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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 52. Go back in thread:
Posted by chujoe on May 30, 2010, at 10:58:44
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Conundrum on May 30, 2010, at 10:20:05
I started out last month on 5 mg of Ritalin three times a day & felt quite a buzz of energy the first couple of days, but then just a bit of increased focus. I asked my NP if I could go up to 5 mg four times a day and that has seemed to work pretty well. Since I'm usually pretty good in the morning, I don't take my first 5 mg until around 10 or 10:30, then space them out over the rest of the day about 3.5 to 4 hours apart. If I'm just going to kick back or go to bed early I might skip the last dose.
I think pdocs & NPs are paranoid of prescribing larger doses because of the perceived potential for abuse, which is mostly a result of the culture of fear surrounding illegal meth use / addiction. That is, I think their reluctance is social rather than medical.
Posted by linkadge on May 30, 2010, at 14:38:24
In reply to Re: Depression? whats that? i can't remember » linkadge, posted by Conundrum on May 30, 2010, at 10:20:05
Well, at first the medication seems to act more like a "stimulant", there is a feeling of being "high" with increased energy etc. In a few days this wears off and I just start to feel more "normal".
I can think clearly, the dark moods are gone and my mood is transparent (i.e. I don't think about how I feel, its just me and the world).
I think its efficacy really depends on what your underlying issue is.
Linkadge
Posted by linkadge on May 30, 2010, at 14:41:10
In reply to Re: Depression? whats that? i can't remember » Conundrum, posted by chujoe on May 30, 2010, at 10:58:44
There is a book I was reading in which methylphenidate was studied in depression via pet scans. Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead". They did before and after scans and after the MPH the cerebral blood flow had improved substantially.
They refered to it as a "PET activator".Linkadge
Posted by SLS on May 30, 2010, at 14:51:25
In reply to Re: Depression? whats that? i can't remember, posted by linkadge on May 30, 2010, at 14:41:10
> Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead".
Yes. The brain does look dead in severe depression. My cerebral cortex showed up as mostly blue on a FDG PET scan. It should have been yellow and orange.
- Scott
Posted by Bob on May 30, 2010, at 15:01:51
In reply to Re: Depression? whats that? i can't remember, posted by SLS on May 30, 2010, at 14:51:25
> > Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead".
>
> Yes. The brain does look dead in severe depression. My cerebral cortex showed up as mostly blue on a FDG PET scan. It should have been yellow and orange.
>
>
> - ScottWell, mine certainly feels like it's dead sometimes, so I guess that makes sense.
Bob
Posted by Conundrum on May 30, 2010, at 15:09:33
In reply to Re: Depression? whats that? i can't remember » SLS, posted by Bob on May 30, 2010, at 15:01:51
Same here. :-/ I guess I could try an experiment with my left over ritalin. I think tricyclics work similarly to, they increase norepinephrine via reuptaked blockade and dopamine release and block reuptake in some places.
Interesting about the scans. It would be neat if they could find meds that worked in certain areas and prescribe them first rather than make everyone go on the drug medi-go-round.
Posted by SLS on May 30, 2010, at 16:10:13
In reply to Re: Depression? whats that? i can't remember » SLS, posted by Bob on May 30, 2010, at 15:01:51
> > > Apparently depression was associated with global reductions in cerebral blood flow. The brain basically just looked "dead".
> > Yes. The brain does look dead in severe depression. My cerebral cortex showed up as mostly blue on a FDG PET scan. It should have been yellow and orange.
> Well, mine certainly feels like it's dead sometimes, so I guess that makes sense.The thing that is particularly scary is that the hypofunction is so global.
- Scott
Posted by SLS on May 30, 2010, at 16:15:27
In reply to Re: Depression? whats that? i can't remember » Bob, posted by Conundrum on May 30, 2010, at 15:09:33
> Same here. :-/ I guess I could try an experiment with my left over ritalin. I think tricyclics work similarly to, they increase norepinephrine via reuptaked blockade and dopamine release and block reuptake in some places.
>
> Interesting about the scans. It would be neat if they could find meds that worked in certain areas and prescribe them first rather than make everyone go on the drug medi-go-round.I think it will eventually happen. They could challenge the brain with drugs to be used as probes and then see on a PET scan which areas light up. Perhaps there will be tests using microarrays to determine which genes are turned on and which are turned off.
- Scott
Posted by bleauberry on May 30, 2010, at 17:12:33
In reply to Depression? whats that? i can't remember, posted by paulbwell on May 27, 2010, at 21:43:10
I love to see people get well like this! Awesome. It doesn't happen very often. But when it does, it is just so cool! Love to witness it. Glad he came in to share his story.
I have zero evidence to back up what I am going to say. Just my own thoughts.
I get the feeling that it is not the ritalin alone that works. It is the synergistic combination of ritain and prozac. Each complimenting each other. Stimulatory and inhibitory all enhanced together, as well as the unique functions that only prozac has amongst the ssri me-toos. I would almost guess that the result of zoloft+ritalin or lexapro+ritalin would not be the same result as prozac+ritalin.
Of interest is the very specific type of ritalin he is using. I have my doubts that any other version would work as well for him. I don't think they would.
It's a fine art. I'm glad he found a masterpiece. Had his doctor had him on a different ssri, or on a regular release generic version of ritalin, the outcome I think would have been much less impressive.
I remember reading about a hospital that treats their elderly depressed patients (90+ years of age) with ritalin as their first choice antidepressant. That's because it works fast, usually in mere days, and has far fewer side effects than so-called antidepressants. It's because in the frail, they just can't handle things cymbalta or whatever the going trend is.
It kind of makes you wonder, if they know ritalin can rapidly restore the frail elderly to the persons they were before depression, why mess around with all the other crap on the market with the rest of us. I would consider myself frail.
I guess a whole book could be written on that topic.
Posted by Phillipa on May 30, 2010, at 19:32:41
In reply to Re: Depression? whats that? i can't remember, posted by SLS on May 30, 2010, at 16:10:13
This may sound silly if the brain looks dead no blood flow per see could it be like a muscle no strength? Without strength how could it function correctly. Could ECT have damaged the bloodflow? Just a thought. Phillipa
Posted by Conundrum on May 30, 2010, at 20:06:05
In reply to Re: Depression? whats that? i can't remember, posted by bleauberry on May 30, 2010, at 17:12:33
I was thinking the same thing about prozac and ritalin. I think there is something about prozac's atypical nature that would make it combine well with ritalin. It increases tonically levels of catecholamines in a way that most drugs can't. It's interesting what you said about the brand ritalin. I didn't realize that the original poster was talking about a brand version. Its ashame more double blind studies aren't done to show how people respond to brand versus generic.
Posted by Conundrum on May 31, 2010, at 0:31:32
In reply to Re: Depression? whats that? i can't remember, posted by bleauberry on May 30, 2010, at 17:12:33
A psychiatrist told me that it wasn't until recently that the contraindication for using ritalin for depression was removed from the DSM.
Posted by Jeroen on May 31, 2010, at 2:21:14
In reply to Re: Depression? whats that? i can't remember » bleauberry, posted by Conundrum on May 31, 2010, at 0:31:32
hey, everything that works, works..... be happy
Posted by Jeroen on May 31, 2010, at 2:27:19
In reply to Re: Depression? whats that? i can't remember, posted by bleauberry on May 30, 2010, at 17:12:33
hey, maybe i should suggest to my doc about ritalin
Posted by sigismund on May 31, 2010, at 3:09:00
In reply to Re: Depression? whats that? i can't remember » bleauberry, posted by Conundrum on May 31, 2010, at 0:31:32
>A psychiatrist told me that it wasn't until recently that the contraindication for using ritalin for depression was removed from the DSM.
Good to know
Posted by bleauberry on May 31, 2010, at 18:21:16
In reply to to blueberry, posted by Jeroen on May 31, 2010, at 2:27:19
> hey, maybe i should suggest to my doc about ritalin
Ya know, Jereon, that sounds like a bizarre idea for someone with treatment resistant psychosis with depression. I mean, in my thinking, ritalin stands a good chance of making psychosis worse or provoking psychosis where one existed before. But ya know what, I actually like the idea. Why? Because it's DIFFERENT.
Logic in your case does not work. Antipsychotics are logical, and not only don't work, but are miserable failures. What is unlogical probably will work. Ritalin represents an unlogical choice. And in your case, I like that.
That's what I've been screaming for over a year now...do something different than friggin antipsychotics. You've been there, done that, done them all, and it was nothing but trouble every single time. That tells me, antipsychotics, wrong road. Well, maybe as part of a combination the right road, but as monotherapy, without a doubt, no question about it, plenty of proof for all to see, wrong road.
Actually, I can actually envision you doing well with something like a nortriptyline zyprexa combo, a prozac zyprexa combo, a zoloft nortriptyline combo, a prozac ritalin combo, a klonopin ritalin combo.
In your case, I especially like anything that represents thinking outside the box.
As a sidenote, couldn't resist, I do remember you and amantadine, a short visit with Valtrex and/or Doxycycline would be very telling. As would be a high dose DMSA urine challenge lab test.
Hey, with ADD people, you know what Ritalin does to them? It makes them calm and peaceful. Just the opposite of what it does to healthy people.
Posted by Phillipa on May 31, 2010, at 19:42:12
In reply to Re: Depression? whats that? i can't remember » bleauberry, posted by Conundrum on May 31, 2010, at 0:31:32
Seriously google Dr. Charles Parker VA Beach VA a pdoc I worked with. I googled his name the other night to see if still in practice he is set up an institute and lots of online videos of stimulants and how they help. Take a look. Phillipa
Posted by Phillipa on May 31, 2010, at 19:53:57
In reply to Re: Depression? whats that? i can't remember » bleauberry, posted by Conundrum on May 31, 2010, at 0:31:32
Hope this works finger crossed. Phillipa
Posted by Bob on June 1, 2010, at 22:02:10
In reply to Re: to blueberry » Jeroen, posted by bleauberry on May 31, 2010, at 18:21:16
> > hey, maybe i should suggest to my doc about ritalin
>
> Ya know, Jereon, that sounds like a bizarre idea for someone with treatment resistant psychosis with depression. I mean, in my thinking, ritalin stands a good chance of making psychosis worse or provoking psychosis where one existed before. But ya know what, I actually like the idea. Why? Because it's DIFFERENT.
>
> Logic in your case does not work. Antipsychotics are logical, and not only don't work, but are miserable failures. What is unlogical probably will work. Ritalin represents an unlogical choice. And in your case, I like that.
>
> That's what I've been screaming for over a year now...do something different than friggin antipsychotics. You've been there, done that, done them all, and it was nothing but trouble every single time. That tells me, antipsychotics, wrong road. Well, maybe as part of a combination the right road, but as monotherapy, without a doubt, no question about it, plenty of proof for all to see, wrong road.
>
> Actually, I can actually envision you doing well with something like a nortriptyline zyprexa combo, a prozac zyprexa combo, a zoloft nortriptyline combo, a prozac ritalin combo, a klonopin ritalin combo.
>
> In your case, I especially like anything that represents thinking outside the box.
>
> As a sidenote, couldn't resist, I do remember you and amantadine, a short visit with Valtrex and/or Doxycycline would be very telling. As would be a high dose DMSA urine challenge lab test.
>
> Hey, with ADD people, you know what Ritalin does to them? It makes them calm and peaceful. Just the opposite of what it does to healthy people.
>
>Hey Bleauberry,
I've heard you mention the combo of zoloft with nortriptyline before, I think. Is it just chance that you picked that SSRI, or do you feel it is superior in this combo to the other ones?
You mention a number of SSRI combos with Zyprexa and I saw elsewhere that you've been on olanzapine. What made you stop taking it?
Bob
Posted by bleauberry on June 2, 2010, at 17:47:14
In reply to Re: to blueberry » bleauberry, posted by Bob on June 1, 2010, at 22:02:10
> Hey Bleauberry,
>
> I've heard you mention the combo of zoloft with nortriptyline before, I think. Is it just chance that you picked that SSRI, or do you feel it is superior in this combo to the other ones?Well, it's tough, everyone responds differently. So I just kind of keep an eye out for trends. When Dr Gillman of psychotropical.com talks highly of that combo, almost as good as maois, and then my hometown doctor likes it a lot too, and my psychiatrist used it a lot, well, I saw a trend there. It could have been any other meds that happened to come out of their mouths, but it wasn't. It was those two meds. So I mention those two meds not so much from my own experinece, but from what others with lots of experience have said.
Me personally, I found zoloft the easiest to tolerate, so maybe a tiny bit of bias there.
As each combination of two meds I think probably has some intrinsic something special about it that no other two meds have, I think the zoloft nortriptyline combo is one of those. Obviously any TCA + SSRI combo is probably going to do better than either alone. The advantage with zoloft is its minimal pharmacological action in impacting the blood levels of the other drug.
>
> You mention a number of SSRI combos with Zyprexa and I saw elsewhere that you've been on olanzapine. What made you stop taking it?
>
> BobYeah 8 years, along with 20mg prozac and 300mg adrafinil. Zyprexa was a good friend for a long time. Great sleep. Great work performance. Comfortable. Some help with anhedonia. For the first time ever I was able to gain a little weight, which for me was a good thing. Still, only about 10 pounds at the height of it. Oh well. Could have used more than that.
So what went wrong? MMmm. That's a tough one. I honestly do not think anything went wrong with zyprexa. I think it was the other stuff going on within me that changed things, to where zyprexa was taken out of its game. It no longer worked on anxiety. It no longer worked on sleep. I was losing weight rapidly. Something profound had changed, and it happened rather quickly in about a 3 month timeframe.
I had four massive huge amalgams in my teeth that whole 8 years. That's a lot of mercury absorption, and my urine test showed that. I don't think there is a psych med on the planet that can compete with the bizarreness of mercury. Not even zyprexa.
And then, well, my diagnosis last year was that I've had lyme disease for probably 15 years. Bizarre nervous system problems are the hallmark of lyme. There are many more psych med failures and complications with lyme than the general population, which is one reason I think more people here are infected with something than they would have themselves believe (they just fit the picture of lymies, ok?).
So, what was it? Zyprexa poopout? Lyme advancement? Accumulation of chronic low level brain mercury?
I do not think it was zyprexa. It was the other two.
I am still a big fan of my old friend zyprexa. I have also been on all of the other popular antipsychotics except geodon, and all I can say is none of them have the magic that zyprexa has. To me anyway.
Posted by Bob on June 2, 2010, at 21:37:19
In reply to Re: to blueberry, posted by bleauberry on June 2, 2010, at 17:47:14
Bleauberry,
"The advantage with zoloft is its minimal pharmacological action in impacting the blood levels of the other drug."
What exactly do you mean by this?
It's interesting (and fortunate) that you only gained 10 lbs on olanzapine, considerting that massive weight gain and diabetes risk are show stoppers for many who try the drug. Unfortunately I always seem to gain weight on psychotropics and fear if I got on Zyprexa I might balloon up uncontrollably.Bob
Posted by Bob on June 2, 2010, at 21:42:48
In reply to Re: to blueberry, posted by bleauberry on June 2, 2010, at 17:47:14
>
> I am still a big fan of my old friend zyprexa. I have also been on all of the other popular antipsychotics except geodon, and all I can say is none of them have the magic that zyprexa has. To me anyway.
>
>
What was your opinion of the other atypicals - in particular Abilify and Risperdal?Why didn't you ever try Geodon?
Would you ever go back on Zyprexa?
Posted by bleauberry on June 3, 2010, at 19:17:46
In reply to Re: to blueberry » bleauberry, posted by Bob on June 2, 2010, at 21:42:48
>
> >
> > I am still a big fan of my old friend zyprexa. I have also been on all of the other popular antipsychotics except geodon, and all I can say is none of them have the magic that zyprexa has. To me anyway.
> >
> >
>
>
> What was your opinion of the other atypicals - in particular Abilify and Risperdal?
>
> Why didn't you ever try Geodon?
>
> Would you ever go back on Zyprexa?
>
All of them seem to worsen my existing Lyme symptoms. That is something I do not need.Geodon was brand new back then. I'm not about to try it now. I can't even handle 1mg lexapro or 10mg nortriptyline, so I don't know how the heck I could ever handle any dose of an antipsychotic. Besides, I don't really have anything that an antipsychotic would be good for, other than weight gain.
Posted by Phillipa on June 3, 2010, at 20:08:23
In reply to Re: to blueberry, posted by bleauberry on June 3, 2010, at 19:17:46
Basically at those low doses your're med free? Phillipa
Posted by Bob on June 3, 2010, at 23:01:39
In reply to Re: to blueberry, posted by bleauberry on June 3, 2010, at 19:17:46
>
> All of them seem to worsen my existing Lyme symptoms. That is something I do not need.
>
> Geodon was brand new back then. I'm not about to try it now. I can't even handle 1mg lexapro or 10mg nortriptyline, so I don't know how the heck I could ever handle any dose of an antipsychotic. Besides, I don't really have anything that an antipsychotic would be good for, other than weight gain.
>
Bleauberry,You know, it's strange how your ultra-sensitivity to activating meds reminds me of myself. I've been assured by my PCP that I don't have Lymes, or MS, or Lupus, or you name it. All my blood tests come up normal.
I'm getting a recommendation to see a fibromyalgia specialist who will also explore other possibilities, such as the ones I've mentioned above, or so I'm told.
What specific symptoms from your Lymes are exacerbated by the drugs? I'm assuming it's something like joint pain?
What status is your Lymes disease currently? I'm assuming it cannot ever by fully cured but is being managed somehow?
Bob
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