Psycho-Babble Medication Thread 904699

Shown: posts 235 to 259 of 281. Go back in thread:

 

Re: Going back to old-school - lithium. » linkadge

Posted by Questionmark on December 10, 2009, at 4:17:52

In reply to Re: Going back to old-school - lithium., posted by linkadge on July 4, 2009, at 7:42:42

I just happened to look through this thread.
What a great little discussion this was. I'd have to say, as i often do, that i agree with Linkadge on this. And he lays it out brilliantly in this post i think.
But yeah for years i've thought the notion that *having a manic reaction on a drug equals you are bipolar* seemed wildly off base and over-simplistic. Kind of like the idea of, "If you take a stimulant and feel calm and focused then you have ADHD; if you take one and feel restless and energetic then you do not have ADHD."
Ah, psychiatry.
Brilliant, brilliant post. So many good points.


> >Yeah. Those with occult bipolar spectrum >disorders.
>
> Well if your definition of bipolar is an individual who has a manic epsode in response to an antidepressant then yes. Otherwise its just a drug reaction.
>
> >Even depression can be parsed using the
> >body's reaction or non-reaction to the >administration of the drug, dexamethasone.
>
> This is rarely used for diagnostic purposes. Even such, a certain response to dexamethasone does not conclusively indicate depression. The patient could have cushings disease for instance and react to dexamethasone in a similar manner to depression. Do they necessarily have depression? No. That is the danger in trying to classify drug reactions as diseases.
>
> >I just don't think that this kind of mentality >went into the decision reached by William Potter >(NIH) in 1992 to understand my illness as being >a variety of bipolar disorder.
>
> Who knows peoples motives. Have you ever noticed that ever since drugs like seroquel have been approved for bipolar depression, there is this big push on internet banners for patients to consider whether they might have bipolar depression. The drug de jour defines how we classify mental illnesses. We are in a perod of AD backlash. Everyone's got bipolar depression now because a) their SSRI pooped out or b) they had a manic response to an antdidepressant. Keep in mind the SSRI's can cause extreme akathesia for some patients. Many of the symptoms of extreme akathesia overlap well with mania - namely irritability, psychomotor agiation, insomnia, etc. etc.
>
> >Perhaps. The question is whether or not it is >downstream from the pharmacological actions of >the drug. Wellbutrin and Prozac hit different >targets even though many downstream effects are >the same.
>
> This is exaclty what I am saying though. If the patient was bipolar already, one would expect the mood elevation itself to accelerate the cycle.
>
> >I have never heard that. Stimulating, yes. It >might be closer in effect to methylphenidate
> >(Ritalin) or amphetamine (Dexedrine).
>
> Exaclty, drugs which people abuse to get high. People high on stimulants have symtpoms identical to manic episodes.
>
> >I do understand where you are coming from with >all of this. If you really want to do some >digging, you might want to try some empirical >research. For example, at what rate does the >general population respond to amphetamine with a >manic episode versus people who seek treatment >for depression.
>
> Anyone who abuses amphetamine is more or less having a manic episode. Elevated mood, increased energy, goal directed behaviors, increased hedonic capacity, less need for sleep, pressure of speech, grandiose ideas, you name it - its all the same thing.
>
> >If Manji can make rats "depressed", I guess he >can make them "manic". How would he go about >making a person manic? Where on the Net can I >find the Manji quote you cited?
>
> He has done losts of work in rats and what he notices is that high dose amphetamines do cause behavior which is used as a model for amphetamines. How do you think all of these bipolar and schizophrenic drugs are identified? By they activity in reducing the manic like excitement caused by stimulants. Stimulants cause a more rapid elevation in signal transduction systems than antidepressants do. Lithium and valproate direclty block the transducton wherase the AP's block the receptor induced transduction.
> Antidepressants also elevate protein kinase C. Actually, the SSRI's have more potent effects on PKC than bupropion does.
>
> If you could relieve depression without causing mania then do you really have bipolar?
>
> Take yourself for instance, what if you initially took (and got well on) bupropion and not nortriptyline. If you never had a manic response to this drug and remained well, would you still be bipolar????
>
> What about agomelatine? I personally think this drug will have an extrelly low propensity to cause mania. No monoamine reuptake. 5-ht receptor blockade. Completely different profile. I think if drugs like this were used more often for depression we'd have fewer manic reactions and ultimately fewer bipolar diagnosis.
>
>
> Linkadge
>
>

 

Re: Going back to old-school - lithium. » SLS

Posted by Questionmark on December 10, 2009, at 4:32:30

In reply to Re: Going back to old-school - lithium., posted by SLS on December 4, 2009, at 8:15:46

Just wanted to say, best of luck to you.

 

Re: Going back to old-school - lithium.

Posted by SLS on January 20, 2010, at 9:29:58

In reply to Re: Going back to old-school - lithium. » SLS, posted by Questionmark on December 10, 2009, at 4:32:30

I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.


- Scott

 

Re: Going back to old-school - lithium. » SLS

Posted by floatingbridge on January 20, 2010, at 10:51:07

In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58

Best wishes Scott--!

Improvement--good. I wish this was an easier process for you.

fb

 

Re: Going back to old-school - lithium.

Posted by Phillipa on January 20, 2010, at 22:26:10

In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 20, 2010, at 10:51:07

Things are looking up excellent!!!!! Phillipa

 

Re: Going back to old-school - lithium.

Posted by hopefullynow on January 23, 2010, at 6:49:20

In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58

Hi Scott!

I'm looking forward for your posts, i read that you exchanged Nardil with Effexor and i wonder that Nardil ineffectiveness combined at that time with lithium, producet that sucky feeling of flatness and detached feelings.

Maybe one AD which really brighen mood at a time(hope this time for you, to be venlafaxine), combined with a modest dose of lithium would have moodstabilizer and augumentor properties without anhedonia and flattening moods.

This summer i did a course of lithium (300-450 mg/day)and it gave me that kind of feelings.Later on, when i already stopped Li, I found out that the AD which I was then, were no longer gave any benefits, completely ineffective.I suppose that if the AD worked, it should take care of nasty feelings, that Li produces.

I really appreciate your tenacity Scott and I wish you all the best.I hope i'll hear from you some time soon that you'll restart the workouts...;).

> I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.
>
>
> - Scott

 

Re: Going back to old-school - lithium. » SLS

Posted by floatingbridge on January 23, 2010, at 14:22:13

In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58

Hi Scott, after rereading this thread, I had a few thoughts. At thanksgiving, you had baseline improvement at about 40%. What is the current estimate?

I forget when you began the effexor--how is it? Probably too early to judge.

I don't see any stimulant on board (except for effexor--is that enough?)--any
reason for that? Off of parnate, would segeline add some neuroprotection in addition to low-dose lithium?

Miraprex or another dopamergenic (is that a word?). Would you consider this type of add-on?

To me, the history of this thread doesn't seem to indicate a great threat of inducing mania, except as you've noted,
and cycling. So you used to be ultra-rapid or somewhat 'disorganized'?

What are your current doses? Ricker has suggested less lamictal. I don't know....

Wondering if the pharmaceutical lid is
too heavy. Dopamine? Maybe abilify isn't quite right.

Hope you receive this comments as they were--notes from another pilgrim.

I'm following your progress; I find your patience a good model. Wishing you success in your current lithium trial.

Hope today is a decent one,

fb
> I restarted lithium three days ago so as to try reducing the severity of my depression, even if only mildly. I am taking 300mg now, and plan on remaining at that dosage. Even at this low dosage, I feel somewhat improved. So far, I am not experiencing much lithium-induced flattening of affect or amotivation.
>
>
> - Scott

 

Re: Going back to old-school - lithium.

Posted by desolationrower on January 24, 2010, at 18:55:56

In reply to Re: Going back to old-school - lithium., posted by SLS on January 20, 2010, at 9:29:58

i think a little lithium is a good thing. i take a small sliver of a pill still.

-d/r

 

Re: Going back to old-school - lithium.

Posted by SLS on January 25, 2010, at 13:43:03

In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 23, 2010, at 14:22:13

I don't know what's going on with me anymore.

My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.

I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.

Does anyone know what countries agomelatine is available in?


- Scott

 

Re: Going back to old-school - lithium. » SLS

Posted by Bob on January 25, 2010, at 14:28:24

In reply to Re: Going back to old-school - lithium., posted by SLS on January 25, 2010, at 13:43:03

> I don't know what's going on with me anymore.
>
> My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.
>
> I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.
>
> Does anyone know what countries agomelatine is available in?
>
>
> - Scott

Scott,

I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.

You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?

Agomelatine is supposedly being brought to the US as Valdoxan, but seems to have been in phase III trials forever and a day. Apparently upon reading about it just, there appears to have been some controversy over its approval in Europe.

http://en.wikipedia.org/wiki/Agomelatine

 

Re: Going back to old-school - lithium. » Bob

Posted by SLS on January 25, 2010, at 19:19:01

In reply to Re: Going back to old-school - lithium. » SLS, posted by Bob on January 25, 2010, at 14:28:24

Hi.

Thanks for the the agomelatine information.

> I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.

For awhile, things seemed to be headed in the right direction. At some point, though, I began to gradually lose the antidepressant effect.

> You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?

I feel more of a mood-brightening effect with Nardil than I do with Parnate. I guess you could say that Nardil is a better treatment for anhedonia. That's not to say that I would continue to respond to Nardil indefinitely. One of my doctors had a patient that needed to switch between the two drugs on a regular basis.

I guess I'm stuck with Effexor for another two weeks. This is probably a good thing, though. It forces me to give it a reasonable chance to work. In the meantime, I get to experiment with Adderall. My doctor hopes that it will help with cognitive impairments.


- Scott

 

Re: Going back to old-school - lithium. » floatingbridge

Posted by SLS on January 25, 2010, at 19:38:39

In reply to Re: Going back to old-school - lithium. » SLS, posted by floatingbridge on January 23, 2010, at 14:22:13

Hi FB.

> Hi Scott, after rereading this thread, I had a few thoughts. At thanksgiving, you had baseline improvement at about 40%. What is the current estimate?

20% - 25%

> I forget when you began the effexor--how is it? Probably too early to judge.

Probably. A few days ago, I experienced a significant improvement that lasted for about a day. Nothing since. If things follow my usual pattern of response, that brief improvement is all I can expect.

> I don't see any stimulant on board (except for effexor--is that enough?)--any
> reason for that?

I just started taking Adderall today.

> Off of parnate, would segeline add some neuroprotection in addition to low-dose lithium?

I experienced an irritable type of dysphoria with Emsam. I stopped taking it after 3 or 4 days.

> Miraprex or another dopamergenic (is that a word?). Would you consider this type of add-on?

I haven't tried Mirapex yet. I tried bromocriptine (Parlodel) a long time ago, but it did very little to improve my depression.

> To me, the history of this thread doesn't seem to indicate a great threat of inducing mania, except as you've noted,
> and cycling. So you used to be ultra-rapid or somewhat 'disorganized'?

I exhibited a dramatic mood-swing between depression and euthymia that followed a regular cycle of 11 days. I would spend 8 days depressed followed by 3 days of euthymia. The switch between one state and the other took about 45 minutes.

> What are your current doses? Ricker has suggested less lamictal. I don't know....

I tried going lower on Lamictal, but I began to deteriorate. 200mg seems to be the minimal effective dosage for me.

Right now, I'm taking:

Effexor 300mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mg
Adderall 20-40mg

> Wondering if the pharmaceutical lid is
> too heavy. Dopamine? Maybe abilify isn't quite right.

Someone here suggested that I give Zyprexa a try. I have been on it in the past. It would help for the better part of the first week, then nothing. I haven't tried it in combination with my current medications, though.

> Hope today is a decent one,

I survived it without incurring too many bruises. It was a decent day.

:-)


- Scott

 

Re: Going back to old-school - lithium. » SLS

Posted by Phillipa on January 25, 2010, at 20:05:52

In reply to Re: Going back to old-school - lithium. » floatingbridge, posted by SLS on January 25, 2010, at 19:38:39

Scott I babbled you it's available. Love Phillipa

 

Re: Going back to old-school - lithium. » SLS

Posted by Bob on January 25, 2010, at 21:54:48

In reply to Re: Going back to old-school - lithium. » Bob, posted by SLS on January 25, 2010, at 19:19:01

> Hi.
>
> Thanks for the the agomelatine information.
>
> > I am so sorry to hear you are having difficulty, as it seemed you were on the road to improvement.
>
> For awhile, things seemed to be headed in the right direction. At some point, though, I began to gradually lose the antidepressant effect.
>
> > You said you may go back to Nardil. What is it about Nardil that you feel helped you more than Parnate?
>
> I feel more of a mood-brightening effect with Nardil than I do with Parnate. I guess you could say that Nardil is a better treatment for anhedonia. That's not to say that I would continue to respond to Nardil indefinitely. One of my doctors had a patient that needed to switch between the two drugs on a regular basis.
>
> I guess I'm stuck with Effexor for another two weeks. This is probably a good thing, though. It forces me to give it a reasonable chance to work. In the meantime, I get to experiment with Adderall. My doctor hopes that it will help with cognitive impairments.
>
>
> - Scott

Well, at least you have the ability to add and subtract meds without too much trouble it seems. I can't take the switches you talk about as I'm just waaaaaay too sensitive.


 

Re: Going back to old-school - lithium. » SLS

Posted by floatingbridge on January 25, 2010, at 22:56:57

In reply to Re: Going back to old-school - lithium., posted by SLS on January 25, 2010, at 13:43:03

Scott, good luck with the adderall--a positive response would be great.

Would you be able to continue adderall if you switched to nardil?

And would any of the above rule out zyprexa?

Seeing your percentages in black and white is very sobering. You must know, and have been told, how strong you are.

Best,

fb

please keep us apprised....


> I don't know what's going on with me anymore.
>
> My doctor thought that adding Adderall would be a good idea. I doubt it could hurt. I filled the prescription today.
>
> I'm going to allow two more weeks to pass. If I feel no better than I am right now, I might opt to return to Nardil and just accept that this is as good as it gets for me. I am considering trying agomelatine, but I don't know how to go about getting it. I doubt my doctor would combine agomelatine with a MAOI, so I would have to make the decision to try it soon.
>
> Does anyone know what countries agomelatine is available in?
>
>
> - Scott

 

Re: Going back to old-school - lithium. » linkadge

Posted by Stephen Martin on April 22, 2010, at 15:02:42

In reply to Re: Going back to old-school - lithium., posted by linkadge on July 3, 2009, at 18:21:31

> 25mg is a lowish dose of 5-htp. I have used it intermittently with an MAOI without problem (not sure about with nortriptyline though).
>
> >What do you think about taking N-acetylcysteine >(NAC)?
>
> I personally don't like the stuff - but it depends on your symtpoms. I found NAC made me very irritable. Alpha lipoic acid was better (for me at least).
>
> You might try sleep deprivation in combination with lithium. There is some evidence of sustaining the AD effect of lithium with periodic SD.
>
> I remember when I was taking lithium + clomipramine. I would be fine for about 4 days then start to crash into depression. At this point I would skip the evening medication dose, pull an all nighter and take meds as usual the next night. This would last for another 4-5 days.
>
> It can be a little taxing on the system (you have to prepare a completely stress free day the next day). But it quickly got me out of a bad funk.
>
> Its great though. I remember feeling like trash (all anxious, worthless, hyper ruminative), then about 2:30 something started to shift over the course of about 5 minutes. Then all of a sudden..normal.
>
> Linkadge
>
>
>
>
>
>
>
>
>

That bit on sleep deprivation is quite interesting, indeed! That lends some creedance to the theory that depression and bi-polar depression have a connection to disruption of the circadian rhythm - in other words, the depressed person isn't as 'awake' as they ought to be during the day; contrarily, Manic patients typically encounter insomnia. It the same with seasonal affective disorder - the reduced daylight in winter confuses the brain's clock into thinking it should sleep more, etc.

Interesting stuff.

 

Re: Going back to old-school - lithium. » Stephen Martin

Posted by Deneb on April 22, 2010, at 21:00:45

In reply to Re: Going back to old-school - lithium. » linkadge, posted by Stephen Martin on April 22, 2010, at 15:02:42

Hello Stephen Martin!

Welcome to Psycho-Babble! I can totally see depression and other mood disorders as having something to do with circadian rhythm disturbance. I know my circadian rhythm is all messed up. I try to fix it, but it just naturally goes back to being all messed up.

Deneb

 

Re: Going back to old-school - lithium. » Deneb

Posted by Stephen Martin on April 22, 2010, at 21:21:19

In reply to Re: Going back to old-school - lithium. » Stephen Martin, posted by Deneb on April 22, 2010, at 21:00:45

> Hello Stephen Martin!
>
> Welcome to Psycho-Babble! I can totally see depression and other mood disorders as having something to do with circadian rhythm disturbance. I know my circadian rhythm is all messed up. I try to fix it, but it just naturally goes back to being all messed up.
>
> Deneb

Dear Deneb:

I feel your frustration! I guess you can observe the fact that the new reform legislation for health care in the U.S. should force more dollars into research and medical technology, and we can all hope that someday, within our lifetimes, medications will be developed that can keep our heads straight without generation dozens of problems and side-effects.

The reason I chose to comment about circadian rhythms is that I find my depression and mania to be linked strongly to seasonal changes. Obviously, the big factor here is the variation in sunlight from solstice to solstice - peaking in June (the month I have had the greatest difficulty with manic episodes) and in December. I observe that I struggle against depression up until May or so, and usually about the time the weather gets warm and sunny my brain kicks into a manic state, almost like to dumb gear shift only works at the two extremes. It's frustrating!

My experience with drugs is also dis-satisfying. I can vouch for both Lithium and Divalproex as being good anti-mania agents, but once the mania has subsided the side effects generated can make life unbearable. uggh.

Anyway, pleased to meet you all!

Steve

 

Re: Going back to old-school - lithium.

Posted by desolationrower on June 11, 2011, at 13:50:09

In reply to Re: Going back to old-school - lithium., posted by desolationrower on September 26, 2009, at 3:23:39

> w-3s do lots of things.
>
> but theres no need for "high quality fish oil" unless you already bought celtic sea salt and still have more money than you want
>
> -d/r

i was looking for something i posted, and saw this.

I should say while 'purified' fish oil isn't important, not being rancid might be important.

Always store in the fridge/freezer. Maybe look for brands with added vitamin e to frevent rancidity. I dunno, i realized the ones i bought smelled rancid when i got them so maybe its a bad idea anyway. The epidemiological evidence (for not-dying, not mental health, but probably still applicable) shows benefit for eating fish, but not taking fish oil. I now, and recommend, just eating fish (mostly shellfish, sardines, not larger fish that could accumulate nasties, and are being overfished too) 1 or 2 a week, and avoiding omega-6 oil is probably best.

-d/r

 

Re: Going back to old-school - lithium. » desolationrower

Posted by floatingbridge on June 11, 2011, at 15:31:54

In reply to Re: Going back to old-school - lithium., posted by desolationrower on June 11, 2011, at 13:50:09

Sardines are a super food. Low toxic accumulation, plus they are eaten bones & all. That's a lot of trace minerals, not to mention calcium.


Good reminder for me, d/r.

Any opinion to venture on krill oil?

fb

 

Re: Going back to old-school - lithium.

Posted by SLS on June 11, 2011, at 16:05:59

In reply to Re: Going back to old-school - lithium., posted by desolationrower on June 11, 2011, at 13:50:09

I get the feeling that high dosages of concentrated fish oil have acute pharmacological activity. When supranutritional amounts are ingested, one's mood can very quickly turn toward mania. For me, it exacerbates my depression. This is a very surprising reaction. When I discontinued this high-dosage regimen, I felt better within 18 hours. I am now looking towards using fish oil omega-3 to make up for a deficit in my diet. As a nutritional supplement rather than a pharmacological agent, I plan on taking no more than 2000mg/day. I want to take just enough to supply the needed material to enhance brain the neuroplasticity induced by lithium.


- Scott

 

Re: Going back to old-school - lithium.

Posted by Questionmark on June 11, 2011, at 16:12:42

In reply to Re: Going back to old-school - lithium. » desolationrower, posted by floatingbridge on June 11, 2011, at 15:31:54

Krill oil is totally over-hyped and not worthwhile, as far as I can tell.

The claim is that krill have much higher concentrations of omega-3s, but this is really ultimately irrelevant since you get a much lower quantity of omega-3s *for your dollar* with krill oil compared to fish oil.


> Any opinion to venture on krill oil?
>
> fb

 

Re: Going back to old-school - lithium. » Questionmark

Posted by floatingbridge on June 11, 2011, at 17:37:32

In reply to Re: Going back to old-school - lithium., posted by Questionmark on June 11, 2011, at 16:12:42

Hi Questionmark,

I take 2,000 per day, and krill is pricey!

It's asked over and over. Here it goes again.

What (brand/type) do you take (if you do)?

Thanks.

fb

 

Re: Going back to old-school - lithium.

Posted by desolationrower on June 11, 2011, at 17:52:30

In reply to Re: Going back to old-school - lithium. » desolationrower, posted by floatingbridge on June 11, 2011, at 15:31:54

> Sardines are a super food. Low toxic accumulation, plus they are eaten bones & all. That's a lot of trace minerals, not to mention calcium.
>
>
> Good reminder for me, d/r.
>
> Any opinion to venture on krill oil?
>
> fb

well, in general i'd say whole fish is the way to go. You get protein and b12 and taurine. I think krill oil might be better than fish oil:

-high concentration of antioxidants to prevent rancidity. I am not sure rancidity is a problem for mental health, though i like to avoid it for its general health/aging issues.

-omega3 fats more integrated into phospholipids, not triglycerides. This might favor integration into cell membranes as opposed to oxidation for fuel. Not sure about use to create signaling molecules. I haven't seen much actual research into this.

-d/r

 

Re: Going back to old-school - lithium.

Posted by floatingbridge on June 11, 2011, at 17:59:53

In reply to Re: Going back to old-school - lithium., posted by desolationrower on June 11, 2011, at 17:52:30

I think the below is what I heard that swayed me toward krill. Just don't expect me to remember.

Thanks. I like it when you sweep the boards. Like "Oklahoma where the wind comes sweeping down the plains."

fb

> -omega3 fats more integrated into phospholipids, not triglycerides. This might favor integration into cell membranes as opposed to oxidation for fuel. Not sure about use to create signaling molecules. I haven't seen much actual research into this.
>
> -d/r


Go forward in thread:


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.