![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 120 to 144 of 201. Go back in thread:
Posted by zonked on October 5, 2011, at 20:11:53
In reply to Re: 40% » ihatedrugs, posted by SLS on October 5, 2011, at 18:09:56
Max Fink told me that I could try the more current procedures in which unilateral right was used at higher dosages.
>
>
> - ScottScott, you had personal contact with Fink? What did you make of him? Based on things he's written (one thing more or less advised the MD to tell the patient any memory loss was psychosomatic whether or not this was actually believed to be true, for his or her own benefit.), I think he's drinking his own ECT Kool-Aid too much.
Posted by huxley on October 6, 2011, at 2:46:01
In reply to Re: 40%, posted by SLS on October 5, 2011, at 5:54:46
> Hi Huxley.
>
> > Hi Scott,
> >
> > I hope you don't take this post as an attack or that it is offensive to you.
> >
> > Have you thought that maybe you have damaged your brain with the amount of drugs you have taken and that your extended depressive state is actually caused by the very thing that is purporting to cure it?
> >
> > Seems to me that it would be quite easy to destabilize the delicately balanced complex brain equilibrium.
>
>
> No offense taken. I am extrememly happy and feel fortunate that you should offer me feedback about my illness. To a great degree, you are absolutely right. It seems rather obvious that repeated antidepressant drug exposures induce a resistance to an array of treatments. Unfortunately, my treatment resistance and pattern of tachyphylaxis (poop-out) showed up with the very first drug I tried: imipramine.
>
> As you so accurately portray, I have grown more and more resistant to treatment. My only extended remission was achieved using a combination of Parnate and desipramine. My doctor at that time proceeded to withdraw these medications after 9 months of remission out of concern for the appearance of mania. Of course, in retrospect, this was a decision that was to cost me two decades of my life. I never responded to that treatment ever again, despite trying it multiple times.
>
> Question: What better choice did I have but to treat the depression with what has been available?
>
>
> Thanks for your thoughtful feedback.
>
>
> - Scott
>
>
>
>That is the million dollar question isn't it.
For myself I have found that a life with no nicotine, no alcohol, a healthy diet and plenty of exercise keeps me well enough.I just strongly suspect that medication is making many of us far worse of than we would be without it.
Posted by SLS on October 6, 2011, at 5:41:46
In reply to Re: 40%, posted by huxley on October 6, 2011, at 2:46:01
> > > I hope you don't take this post as an attack or that it is offensive to you.
> > >
> > > Have you thought that maybe you have damaged your brain with the amount of drugs you have taken and that your extended depressive state is actually caused by the very thing that is purporting to cure it?
> > >
> > > Seems to me that it would be quite easy to destabilize the delicately balanced complex brain equilibrium.> > No offense taken. I am extrememly happy and feel fortunate that you should offer me feedback about my illness. To a great degree, you are absolutely right. It seems rather obvious that repeated antidepressant drug exposures induce a resistance to an array of treatments. Unfortunately, my treatment resistance and pattern of tachyphylaxis (poop-out) showed up with the very first drug I tried: imipramine.
> >
> > As you so accurately portray, I have grown more and more resistant to treatment. My only extended remission was achieved using a combination of Parnate and desipramine. My doctor at that time proceeded to withdraw these medications after 9 months of remission out of concern for the appearance of mania. Of course, in retrospect, this was a decision that was to cost me two decades of my life. I never responded to that treatment ever again, despite trying it multiple times.
> >
> > Question: What better choice did I have but to treat the depression with what has been available?
> >
> >
> > Thanks for your thoughtful feedback.
> That is the million dollar question isn't it.
>
>
> For myself I have found that a life with no nicotine, no alcohol, a healthy diet and plenty of exercise keeps me well enough.That's great. I wish for you that you remain in good health.
I wish I could say the same for myself. I have tried what you describe, and it just doesn't make a dent in my condition. That is not to say that your methods don't work for some people. They do. Just not me. Perhaps bipolar disorder is less responsive to exercise.
> I just strongly suspect that medication is making many of us far worse of than we would be without it.
In the future, it should be possible to choose drugs based upon genetic tests. This should predict which drugs will help and which drugs will hurt.
- Scott
Posted by uncouth on October 6, 2011, at 19:13:23
In reply to Re: 40%, posted by SLS on October 5, 2011, at 5:54:46
Scott, that is interesting what you mention about being on parnate and desipramine and being withdrawn, then having it NEVER work again. Were you on that MAOI for a long time?
Are you familiar with David Foster Wallace's story? He was on Nardil for something like 15 years, and he and his pdoc thought, hey my life is going well, i just got married, i'm settled, i'm dealing with my success pretty well these days, and i just had a bad med food reaction, maybe its time to try something else, because hey we've had a lot of advances in depression treatments since they started me on nardil.
he withdrew, over a long period of time too, and about a year later killed himself. NOTHING -- NOTHING else worked, including ECT, and even rechallenging with MAOIs.
Have you heard of this long-term MAOI poop out, then NOT working when rechallenged happening to otehrs? I wonder what is behind it?
What do you think happens when MAOIs are discontinued in the brain?
Posted by floatingbridge on October 6, 2011, at 19:37:55
In reply to Re: 40% » SLS, posted by uncouth on October 6, 2011, at 19:13:23
Uncouth,
I heard a different story about DFW. His story is a complicated one like many of ours. He had a history of suicide attempts and urges. Not everyone of us contends with these urges at the same intensity. He is one high profile Nardil user. None of us here are exactly the same. And there is no way to predict
with certainty success or failure, though we don't stop trying :-)Opening to the possibility of success and the variuos forms success might take is both a talent and a skill one can develop. Accepting uncertainty in life is an act
and gift of grace in my opinion.I wish DFW had lived long enough to regain his stability because a year or less is such a short time when dealing with MI and medication.
Posted by floatingbridge on October 7, 2011, at 20:45:50
In reply to Re: 40% » SLS, posted by uncouth on October 6, 2011, at 19:13:23
Uncouth,
I heard a different story about DFW. His story is a complicated one like many of ours. He had a history of suicide attempts and urges. Not everyone of us contends with these urges at the same intensity. He is one high profile Nardil user. None of us here are exactly the same. And there is no way to predict
with certainty success or failure, though we don't stop trying :-)Opening to the possibility of success and the variuos forms success might take is both a talent and a skill one can develop. Accepting uncertainty in life is an act
and gift of grace in my opinion.I wish DFW had lived long enough to regain his stability because a year or less is such a short time when dealing with MI and medication.
Posted by ihatedrugs on October 8, 2011, at 3:05:37
In reply to Re: 40% » ihatedrugs, posted by SLS on October 5, 2011, at 18:09:56
Posted by SLS on October 17, 2011, at 17:57:40
In reply to Viibrid Treatment, posted by SLS on September 28, 2011, at 9:13:28
> I have a good feeling about Viibryd. Wish me luck.
I am not so optimistic now. It has been three weeks since I started taking Viibryd. I have been taking 40mg for two weeks. I feel stuck. I have not gained very much over this last week. I have the patience to continue with treatment, but not the patience to remain confident that Viibryd will bring me to remission.
Actually, this is the week that is most likely to demonstrate initial results. I guess I should have waited a few days before posting this.
Call me greedy, but I like when things work immediately and keep working indefinitely.
- Scott
Posted by FrustratedMama on October 17, 2011, at 22:32:42
In reply to Re: Viibrid Treatment » SLS, posted by SLS on October 17, 2011, at 17:57:40
Crossing fingers that tomorrow is a better day than today for you!
Posted by Conundrum on October 17, 2011, at 23:18:23
In reply to Re: Viibrid Treatment » SLS, posted by SLS on October 17, 2011, at 17:57:40
So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?
> > I have a good feeling about Viibryd. Wish me luck.
>
> I am not so optimistic now. It has been three weeks since I started taking Viibryd. I have been taking 40mg for two weeks. I feel stuck. I have not gained very much over this last week. I have the patience to continue with treatment, but not the patience to remain confident that Viibryd will bring me to remission.
>
> Actually, this is the week that is most likely to demonstrate initial results. I guess I should have waited a few days before posting this.
>
> Call me greedy, but I like when things work immediately and keep working indefinitely.
>
>
> - Scott
Posted by SLS on October 18, 2011, at 5:04:20
In reply to Re: Viibrid Treatment » SLS, posted by Conundrum on October 17, 2011, at 23:18:23
Hello Conundrum.
Long time - no see.
> So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?Good question.
The improvement that I received initially remains intact for now. I had only one setback a few days ago. Otherwise, things are stable. I know when things are heading in the right direction. I know what a high-quality antidepressant response feels like. There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
- Scott
Posted by Conundrum on October 18, 2011, at 5:14:02
In reply to Re: Viibrid Treatment » Conundrum, posted by SLS on October 18, 2011, at 5:04:20
> Hello Conundrum.
>
> Long time - no see.
>
>
> > So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?
>
> Good question.
>
> The improvement that I received initially remains intact for now. I had only one setback a few days ago. Otherwise, things are stable. I know when things are heading in the right direction. I know what a high-quality antidepressant response feels like. There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
>
>
> - Scott
>
>Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
Posted by SLS on October 18, 2011, at 6:01:05
In reply to Re: Viibrid Treatment, posted by Conundrum on October 18, 2011, at 5:14:02
> > Hello Conundrum.
> >
> > Long time - no see.
> >
> >
> > > So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?
> >
> > Good question.
> >
> > The improvement that I received initially remains intact for now. I had only one setback a few days ago. Otherwise, things are stable. I know when things are heading in the right direction. I know what a high-quality antidepressant response feels like. There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
> >
> >
> > - Scott
> >
> >
>
> Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil 60mg.Damned brain.
- Scott
Posted by SLS on October 18, 2011, at 6:37:11
In reply to Re: Viibrid Treatment » SLS, posted by SLS on October 17, 2011, at 17:57:40
> > I have a good feeling about Viibryd. Wish me luck.
>
> I am not so optimistic now. It has been three weeks since I started taking Viibryd. I have been taking 40mg for two weeks. I feel stuck. I have not gained very much over this last week. I have the patience to continue with treatment, but not the patience to remain confident that Viibryd will bring me to remission.
>
> Actually, this is the week that is most likely to demonstrate initial results. I guess I should have waited a few days before posting this.
>
> Call me greedy, but I like when things work immediately and keep working indefinitely.
>
>
> - Scott
Time is passing too slowly for me. I feel as if I have been on this stuff for a lot longer than 3 weeks.
- Scott
Posted by Conundrum on October 18, 2011, at 7:38:27
In reply to Re: Viibrid Treatment » Conundrum, posted by SLS on October 18, 2011, at 6:01:05
> > > Hello Conundrum.
> > >
> > > Long time - no see.
> > >
> > >
> > > > So the results you experienced initially are no longer there, or you just have not seen an improvement from that level of improvement?
> > >
> > > Good question.
> > >
> > > The improvement that I received initially remains intact for now. I had only one setback a few days ago. Otherwise, things are stable. I know when things are heading in the right direction. I know what a high-quality antidepressant response feels like. There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
> > >
> > >
> > > - Scott
> > >
> > >
> >
> > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
>
>
> Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil 60mg.
>
> Damned brain.
>
>
> - Scott
>Interesting. I find that Nardil has the opposite effect for me. Do your BP meds contribute to these symptoms at all?
Posted by SLS on October 18, 2011, at 8:38:28
In reply to Re: Viibrid Treatment » SLS, posted by Conundrum on October 18, 2011, at 7:38:27
> > > > There is something missing for me right now. Anhedonia and brain-fog are still unremitting.
> > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
> > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil 60mg.
> Interesting. I find that Nardil has the opposite effect for me. Do your BP meds contribute to these symptoms at all?
Not at present, although I have experienced brain-fog as a side effect with Zoloft, Neurontin, Lyrica, and Geodon (to name a few).
- Scott
Posted by floatingbridge on October 18, 2011, at 12:39:22
In reply to Re: Viibrid Treatment » Conundrum, posted by SLS on October 18, 2011, at 8:38:28
> > > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
>
> > > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil
>
>
> - ScottScott, is it possible that adding a little amphetamine would help clear some of the anhedonia and fog? I think I recall you saying once you were not very responsive to stimulants. Looking at the above about parnate and the beginning of nardil, I wonder if there would be any benefit in retrying a small amount. Maybe rotating days on and off, if it indeed worked, might help trick your brain from growing too accustomed. Hang in there with this.
fb
Posted by SLS on October 18, 2011, at 13:14:03
In reply to Re: Viibrid Treatment » SLS, posted by floatingbridge on October 18, 2011, at 12:39:22
> > > > > Those seem to be a couple of the trickier symptoms to eliminate. Did you experience brain fog/anhedonia with Nardil?
> >
> > > > Yes, although it was much reduced. When I responded so well to Parnate + desipramine, the brain-fog was totally absent. It was also absent for a few weeks the first time I took Nardil
> >
> >
> > - Scott
>
> Scott, is it possible that adding a little amphetamine would help clear some of the anhedonia and fog? I think I recall you saying once you were not very responsive to stimulants. Looking at the above about parnate and the beginning of nardil, I wonder if there would be any benefit in retrying a small amount. Maybe rotating days on and off, if it indeed worked, might help trick your brain from growing too accustomed. Hang in there with this.
I guess I could try it. I have nearly a full vial of Dexedrine from my last unsuccessful trial performed last year.Tbanks for the suggestion.
- Scott
Posted by SLS on October 19, 2011, at 6:31:00
In reply to Re: Viibrid Treatment » floatingbridge, posted by SLS on October 18, 2011, at 13:14:03
Well, it looks as though Viibryd will not be my magic potion. I am losing more ground each day as my depressive illness asserts itself. My guess is that the improvement I experienced over the course of the first few weeks was actually an effect due to the discontinuation of Nardil. It has happened to me before that discontinuing Nardil has produced a withdrawal-rebound improvement that lasts 2-3 weeks. It is possible that Viibryd "piggy-backed" this rebound effect and may have caused me to feel genuinely better temporarily.
I intend to keep taking Viibryd for a few weeks. I guess you never know what can happen with these drugs. My guess is that I will end up switching from Viibrid to either Effexor or Pristiq and just accept that I will be denied a life without depression - at least until there are new drugs and new understandings. Not fun.
http://www.ncbi.nlm.nih.gov/pubmed/12776393
http://www.ncbi.nlm.nih.gov/pubmed/3435883
- Scott
Posted by europerep on October 19, 2011, at 8:39:29
In reply to Re: Viibrid Treatment, posted by SLS on October 19, 2011, at 6:31:00
Hello Scott,
to be honest, what I don't understand is why you don't consider participating in clinical trials for more novel agents. (Or, if you do, you never talk about it.) There are a bunch of trials going on in the US for ketamine in TRD, either intravenous or intranasal. If you profited from it, you could still get it from the black market if the doctors refused to give it to you on a regular basis. If you're afraid of legal trouble, try methoxetamine, which is an unregulated substance somewhat similar to ketamine.
I know you are very patient, but I'm wondering whether you may actually be *too* patient. After trying out I-don't-know-how-many drugs that act on 5HT/NE/DA, I would conclude that it's time to look elsewhere. Buprenorphine may be worth trying as well.
Just my thoughts...
ER
Posted by SLS on October 19, 2011, at 13:05:11
In reply to Re: Viibrid Treatment » SLS, posted by europerep on October 19, 2011, at 8:39:29
> Hello Scott,
>
> to be honest, what I don't understand is why you don't consider participating in clinical trials for more novel agents.I did a lot of that in the 80s and 90s. I am not too keen on discontinuing everything I am currently taking in order to participate in a clinical trial. I would certainly try something new were there to be compelling results already established. The other thing to consider is that most of these investigations exclude me from consideration because of my bipolar history.
> There are a bunch of trials going on in the US for ketamine in TRD, either intravenous or intranasal.
I'll look into that. I know there is at least one compound being developed that works like ketamine, but without the euphoria. I don't remember the name of it.
> If you profited from it, you could still get it from the black market if the doctors refused to give it to you on a regular basis.
I had thought of that, but I wouldn't know where to get it. Unfortunately, the window for ketamine is very, very narrow. It might be a difficult drug to dose properly.
> If you're afraid of legal trouble, try methoxetamine, which is an unregulated substance somewhat similar to ketamine.
Thanks for the lead. I had never heard of it. I see on Wiki that methoxetamine is also a dopamine reuptake inhibitor. Just what the doctor ordered.
> I know you are very patient, but I'm wondering whether you may actually be *too* patient.
I certainly wish that I hadn't spent this past year taking Nardil. I felt encouraged to do so based upon the occurrence of a second wave of improvements that occurred last December.
> After trying out I-don't-know-how-many drugs that act on 5HT/NE/DA, I would conclude that it's time to look elsewhere. Buprenorphine may be worth trying as well.
The last time I asked my doctor about buprenorphine, he refused to work with it.
> Just my thoughts...
Good ones. Thanks.
I will definitely keep them in mind. I think you are right about me having to look elsewhere for help.
I would like to have seen the triple reuptake inhibitors rise up through Phase III trials. They seem to have been dropped.
http://www.neurotransmitter.net/newdrugs.html
- Scott
Posted by zonked on October 19, 2011, at 13:42:00
In reply to Re: Viibrid Treatment » europerep, posted by SLS on October 19, 2011, at 13:05:11
Scott,
What did Dexedrine do to you? Most people feel better within 30 minutes. No effect, anxiety...?
Just curious. I would think with your treatment history, buprenorphine would be a logical choice if you have one or two more failed trials.
If your doctor knows your history, he knows you're not an "addict" - you just desperately want relief. If he was concerned about addiction potential, couldn't he prescribe you a week's worth and follow up with you? Just an idea. I know it's worse than pulling teeth to get docs to try opiods for depression.
Have you ever had pain so severe to warrant a Vicodin prescription? I am not suggesting that you bring up Vicodin, it's not an appropriate agent (tylenol, conventional opiod); but was wondering if you feel the AD response so many of us do when taking that. I have severe migraines about twice a year, and always flux on whether or not to accept a Vicodin RX because it's sort of a tease. (If you know what I mean.)
-z
Posted by markwell on October 19, 2011, at 15:12:26
In reply to Re: Viibrid Treatment, posted by SLS on October 19, 2011, at 6:31:00
Scott, I'm in the same boat with you. I'm going to try to stay with viibryd but my anxiety is off the charts. Did you get any anxiety relief with viibryd? I'm only 2 days at 20mgs so I don't know if it will improve my depression. I feel for you.
Mark
Posted by SLS on October 19, 2011, at 15:24:04
In reply to Re: Viibrid Treatment, posted by markwell on October 19, 2011, at 15:12:26
> Scott, I'm in the same boat with you. I'm going to try to stay with viibryd but my anxiety is off the charts. Did you get any anxiety relief with viibryd?
Viibryd definitely caused me to experience mild to moderate anxiety while I was titrating up to 40mg. I think there is a tendency for this drug to increase anxiety rather than decrease it. Until someone responds very well to Viibryd, we won't know if this anxiety disappears with time or is a sign that it won't work.
> I'm only 2 days at 20mgs so I don't know if it will improve my depression.
I'll have to speak to my doctor again. He said that it takes longer to respond to Viibryd than to other antidepressants.
Make sure you impress upon your doctor how severe your anxiety is. Perhaps he will give you something to reduce it temporarily. This was a common practice with Prozac when it was discovered that it was producing anxiety as a side effect at the beginning of treatment.
- Scott
Posted by floatingbridge on October 19, 2011, at 17:35:01
In reply to Re: Viibrid Treatment » markwell, posted by SLS on October 19, 2011, at 15:24:04
The anxiety is really too bad. And contrary to what the wiki entry suggests. Though the entry is likely based on theory. Still, I am surprised. And of course I had been wishing what wiki wrote up was true irl.
Well, very best to both of you Markwell and Scott.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.