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Dr. Bob is Robert Hsiung, MD,
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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?
>
>
> - ScottScott,
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
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
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
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
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.
>
>
> - ScottWell, 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.
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
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.
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
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.
>
> DenebDear 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
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/ri 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
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
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
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
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
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?
>
> fbwell, 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
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
Posted by desolationrower on June 11, 2011, at 21:06:42
In reply to Re: Going back to old-school - lithium., posted by floatingbridge on June 11, 2011, at 17:59:53
> 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
>
>hah, thanks.
-Aeolus
Posted by Phillipa on June 11, 2011, at 21:30:02
In reply to Re: Going back to old-school - lithium., posted by desolationrower on June 11, 2011, at 21:06:42
d/r it is good to see you back. Love Phillipa
Posted by utopizen on June 13, 2011, at 6:43:27
In reply to Re: Going back to old-school - lithium., posted by desolationrower on June 11, 2011, at 13:50:09
> I should say while 'purified' fish oil isn't important, not being rancid might be important.
>I store mine in the refrigerator, too-- but keep in mind any rancid product would have more to do with Quality Assurance discipline at the plant, not the consumer.
Remember Able Labs? It was a fairly large generics company that went under in 2005 after it was cited by the FDA for "sanitation" and had a mass recall of all their stuff.
There's other terms that also mean sanitation when a recall is made, but sound more benign... anyhow, that basically means rat waste from the ceiling, etc. is being found. Honestly, you have to be doing a bad job for the FDA to ask for such a thing- it's not like some health inspector having a bad day.
At any rate, avoid independent nature food store-branded fish oil-- they were one of the very few cited by Greenpeace or some other environmental group in a lab sampling of all of the major makers. It's easy enough to google "fish oil independent rankings environmental toxins" or such.
The biggest violator was a company that I've never seen before, but markets to health food stores (tiny ones), letting them brand the health food's name on the package. It included some toxin that was a huge deal. Most actually passed with flying colors, including Nature Made.
There's a $46 bottle (of 30) that's sold at Whole Foods. I use to buy it. If I had vast amounts of money, I'd justify it still, but it's just unreasonable. They claim they do all this stuff to it, but even their own marketing seems to basically reduce itself to "you don't have to take more pills because it's more potent."
It's used in research, likely because they use the Oral-B trick my dentist tipped me off to: if you give a profession something for free, it's remarkable how often they use it themselves.
Since they're referring to 3-4/day of the fish oil capsules their $12 competitors' dosing is, I'd rather oppress myself with the drudgery of swallowing an additional gulp of water after taking my 3rd or 4th dose.
I asked the $47/bottle company if I could be spared free bottles, as I'm poor and it would be like pharmaceutical assistance-- given they're so into marketing themselves as "pharmaceutical-grade"-- They never got back to me.
Posted by floatingbridge on June 13, 2011, at 9:25:01
In reply to avoid store-*labeled* fish oil, posted by utopizen on June 13, 2011, at 6:43:27
The expensive brand you speak of is a Japanese company? I tried taking their mood formulation. Sometimes my market would sell it deeply discounted. I spent a lot of time converting doses and counting pills. I had to give them up, but did and do shell out for krill oil.
I was told and read that presently, all krill oil is made from one source, Neptune (?), so I take Now brand after being reassured. Plus Now puts it's source on the label.
Any thoughts?
Posted by Questionmark on June 15, 2011, at 17:24:40
In reply to Re: Going back to old-school - lithium. » Questionmark, posted by floatingbridge on June 11, 2011, at 17:37:32
Yes, way to pricey to seem worthwhile.
I generally take the bulk liquid of Carlson's brand fish oil. Nordic Naturals also seems really good but more costly. I'm sure there are other very good ones.
... In response to the comment about rancidity not being a problem for mental health, I don't think this is quite true. My [layman's] understanding is that rancid fats can increase oxidation (lipid peroxidation?) in the body including the brain. I also wonder if there can be some change in the molecular structure of the omega-3 fatty acids when there is rancidity. I don't know, i'm just surmising a possibility.
> 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
Posted by larryhoover on June 15, 2011, at 21:35:13
In reply to Fish oil brands. Re: Going back to .. » floatingbridge, posted by Questionmark on June 15, 2011, at 17:24:40
> Yes, way to pricey to seem worthwhile.
>
> I generally take the bulk liquid of Carlson's brand fish oil. Nordic Naturals also seems really good but more costly. I'm sure there are other very good ones.Carlson's and Nordic are indeed fine products. Kept in the fridge, they seem to stay in good shape to the end of the container.
> ... In response to the comment about rancidity not being a problem for mental health, I don't think this is quite true. My [layman's] understanding is that rancid fats can increase oxidation (lipid peroxidation?) in the body including the brain.Fats can oxidize in chain reactions, where one free radical can damage a number of fat molecules, but ingesting rancid fats doesn't lead to that happening. The damaged fat molecules go to energy production.
>I also wonder if there can be some change in the molecular structure of the omega-3 fatty acids when there is rancidity. I don't know, i'm just surmising a possibility.
Well, for a surmise, you surmise quite well. ;-)
When we detect rancid fat by smell, it's because our noses have evolved to tell us how fresh a fatty food might be. If it's begun to oxidize, the products of the oxidized unsaturated fats include aldehydes and ketones, which are much more volatile, and they stink. Well, we sense the smell as a stink, because we are programmed to reject the smell of rancid food. So, you're absolutely correct, rancidity is a change in the molecular structure of an unsaturated fat. Small pieces of it are broken away, and they evaporate.
Lar
Posted by larryhoover on June 15, 2011, at 21:50:24
In reply to Fish oil brands. Re: Going back to .. » floatingbridge, posted by Questionmark on June 15, 2011, at 17:24:40
I just wanted to add that the hydroperoxide chain reaction that you were concerned about is readily quenched by vitamin E. So, if your fish oil supplement contains vitamin E, the risk is essentially zero.
Lar
Posted by Questionmark on June 16, 2011, at 16:55:39
In reply to Re: Fish oil brands. Re: Going back to .. » Questionmark, posted by larryhoover on June 15, 2011, at 21:35:13
> Fats can oxidize in chain reactions, where one free radical can damage a number of fat molecules, but ingesting rancid fats doesn't lead to that happening. The damaged fat molecules go to energy production.
>Oh, but so do fats that are oxidized produce free radicals? I thought that most molecules that are oxidized become pro-oxidants themselves.
Why have we evolved to not want rancid food?> Well, for a surmise, you surmise quite well. ;-)
Oh good, thank you.
And thank you for that other info. Interesting. And helpful.
Posted by larryhoover on June 16, 2011, at 19:56:32
In reply to Re: Fish oil brands. Re: Going back to .. » larryhoover, posted by Questionmark on June 16, 2011, at 16:55:39
> Oh, but so do fats that are oxidized produce free radicals? I thought that most molecules that are oxidized become pro-oxidants themselves.
Yes, but. The buts do matter.
Usually, you can plot the reactants and products on a reactivity chart such that what goes in is more reactive than what comes out. So, that's a general trend, entropy.
In a petri dish, or a test tube, you can get long-standing chain reactions. A candle flame burning sheep fat or whale oil is a chain reaction. In our bodies, we have protective mechanisms to break those chains. Antioxidants such as superoxide dismustase, glutathione, vitamins E and C, and a variety of supporting cast members such as CoQ10 or melatonin or heme-type structures quench the reactivity of the oxidizers.
Your own mitochondria are virtual free-radical machines, churning out massive numbers/types of oxidizers. Somehow, we keep ourselves from catching fire, and only maintain a temperature of 37C/98.6F.
The bottom line is, we're well protected, even from rancid fats. I think people get too caught up in the details.
> Why have we evolved to not want rancid food?
I think of it as a "lack of freshness" detection system. Given a choice, we choose the fresher food. I don't know about you, but when I'm cleaning out the fridge, the process is as much one of smelling the materials as it is about reading best before dates.
As I've become more mature, I find that I've trained my nose, also. Certain aromas from cheese I now find inviting, whereas before I'd have thought they indicated spoilage. But in contrast, I'm exquisitely sensitive to rancidity in nutmeats. I just can't bear nuts that aren't fresh, and it has nothing to do with what I think about the situation. When it comes to rancidity, I lean towards nature, rather than nurture.
> And thank you for that other info. Interesting. And helpful.
My pleasure. Truly.
Lar
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Dr. Bob is Robert Hsiung, MD,
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