![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by floatingbridge on January 16, 2010, at 12:17:50
How are you doing?
fb
Posted by SLS on January 16, 2010, at 14:09:16
In reply to Scott, posted by floatingbridge on January 16, 2010, at 12:17:50
> How are you doing?
So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
Thanks for asking.
- Scott
Posted by Willful on January 16, 2010, at 15:17:37
In reply to Re: Scott » floatingbridge, posted by SLS on January 16, 2010, at 14:09:16
I'm so sorry to hear that Scott. I had hoped you were doing better than that.
Has your pdoc said anything about drugs that might be coming available in the next year?
Willful
Posted by SLS on January 16, 2010, at 15:33:26
In reply to Re: Scott, posted by Willful on January 16, 2010, at 15:17:37
> I'm so sorry to hear that Scott. I had hoped you were doing better than that.
>
> Has your pdoc said anything about drugs that might be coming available in the next year?He hasn't mentioned anything new. One of the reasons I discontinued Parnate was to allow me to try new things as they become available.
I am bringing lithium back on board at 300mg per day to see if I can glean some antidepressant effect without feeling flat.
This is getting old.
- Scott
Posted by floatingbridge on January 16, 2010, at 15:42:15
In reply to Re: Scott » floatingbridge, posted by SLS on January 16, 2010, at 14:09:16
Scott, you've been on my mind--I'm sorry to hear you're not feeling better. Yes, I imagine this is getting pretty old. I'm sorry. I want you to know I'm pulling for you and looking for your posts.
fb
>
> So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
>
> Thanks for asking.
>
>
> - Scott
Posted by SLS on January 16, 2010, at 15:48:22
In reply to Re: Scott » SLS, posted by floatingbridge on January 16, 2010, at 15:42:15
Posted by Justherself54 on January 16, 2010, at 16:31:54
In reply to Re: Scott » Willful, posted by SLS on January 16, 2010, at 15:33:26
I too am sorry to hear you're feeling pretty flat. Me too. Here's to something, anything, that will work for you.
Posted by janejane on January 16, 2010, at 18:40:20
In reply to Re: Scott - Thanks... :-) (nm) » floatingbridge, posted by SLS on January 16, 2010, at 15:48:22
Sorry to hear you're not doing well, Scott. It's always good to see you around. Your posts are always so informative, even if the science-y stuff is above my head. ;-)
Posted by Roslynn on January 16, 2010, at 19:31:47
In reply to Scott, posted by floatingbridge on January 16, 2010, at 12:17:50
Scott,
I wanted to let you know I am pulling for you too.
Roslynn
Posted by Phillipa on January 16, 2010, at 20:01:44
In reply to Re: Scott, posted by Roslynn on January 16, 2010, at 19:31:47
Scott you are on the effexor? Geez something has to work have you tried requip? That and low doses of abilify working so well for old babbler. He's also on some low doses of other meds? But he is bipolar also. love Phillipa
Posted by bulldog2 on January 17, 2010, at 8:05:00
In reply to Re: Scott » floatingbridge, posted by SLS on January 16, 2010, at 14:09:16
> > How are you doing?
>
> So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
>
> Thanks for asking.
>
>
> - ScottScott what is your current combo?
Posted by bleauberry on January 17, 2010, at 12:06:28
In reply to Scott, posted by floatingbridge on January 16, 2010, at 12:17:50
Hi Scott. Was thinking about you this morning.
Did you discontinue Parnate already? I thought maybe you were in the process of weaning off it?
What else are you taking?Hey, I know this is going to sound crazy because it doesn't fit the scientific clinical proof point of view that you are accustomed to. But seriously, I mean real serious, please consider LDN along with whatever you do.
I look back on your history and I see every possible tweaking of serotonin, NE, DA, sodium/calcium channels, on and on.
Endorphins.
I don't think anyone knows the extent to which our natural endorphins play in health and disease, except that in LDN communities they are proving to be profounding involved in psychiatric mood disorders, immune system regulation, thyroid and adrenal regulation. I mean, we're talking everything from Crohn's disease to Lyme to Hashimotos to gluten intolerance to depression and everything inbetween.
One single 50mg pill equals 50 doses. What harm is there in trying such a small amount? None. What potential benefits are there? Tons.
I can only say from my own viewpoint, LDN is good for rapid mood improvement (in combination with something else, not that strong by itself), energy restoration, brain-fog elimination, renewed interest in life, anti-anxiety without sedation, very smooth mood stabilization, and geez, how can such a tiny amount do all that?
The theory is that blocking the opioid receptors for a short time with a small dose interrupts the feedback loop and causes the creation of more endorphins, up to 300% more the following day. And we both know that blocking a receptor will eventually cause them to become more sensitive and responsive when they are opened up, in addition to increasing the numbers of them. So, a lot more endorphins, receptors that can enjoy them, and well, it makes sense for improving mood.
Nortriptyline + Zoloft + LDN. You might feel like your old self before all this crap began, in a matter of 3 days.
I would have to put together several dozens, maybe a hundred, of comments from LDN users, as well as the small pilot studies and open studies done, to back up my hunch this could well be that missing link in your life, but I don't want to do that. Trust me. LDN is for real.
I remember a long time ago, 12 years maybe, in Dr Bobs Psychopharmacology tips there was a doctor who discovered that Naltrexone reversed Prozac poopout, and created remission in partial responders. There was a group of us here that tried it, and it was a fad for a while, but no one could duplicate that doctor's results.
Today we know why. The 25mg and 50mg he was using were far too high, blocking the opioid receptors strongly 24/7. That's the wrong approach. We only want to block them weakly for a few hours.
Even at my dose of 25mg though I could tell there was a lot of something else going on besides merely blocking opioid receptors. I am totally convinced those receptors are intricately communicative with serotonin and dopamine. Again, I could go into a long story of my own experiences and literature explaining that, but just trust me. Too much stuff.
LDN. No matter what it is you do going forward, whether it is a SSRI + TCA, SNRI + TCA...make sure 1mg Naltrexone goes along with it. A 50mg pill can be crushed and then 1/50th crumbs estimated, or get your doctor to call in a prescription to a compounding pharmacy. If you do a google search on LDN you'll find a home page that has the most experienced LDN compounding pharmacies listed.
This is kind of awkward because I feel like the student making suggestions to the expert teacher that you are, but I would also strongly suggest a protocol of Diflucan 100mg twice a week for 4 or 5 months. I know you eat yogurt everyday and that's a good thing. I feel that by itself is not enough to ward off the opportunistic environment created by longstanding stress on the body due to feeling bad for so long, and the unavoidable chronic ingestion of pharmaceuticals. Excess yeast/fungi in the gut and body feels every bit as bad and the same as the DSM depression. Being a fast metabolizer, Diflucan will also slow things down a little bit. There is liver risk with daily usage, but it is nontoxic and safe for long periods of time when taken weekly.
I have no doubt you are making plans for your next ADs. I wholeheartedly desperately want to see things work. To increase the odds of that happening, I am totally absolutely 100% convinced LDN and Diflucan will make the game-winning touchdown. Not by themselves however. They need to go with SSRI/TCA, SNRI/TCA.
Unlike the myriad of choices we have in the pharmaceutical world, these two meds offer a distinctly unique profile...very high potential, near zero risk, zero side effects. As I see it, there is no argument anyone could make to not try them.
I hate it when people say, "Have a good day." They have no idea. But I will wish for you my favorite line, "Have a smooth day." Better days are ahead for you, I can see it.
Fondly and respectfully.
Bleauberry
Posted by SLS on January 17, 2010, at 12:32:33
In reply to Re: Scott, posted by bleauberry on January 17, 2010, at 12:06:28
Hi Bleauberry.
I am grateful that you took the time to post this. It is going to take me a while to read it all. I have thought about naltrexone, but never looked into it enough to learn how to go about using it. I would have to sell my doctor on the idea, though.
Thanks.
- Scott
---------------------------------------------
> Hi Scott. Was thinking about you this morning.
>
> Did you discontinue Parnate already? I thought maybe you were in the process of weaning off it?
> What else are you taking?
>
> Hey, I know this is going to sound crazy because it doesn't fit the scientific clinical proof point of view that you are accustomed to. But seriously, I mean real serious, please consider LDN along with whatever you do.
>
> I look back on your history and I see every possible tweaking of serotonin, NE, DA, sodium/calcium channels, on and on.
>
> Endorphins.
>
> I don't think anyone knows the extent to which our natural endorphins play in health and disease, except that in LDN communities they are proving to be profounding involved in psychiatric mood disorders, immune system regulation, thyroid and adrenal regulation. I mean, we're talking everything from Crohn's disease to Lyme to Hashimotos to gluten intolerance to depression and everything inbetween.
>
> One single 50mg pill equals 50 doses. What harm is there in trying such a small amount? None. What potential benefits are there? Tons.
>
> I can only say from my own viewpoint, LDN is good for rapid mood improvement (in combination with something else, not that strong by itself), energy restoration, brain-fog elimination, renewed interest in life, anti-anxiety without sedation, very smooth mood stabilization, and geez, how can such a tiny amount do all that?
>
> The theory is that blocking the opioid receptors for a short time with a small dose interrupts the feedback loop and causes the creation of more endorphins, up to 300% more the following day. And we both know that blocking a receptor will eventually cause them to become more sensitive and responsive when they are opened up, in addition to increasing the numbers of them. So, a lot more endorphins, receptors that can enjoy them, and well, it makes sense for improving mood.
>
> Nortriptyline + Zoloft + LDN. You might feel like your old self before all this crap began, in a matter of 3 days.
>
> I would have to put together several dozens, maybe a hundred, of comments from LDN users, as well as the small pilot studies and open studies done, to back up my hunch this could well be that missing link in your life, but I don't want to do that. Trust me. LDN is for real.
>
> I remember a long time ago, 12 years maybe, in Dr Bobs Psychopharmacology tips there was a doctor who discovered that Naltrexone reversed Prozac poopout, and created remission in partial responders. There was a group of us here that tried it, and it was a fad for a while, but no one could duplicate that doctor's results.
>
> Today we know why. The 25mg and 50mg he was using were far too high, blocking the opioid receptors strongly 24/7. That's the wrong approach. We only want to block them weakly for a few hours.
>
> Even at my dose of 25mg though I could tell there was a lot of something else going on besides merely blocking opioid receptors. I am totally convinced those receptors are intricately communicative with serotonin and dopamine. Again, I could go into a long story of my own experiences and literature explaining that, but just trust me. Too much stuff.
>
> LDN. No matter what it is you do going forward, whether it is a SSRI + TCA, SNRI + TCA...make sure 1mg Naltrexone goes along with it. A 50mg pill can be crushed and then 1/50th crumbs estimated, or get your doctor to call in a prescription to a compounding pharmacy. If you do a google search on LDN you'll find a home page that has the most experienced LDN compounding pharmacies listed.
>
> This is kind of awkward because I feel like the student making suggestions to the expert teacher that you are, but I would also strongly suggest a protocol of Diflucan 100mg twice a week for 4 or 5 months. I know you eat yogurt everyday and that's a good thing. I feel that by itself is not enough to ward off the opportunistic environment created by longstanding stress on the body due to feeling bad for so long, and the unavoidable chronic ingestion of pharmaceuticals. Excess yeast/fungi in the gut and body feels every bit as bad and the same as the DSM depression. Being a fast metabolizer, Diflucan will also slow things down a little bit. There is liver risk with daily usage, but it is nontoxic and safe for long periods of time when taken weekly.
>
> I have no doubt you are making plans for your next ADs. I wholeheartedly desperately want to see things work. To increase the odds of that happening, I am totally absolutely 100% convinced LDN and Diflucan will make the game-winning touchdown. Not by themselves however. They need to go with SSRI/TCA, SNRI/TCA.
>
> Unlike the myriad of choices we have in the pharmaceutical world, these two meds offer a distinctly unique profile...very high potential, near zero risk, zero side effects. As I see it, there is no argument anyone could make to not try them.
>
> I hate it when people say, "Have a good day." They have no idea. But I will wish for you my favorite line, "Have a smooth day." Better days are ahead for you, I can see it.
>
> Fondly and respectfully.
> Bleauberry
Posted by SLS on January 17, 2010, at 12:44:01
In reply to Re: Scott » SLS, posted by bulldog2 on January 17, 2010, at 8:05:00
> > > How are you doing?
> >
> > So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
> >
> > Thanks for asking.
> >
> >
> > - Scott
>
> Scott what is your current combo?
Currently:Effexor 225mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
I've been at 225mg of Effexor for 10 days. So far, it has had very little effect. I am not at all optimistic.
- Scott
Posted by bulldog2 on January 17, 2010, at 13:27:33
In reply to Re: Scott » bulldog2, posted by SLS on January 17, 2010, at 12:44:01
> > > > How are you doing?
> > >
> > > So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
> > >
> > > Thanks for asking.
> > >
> > >
> > > - Scott
> >
> > Scott what is your current combo?
>
>
> Currently:
>
> Effexor 225mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
>
>
> I've been at 225mg of Effexor for 10 days. So far, it has had very little effect. I am not at all optimistic.
>
>
> - Scott
>
>You have never tried marplan. From what I've read that people tend to underdose on that and is just as strong as others at the right dose.
Also as far as effexor goes the higher you go the more that ne and dopamine get involved. How about adding remeron for California rocket fuel. Or using Ixel which is now available in this country approved for fibromyalgia as an add on to effexor. Maybe replace the nortriptytline with wellbutrin.
So as far as your current combo goes
1. How high can you go with effexor? Goes as high as you can and 10 days is to soon to draw a copnclusion.
2. Replace nortriptyline with either wellbutrin, remeron or minalciprin. With minalciprin or remeron you get dual action.
Good luck and try and remain optimistic. As long as there's a new combo to try there's hope.
Posted by polarbear206 on January 17, 2010, at 13:52:54
In reply to Re: Scott, posted by bulldog2 on January 17, 2010, at 13:27:33
> > > > > How are you doing?
> > > >
> > > > So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
> > > >
> > > > Thanks for asking.
> > > >
> > > >
> > > > - Scott
> > >
> > > Scott what is your current combo?
> >
> >
> > Currently:
> >
> > Effexor 225mg
> > nortriptyline 150mg
> > Lamictal 200mg
> > Abilify 10mg
> >
> >
> > I've been at 225mg of Effexor for 10 days. So far, it has had very little effect. I am not at all optimistic.
> >
> >
> > - Scott
> >
> >
>
> You have never tried marplan. From what I've read that people tend to underdose on that and is just as strong as others at the right dose.
>
> Also as far as effexor goes the higher you go the more that ne and dopamine get involved. How about adding remeron for California rocket fuel. Or using Ixel which is now available in this country approved for fibromyalgia as an add on to effexor. Maybe replace the nortriptytline with wellbutrin.
>
> So as far as your current combo goes
>
> 1. How high can you go with effexor? Goes as high as you can and 10 days is to soon to draw a copnclusion.
>
> 2. Replace nortriptyline with either wellbutrin, remeron or minalciprin. With minalciprin or remeron you get dual action.
>
> Good luck and try and remain optimistic. As long as there's a new combo to try there's hope.Scott, Why don't you take the effexor up to 300mg and see if this helps. That's what I take. If I go below, I don't get enough of the ne/dop effect to keep me moving and motivated. If this works, you may be able to lower the nortrip at some point
PB
Effexor 300mg
Lamictal 200mg
Klonopin 1mg prn
Posted by KaylaBear on January 17, 2010, at 14:50:40
In reply to Re: Scott » bleauberry, posted by SLS on January 17, 2010, at 12:32:33
I'm reposting this observation about naltrexone. Not sure if this information would be useful to you or not...
What is the source of the controvery mentioned with PDocs precribing this medication? I'm considering trying it if my doctor would agree to a trial. Has anyone tried this with Lamictal?
"This phenomena of the SSRI "poop out" can usually be reversed by adding 25 mg of naltrexone (marketed in the US as Revia), usually on top of supper to avoid transient nausea. In anywhere from two weeks to five of once daily dosing the SSRI regains the full effect and often is perceived as working better than it did at first. I have done this in over forty cases where this has been most gratifying. At this dose of naltrexone the incidence of side effects is very low, and the improvement is sustained over a period of years. It has been the end of poop out in my practice."
http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
Posted by floatingbridge on January 17, 2010, at 16:35:30
In reply to Re: Scott » SLS, posted by KaylaBear on January 17, 2010, at 14:50:40
Kbear,
I'm adding ldn to the list I take to my consult. My mornings are the worst.
Sorry I can't address your questions.
fb
Posted by Phillipa on January 17, 2010, at 20:10:51
In reply to ldn info » KaylaBear, posted by floatingbridge on January 17, 2010, at 16:35:30
My mornings also hence stay up so late. Phillipa
Posted by Lou Pilder on January 17, 2010, at 20:26:21
In reply to Re: Scott » bulldog2, posted by SLS on January 17, 2010, at 12:44:01
> > > > How are you doing?
> > >
> > > So-so. I'm not feeling terrible, but I sure ain't feeling well. I have no interest or motivation to do anything. I keep reminding myself that things could be worse.
> > >
> > > Thanks for asking.
> > >
> > >
> > > - Scott
> >
> > Scott what is your current combo?
>
>
> Currently:
>
> Effexor 225mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
>
>
> I've been at 225mg of Effexor for 10 days. So far, it has had very little effect. I am not at all optimistic.
>
>
> - Scott
>
> Friends,
If you are considering responding in this thread, I ask that you consider the consequences that could happen when the drugs in question are combined. One of the consequences is death.
Here is a link to a site that shows drug interactions.
Lou
http://www.drugs.com/interactions-check.php
Posted by Laney on January 18, 2010, at 11:12:44
In reply to Re: Scott » bleauberry, posted by SLS on January 17, 2010, at 12:32:33
Blueberry,
How much LDN do you take? I tried to up my paxil after being on it at 10mg. for a year to 20 and it's causing muscle tension in my face, neck and jaw. So paxil isn't going to do it for me this time and I'm wondering if adding the LDN would make sense. I think you can order it yourself correct?
Thanks,
Laney
Posted by floatingbridge on January 18, 2010, at 12:15:00
In reply to Scott, posted by floatingbridge on January 16, 2010, at 12:17:50
Thinking of you today.
Is rTM, or is it TMr on your radar these days? (never was good at spelling)
fb
Posted by bleauberry on January 18, 2010, at 18:17:30
In reply to Re: Scott » bleauberry, posted by SLS on January 17, 2010, at 12:32:33
Scott, ok so LDN has been mentioned. I'll explain it a bit better here.
But I also wanted to bring up a topic that was mentioned before. It has been combined with Effexor, Duloxetine, Wellbutrin, Paxil, and Luvox without problems but remarkable benefits. Also goes very well with Pindolol, Risperdal, or Zyprexa. Case studies, small studies, open studies, patient forums. The drug I'm talking about is Milnacipran. Savella in USA. There is something very different about this med. To simply categorize something as a SSRI or SNRI, and Savella is a SNRI, doesn't do this med justice. There is something else going on with it.
LDN is pretty simple. Get the doc to prescribe 1.5mg and give him the phone number of your chosen compounding pharmacy you can get at an LDN homepage. Several good sites out there now and many choices in pharmacies and fillers too. Simply take 1.5mg at bedtime. People work up to a max dose of 4.5mg. For me, I need less than 1.5mg, so I empty a 1.5mg capsule and make my own custome sizes.
Do some reading on it when you get a chance. I know you don't have MS or Lupus or Chrons or autoimmune diseases, which is what LDN is really good for, but you and me are looking for the endorphins. At just one week I can tell something is going on, because for the first time in years I don't feel chilled and cold all the time. Mood is still mostly down and fluctuates, but at random sporadic moments during a day it will actually get good, and then bad again. It's early. I have dosage experimenting to do. But there is really something going on rather impressive, considering it's only 1/50th of a normal dose. Who would have ever thought the the smaller the dose the better? Smile. It is so backwards from the way you and I have always been trained.
Milnacipran.
LDN.
Both fine with your current meds.
Posted by Phillipa on January 18, 2010, at 19:12:36
In reply to Re: Scott » SLS, posted by bleauberry on January 18, 2010, at 18:17:30
Blu did you see the LDN website in a separate link? I copied and pasted it for further reference. Phillipa
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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