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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by floatingbridge on June 18, 2011, at 2:40:53
The word desperate has finally emerged.
Two paths: maoi's for atypical depression
Opoids for endogenous depression.
I'm not a flippin' doctor. I am tired of med trials. I have a son. He's young. But I've been depressed his entire life in one form or another.
I responded really well to tramadol. So well, in fact, that I alarmed everyone. Not because of mania, but somehow it was only to affect pain, not mood. That
was weird, and I'm still digging out of the shame I felt. Wiki says endogenous
depression responds to synthetic opoids
but treatment is usually withheld due to
cultural reasons.I've had atypical, my major break was melancholic, I can slide into atypical, but
lately, I have little positive mood
reactivity. It could be the emsam. I can get out of bed now for longer periods, but damn it's grim.I am at a complete loss. With some recent nardil success at babble, despite
my fatigue, I think it looks good, but I haven't come across any women on the board using it.Mostly parnate, which is energizing
(good), but also, maybe, aggitating. I would love to be stripped clean of a lifetime of anxiety without bludgeoning myself with benzos.I don't know what to do. It's very difficult to forward any maoi agenda with
my current doc. And frankly, while I could build a case for the synthic opoid, like yeah. Anyone taking that seriously?Oh dear. This coming week I have an interview by phone for Stanford mental
health again plus a long planned consult to their pain clinic. Plus my pdoc is pulling my husband into our session. The last time that happened was just awful.Crumbs. Same song. I don't expect advice. Thanks for the ear.
fb
Posted by sigismund on June 18, 2011, at 2:47:24
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
Buprenorphine makes more sense than Tramadol if you go that way, although I've not tried bupe.
And it makes more sense to try Nardil before Parnate.
Posted by floatingbridge on June 18, 2011, at 2:58:51
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by sigismund on June 18, 2011, at 2:47:24
Posted by zonked on June 18, 2011, at 9:14:29
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
> I responded really well to tramadol. So well, in fact, that I alarmed everyone. Not because of mania, but somehow it was only to affect pain, not mood. That
> was weird, and I'm still digging out of the shame I felt. Wiki says endogenous
> depression responds to synthetic opoids
> but treatment is usually withheld due to
> cultural reasons.
>
> I've had atypical, my major break was melancholic, I can slide into atypical, but
> lately, I have little positive mood
> reactivity. It could be the emsam. I can get out of bed now for longer periods, but damn it's grim.
>
> I am at a complete loss. With some recent nardil success at babble, despite
> my fatigue, I think it looks good, but I haven't come across any women on the board using it.Consider that far more women are prescribed antidepressants than men (cultural reasons I think, men are more likely to drink, do drugs or act out than admit to an authority figure that something's wrong and they need help). Also take a look at http://www.askapatient.com/viewrating.asp?drug=11909&name=NARDIL - there are plenty of females on Nardil. One of my friends without MI actually had heard of Nardil because his grandmother has taken it for decades. :-)
> Mostly parnate, which is energizing
> (good), but also, maybe, aggitating. I would love to be stripped clean of a lifetime of anxiety without bludgeoning myself with benzos.I speak from personal experience alone, but I found Parnate not at all agitating. Selegiline (Emsam) made me very irritable and sort of quick to snap at people (not my natural personality at all.)
Unfortunately, Parnate also propelled me into hypomania which is very unusual for Parnate, I think. That's the only reason I stopped taking it.
> I don't know what to do. It's very difficult to forward any maoi agenda with
> my current doc. And frankly, while I could build a case for the synthic opoid, like yeah. Anyone taking that seriously?Here? Absolutely. In the field? You might have to call around and screen docs. Your case deserves the attention of an expert psychopharmacologist - I don't know your financial situation or the details of your coverage, but I can and will make a referral in babblemail.
> Crumbs. Same song. I don't expect advice. Thanks for the ear.
Any time.
-z
Posted by floatingbridge on June 18, 2011, at 10:23:30
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by zonked on June 18, 2011, at 9:14:29
Funny I didn't think to run nardil past that old standby, askapatient thing.
Thanks zonked.
Looked up buperione that sigi mentioned. First reaction Yikes, what is this stuff! followed by yeah who would give me this stuff if one doc had a cow and had it stuffed over my mood response to tramadol.
Posted by europerep on June 18, 2011, at 10:24:44
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
Does your doc know *how* bad you feel? Of course he knows you feel bad, otherwise you wouldn't be seeing him and doing all that, but does he know how bad it is?
Maybe it would be good to mention this openly. Ask him what he thinks about an opioid in depression or mixed pain/depression. Although it may be easier to get him there if you have been on either Nardil or Parnate. As I see it, there are two issues for a doctor when it comes to prescribing opioids: abuse/addiction and liability issues. With a pain condition, maybe the "threshold" for prescribing an opioid is a little but lower.
Why did you go off tramadol back then though? Did it not deal with pain effectively? For how long did you take it? And did you feel a need to increase dosage regularly, or did you have one steady dose and were fine with it? If you feel you could responsibly use it - maybe with your husband keeping an eye on your dose (tramadol is a weaker opioid, but it still has considerable potential for abuse, and I don't think anyone is really 0% vulnerable to that) - couldn't you instead get it directly from a pain specialist? I mean, it's not like Oxys or Opana, and isn't it even in a different Schedule? I think so.
You could of course also write emails to those psychiatrists who have published on the use of opioids in depression, describe to them your case and ask whether they could offer any help to you. Most university professors I have contacted that way have replied, and usually they were very friendly. Maybe it's because I'm still quite young and they had sympathy/pity with me, but it's always worth a try.
Posted by jedi on June 18, 2011, at 10:56:50
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
Good Luck fb, I sure empathize with your pain. It can be so hard when we are sick and have to do the research ourselves to even get a doctor to look at a possible solution. Especially with you, with the added pressure of raising a child through this.
I'm with zonked on this one. Somehow you have to see an expert psychopharmocologist. Once you have a treatment that works, then any MD can write the script. Getting opiods for depression is so hard, if not impossible. I almost considered doing some hard drugs once, just to get on the buphrenorphine. No, I don't recommend this! But the narcotics have always reduced my depression short term. Read some of Elizabeth's old posts on buphrenorphine. She hasn't been around for a long time, but that woman knew more about treatment resistant depression than any PDOC I've ever talked to. I think she must of had a photographic memory or something. http://www.google.com/search?source=ig&hl=en&rlz=1G1GGLQ_ENCA278&q=Elizabeth+buprenorphine+OR+opiod+site%3Awww.dr-bob.org&btnG=Google+Search&aq=f&aqi=&aql=&oq= (Hope the link works)
Hang in there fb. There are a lot of people that care about you!
Be well,
Jedi
Posted by sigismund on June 18, 2011, at 11:25:41
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by jedi on June 18, 2011, at 10:56:50
http://health.groups.yahoo.com/group/psycho-babble-tips/links/buprenorphine_for_de_001146748536/
Posted by Phillipa on June 18, 2011, at 12:02:44
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
FB seriously thought pain was the issue more than others? Love Phillipa
Posted by floatingbridge on June 18, 2011, at 12:11:24
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by europerep on June 18, 2011, at 10:24:44
Hi e/r,
The tramadol story. Sigh. I took it while on an snri soup. It helped pain, but not the same pain norco could. And the entire project of this doctor was to get me off norco (I am presently taking 20mg norco daily). Two things happened. One was he asked me about the Ultram er. Great! I said. Well, not so great for pain, but it really helps my mood. The expression on his face led me to believe I had said something really wrong. Two, I was given regular tramadol tabs for breakthrough pain. Frankly, the tabs didn't quite touch the deep pain. I was allowed 6 per day. One day I took 9. I
wrote it in my little med journal and told him of this incident the very next visit. That's when everything shifted and began pill-counting accountability, him short scripting me (absent-minderly) but blaming me first. I tried cymbalta after that, lyrica after that.Before the emsam came on board, I was unmedicated, wallowing, and needed to meet a family member who flew into a near by city. But how? Damn it. I took a total of 300 ultram er throughout the
day. I felt normal. *normal*.Would that be sustainable? I don't really think so. And the idea (which I do not understand the workings of) 'bupe' worry mr. It's just that I read this thing about synthetic opoids and endogenous depression.
After all this time I didn't know the types of depression, do looked them up--hence my post--more like notes to myself about the various depressive states I've experienced.
I suspect pdoc is requesting hubby for objectivity, like how is she, what do you see her do, etc.
I know that when he finally heard in words that 3/4 of my life is spent in bed on any given day, it flipped some kinda switch. Just wish he'd confide in me. I confide in him :(
Thanks E/R, Jedi, zonked, sigi....
I don't know what the pain clinic will do. Myself, norco works, but there is so much tylenol and pill popping +escalation. :( There are transdermal things. Those might be too strong, and maybe they escalate too. I don't really know about pain meds. But a patch sounds so good. A nice, low dose patch. Cymbalta nearly killed me.
Thanks again.
fb
Posted by sigismund on June 18, 2011, at 12:37:57
In reply to Re: more thoughts on my depression treatment options » europerep, posted by floatingbridge on June 18, 2011, at 12:11:24
>I don't really know about pain meds.
They suck, but not as much as ADs :)
I don't know, I can see why they are restricted....you reach an equilibrium where the net effect is zero....that's just my opinion, many will not agree......but still they are to the point.
You've got back pain, right? Like sciatica, if not that....that sharp nervy pain?
Posted by floatingbridge on June 18, 2011, at 12:55:28
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by sigismund on June 18, 2011, at 12:37:57
Hi Sigi,
The tiers of pain.
Bone on bone.
Nerve compression
Fibromyalgia in lower half, esp feet! and calves.
Improvement with my osteopath :D. But yeah.
And the fatigue goes or worsens with the pain.
The pain worsens when I stand.
I lie down and further fall to deconditioning.
The best thing about getting off my snri soup, besides a modicum of emotional lucidity, was that the pain stopped occupying my entire body and localized. I could speak to it and it would talk back.
Posted by sigismund on June 18, 2011, at 13:26:27
In reply to Re: more thoughts on my depression treatment options » sigismund, posted by floatingbridge on June 18, 2011, at 12:55:28
Right.
I'm really ignorant about fibro, but I do know what back disc pain is like.
Nerve compression in the back?
I had a ruptured disc at L4/5, as we were saying once.
I thought the SNRIs were supposed to help with pain, as is amitrip, though I have my doubts.
In retrospect, if I were you, I would be happiest on hydrocodone, and would regret the upset to the former arrangements.
It's just all that dreadful paracetamol.
Tramadol seems like nonsense.
If you've got any pain, its not going to work, and it's sort of murky.
Didn't stop me of course.
Posted by floatingbridge on June 18, 2011, at 14:52:03
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by sigismund on June 18, 2011, at 13:26:27
Thanks sigi,
Nah. I'm not looking to tramadol. It doesn't really help my pain, and it's murky as you say.Simple things that do real things.
Decrease drepression whatever stripe this is.Decrease anxiety.
Decrease pain.
When I feel better, I am so much more active. Being active helps one feel better. I want to get a positive cycle going.
Thanks sigi.
fb
Posted by floatingbridge on June 18, 2011, at 15:10:29
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by sigismund on June 18, 2011, at 13:26:27
Thanks sigi,
Nah. I'm not looking to tramadol. It doesn't really help my pain, and it's murky as you say.Simple things that do real things.
Decrease drepression whatever stripe this is.Decrease anxiety.
Decrease pain.
When I feel better, I am so much more active. Being active helps one feel better. I want to get a positive cycle going.
Thanks sigi.
fb
Posted by europerep on June 18, 2011, at 16:33:08
In reply to Re: more thoughts on my depression treatment options » europerep, posted by floatingbridge on June 18, 2011, at 12:11:24
Hey fb...
>
Two things happened. One was he asked me about the Ultram er. Great! I said. Well, not so great for pain, but it really helps my mood. The expression on his face led me to believe I had said something really wrong.Haha, yeah, in doctor's speak that is "well, they are so-so for pain, but they give a GREAT high!" *grin*.. doctors are very wary of course of people abusing their pain meds, and that is also justified seeing how many people develop addiction starting with a regular pain med prescription.. Although 9 instead of 6 one day is, hmmm, tolerable I think. The fact that a pain patient *occasionally* takes more than a prescribed dose is commonly seen in pain therapy. Anyways..
> Would that be sustainable? I don't really think so. And the idea (which I do not understand the workings of) 'bupe' worry mr. It's just that I read this thing about synthetic opoids and endogenous depression.This confuses me now. In your last post to Sigismund you said you didn't want tramadol, which I had mistakenly thought you were dreaming of going back to. But if you don't want tramadol then buprenorphine would seem like the only possibility (within the opioid range of course). By the way, buprenorphine is a synthetic opioid too. Synthetic basically just means that it's not one of the natural products of the opium plant. (And the word opioid actually even comprises that information, the natural ones are called opiates.) Since buprenorphine is a quite potent pain med, it might be an ideal choice. It could be combined with, say, milnacipran for fibromyalgia which wouldn't be possible with tramadol because of the risk of serotonin syndrome.
> After all this time I didn't know the types of depression, do looked them up--hence my post--more like notes to myself about the various depressive states I've experienced.Personally, I'm not sure whether these classifications of depressions really have a huge practical value. I mean, if someone is treatment-resistant, they'll throw at you what they have - or at least that's what they should do if they aren't too timid to go beyond SSRIs - pretty much regardless of whether it's 'atypical', 'melancholic', 'endogenous' etc.
In short, if you want to try anything opioid-related but not tramadol, I would indeed recommend you try to get buprenorphine. Whether you *could* get that is probably a different question, and maybe that would even depend on where you are in the States. Also, and I am not trying to "proselytize" here, but over here mixed conditions of pain/depression are sometimes treated with the local version of Marinol. Just a thought.
Best wishes,
ER
Posted by floatingbridge on June 18, 2011, at 17:19:11
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by europerep on June 18, 2011, at 16:33:08
Hi e/r
Marinol?
Anyway, not eager either which way about buperinone. And I'm just thinking through all this stuff out loud. I know that buperione is used for trd sometimes, but I don't think I want to go there because I don't understand it, how it would work, if it would work for pain, and mood. Basically I bumped into the buperione thing but feel that's over my head right now. Is it a pain med? An addiction med substitute?
I just really need some symptoms treated and the darn pain issues just
throw a wrench in the works.Thanks for even taking the time to think through my thinking through.
Blech.
Posted by jono_in_adelaide on June 18, 2011, at 18:06:47
In reply to more thoughts on my depression treatment options, posted by floatingbridge on June 18, 2011, at 2:40:53
Consider trying Nardil plus either nortriptyline or desipramine, to hit both the atypical and endrogenous depression at the same time.
I think the chances of any doctor giving you any opioid beyond tramadol for depression are 3/5 of 5/8 of **** all....... the DEA and medical boards would have a field day if they found a doctor was handing out Dilaudid for psychological problems.
The combo of Nardil plus a tricyclic can be extremely effective as a last resort, and it may well control your anxiety without benzos.
Posted by jono_in_adelaide on June 18, 2011, at 18:08:55
In reply to Re: more thoughts on my depression treatment options » floatingbridge, posted by zonked on June 18, 2011, at 9:14:29
And why are you ashamed you responded well to Tramadol - if you're in pain, and an analgesic worked, that is hardly suprising, its what any doctor would exoect - no reason to be ashamed there. What is the cause of your pain?
Posted by floatingbridge on June 18, 2011, at 21:18:19
In reply to Re: more thoughts on my depression treatment options, posted by jono_in_adelaide on June 18, 2011, at 18:08:55
Hi Jono,
I have lower back damage. The fibromyalgia is mainly from the waist down except for the occasional 'run over by a truck ' feeling people with fibromyalgia quote. There is also a large overlap with fatigue. The pain is daily, but I think workable.
The shame I felt was that tramadol positively affected my mood and not really the pain, and the doctor at the time never treated me as well after I was naive enough to share that with him.
Make sense?
Thanks for asking.
fb
Posted by floatingbridge on June 18, 2011, at 21:23:09
In reply to Re: more thoughts on my depression treatment options » jono_in_adelaide, posted by floatingbridge on June 18, 2011, at 21:18:19
The good lord help me. I'm going to request a trial of nardil (or parnate).
I also have an phone interview at Stanford. They reccommended maoi's once, maybe they will again.
Thanks for helping me think this through. Kinda like counting on ones fingers or moving ones lips when reading.
fb
Posted by emmanuel98 on June 19, 2011, at 20:39:28
In reply to o.k. wish me luck again » floatingbridge, posted by floatingbridge on June 18, 2011, at 21:23:09
When I was in McLean two years ago waiting for the washout to try parnate, I told the doctor that I saw my last hope as suboxone. I had self-medicated with opiates (successfully!) for five years. She said she would consult on it. As it turned out, the parnate helped, though it seems to have somewhat pooped out. I still see suboxone as the last resort -- can't be abused but provides that opiate high.
Posted by floatingbridge on June 19, 2011, at 21:16:25
In reply to Re: o.k. wish me luck again, posted by emmanuel98 on June 19, 2011, at 20:39:28
Posted by jono_in_adelaide on June 20, 2011, at 18:25:42
In reply to Re: o.k. wish me luck again, posted by emmanuel98 on June 19, 2011, at 20:39:28
What leads you to beleive that suboxone cant be abused?
It is a potent opoid, and is a controlled drug in virtualy every country.
The abuse potential is lower than morphine, but it certainly can be abused
Posted by floatingbridge on June 20, 2011, at 18:29:29
In reply to Re: o.k. wish me luck again, posted by jono_in_adelaide on June 20, 2011, at 18:25:42
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