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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by weatherfreak on July 6, 2010, at 20:13:59
Do you think there is a med out there to help me. I know there's no magic pill, but what do you think could help me get on with my life. Almost 20 years now.
DX- GAD + SP with Recurring MDD for 20+ years, Obstructive Sleep Apnea with RLS. OSA and RLS are under control.
I'm currently experiencing one of my worst MDD's in years and was prescribed Mirtazapine for it which made it so much worse. I've had side effects before but never anything that made my depression much worse on commencing an AD. It sent me to a very, very dark place, quite quickly and I had to stop it after a week.
My main problem is, anything that touches serotonin, in any way shape or form eventually makes me worse. So I'll take any suggestions as long as it has absolutely nothing to do with serotonin. Meds that have helped but have pooped out are reboxetine, modafinil, ropinirole and ritalin, which I'm currently on but it's not working anymore.
Meds that I've tried over the years to no avail, or worked for a brief period of time.
TCA's
imipramine
anafranil
doxepinSSRI's and SNRI's
fluoxetine
fluvoxamine
citalopram
sertraline
paroxetine
venlafaxine
duloxetineRIMA
moclobemideAntipsychotics
olanzapine
quetiapine
ziprasidoneMood Stabilizers
sodium valproate
lamotrigine
clonazepamBenzo's
alprazolam
diazepam
oxazepam
lorazepam
flunitrazepam
nitrazepam
temazepam
triazolamI know there's more but I can't remember all of them.
I'm currently taking a low dose of Ritalin and Clonazepam
Thanks everyone
Posted by SLS on July 6, 2010, at 20:36:10
In reply to Hi peeps, tricky med question. Is solving it pos?, posted by weatherfreak on July 6, 2010, at 20:13:59
Roche could not get moclobemide approved in the US for social anxiety disorder for lack of efficacy. I don't think you can extrapolate your lack of response to moclobemide to all MAOIs. You might want to put Nardil on your list of things to try.
- Scott
Posted by weatherfreak on July 6, 2010, at 20:50:25
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » weatherfreak, posted by SLS on July 6, 2010, at 20:36:10
Thanks so much for replying Scott, I really appreciate it. I'm in Australia so there's quite a few meds that we can't get here. Does Nardil play with serotonin at all?
I tried moclobemide about 15 years ago, it's a tad hard to remember but I do remember it wasn't overly effective at all until I had xanax added onto it. I still think it was the xanax that was doing the work, so I can kind of see their point in the lack of efficacy, well for me anyway.
Thanks again.
> Roche could not get moclobemide approved in the US for social anxiety disorder for lack of efficacy. I don't think you can extrapolate your lack of response to moclobemide to all MAOIs. You might want to put Nardil on your list of things to try.
>
>
> - Scott
Posted by Phillipa on July 6, 2010, at 21:01:29
In reply to Hi peeps, tricky med question. Is solving it pos?, posted by weatherfreak on July 6, 2010, at 20:13:59
I don't see wellbutrin on your list? Phillipa
Posted by morgan miller on July 6, 2010, at 21:05:38
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » SLS, posted by weatherfreak on July 6, 2010, at 20:50:25
It's going to be hard to find a good antidepressant that does not at least have some effect on serotonin.
Did you say you have tried buproprion? Sorry I can't remember.
Nardil is an MAOI that inhibits both MAO A and B, so it does increase serotonin levels. I would give it a try anyway. Then there is Parnate which is similar.
Posted by morgan miller on July 6, 2010, at 21:11:20
In reply to Hi peeps, tricky med question. Is solving it pos?, posted by weatherfreak on July 6, 2010, at 20:13:59
Since Ritalin is not working anymore, but maybe maintaining you some, have you considered trying Focalin or Focalin XR?
What are you doing with your life when antidepressants/medications are working for you? Are you exercising regularly and eating well? Are you taking any supplements like fish oil? Are you in therapy or group therapy? What I'm getting at is that there may be other things at play here that are contributing to you not being able to stay in remission other than just medications ceasing to work well.
Posted by weatherfreak on July 7, 2010, at 0:33:11
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » weatherfreak, posted by Phillipa on July 6, 2010, at 21:01:29
It's Zyban here and it's only approved for smoking cessation. It can be prescribed off label for depression but it costs a fortune.
> I don't see wellbutrin on your list? Phillipa
Posted by weatherfreak on July 7, 2010, at 0:47:46
In reply to Re: Hi peeps, tricky med question. Is solving it pos?, posted by morgan miller on July 6, 2010, at 21:11:20
Thanks for the MAOI suggestions but the serotonin factor freaks me out big time. I'll look into though and the Focalin too.
When my meds are working I'm working 40+hrs a week, eating well and enjoying life in general. I exercise everyday, I walk everywhere as I don't own a car. I take fish oil everyday and have therapy once a week. My doc and T are looking into a TRD pdoc specialist this week as this has just become too much.
Thanks for your suggestions.
Posted by morgan miller on July 7, 2010, at 2:15:25
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » morgan miller, posted by weatherfreak on July 7, 2010, at 0:47:46
> Thanks for the MAOI suggestions but the serotonin factor freaks me out big time. I'll look into though and the Focalin too.
>
> When my meds are working I'm working 40+hrs a week, eating well and enjoying life in general. I exercise everyday, I walk everywhere as I don't own a car. I take fish oil everyday and have therapy once a week. My doc and T are looking into a TRD pdoc specialist this week as this has just become too much.
>
> Thanks for your suggestions.What's a TRD pdoc?
Sounds like your doing all the right things and taking pretty good care of yourself. Hope you find a med that makes you feel better soon.
Posted by weatherfreak on July 7, 2010, at 4:25:40
In reply to Re: Hi peeps, tricky med question. Is solving it pos?, posted by morgan miller on July 7, 2010, at 2:15:25
treatment resistant depression
Posted by SLS on July 7, 2010, at 6:32:12
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » morgan miller, posted by weatherfreak on July 7, 2010, at 0:47:46
> Thanks for the MAOI suggestions but the serotonin factor freaks me out big time.
MAOIs don't inhibit the reuptake of serotonin like SSRI and SNRI drugs do. They definitely "feel" different when taking them. MAOIs increase the amount of monoamine neurotransmitters stored in the storage vesicles and available for release upon synaptic firing. The metabolites of Nardil and Parnate might amplify this effect.
- Scott
Posted by linkadge on July 7, 2010, at 8:22:13
In reply to Hi peeps, tricky med question. Is solving it pos?, posted by weatherfreak on July 6, 2010, at 20:13:59
Have you tried magnesium? I can sometimes help with methylphenidate tollerance.
Linkadge
Posted by SLS on July 7, 2010, at 9:14:39
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » weatherfreak, posted by SLS on July 7, 2010, at 6:32:12
> MAOIs don't inhibit the reuptake of serotonin like SSRI and SNRI drugs do. They definitely "feel" different when taking them. MAOIs increase the amount of monoamine neurotransmitters stored in the storage vesicles and available for release upon synaptic firing. The metabolites of Nardil and Parnate might amplify this effect.
I forgot to mention that this amplification would involve increased release of dopamine and not serotonin.
- Scott
Posted by ed_uk2010 on July 7, 2010, at 16:30:25
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » morgan miller, posted by weatherfreak on July 7, 2010, at 0:47:46
>Thanks for the MAOI suggestions but the serotonin factor freaks me out big time.
MAOIs affect serotonergic neurotransmission in a different way to SSRIs and other antidepressants. I do not believe that your reaction to SSRIs can be used to predict how you would respond to Nardil or Parnate. The MAOIs are really quite different.
Posted by bleauberry on July 7, 2010, at 17:42:33
In reply to Hi peeps, tricky med question. Is solving it pos?, posted by weatherfreak on July 6, 2010, at 20:13:59
If any of the ssri's ever helped you before all the bizarreness came in to the story, you may still be able to use them. But in a very different way.
Any of them go well with ritalin synergistically, better than either alone. Ever heard of someone doing well on 1 drop of lexapro? (that's 1/10th of 1 milligram). 10 drops? 1mg? Well, in my doctor's office that happens. His patients are a different breed...mostly Lymies...but they share what you have...that is, extraordinary sensitivities to psych meds and profound paradoxical reactions.
That is the clue that extremely tiny doses will do the job...you are no longer in the general population and no longer fit the description of someone who will take the dose listed in the book. Something has changed and you are now in a totally different ballgame with a totally different set of rules.
This doctor is really smart and has been doing this for decades, so it's not just some weird quack or something. People come from hundreds of miles away to see him. You just learned one of his tricks.
Don't feel bad. Almost all psych meds make me profoundly more depressed. It didn't used to be that way. Something changed. Probably the friendliest things I've done in recent times were LDN, very low dose Zoloft (2.5mg) with very low dose Nortriptyline (5mg), ritalin sometimes. One of the doctor's favorite meds is brand name Gabapentin (not generic). We don't see much use of that med. But for the bizarre patients it seems to be a good one.
The absolute best I had was Vicidin for pain after outpatient surgery. Wow. Within a couple hours I was normal. Purely normal in remission. Wonderful. Not at all euphoric. Just normal. That tells me...it aint serotonin or whatever...it is something to do with the opioid system. In my case it makes sense. A handful of chronic infections...bacterial, viral, fungal...excrete toxins that bind to and clog opioid receptors, as well as contaminate serotonin. I have often wondered...is that why serotonin meds make us worse?...because we are increasing the amount of not serotonin, but rather contaminated serotonin? Just a thought.
Anyway, I think you and I are in a different ballgame than we used to be. Which requires thinking outside the normal box. That's when things like LDN, super tiny doses, various herbs, and antibiotics and/or antifungals come into the picture. That said, the most beneficial and reliable things I have discovered to address my psych issues are antibiotics and DMSA. If those good reactions tell a story, then it makes sense...infection(s) involved, and lead/mercury involved.
I'm not really saying anything in particular here except this. It is time to expand out of the four walls of psychiatry and begin looking all around you. The huge laundry list of previously tried psych meds pretty much says the same thing.
Posted by jade k on July 7, 2010, at 17:47:03
In reply to Re: Hi peeps, tricky med question. Is solving it pos? » morgan miller, posted by weatherfreak on July 7, 2010, at 0:47:46
> Thanks for the MAOI suggestions but the serotonin factor freaks me out big time.
Hi weatherfreak,
I can't take SSRI's or anything seratonin. They really make me feel wired and wierd.
I didn't get that from Parnate at all. Its a completely different feeling *to me*
~Jade
Posted by weatherfreak on July 8, 2010, at 3:23:21
In reply to Re: Hi peeps, tricky med question. Is solving it pos?, posted by linkadge on July 7, 2010, at 8:22:13
I've already thanked a few but to Scott again, I'll take it onboard. I've just had some bad hypertension reactions to SSRI/SNRI's so my docs are very wary to prescribe me MAOI's. Normally my blood pressure is spot on. Even while on 20mg of Ritalin it's 110/70 and I'm 40 in a couple of weeks. I'm interested in the release of dopamine from MAOI's though as it seems to work the best of all for me, so thank you.
Linkadge I have tried magnesium by default. I've been on it the whole time :) I use muscleback magnesium complex for a bad back, thank you I appreciate it.
Ed thanks, even though mirtazapine really messed with my head it didn't mess with my blood pressure. Do MAOI's mess with blood pressure? I know they do if you mess up the diet, but do they in general?
Bleauberry, that was quite an amazing post to me. The 1st time I popped 10mgs of Ritalin into my mouth about 8 months ago, I was on the phone to my doctor 45 mins later going I feel so normal that I feel guilty. Not high at all, just totally normal. I now only need 2.5mg somedays or 30mg other days which isn't very often. I have never had anything else do that to me except for oxycodone. The 1st does did exactly the same thing, at first, 5mg tab instant release. Then I was rather ill 30mins later for about half an hour. It never made me sick again, or high again. The first dose did get me really out of it though, the other doses didn't, they just made me feel normal and got rid of my terrible back pain. I haven't had to take it for just over a month now. Thank you!
And Jade, I hear you loud and clear :)
Posted by SLS on July 8, 2010, at 4:17:09
In reply to Re: Hi peeps, tricky med question. Thanks ALL, posted by weatherfreak on July 8, 2010, at 3:23:21
> Ed thanks, even though mirtazapine really messed with my head it didn't mess with my blood pressure. Do MAOI's mess with blood pressure? I know they do if you mess up the diet, but do they in general?
MAOIs will usually reduce blood pressure as long as you don't trigger a hypertensive reaction by ingesting too much tyramine. Although infrequent, some people will experience an increase in blood pressure with Parnate.
- Scott
Posted by weatherfreak on July 9, 2010, at 7:38:49
In reply to Re: Hi peeps, tricky med question. Thanks ALL » weatherfreak, posted by SLS on July 8, 2010, at 4:17:09
Thanks again Scott. I just eat so many of the things on that list, some on a daily basis. My motto through life is, "There's nothing wrong with being vague." So I do have to admit I can see myself on my lunch break eating a toasted salami and cheese sandwich. Not to mention quite a few other things. It does frighten me a little.
>
> MAOIs will usually reduce blood pressure as long as you don't trigger a hypertensive reaction by ingesting too much tyramine. Although infrequent, some people will experience an increase in blood pressure with Parnate.
>
>
> - Scott
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