. but thats it. i'm no longer drowning. and i feel i should be happy with that. and i feel guilty for looking further.
but i get tears in my eyes when i remember how much more energy i had, and how i could actually interact with people (or wanted to) and laugh about nothing.how i could have a day...a week go by without thoughts of death breeze through my mind.
***********************
im what you would call 'stable' right now.
but i'm not ...'happy'. i'm getting by. i back to being able to 'pretend' to be happy.
but i'm not. and now it's worse because i can remember how happy i could be.i hate 'playing' with my meds. especially with little to no help from my pdoc who seems to thing no change in my meds might help me????!!
so the only time things change is when i suggest them.
so my paradox, is playing with meds.
am i doing it because i'm forever looking for the "Just right med combo" that may not even be out there for me, or has it become that obsession?i don't know. maybe a little of both.
but i know i can't stop now.
and i usually stick things out if anything too long through horrible SE. only for them not to work after all.the only thing i hate worse than this, is the outside worlds views on this. how most people really don't have a clue about med changes and what we go through.
i'm ranting now because i had to drop a class for the fall because i knew i'd miss more than three classes and she would fail anyone that missed that...no exceptions. i even told her i had medical issues and i asked her if i'd be better off dropping the class? she simply emailed back "yes".but my health is more important right now (i convince myself)
like SLS says...the stakes are too high.
Posted by Justherself54 on August 20, 2008, at 14:26:03
In reply to Re: The stakes are too high., posted by B2chica on August 20, 2008, at 13:01:21
You're right..people don't know what we go through with med changes...I think a lot of us do med changes as we don't want to just exist..we want to live again..and we keep hoping we'll find the right combo that lets us become the person we were before all this happened to us..
Posted by bulldog2 on August 20, 2008, at 15:01:47
In reply to Re: The stakes are too high. » atmlady, posted by Hygieia's Bowl on August 20, 2008, at 7:33:13
> Hey There Ms. atm
>
> > I agree with you, Hy.
>
> I am so very pumped as I rarely get an agreement. ; )
>
> I am slowly realizing I am allowing the posted experiences of a few to cloud how I preceive and evaluate the manner in which folks are going about their treatment plans and maybe, just maybe, I'm not seeing the forest for the trees.
>
> I wish you the very best in your quest. I've been doing well for some years now and it's a wonderful thang.I think you hit the nail on the head. One goes to a p-doc and has a game plan to try meds to get better. Than one comes here for med info and reads rants that meds don't work and someone's life history of med failures. So who does one believe? Do you believe in your p-doc and his meds or the ranter and his failures? I think at times this has caused vacillation and doomed my med trials to failure.It's one thing to start a med trial and endure the sides in the hope you will achieve remission and another to endure sides in a fruitless quest. Once the seeds of doubt are planted there's a good chance the med trial will fail.
I have heard many success stories talking to people who were on ad's. They were not on for life but used them for a while and were able to discontinue when not needed. But when they went to their docs they probably believed the meds had a chance of working. Had they come here first and read the rants who knows what the outcome would have been.
Posted by Bob on August 20, 2008, at 18:00:56
In reply to The stakes are too high., posted by SLS on August 19, 2008, at 8:11:07
> I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
>
> Don't stop.
>
> You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
>
> By the way, drugs work.
>
>
> - Scott
>
Scott:If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?
Bob
Posted by mknight on August 20, 2008, at 19:02:25
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 5:08:11
> I really don't care how people get well, as long as the treatment is inherently safe.
> - Scott
You answered my question a few weeks ago about Nardil being hepatotoxic, but after reading your above sentence, I just have to ask.What about MAOIs and TCAs being hepatotoxic, causing hepatic failure, increasing intraocular pressure, etc?
What about atypical antipsychotics causing tardive dyskinesia, diabetes, etc.
Do you think that the above side effects occur in only a small percentage of the population and the benefit of the proper treatment outweighs the risks?
My reason for asking is that for 14 years I have felt stoned and spacey as if I had smoked marijuana or taken mescaline. I have taken Paxil, Zoloft, Celexa, Prozac, Wellbutrin, Mirtazapine, Methylphenidate, and Dexedrine. The SSRIs make me more stoned. Paxil was like taking LSD. Wellbutrin helps for a few weeks but 6 months later does nothing. Methylphenidate and Dexedrine put me to sleep and cause fatigue.
I have read that hallucinogenic drugs act as an agonist at 5HT2a. So I thought that a 5HT2a antagonist like Mirtazapine would help but it did nothing. My other option is atypical antipsychotics but I am concerned about long term side effects.
I may possibly fit the diagnosis for atypical depression for which MAOIs are supposed to work, but once again I do not want to fix my brain only to destroy my liver.
The only time in 14 years that I have not been stoned is after 2 separate stays in the hospital for an intestinal infection and a burst appendix. I felt completely normal for 5 months after each stay. I was given a sodium, chloride, potassium IV and IV Flagyl and Cipro antibiotics. None of my doctors have any answer for this.
I do not feel depressed just stoned, unmotivated, tired.
Posted by SLS on August 21, 2008, at 1:32:16
In reply to Re: The stakes are too high. » SLS, posted by Bob on August 20, 2008, at 18:00:56
>
> > I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
> >
> > Don't stop.
> >
> > You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
> >
> > By the way, drugs work.
> >
> >
> > - Scott
> >
>
>
> Scott:
>
> If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?Yes. I am an unusual bipolar who stays severely depressed for decades, but who can be made psychotically manic by certain antidepressant drugs. I believe there will be a new diagnosis for this condition added to the DSM V. Furthermore, I spent a few years as an ultra rapid cycler with a period of 11 days marked by 8 days of severe depression followed by 3 days of normalcy. I think most rapid cyclers are true bipolars, whether the reach mania or not.
- Scott
Posted by SLS on August 21, 2008, at 1:50:58
In reply to Re: The stakes are too high. » SLS, posted by mknight on August 20, 2008, at 19:02:25
> I may possibly fit the diagnosis for atypical depression for which MAOIs are supposed to work, but once again I do not want to fix my brain only to destroy my liver.
The risk is rather small and can be monitored for by blood tests assaying liver enzymes. It is worth mentioning, though. I know that Terrence Ketter, MD, now at Stanford, will choose Marplan before Nardil to avoid hepatic stress. I have never known anyone to suffer this reaction. But, then again, I don't know 100,000 people taking Nardil.
> The only time in 14 years that I have not been stoned is after 2 separate stays in the hospital for an intestinal infection and a burst appendix. I felt completely normal for 5 months after each stay. I was given a sodium, chloride, potassium IV and IV Flagyl and Cipro antibiotics. None of my doctors have any answer for this.
I might be able to. It is either an anti-inflammatory property of one of the antibiotics or Lyme disease. How long have you been suffering for?
> I do not feel depressed just stoned, unmotivated, tired.
You know, I discussed "brain fog" with my doctor just last month. Unfortunately, I can't remember the details at the moment, but he had identified several mechanisms by which it could occur. I think he had referred to excessive glutamate.
Your rationale to try Remeron is quite astute. I'm glad you followed up on it just to be sure. Did Remeron make things worse in any way?
- Scott
Posted by seldomseen on August 21, 2008, at 6:39:15
In reply to Re: The stakes are too high. » SLS, posted by mknight on August 20, 2008, at 19:02:25
You are not the first to speculate that there might be a connection between depression/malaise and intestinal problems/treatments.
There has been a lot of discussion regarding inflammation and mental illness.
Do you take fish oils?
Seldom
Posted by Bob on August 21, 2008, at 14:16:50
In reply to Re: The stakes are too high. » Bob, posted by SLS on August 21, 2008, at 1:32:16
> >
> > > I think I project a great deal of my recent success using drug therapy onto the majority. It is wishful thinking, I know, but sometimes wishful thinking leads to success.
> > >
> > > Don't stop.
> > >
> > > You have only one chance at life. Don't waste too many ticks of the clock thinking that you are smarter than man's current compendium of knowledge.
> > >
> > > By the way, drugs work.
> > >
> > >
> > > - Scott
> > >
> >
> >
> > Scott:
> >
> > If you don't mind me asking, what would you characterize your base core illness as, i.e. what is your official diagnosis? Are you a more or less pure unipolar depressive, or are there complicating factors for you?
>
> Yes. I am an unusual bipolar who stays severely depressed for decades, but who can be made psychotically manic by certain antidepressant drugs. I believe there will be a new diagnosis for this condition added to the DSM V. Furthermore, I spent a few years as an ultra rapid cycler with a period of 11 days marked by 8 days of severe depression followed by 3 days of normalcy. I think most rapid cyclers are true bipolars, whether the reach mania or not.
>
>
> - Scott
>
>
I think if I searched long and hard enough I could find a doctor to classify me as BP not otherwise specified, but I'm not sure how it would change my treatment. I've never been full manic at all, and have only experienced what I would call true hypomania from meds, so whatever I have it's strange. Problem with any type of a bipolar diagnosis is that then docs start talking mood stabilizers, and for me that mean depression, lethargy, fatigue, confusion and even suicidality from some.
Posted by Cecilia on August 22, 2008, at 0:25:23
In reply to Re: The stakes are too high. » Cecilia, posted by SLS on August 20, 2008, at 8:03:35
> Don't get mad at me for trying.
>
> Something I read recently demonstrated that, for certain drugs, more is better when it comes to a starting dosage to avoiding side effects. Prozac and Geodon are examples. Prozac at 20mg is probably less problematic than at 5mg. At lower dosages, it can be anxiogenic, at higher dosages it becomes anxiolytic and antidepressive. The same thing has been shown to be true of Geodon. It is less problematic at 40mg than it is at 20mg. I wonder if Abilify follows a similar pattern. I also wonder if at lower dosages, Effexor is more dopaminergic relative to serotonin and norepinephrine and more likely to produce a nausea that lingers.
>
> With Abilify, I started at 20mg. I had very little problem with agitation, restlessness, or anxiety. The doctor who managed me was pretty smart.
>
> Anyway, I am still on your side, even if my current positive outlook becomes annoying.
>
> Any chance of mixing Wellbutrin with Lamictal?
>
>
> - Scott
>
>
>
I'm not mad at you, just frustrated and hopeless. Maybe it's theoretically possible that for some meds higher doses have fewer side effects than lower ones. but it certainly doesn't seem very likely. I know with Prozac it certainly didn't work that way for me , when this "magic" pill first hit the market it only came in 20 mg capsules, even though the manufacturers's own research demonstrated that 5 mg worked for almost as many people as 20, with fewer side effects. I found the insomnia and anxiety horrible at 20, had an idiot doctor who when I said, "this doesn't work" had me double to 40, of course I couldn't tolerate that at all and dropped it. 16 years later I decided to give Prozac another try, asked my doctor for the now available liquid version, started at 1mg/day and worked up over months. Was able to tolerate it that way, but it never did anything for my depression.Is there supposed to be a synergistic effect between Wellbutrin and Lamictal? Both had unpleasant side effects and no beneficial effects. Definitely had adequate trials of each, again working up over many months.
Cecilia
Posted by SLS on August 22, 2008, at 8:50:08
In reply to Re: The stakes are too high. » SLS, posted by Cecilia on August 22, 2008, at 0:25:23
> > Any chance of mixing Wellbutrin with Lamictal?
> Is there supposed to be a synergistic effect between Wellbutrin and Lamictal?
My doctor and his colleagues seem to think so.
- Scott
Posted by mknight on August 22, 2008, at 15:36:36
In reply to Re: The stakes are too high. » mknight, posted by seldomseen on August 21, 2008, at 6:39:15
> You are not the first to speculate that there might be a connection between depression/malaise and intestinal problems/treatments.
> There has been a lot of discussion regarding inflammation and mental illness.
>
> Do you take fish oils?
>
> SeldomI have a lot of sensitivities to foods. Fruit, fruit juice, sugar, bread, potatoes, and rice all send me through the roof as far as a stoned, fat head, headache type of feeling. The only foods I can eat without either an immediate or next day reaction are meat and vegetables. Even then, one day out of seven, ground beef and steamed cabbage will give me a splitting headache and I will be spaced out all day.
Before taking any psychotropic drugs, I tried anything on the market that you could name. Fish oil is about the only item I have not tried. I did try flax oil for omega-3, but that depends on your body being able to convert it, so it may not have proved anything.
Posted by mknight on August 22, 2008, at 15:59:10
In reply to Re: The stakes are too high., posted by SLS on August 21, 2008, at 1:50:58
> > None of my doctors have any answer for this.
>
> I might be able to. It is either an anti-inflammatory property of one of the antibiotics or Lyme disease. How long have you been suffering for?All of my problems started in Oct 1994. I have seen 20 different doctors including neurologists, osteopaths, chiropractor, MDs, psyphiatrists, psychologists, and naturopath. To my knowledge, I have not been bitten by a tick.
> Your rationale to try Remeron is quite astute. I'm glad you followed up on it just to be sure. Did Remeron make things worse in any way?
I could notice the antihistamine effects but nothing else. One reason I thought about atypical antipsychotics is because of the ability to antagonize 5HT2a and also block D2 which some sources say hallucinogenics enhance. But I am seriously concerned about long term damage from taking them.
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