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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by B2chica on June 15, 2011, at 14:29:37
here is my list of all ive been on in the last 6 years.
the trick is i've been on Various doses of all of them (except perphenazine and lamictal.
Also i've been on VARIOUS combinations of almost all of them, at one time or another. almost each trial included some type of benzo. primarily xanax.
Hope i didnt forget any.all of these have either pooped out, or didn't work, or bad side effects.
so my question is...1. if i have to try another med. where do i go from here.
2. if i've had poor response to other TCA's should i even bother with others? (like little to no response at all)AXIETY
xanax
sonata
klonipin
ambien
gabapentin
Inderal (didnt know where else to put this one.)
SSRI/SNRI
effexor
symbyax
wellbutrin (also XL, and two generics)
trazadone
remeron
zoloft
lexapro
pristiqAP
zyprexa
seroquel
risperdal
geodon
abilify
perphenazineMOOD STAB
trileptal
topamax
lamictal
STIMULANT
strattera
ritalin LA (and SA ritalin)
Adderall
paxil and luvox were taken off my list as i was advised not to try them due to my reaction to some other med...cant remember which. maybe prozac?so i could go
cymbalta, serzone
anyone heard of Ludiomil?
amitriptyline
desipramine
doxepin
imipramine
protriptyline (which i was actually thinking along with perphenazine)
trimipramine.
MOAI and Lithium i'm saving for very very last.
Posted by B2chica on June 15, 2011, at 15:22:43
In reply to My 'List'. what is next any suggestions., posted by B2chica on June 15, 2011, at 14:29:37
ok. so i'm not feeling quite so hopeless. i'm coming across many i haven't tried yet.
though most are in the same class. so not sure. but making me feel better anyway.here are some others that i'm coming across while looking at the chemistry of what has worked for me in the past.
i've heard some people here on some of these before.
i'm in the states and didnt' know if some of these can be used for off label tx of depression or not.Trivastal?
Mirapex?
amineptine?
modafinil?
Reboxetinein MOAI would nardil be my best bet?
so are all MAOI's dopaminergics?
Posted by jerseygal1 on June 15, 2011, at 16:02:36
In reply to My 'List'. what is next any suggestions., posted by B2chica on June 15, 2011, at 14:29:37
Seems like cymbalta might be worth a try if pristiq worked for you. What happened when you tried prozac? Prozac was a great med for me for 11 years until it pooped out. I'll take another good run for 11 years if I can get it.
Posted by B2chica on June 15, 2011, at 16:26:46
In reply to Re: My 'List'. what is next any suggestions., posted by jerseygal1 on June 15, 2011, at 16:02:36
lets just say that landed my very first hospital stay. and i was there for 2 weeks... until they switched my meds.
bad.
bad.
Posted by jono_in_adelaide on June 15, 2011, at 22:26:13
In reply to Re: My 'List'. what is next any suggestions., posted by B2chica on June 15, 2011, at 16:26:46
Of all the meds you list, which ones have worked, if any.
If they worked, why did you stop (side effects etc?)
Have you tired the combo of Remeron plus Cymbalta/Effexor/Pristiq
Posted by Phillipa on June 16, 2011, at 0:31:28
In reply to Re: My 'List'. what is next any suggestions., posted by jono_in_adelaide on June 15, 2011, at 22:26:13
cymbalta is worth a try with benzo. If you could take SSRI's I'd say luvox and ativan as absolutely no side effects for me at all. And did get in a few days to 250mg. Quite a feat for me. Glad you are feeling more hopeful Phillipa
Posted by desolationrower on June 16, 2011, at 22:59:41
In reply to Re: My 'List'. what is next any suggestions., posted by B2chica on June 15, 2011, at 16:26:46
what worked best, or worked ok except for intolerable side effects? and what drugs were worst? the more info, the more likely someone can spot a pattern.
i don't think i saw any glutamatergic drugs.
Also, you might want to think about making sure you have avoided nutritional deficiencies. you might be in the far end of a bell curve for need of some nutrient or other. Rats that have strong improvement with antidepressants are genetically standardized and fed chow with sufficient nutrients. I think this is more and more important the more med failures you rack up. your list is one of the longer ones. (sorry)
Sorry, i know you have posted a lot but i can't remember you main dx & symptoms?
-d/r
Posted by jono_in_adelaide on June 17, 2011, at 0:11:14
In reply to Re: My 'List'. what is next any suggestions., posted by desolationrower on June 16, 2011, at 22:59:41
I agree with the nutrient thing - I take a Twinlab Daily One every day (high potency multi vitamin/mineral) to make sure I'm getting enough of everything.
As a nice side effect, while I still get colds, they only last 2-3 days, rather than a week or so as they used to.
Posted by B2chica on June 17, 2011, at 8:31:39
In reply to Re: My 'List'. what is next any suggestions., posted by desolationrower on June 16, 2011, at 22:59:41
my dx has bounced around over the years. Always with PTSD.
but mostly between Biopolar-Mixed and psychotic depression.
the only thing on the list that has worked slightly was lexapro
but 1)i had to keep titrating up and up and 2) it made me so exhausted i could not function. that was when my 1st child was about 14 mo old. not an option.the only other one that has worked consistently is stimulant and zyprexa.but even my doc gets concerned about the weight gain.
on 5 no weight gain but i seem to need 10mg.all the others either had Horrible side effects (mostly the SSRI's) or (most common) did nothing (tca's and AP).
pdoc is very holistic so he has me on exercise and watching my food intake as well.
Posted by B2chica on June 17, 2011, at 9:01:56
In reply to Re: My 'List'. what is next any suggestions., posted by desolationrower on June 16, 2011, at 22:59:41
Symptoms.
Anxiety
Severe depression-hopelessness,self-depricating, anhedonia, nihlistic thinking, switching to aggitation, extreme disdain for everything, and of course always ending in suicidal thinking, or actions.
Also have auditory, visual illusions and what i call 'visuals or visions' that are maybe like what we know as daydreams only they are flashes of HORRIBLE pain and anguish of persons that i get normally only lasting for probably seconds but they feel SO REAL and seem like they last forever.**************
For anxiety only the xanax and gabapentin have worked. the xanax though lately started me to crave more and more and wanting to take too much.
so switched to gaba.
when anxiety was really bad i was taking from 12-1500.
so that's when got perphenazine and it helped big time with anxiety.SSRI's
all had either bad side effects (didnt work) except for Wellbutrin which lasted one beautiful year before it pooped out. tried to go back on it a couple years later and still nothing, also tried two of its generics...bad side effects and no effect.AP
seroquel gave cog. blunting
risperdal, did nothing
geodon made me psychotic
abilify make me horrendously angry and impulsive
perphenazine workedMOOD Stab
all actually give me mood swings.
one almost made me stroke out, giving me ataxia and had LIS for about 12hours.
Posted by B2chica on June 17, 2011, at 11:04:42
In reply to My 'List'. what is next any suggestions., posted by B2chica on June 15, 2011, at 14:29:37
Posted by sigismund on June 17, 2011, at 15:05:43
In reply to more info » desolationrower, posted by B2chica on June 17, 2011, at 9:01:56
>extreme disdain for everything,
Hey, I've got that too :)
Posted by desolationrower on June 21, 2011, at 0:08:58
In reply to more info » desolationrower, posted by B2chica on June 17, 2011, at 9:01:56
"Also have auditory, visual illusions and what i call 'visuals or visions' that are maybe like what we know as daydreams only they are flashes of HORRIBLE pain and anguish of persons that i get normally only lasting for probably seconds but they feel SO REAL and seem like they last forever."
this sounds a bit like something i had: i'd have visualization of bad things happening to me, like seeing drill going into my head. I noticed they were strongly reduced by risperdal and other 5ht2 antagonists.
You seem to get better on pro-convulsive drugs, and worsen on anticonvulsants.
I forget the enzymes that metabolized drugs, but if TCAs are typically 'doing nothing' you may need quite high doses. i think there are blood tests for some.
i'll try to post some better thoughts soon
-d/r
Posted by B2chica on June 21, 2011, at 7:49:37
In reply to Re: more info » B2chica, posted by desolationrower on June 21, 2011, at 0:08:58
> this sounds a bit like something i had: i'd have visualization of bad things happening to me, like seeing drill going into my head. I noticed they were strongly reduced by risperdal and other 5ht2 antagonists.
EXACTLY!
i've never talked to Anyone that has had this before. i have tears typing. These have made me feel So alone. and i'm usually told those 'visuals' were psychological not biological just because i have an abuse history.
i've KNOWN that they're not. in my gut. i Know they are not related. i've had this since i was about 19.
they do get more frequent under stress but thats about it.
> You seem to get better on pro-convulsive drugs, and worsen on anticonvulsants.
> I forget the enzymes that metabolized drugs, but if TCAs are typically 'doing nothing' you may need quite high doses. i think there are blood tests for some.These are exactly the types of comments i was hoping for.
i cant even say thank you so much.
for that insight.You are Greatly Appreciated...
b2c.
Posted by desolationrower on June 23, 2011, at 23:11:46
In reply to Re: more info » desolationrower, posted by B2chica on June 21, 2011, at 7:49:37
> > this sounds a bit like something i had: i'd have visualization of bad things happening to me, like seeing drill going into my head. I noticed they were strongly reduced by risperdal and other 5ht2 antagonists.
>
> EXACTLY!
> i've never talked to Anyone that has had this before. i have tears typing. These have made me feel So alone. and i'm usually told those 'visuals' were psychological not biological just because i have an abuse history.
> i've KNOWN that they're not. in my gut. i Know they are not related. i've had this since i was about 19.
> they do get more frequent under stress but thats about it.glad you found that helpful. by the way, my sister cut herself when she was a teenager, and i sort of think it might be related.
"usually told those 'visuals' were psychological not biological just because i have an abuse history." hearing that would drive me nuts. the psychological IS the biological. Its like saying 'this cd looks very different from how it sounds when you play it" - NO its the same thing, just different paradigm for considering it.
risperidal helped, as did tranylcypromine. it is rare i get them now, on nortriptyline.the common thread seemed to be 5ht2.
> > You seem to get better on pro-convulsive drugs, and worsen on anticonvulsants.
> > I forget the enzymes that metabolized drugs, but if TCAs are typically 'doing nothing' you may need quite high doses. i think there are blood tests for some.
>
> These are exactly the types of comments i was hoping for.
> i cant even say thank you so much.
> for that insight.
>
> You are Greatly Appreciated...
>
> b2c.
>
>
Sometime people (myself included) say a drug did 'nothing' even though it was definately doing 'something', just not anything good or related to one's symptoms.i think amytriptyline and imipramine are the dirtiest TCAs. i'm not sure if they can do blood levels for those
do you include lithium in your mood stabilizer category? it isn't really an anticonvulsant, unlike 'mood stablizers' like valproate, lamotragine, etc.
i don't know much about PTSD. dxs that focus on a cause, instead of symptoms, seem to be more diverse. it seems ot be true for social anxiety, and PTSD. I just remember a lot of conflicting data on if certain receptors are upregulated or downregulated, if certain drugs help, etc.
i personally would probably try a run on a TCA first, then do tranylcypromine, and then tranylcypromine + augmenters like lithium, NAC, etc.
-d/r
Posted by B2chica on June 27, 2011, at 12:44:12
In reply to Re: more info » B2chica, posted by desolationrower on June 23, 2011, at 23:11:46
Posted by hyperfocus on June 29, 2011, at 23:44:37
In reply to Re: more info » desolationrower, posted by B2chica on June 21, 2011, at 7:49:37
If you responded to Cymbalta and Wellbutrin, then a TCA like amitriptyline with a strong NE effect could be tried. Be warned though - the side-effects are very harsh initially for many people. But everybody's different and it could be that you might be one of the people whose brains can tolerate it. Nortriptyline is the active metabolite and has much less anticholenergic side effects.
I also have intrusive thoughts and visions of myself or others coming to terrible harm. It's not psychotic because I can never mistake them for reality. It seems they are part of the dissociation that developed out of my untreated anxiety. I also know quite well the spiral of dysphoric thoughts than can eventually lead to suicidal thoughts. Have you had the anxiety for a very long time? Do you experience very rapid cycles of dysphoria - like you'll be feeling good for a short time and then your thoughts just turn, for no apparent reason to dysphoria? Do you find your mood or thinking to be borderline - like simple things can turn your mood to negative drastically? Do you have like attachment problems, like problems with relationships with other people?
If you've been suffering with it for a long time you could be experiencing symptoms of Complex PTSD. It's not really a useful dx for treatment, but it does describe well a certain cluster of clinical symptoms and personality problems. Amitriptyline has helped people suffering with PTSD and complex PTSD symptoms. APs may not help you on their own but you could also try augmenting an AD with a low-dose atypical AP like Risperdal or Abilify. There's always the nuclear option - Nardil or Parnate, maybe with a benzo.
Posted by B2chica on June 30, 2011, at 10:19:20
In reply to Re: more info » B2chica, posted by hyperfocus on June 29, 2011, at 23:44:37
thank you for the great response hf.
im back on my regular adderall and seems to be making enough of a difference with my mood.i have some 'dips' but nothing like earlier. so that may have been an effect from going off my standard form of adderall.
i have never been on cymbalta, but i was thinking either amitriptyline, but nortriptyline may be something i would try first.
my visions are real enough that they stop me in my tracks. i cant always tell if its happening or not until its over, luckily its over fairly fast. i can tell because it effects my breathing and heart rate. i see hear and pseudo-feel the bone-breaking and gunshotsetc. i normally have to take a breather after i experience them, as i'm a bit out of it.
However, it could be part of that'complex PTSD' as i do have PTSD and dissociation. Although my dissociation is Much better this last year.i don't experience cycles of dysphoria, and i guess situational things can effect my mood but normally the bad 'down' is typically from nothing that i can think of. it just starts to decline normally over about a two week period.
i've tried risperdal and ability. the first did nothing for my symptoms and ability made me quite aggitated and seemingly more dysphoric
and if i had to go nuclear i would try Nardil first i think. from hearing what vie heard of it, it would see the best fit.
Thank you so very much for some great insight. your comments were helpful.
Thanks
b2c
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