![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 109 to 133 of 317. Go back in thread:
Posted by SLS on January 16, 2012, at 6:35:40
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 15, 2012, at 11:57:22
> Thanks Scott for the references.
>
> Whatever I get I will be using the lowest possible dose
Good luck.If you are chronically sleep-deprived, you might be very surprised by how differently you will feel once you make up the sleep-debt.
- Scott
Posted by SLS on January 16, 2012, at 6:44:52
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
I experienced a lull in my response to treatment. It lasted for about a week. I had been greatly disappointed by this. I came to believe that my improvement had plateaued and was fading.
I am doing significantly better today. Something must still be working. I am more hopeful that my progress will continue and result in a robust antidepressant response. I guess I should expect that the course of improvement will not be linear, and that I should expect occasional lulls.
- Scott
Posted by sigismund on January 17, 2012, at 16:18:02
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 16, 2012, at 6:44:52
It would have been interesting for you to have tried Prazosin in the past to see what it did on its own.
Posted by SLS on January 17, 2012, at 17:20:27
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 17, 2012, at 16:18:02
> It would have been interesting for you to have tried Prazosin in the past to see what it did on its own.
Yes. It might have saved me from carrying around an extra 50 pounds.
I hope you receive benefit from one of the treatments you select. I am finding that 6 mg/day of prazosin is producing a certain amount of sleepiness during the day, which I don't like. I have been taking 2 mg t.i.d. At some point, I will try to reduce the dosage.
- Scott
Posted by Phillipa on January 17, 2012, at 20:47:52
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 17, 2012, at 17:20:27
Scott don't "rock the boat" so to speak as it's working. Phillipa
Posted by sigismund on January 18, 2012, at 2:48:09
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 17, 2012, at 17:20:27
My shrink is more sceptical than me. I told him trimipramine improved sleep architecture. He looked at me as if to say 'If you believe that, you'll believe anything'. That might be why I said 'I read it on Wikipedia'. So I didn't have the heart to mention the other 3 things, not to speak of the more adventurous and interesting pharmaceutical approaches (GHB for sleep, amphetamine for daytime use), although I did mention Serzone which he told me is no longer available here.
Posted by SLS on January 18, 2012, at 7:15:46
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 17, 2012, at 20:47:52
> Scott don't "rock the boat" so to speak as it's working. Phillipa
That's good advice. It's just that I'm not getting anything done, and I sleep too much during the day.
If you do my laundry...
- Scott
Posted by SLS on January 18, 2012, at 7:17:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 18, 2012, at 2:48:09
> My shrink is more sceptical than me. I told him trimipramine improved sleep architecture. He looked at me as if to say 'If you believe that, you'll believe anything'. That might be why I said 'I read it on Wikipedia'. So I didn't have the heart to mention the other 3 things, not to speak of the more adventurous and interesting pharmaceutical approaches (GHB for sleep, amphetamine for daytime use), although I did mention Serzone which he told me is no longer available here.
Frustrating, to say the least.
- Scott
Posted by Phillipa on January 18, 2012, at 18:50:56
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 18, 2012, at 7:15:46
Scott you are tireder than I thought. Laundry? What's that? Easier to wear, throw away and buy new. Wishful thinking. Phillipa
Posted by creepy on January 26, 2012, at 1:42:11
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 18, 2012, at 7:17:29
Ive had bad results making suggestions to pdocs, and Ive tried it in many different ways as suggested by my therapist. They seem to perceive it as some sort of challenge or control issue. All I want is to get better faster and not go through another failed trial that jeopardizes my employment with sick days, cognitive fog and irritability.
Ive found its better to just say 'well a relative does better on this'.
It sucks, but Ive found more often than not you screw up the relationship with the doc making any sort of suggestions. Counter-transference? dunno.
Posted by SLS on January 27, 2012, at 19:17:06
In reply to Re: Adding Parnate and prazosin., posted by creepy on January 26, 2012, at 1:42:11
I am having trouble remaining optimistic with my taking prazosin. I don't see a trend towards further improvement. I feel like I have arrived at a plateau. Maybe things will be different a week from now.
- Scott
Posted by Phillipa on January 27, 2012, at 20:58:00
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 27, 2012, at 19:17:06
Scott how improved are you at this point? Talked with your doc? Remember even in weight loss plateus happen. Phillipa
Posted by papillon2 on January 28, 2012, at 2:40:42
In reply to Re: Adding Parnate and prazosin., posted by creepy on January 26, 2012, at 1:42:11
> Ive found its better to just say 'well a relative does better on this'.
I'm having trouble finding the research paper/study, but I did read that a good indicator of how an individual will respond to a psychiatric medication (level of inprovement, side effects) is how a relative, especially a first degree relative, has responded.
Posted by SLS on January 28, 2012, at 5:20:34
In reply to Re: Adding Parnate and prazosin., posted by papillon2 on January 28, 2012, at 2:40:42
> > Ive found its better to just say 'well a relative does better on this'.
>
> I'm having trouble finding the research paper/study, but I did read that a good indicator of how an individual will respond to a psychiatric medication (level of inprovement, side effects) is how a relative, especially a first degree relative, has responded.This has been observed for many years. It sure beats blinded trial-and-error.
- Scott
Posted by SLS on January 28, 2012, at 5:31:11
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 27, 2012, at 20:58:00
> Scott how improved are you at this point? Talked with your doc? Remember even in weight loss plateus happen.
Yes. However, I can't say that I am any better now than I was for the first two weeks that I took prazosin. I just don't see a trend towards improvement right now.
One thing nice - I was able to read two entire Scientific American articles and comprehend them. I haven't had that kind of mental focus in over ten years. For now, I am using that improvement as a source of hope.
I have an appointment to see my doctor in two weeks. That will allow more time to see where this thing is headed. Maybe he'll increase the prazosin. Postural hypotension dizziness is only an intermittent problem.
Today, I am feeling about 25% improved. I'm pretty sure that I could go back to work at 50%.
- Scott
Posted by Phillipa on January 28, 2012, at 18:35:59
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 28, 2012, at 5:31:11
Scott is this the best response since the first parnate response? What GAF do you feel you would receive? If your doc uses them? Phillipa
Posted by sigismund on January 28, 2012, at 19:27:24
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 28, 2012, at 5:31:11
Scott, can you explain something for me?
The ADs you have taken have increased NE (so to speak) and the prazosin blocks it (or something like that).
It just seems back the front, if you see what I mean.
Posted by Phillipa on January 28, 2012, at 21:04:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 28, 2012, at 19:27:24
Sigi are you saying that the combo of two are normalizing Scotts brain back to what it was before MDD? PJx
Posted by SLS on January 29, 2012, at 6:41:52
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 28, 2012, at 19:27:24
> Scott, can you explain something for me?
Probably not, but I'll try.
> The ADs you have taken have increased NE (so to speak) and the prazosin blocks it (or something like that).
Yes. Prazosin blocks NE alpha-1 receptors.
> It just seems back the front, if you see what I mean.
Yes. That's why I don't pay too much attention to theories anymore when it comes to choosing drugs for treatment. Theories are sometimes valuable to include drugs for consideration, but not for their exclusion.
I offered my doctor one possible explanation in an email I sent him:
"It occurred to me that prazosin might quiet those neurons that are observed to be hyperactive in cingulate cortex (Brodmann areas 24, 25) in indviduals with MDD. If so, it would effectively mimic DBS."
This is really nothing more than a wild guess for which I have little evidence to support. However, NE alpha-1 receptors do exist in the regions I specified.
- Scott
Posted by SLS on January 29, 2012, at 14:03:49
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 28, 2012, at 5:31:11
> One thing nice - I was able to read two entire Scientific American articles and comprehend them. I haven't had that kind of mental focus in over ten years.
Actually, it has been over thirty years since I was last able to read unimpaired. By 1980, I had to drop out of college because I could no longer read, learn, or remember. I had a six-month reprieve in 1987 during which I was able to read. I read a good book on physics called "Dance of the Wu Li Masters". Then, in 1998, I experienced a few days of improved cognitive function. Of course, I wasted them by reading about pindolol augmentation of SSRIs in the American Journal of Psychiatry. I could have instead better spent the time reading the articles in Playboy.
While we are on the subject, I have experienced a noticeable decrease in my sex-drive. I am pretty sure that it is the prazosin that is responsible for this. It seems to be a common side effect of this drug. Remission is worth the trade-off, though. Even a 50% improvement is worth the trade-off.
It's always something.
- Scott
Posted by Phillipa on January 29, 2012, at 18:34:45
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 29, 2012, at 14:03:49
Scott and to me to put into perspective more the what if thoughts say what if you had cancer of the prostrate and the treatment took away your ability to engage in sex. Would you die rather than get treated? Just my thoughts on the subject. Phillipa
Posted by SLS on January 31, 2012, at 0:31:09
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 29, 2012, at 18:34:45
After experiencing diminishing returns with treatment for the past two weeks, I have come to the conclusion that my discontinuation of Abilify is responsible for this diminution of response.
I would prefer to not take Abilify because it raises my triglycerides level to over 400 mg/dL and keeps me 50 pounds overweight. I might try Latuda first before returning to Abilify.
- Scott
Posted by Bob on January 31, 2012, at 0:34:46
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 31, 2012, at 0:31:09
> After experiencing diminishing returns with treatment for the past two weeks, I have come to the conclusion that my discontinuation of Abilify is responsible for this diminution of response.
>
> I would prefer to not take Abilify because it raises my triglycerides level to over 400 mg/dL and keeps me 50 pounds overweight. I might try Latuda first before returning to Abilify.
>
>
> - Scott
I wonder if Abilify will prove to have just as much of a weight problem as Zyprexa in the long term. My sister is currently on a low dose and has gained over 20 lbs in about 2 months. She is very unhappy about it.
Posted by SLS on January 31, 2012, at 1:04:07
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on January 31, 2012, at 0:34:46
> > After experiencing diminishing returns with treatment for the past two weeks, I have come to the conclusion that my discontinuation of Abilify is responsible for this diminution of response.
> >
> > I would prefer to not take Abilify because it raises my triglycerides level to over 400 mg/dL and keeps me 50 pounds overweight. I might try Latuda first before returning to Abilify.
> >
> >
> > - Scott
>
>
> I wonder if Abilify will prove to have just as much of a weight problem as Zyprexa in the long term. My sister is currently on a low dose and has gained over 20 lbs in about 2 months. She is very unhappy about it.
My observations with Abilify are that the onset of weight gain is latent and insidious. There doesn't seem to be a plateau of effect, one just keeps gaining. Weight gain was not observed with clinical trials of Abilify because the subjects were not followed for long enough. The same thing happened with Prozac.Portion control helps.
- Scott
Posted by SLS on February 5, 2012, at 9:55:02
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on January 31, 2012, at 1:04:07
> > > After experiencing diminishing returns with treatment for the past two weeks, I have come to the conclusion that my discontinuation of Abilify is responsible for this diminution of response.
> > >
> > > I would prefer to not take Abilify because it raises my triglycerides level to over 400 mg/dL and keeps me 50 pounds overweight. I might try Latuda first before returning to Abilify.Well, Latuda did not produce acceptable results. At 40 mg, it did not produce a satisfactory antidepressant response, and it left me feeling cognitively numb and in a "brain-fog". Still, I believe that Latuda will help some people with depression. Researchers are looking closely at 5-HT7 receptor antagonism and its antidepressant effects. Latuda does this. Some people may not need the D2/D3 partial agonism of Abilify, in which case, Latuda might be a good choice for its lack of metabolic side effects.
I restarted Abilify at 10 mg few days ago, and I am beginning to recapture an antidepressant response.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgIt pisses me off that I need to take so many drugs, but beggars can't be choosers.
- 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.