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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by hansi555 on November 7, 2008, at 5:15:21
Hi all
As many others on this site I am searching for right drug or combination of these.
I am currently on 20 mg Lexapro and 30 mg Remeron (taken for sleep around bed-time). 5 weeks ago I was added 25 mg of Nortriptyline and the original plan was to skip Lexapro and go full speed on Nort due to melancholic features. But the adding (or just pure luck?) of just 25 mg of Nort made me feel better than for a long time, so we (PD and I) decided to use a small dose Nort as augmentor for the Lex.
It has been working good for 3 out of these past 5 weeks.But the last couple of days I have yet agian had crying spells and depression-like feelings.
When looking back through my notes I can see that the periods when I feel normal/good lasts for 9-14 days.
A good period is then followed by a similar lenght period of mixed days, some days are bad w crying spells, other days are ok.
Then comes a new good period, then a new mixed/bad period etc.I am regarded uni-polar depression (stress released and stress burnt out after 12-18 months of waaaay too much to do). I have the melancholic features, these seem to have more or less vanished since the adding of Nort.
I am working currently 25-30 hours a week (part time) as area sales manager and doing pretty well - my area of responsability has been reduced to a minimum. I have cut down on a lot of activities in my spare time as well.
My question is:
a. is my pattern normal for a depression? Thought that the drugs should make me more stable than this...
b. if I am still doing to many things as I do in the good periods (I am not feeling stressed) and this can cause bad periods?
c. should I just accept the relapsing thing or go for heavier drugs
d. if so should it be more Nortriptyline og maybe Lamictal/Lithium?Thanks for all inputs...
Posted by Phillipa on November 7, 2008, at 10:33:37
In reply to In which direction should I go?, posted by hansi555 on November 7, 2008, at 5:15:21
Are you sleeping enough? When your're busy your're okay and when not you dip down. Same thing happens to me. So I try and keep busy. Any symptoms that would lead you to think your're bipolar? if not maybe just normal rhythmn for you? Phillipa
Posted by azalea on November 7, 2008, at 15:23:42
In reply to In which direction should I go?, posted by hansi555 on November 7, 2008, at 5:15:21
It sounds a bit like subtle cycling, it and out of depression, but without mania or hypomania. This type of mood disorder typically responds well to mood stabilizers. I vote for choice D, Lamictal or Lithium.
> Hi all
> As many others on this site I am searching for right drug or combination of these.
> I am currently on 20 mg Lexapro and 30 mg Remeron (taken for sleep around bed-time). 5 weeks ago I was added 25 mg of Nortriptyline and the original plan was to skip Lexapro and go full speed on Nort due to melancholic features. But the adding (or just pure luck?) of just 25 mg of Nort made me feel better than for a long time, so we (PD and I) decided to use a small dose Nort as augmentor for the Lex.
> It has been working good for 3 out of these past 5 weeks.
>
> But the last couple of days I have yet agian had crying spells and depression-like feelings.
>
> When looking back through my notes I can see that the periods when I feel normal/good lasts for 9-14 days.
> A good period is then followed by a similar lenght period of mixed days, some days are bad w crying spells, other days are ok.
> Then comes a new good period, then a new mixed/bad period etc.
>
> I am regarded uni-polar depression (stress released and stress burnt out after 12-18 months of waaaay too much to do). I have the melancholic features, these seem to have more or less vanished since the adding of Nort.
>
> I am working currently 25-30 hours a week (part time) as area sales manager and doing pretty well - my area of responsability has been reduced to a minimum. I have cut down on a lot of activities in my spare time as well.
>
> My question is:
>
> a. is my pattern normal for a depression? Thought that the drugs should make me more stable than this...
> b. if I am still doing to many things as I do in the good periods (I am not feeling stressed) and this can cause bad periods?
> c. should I just accept the relapsing thing or go for heavier drugs
> d. if so should it be more Nortriptyline og maybe Lamictal/Lithium?
>
> Thanks for all inputs...
Posted by polarbear206 on November 7, 2008, at 20:07:44
In reply to Re: In which direction should I go? » hansi555, posted by azalea on November 7, 2008, at 15:23:42
> It sounds a bit like subtle cycling, it and out of depression, but without mania or hypomania. This type of mood disorder typically responds well to mood stabilizers. I vote for choice D, Lamictal or Lithium.
>I agree with the above post.
You've definatley got some soft cycling going on. I went through the same thing. Lamictal has done wonders for me.
Posted by hansi555 on November 8, 2008, at 4:43:31
In reply to Re: In which direction should I go?, posted by polarbear206 on November 7, 2008, at 20:07:44
> > It sounds a bit like subtle cycling, it and out of depression, but without mania or hypomania. This type of mood disorder typically responds well to mood stabilizers. I vote for choice D, Lamictal or Lithium.
> >
>
> I agree with the above post.
> You've definatley got some soft cycling going on. I went through the same thing. Lamictal has done wonders for me.
Okay then, thanks both of youWhat about SE for Lamictal? Would you consider SE for Lamictal worse than for Nortriptyline?
If I go for Lamictal, should I continue with another AD such as Lexapro or maybe even Nortriptyline?
Have to add that my depression originally broke out in february 2008. Has been upps and downs since then, no matter what combination I tried it will not stay good.
In general I have improved as most of my melancholic features (early wakening, nausea, lack of appetite, morning worsening) have disappaered since Nortriptyline in a small dose came into my combo.I am also wondering if I really need Remeron (30 mg) in the evening and if it is doing more harm than good in regards of the melancholic features?
Posted by azalea on November 8, 2008, at 13:15:58
In reply to Re: In which direction should I go?, posted by hansi555 on November 8, 2008, at 4:43:31
Some recommend a trial of Lamictal without an antidepressant on board. However, another option would be t add the Lamictal, then slowly taper off antidepressants if you're doing well. The concering side effect of Lamictal is a small risk of a life-threatening rash called Stevens Johnson Syndrome. This can be minimized by starting at a low dose and titrating slowly. Other Lamictal side effects are mild or nonexistent compared to TCAs.
> > > It sounds a bit like subtle cycling, it and out of depression, but without mania or hypomania. This type of mood disorder typically responds well to mood stabilizers. I vote for choice D, Lamictal or Lithium.
> > >
> >
> > I agree with the above post.
> > You've definatley got some soft cycling going on. I went through the same thing. Lamictal has done wonders for me.
>
>
> Okay then, thanks both of you
>
> What about SE for Lamictal? Would you consider SE for Lamictal worse than for Nortriptyline?
>
> If I go for Lamictal, should I continue with another AD such as Lexapro or maybe even Nortriptyline?
>
> Have to add that my depression originally broke out in february 2008. Has been upps and downs since then, no matter what combination I tried it will not stay good.
> In general I have improved as most of my melancholic features (early wakening, nausea, lack of appetite, morning worsening) have disappaered since Nortriptyline in a small dose came into my combo.
>
> I am also wondering if I really need Remeron (30 mg) in the evening and if it is doing more harm than good in regards of the melancholic features?
>
Posted by bleauberry on November 8, 2008, at 21:32:31
In reply to In which direction should I go?, posted by hansi555 on November 7, 2008, at 5:15:21
Well it is obvious there is some cycling going on. However, it appears to be a predictable cycle with a pattern to it. That pretty much rules out bipolar as I see it. If female, that pattern would obviously fit into the monthly hormone cycles. But, men have regular hormone cycles too, not much talked about and not usually of any consequence, but there is movement going on. Things are not stationary.
But even if that is true, how to balance hormones? I don't know. I think the best we can do is balance the end result of what they do, which means taking a mood stabilizer.
Herbs are kind of uncharted waters when mixed with meds, but there are some herbs known for their hormone balancing actions.
You might take a real close look at things like sleeping patterns, what you eat each day, and be a detective looking for something that is setting this thing in motion. Something, anything. If you could afford it, you could even take a cortisol, dhea, free T3, free T4, total T4 hormone lab test when you are feeling good, and take them again when you are feeling bad. Include other hormones as afforded. Who knows, maybe there is something going on with the thyroid? A subtle case of Hashimotos? Maybe adrenals are exhausted but not severely, to where they have enough ooomph to get you through a short period, then they are too tired and fall behind, but then while you are slowed down they have time to recover and kick in again? These kinds of things are worth exploring before making yet another addition of a powerful med. Any venture at a diagnosis without these kinds of detective tests is purely guesswork.
Posted by polarbear206 on November 8, 2008, at 23:07:06
In reply to Re: In which direction should I go?, posted by bleauberry on November 8, 2008, at 21:32:31
> Well it is obvious there is some cycling going on. However, it appears to be a predictable cycle with a pattern to it. That pretty much rules out bipolar as I see it. If female, that pattern would obviously fit into the monthly hormone cycles. But, men have regular hormone cycles too, not much talked about and not usually of any consequence, but there is movement going on. Things are not stationary.
>
> But even if that is true, how to balance hormones? I don't know. I think the best we can do is balance the end result of what they do, which means taking a mood stabilizer.
>
> Herbs are kind of uncharted waters when mixed with meds, but there are some herbs known for their hormone balancing actions.
>
> You might take a real close look at things like sleeping patterns, what you eat each day, and be a detective looking for something that is setting this thing in motion. Something, anything. If you could afford it, you could even take a cortisol, dhea, free T3, free T4, total T4 hormone lab test when you are feeling good, and take them again when you are feeling bad. Include other hormones as afforded. Who knows, maybe there is something going on with the thyroid? A subtle case of Hashimotos? Maybe adrenals are exhausted but not severely, to where they have enough ooomph to get you through a short period, then they are too tired and fall behind, but then while you are slowed down they have time to recover and kick in again? These kinds of things are worth exploring before making yet another addition of a powerful med. Any venture at a diagnosis without these kinds of detective tests is purely guesswork.
Many women with bipolar are extra sensitive to monthly hormone fluctuations. There is plenty of info out there to support this. As suggested, get a complete work-up to rule out any underlying medical issues. Keep a detailed journal of your sleep patterns, mood, energy levels, etc..
Posted by hansi555 on November 9, 2008, at 8:04:02
In reply to Re: In which direction should I go?, posted by polarbear206 on November 8, 2008, at 23:07:06
> > Well it is obvious there is some cycling going on. However, it appears to be a predictable cycle with a pattern to it. That pretty much rules out bipolar as I see it. If female, that pattern would obviously fit into the monthly hormone cycles. But, men have regular hormone cycles too, not much talked about and not usually of any consequence, but there is movement going on. Things are not stationary.
> >
> > But even if that is true, how to balance hormones? I don't know. I think the best we can do is balance the end result of what they do, which means taking a mood stabilizer.
> >
> > Herbs are kind of uncharted waters when mixed with meds, but there are some herbs known for their hormone balancing actions.
> >
> > You might take a real close look at things like sleeping patterns, what you eat each day, and be a detective looking for something that is setting this thing in motion. Something, anything. If you could afford it, you could even take a cortisol, dhea, free T3, free T4, total T4 hormone lab test when you are feeling good, and take them again when you are feeling bad. Include other hormones as afforded. Who knows, maybe there is something going on with the thyroid? A subtle case of Hashimotos? Maybe adrenals are exhausted but not severely, to where they have enough ooomph to get you through a short period, then they are too tired and fall behind, but then while you are slowed down they have time to recover and kick in again? These kinds of things are worth exploring before making yet another addition of a powerful med. Any venture at a diagnosis without these kinds of detective tests is purely guesswork.
>
>
> Many women with bipolar are extra sensitive to monthly hormone fluctuations. There is plenty of info out there to support this. As suggested, get a complete work-up to rule out any underlying medical issues. Keep a detailed journal of your sleep patterns, mood, energy levels, etc..Okay thanks, will try and talk w my doc about this, cannot be that difficult to get these tests taken, BTW all doctors and hospitals are free here in Denmark...
(for that we pay a LOT of tax)
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