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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 95 to 119 of 119. Go back in thread:
Posted by Phidippus on December 16, 2011, at 17:48:19
In reply to Re: Effexor 450 mg? » Bob, posted by SLS on December 15, 2011, at 8:49:41
Vagal Nerve Stimulation may be more efficacious for the treatment of depression than DBS. You are concious during the procedure and as they tune the device, improvements can be felt. (this goes for both proceddures).
Eric
Posted by Bob on December 16, 2011, at 17:51:20
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 16, 2011, at 17:41:36
> Describe your depression to me. Negative thoughts, no joy? What?
>
> Something's not right with your picture, you know that. You're on a lot of drugs that provide antidepressant benefit, yet you're still stuck? These drugs aren't working for you, period.
>
> You're stuck with the complexity of bipolar depression, correct? I'm assuming you're bipolar because you take Lamictal and Lithium.
>
> Bipolar depression is a different beast. Living with it I have discovered it does not respond to antidepressant therapy the same way regular depression does. There are drugs, though that have proven efficacious for bipolar depression: Zonegran, Riluzole, Ketamine, Opiates, Mirapex, etc.
>
> The combination you are on is not working for you. Stop going back to medications that may have worked in the past. Try to look at your situation with a different perspective. You don't need all these ADs.
>
> Eric
>
I'm not sure where he would get ketamine, opiates, VNS, or DBS for that matter. The only available outlets are studies which involves some luck for getting into. He does need to reset somehow though I think. Short of ECT which seems just to be too much all at once for some (me included), what about rTMS? It might be a little easier to get some treatment with that modality and it just may change the baseline a little.Of course, if he is able to get any of the the aforementioned treatments, then I personally would go for it. Come to think of it, VNS is FDA approved now, so that might be easier to get.
Bob
Posted by Bob on December 16, 2011, at 17:57:58
In reply to Re: Effexor 450 mg? » SLS, posted by Phidippus on December 16, 2011, at 17:48:19
> Vagal Nerve Stimulation may be more efficacious for the treatment of depression than DBS. You are concious during the procedure and as they tune the device, improvements can be felt. (this goes for both proceddures).
>
> Eric
Eric,I have the DBS implant and was involved in the St. Jude Medical BROADEN study at Columbia University. Patients are not conscious any longer when the implantation is performed. They did it that way during the initial investigative phase as I understand, but eventually stopped, ostensibly because there was no discernible correlation between those that reported a sudden antidepressant effect in surgery and those that went on to be "responders" to the device stimulation long term.
There is a competing group of studies headed by the Medtronic and the Cleveland Clinic I believe which targets a different area of the brain. Possibly patients are awake during that procedure, but I don't know.
Bob
Posted by Phidippus on December 16, 2011, at 18:07:49
In reply to Re: reset » ed_uk2010, posted by SLS on December 16, 2011, at 15:02:04
VNS.
Eric
Posted by hyperfocus on December 16, 2011, at 20:14:02
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
> I continue to lie to myself that I will ever get well. I am afraid of where the truth would lead me.
The only truth that matters is that you're a good person who tries to help people. That's the only thing human beings really have control of. No one, rich or poor, can will their immune system to function normally or their cancer cells to stop reproducing.
"Blessed are they who have been persecuted
within themselves. It is they who have truly come to know the
Father. Blessed are the hungry, for the belly of him who desires
will be filled."I came across this in the Gospel of Thomas. Maybe it means something. Maybe it doesn't. Who knows. One day you'll look back at this time and feel like all the struggle was worth it.
Posted by Phidippus on December 17, 2011, at 16:19:32
In reply to Re: Effexor 450 mg? » Phidippus, posted by Bob on December 16, 2011, at 17:51:20
>I'm not sure where he would get ketamine, opiates
My doctor has prescribed me both. There's enough research out there to persuade a pdoc.
Scott needs to start over. He's stuck with four medications which are not working.
Eric
Posted by Phidippus on December 17, 2011, at 16:24:45
In reply to Re: reset » hyperfocus, posted by SLS on December 16, 2011, at 13:50:50
>I continue to lie to myself that I will ever get >well. I am afraid of where the truth would lead me.
Depression is an illusion. It never feels real.
Start from scratch, Scott. Try Zonegran. Take some Tramadol. Try an NMDA antagonist. Ketamine could work real well for you.
I just don't understand why you stay on a cocktail that obviously barely works.
Eric
Posted by SLS on December 17, 2011, at 18:49:31
In reply to Re: reset » SLS, posted by Phidippus on December 17, 2011, at 16:24:45
> I just don't understand why you stay on a cocktail that obviously barely works.
The trick is finding something that will work at all. Something is better than nothing. I know it is frustrating to see me fail to respond to almost everything. I don't mean to be difficult. I just don't know what else to do.
What do you think of using prazosin to treat anergic bipolar depression? How has this drug helped you?
I guess buprenorphine is to be considered in the future. I hope my doctor relents in his opposition to trying it. The Bodkin study is not sufficient for him. I wish I had a couple of oxycodones to experiment with.
Thanks, Eric.
- Scott
Posted by Bob on December 18, 2011, at 0:18:40
In reply to Opiates aren't that hard to get. » Bob, posted by Phidippus on December 17, 2011, at 16:19:32
> >I'm not sure where he would get ketamine, opiates
>
> My doctor has prescribed me both. There's enough research out there to persuade a pdoc.
>
> Scott needs to start over. He's stuck with four medications which are not working.
>
> Eric
My doctor will not do it.
Posted by ed_uk2010 on December 18, 2011, at 5:59:01
In reply to Re: reset » ed_uk2010, posted by SLS on December 16, 2011, at 15:50:17
> > >Abilify actually gives me a little more energy and motivation.
> >
> > I understand, but a dose below 10mg might actually be optimal. Above 10mg dulls your senses, so are you sure 10mg is the most effective dose for you?
>
>
> You're right. I have never stayed at 5 mg.
>
>
> - ScottIt could be worth a try Scott. Perhaps you could try 7mg (5mg + 2mg) for a few weeks, and then, if appropriate, 5mg. With antipsychotics, 'too much of a good thing' can turn into a bad treatment.
Posted by Phidippus on December 18, 2011, at 18:18:16
In reply to Re: reset » Phidippus, posted by SLS on December 17, 2011, at 18:49:31
While using Prazosin has improved my mood a little. It seems to do this by increasing extracellular DA in the frontal cortex while lowering it in the nucleus acumbens.
It works extremely well for anxiety.
Have you tried Zonegran or any of the NMDA antagonists?
Eric
Posted by Phillipa on December 18, 2011, at 20:33:02
In reply to Re: reset » SLS, posted by Phidippus on December 18, 2011, at 18:18:16
Scott anyone else in family with depression, bipolar? Was thinking of family history today? Phillipa
Posted by SLS on December 18, 2011, at 21:58:38
In reply to Re: reset » SLS, posted by Phidippus on December 18, 2011, at 18:18:16
> While using Prazosin has improved my mood a little. It seems to do this by increasing extracellular DA in the frontal cortex while lowering it in the nucleus acumbens.
That's interesting.
> It works extremely well for anxiety.
PTSD anxiety states or all anxiety states?
> Have you tried Zonegran
Yup. Neutral.
> or any of the NMDA antagonists?
Memantine 20 mg. I may revisit it once I start Parnate.
I might experiment this week with tramadol or hydrocodone. If I respond positively to either drug, I will petition my doctor for buprenorphine.
- Scott
Posted by JohnLA on December 18, 2011, at 22:58:52
In reply to Effexor 450 mg?, posted by SLS on December 1, 2011, at 12:20:25
scott-
i'm a bit new here as you know. i am at the 21 month of my first unremitting severe depression. you know a bit of my story; several meds, a round of ect, 2 in-patient stays, etc.
i literally have been in bed 24/7 for the past 21 months for the most part.
i know this is a pro-med site, but any thought to finding a place (not a hospital) but a residential treatment place or community that in addition to (or not) meds may be a new approach?
i'm 'only' at 21 months, but i don't think meds are gonna get me where i wanna be. i need structure and a 'push' to get out of bed. maybe you could use the same push.
i'm currently researching different types of potential facilities. i'm even thinking of going back to where i grew-up (greece) and going to mount athos (google it) and live with the monks for a while! crazy i know, but not as crazy as laying in bed all these months. mount athos actually allows people seeking spiritual growth/healing to live and work the monastic life. biggest problem is they start their day at 4am and go to bed at sunset. ouch. ;)
i'd rather find something closer to home of course here in california. i'm hoping i will.
my point is; let's all think 'outside of the box' here. again, i'm new here and don't want to step on any toes. but, all the suggestions so far are meds and more meds. maybe time for a different approach?
have you heard about the soteria program? i don't know much about is, but i know they are residential places for people like us. i also think they have 'homes'
in different parts of the country. in fact let me go get some info and post about it.john
Posted by Phidippus on December 18, 2011, at 23:32:48
In reply to Re: reset » Phidippus, posted by SLS on December 18, 2011, at 21:58:38
Prazosin has been studied in the treatment of GAD, OCD and especially panic disorder.
Zonegran has a few case reports about its efficacy in treating bipolar depression. It has a complex mechanism of action, but for are purposes it facilitates the transmittion of seratonin and dopamine. It is also an NMDA antagonist.
I think Tramadol is a better bet than buprenorphine. You may have to play with it for more than a week as its an SNRI.
Eric
Eric
Posted by JohnLA on December 19, 2011, at 0:32:39
In reply to newbie with a suggestion, posted by JohnLA on December 18, 2011, at 22:58:52
here is some basic info on soteria;
http://en.wikipedia.org/wiki/Soteria
the only one i have found still open is in alaska. (sigh.) or, you and i head over to europe. from what i quickly read they have expanded the criteria for admission to be not just limited to schizophrenics, but include those under mental duress.
anyway, maybe people here at babble could suggest some other type of similar places.
hoping you find some answers soon scott.
john
ps i had an uncle in greece named 'soteri' the male version of the female name soteria. it means salvation in greek...and, as i'm sure you know, psyche means 'soul' in greek.
Posted by SLS on December 19, 2011, at 7:50:25
In reply to newbie with a suggestion, posted by JohnLA on December 18, 2011, at 22:58:52
Hi John.
> i know this is a pro-med site, but any thought to finding a place (not a hospital) but a residential treatment place or community that in addition to (or not) meds may be a new approach?
I did that for a few years. I was also in a partial hospitalization program that I went to on a daily basis for almost ten years. I manage to get out of bed okay. I just have nothing to do for the rest of the day. The people at the programs are simply too sick for me to be around. I was hoping that Nardil would have gotten me back to work. That would be structure.
21 months is long enough. Of course 21 years is, too. Any time spent in depression is too much. I hope you are able to add structure to your life. I'm sure it would be helpful for the health of your mind even if it can't be helpful for the health of your brain. It sounds like you are heading in the right direction.
Thanks for the ideas.I have tramadol and hydrocodone to play with, but I am reluctant to try these opioids. I'm afraid they might work.
- Scott
Posted by europerep on December 19, 2011, at 16:09:25
In reply to Opiates aren't that hard to get. » Bob, posted by Phidippus on December 17, 2011, at 16:19:32
Hello there,
I would actually agree with the headline of Phid's post. I'm not sure how he got ketamine prescribed, because over here at least, it's not a drug that you can get prescribed and that is stocked in a pharmacy. It's like with the fentanyl derivatives, ketamine is used only for anaesthesia in hospitals and clinics. At any rate, ketamine is indeed not that hard to get. If not from a doctor, then from the Internet. But that's all a different story...
The point is, Scott, I don't really understand what it is that you are trying to do. You are hovering around at what you described in the Viibryd thread as "25%", and this has been more or less the same with the very wide range of drugs and combinations that you have taken. I will stress that I am not a doctor, but how can you realistically expect that any drug that is targeting the neurotransmitters you have now been targeting for so long, is ever going to produce more than 25%, or maybe 27% or 31%. Lowering aripiprazole might add a couple of percentage points, or it might not. In any case, it won't be the solution.
So, if you are going to go with another pharmacological treatment (which would be a decision that I agree with), target parts of the brain that you haven't been targeting. A mild opioid could be a good start. A fairly potent but atypical opioid would be another. And if your doctor won't prescribe you buprenorphine then... go to another doctor. Hell, call the guys at McLean's if necessary, and ask whether they are still treating select TRD patients with buprenorphine. I understand you have been for treatment at the NIH, and you have documentations from that? Great, that is about the best documentation you could get showing that you have been ill for a long time and that your illness is serious enough to warrant "experimental" treatment. But please, do something different from what you have been trying now for so long!
I can say that it is *very* frustrating to read your posts going from one mainly serotonergic drug to the next, expecting that somehow it might be a "magic potion". Well, yeah it might, but it is very very unlikely. And I am not saying that it is frustrating to see you like that in order to make you feel bad. I am saying it because there is at least a chance that there is something out there that can help you. Find it! Is that difficult while in depression? Of course, but if you have the power to write all those posts on here, you also have the power to sum up your treatment history and call or email it to some psychiatrists across the US to see what they could offer you.
ER
Posted by europerep on December 19, 2011, at 16:14:41
In reply to Re: newbie with a suggestion » JohnLA, posted by SLS on December 19, 2011, at 7:50:25
> I have tramadol and hydrocodone to play with, but I am reluctant to try these opioids. I'm afraid they might work.
So wait a minute, you actually have access to opioids? Then what are you waiting for?
There's two decisions to make here. Will you try them or not? If the answer is yes, the next question is: do you have a possibility to give the drug that you are going to try to someone else so that they can give it you at the correct dose each day? If yes, and if that is what you want to do because you are scared of addiction, give the pills to someone else. If you can't do or don't want that, tell yourself how important it is to stay at the dose you or your doc prescribed to you, and then go for it! Depending on the strength of the products you have, you can cut the pill in two or even in four if necessary to start at a low dose. Then see what happens.
There is only one way to go about that. Do it or don't.
Posted by Phillipa on December 19, 2011, at 18:01:28
In reply to Re: newbie with a suggestion » SLS, posted by europerep on December 19, 2011, at 16:14:41
I agree the times I have had percocet it has been such an upper and I don't have depression. But they do work. If only docs were not afraid of them. As when it comes down to it most meds are addictive if used incorrectly. Did you say you were afraid to get well? Phillipa
Posted by Vincent_Qc on December 19, 2011, at 19:21:48
In reply to Re: newbie with a suggestion, posted by Phillipa on December 19, 2011, at 18:01:28
> I agree the times I have had percocet it has been such an upper and I don't have depression. But they do work. If only docs were not afraid of them. As when it comes down to it most meds are addictive if used incorrectly. Did you say you were afraid to get well? Phillipa
I dont understand why the opiates can lift your mood. I cant tolerate them, they make me feel very anxious and depress and also make ma heart race at 140 and more. When I had my last 2 surgery last october, the only one opiate I was able to tolerate at alow dose was the demerol iv 50 mg maximum, it was not effective to reduce the pain but I took it for being able to sleep. After 12 days on the demerol the Doc say its enough cause the demerol have active metabolites who are dangerous and can lead to seizure so heput me onthe dilaudid iv 2 mg and had a very bad reaction to it,no pain relief ...just a fast heart rate of 160 for 3 hours non stop... the nightafter I was in pain and ask for something else and had vicodin and had the same reaction, so the next morning they give morphine and it was the same so in the afternoon I. again for the demerol was allowed to have it again just one time and strangely my heart rate drop to 60 and less and fall asleep 4 hours was put on a nsaid call indocine who dont reduce the pain from the surgery but was very effective to kill my daily headache, I ask the Doc to have a RX of the indocine for wheni return home but said it was not good for the heart since its one of the older nsaid....anyway I had tramadol 3 times in the past and it was ok no heart issue but again no pain relief at all...really weird,I think im not human. Lol
Posted by Phillipa on December 19, 2011, at 21:04:31
In reply to Re: newbie with a suggestion » Phillipa, posted by Vincent_Qc on December 19, 2011, at 19:21:48
Vincent you are human we are all just different. Phillipa
Posted by JohnLA on December 19, 2011, at 21:34:34
In reply to Re: newbie with a suggestion » JohnLA, posted by SLS on December 19, 2011, at 7:50:25
got it scott. at least i hope my subject title made you smile a bit?
i agree about the hospital programs. both in-patient and out-patient. i tried them too. not for me.
well, you are doing better than me if you are getting out of bed every day. i think that is huge.
i'm not giving-up on the idea of some low stress daily program. anything to break the rut i am in. today i am researching monasteries here in the US. i'll keep you posted just for the heck of it.
as always, hope you find some peace soon.
john
Posted by Ben on December 21, 2011, at 9:21:15
In reply to Effexor 450 mg?, posted by SLS on December 1, 2011, at 12:20:25
I was on 600mg Effexor ER but I had to give it up because I didn`t respond. Plasma level were above the upper range.
Did you checked the plasma level?
Posted by SLS on December 21, 2011, at 9:30:04
In reply to Re: Effexor 450 mg?, posted by Ben on December 21, 2011, at 9:21:15
> I was on 600mg Effexor ER but I had to give it up because I didn`t respond. Plasma level were above the upper range.
> Did you checked the plasma level?I didn't know that there were established therapeutic levels for Effexor. I am currently washing out in preparation for going on Parnate.
- Scott
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