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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by FrequentFryer on February 3, 2012, at 3:37:14
SLS Im freaking out bad now its almost at 3 weeks on 75mg of Phenelzine and its not doing anything (usually after 1 - 2 weeks) its good.
Ill keep taking it it for 4 weeks but then what....You said Effexor + Welbutrin was good. The fist time I took Venlafaxine it was great,, like Phenelzine for 4 months until it pooped, the 5th time it was ok,,, but now the 12th-15th time I take a huge dose of any SNRI it turns me into a bit of a zombie for a few weeks(which is good) but then just side effects.
2. I don't think I have Bi-polar but should I chuck some Lithium into the mix with the Nardil to see what happens before I play with other stuff (Nortriptaline didn't help).
1. Bupropion, (Im from Australia) has never helped me.. But do you think 225mg venlafaxine + a decent amount of Bupropion might help.
And could I try DESvenlafaxine instead.2. Have you guys ever tried pircitam / aniniercitam?? they any good?
Posted by papillon2 on February 3, 2012, at 4:55:27
In reply to Help Please SLS + the Elite Veterans., posted by FrequentFryer on February 3, 2012, at 3:37:14
Hey fellow Aussie!
I'm not an Elite or a Veteran, but here are my thoughts.
I was on Effexor 7 years before it pooped out and it was said that another SNRI would be too close in mechanism of action to work effectively enough, let alone a 'me too' version of Effexor in the form of desvenlaflaxine.
Augmenting with Lith, Bupropion, AEDs or AAPs is a good idea provided you're getting something out of your anti-depressant to begin with. I'd try that first, though I'm pretty sure bupropion and MAOIs can't be combined?
If that's not successful, maybe try Avanza (Mirtazipine) or Nortriptyline. I'd be inclined to have these augmented too. It seems a bit backwards to have been prescribed a MAOI before a TCA, but I'm in no position to question your doc.
Posted by torrid2 on February 3, 2012, at 7:47:05
In reply to Help Please SLS + the Elite Veterans., posted by FrequentFryer on February 3, 2012, at 3:37:14
if anxiety is the trouble have to tryed hydroxyzine, it's an antihistamine used for anxiety. It works by calming down the CNS. I was doubtful for a long time that it would were but when I truely gave it a try I found that it works.
Posted by SLS on February 3, 2012, at 7:49:35
In reply to Help Please SLS + the Elite Veterans., posted by FrequentFryer on February 3, 2012, at 3:37:14
> SLS Im freaking out bad now its almost at 3 weeks on 75mg of Phenelzine and its not doing anything (usually after 1 - 2 weeks) its good.
If I were in your position, I would be freaking-out, too. How can I convince you to slow down and catch your breath? Try to relax and approach your continued exploration of treatments logically. You have alternatives.
How long have you been at 75 mg? You really should give Nardil a minimum of 3 weeks after dosage adjustments before evaluating its usefulness. You might want to go up to 90 mg now, simply because it is the quickest treatment change to trial.
Bupropion can be added to a MAOI. I added it to Parnate without sequalae. However, you don't get any therapeutic benefits from bupropion monotherapy, so it might not make sense to do this.
Adding low dosages of lithium 300-600 is worthy of consideration. I glean benefit from 300 mg. If lithium is to help, it should demonstrate efficacy within two weeks. More often than not, it takes only 3-10 days to show results.
Have you already tried adding nortriptyline to Nardil? If so, what dosage of nortriptyliine did you use? Did you check your blood-levels?
I have experienced a partial response from combining Effexor and nortriptyline. I like this treatment.
For some people, desvenlafaxine works better than venlafaxine. I won't even guess as to why this should be. I know someone for whom this is true. Desvenlafaxine may not be a "me too" patent extender after all.
You could add Abilify and/or Lamictal as augmentors of Nardil.
The "-acetams" might help with cognition. However, I have not seen anything suggestive of them producing robust antidepressant effects.
If you are still freaking-out, just try to hang in there for now. Distraction sometimes helps. If you are in crisis, you might want to contact your doctor. Perhaps he would have you take an anxiolytic temporarily. You have demonstrated responsivity to medication in the past. It is unlikely that you are now unresponsive to all treatments. It is my guess that you would do well to remain on an effective treatment indefinitely.
Don't forget about rTMS.
- Scott
Posted by Phillipa on February 3, 2012, at 10:16:51
In reply to Re: Help Please SLS + the Elite Veterans. » FrequentFryer, posted by SLS on February 3, 2012, at 7:49:35
Scott how do you learn to relax. As you know I also do the same things and am freaking over an itching now that I bet is pancreatic cancer. So in essence since was told have ocd could FF? Phillipa
Posted by SLS on February 3, 2012, at 13:56:07
In reply to Re: Help Please SLS + the Elite Veterans. » SLS, posted by Phillipa on February 3, 2012, at 10:16:51
> Scott how do you learn to relax. As you know I also do the same things and am freaking over an itching now that I bet is pancreatic cancer. So in essence since was told have ocd could FF? Phillipa
If, after treatment is optimized with medication, there is still residual anxiety, CBT or DBT might help.
- Scott
Posted by Phillipa on February 3, 2012, at 20:58:19
In reply to Re: Help Please SLS + the Elite Veterans. » Phillipa, posted by SLS on February 3, 2012, at 13:56:07
It's worse the pain/itch is worse. I just lost it with hours of crying and they said I'm strong. Not any more. Phillipa
Posted by FrequentFryer on February 4, 2012, at 5:33:02
In reply to Re: Help Please SLS + the Elite Veterans. » FrequentFryer, posted by papillon2 on February 3, 2012, at 4:55:27
> Hey fellow Aussie!
>
> I'm not an Elite or a Veteran, but here are my thoughts.
>
> I was on Effexor 7 years before it pooped out and it was said that another SNRI would be too close in mechanism of action to work effectively enough, let alone a 'me too' version of Effexor in the form of desvenlaflaxine.
Theres another SNRI called Duloxetine, if your not doing to good at the moment.> Augmenting with Lith, Bupropion, A Eds or AAPs is a good idea provided you're getting something out of your anti-depressant to begin with. I'd try that first, though I'm pretty sure bupropion and MAOIs can't be combined?
>
Dont worry I am well aware of the interactions with MAOI's what's an EDS?> If that's not successful, maybe try Avanza (Mirtazipine) or Nortriptyline. I'd be inclined to have these augmented too. It seems a bit backwards to have been prescribed a MAOI before a TCA, but I'm in no position to question your do
NO EVERYONE IS IN THE POSITION TO QUESTION MY DOC.
However I believe Mirtazapine should only be for anorexics and Nortrip I tried with Nardil 1nc but I think it put my blod preasure way up, but now I have BP pilss to counteract tha... AAAAAAAAAAhhhhhhhhhhhh
Posted by FrequentFryer on February 4, 2012, at 5:43:41
In reply to Re: Help Please SLS + the Elite Veterans. » FrequentFryer, posted by torrid2 on February 3, 2012, at 7:47:05
> if anxiety is the trouble have to tryed hydroxyzine, it's an antihistamine used for anxiety. It works by calming down the CNS. I was doubtful for a long time that it would were but when I truely gave it a try I found that it works.
Huh I will look into it. Any examples of how it worked.)
Posted by FrequentFryer on February 4, 2012, at 6:02:01
In reply to Re: Help Please SLS + the Elite Veterans. » FrequentFryer, posted by SLS on February 3, 2012, at 7:49:35
> > SLS Im freaking out bad now its almost at 3 weeks on 75mg of Phenelzine and its not doing anything (usually after 1 - 2 weeks) its good.
Nah I will be ok, just would like to hold this new job, havn't had on in years cos of depression.. The Interviewer said they hired me because of my funny personality not so much my IT skills. But for the last three or four days I havn't been abel to get out og bed to feed myself and have litterally een spending 98% of my time in bed (to adhd to read books and cant get ahold of any new multimedia, don't wanna go to the video library.
> If I were in your position, I would be freaking-out, too. How can I convince you to slow down and catch your breath? Try to relax and approach your continued exploration of treatments logically. You have alternatives.
>
> How long have you been at 75 mg? You really should give Nardil a minimum of 3 weeks after dosage adjustments before evaluating its usefulness. You might want to go up to 90 mg now, simply because it is the quickest treatment change to trial.mm I could jack it to 90 and take some lith,, well no I would just try lithium.... OR.
>
> Bupropion can be added to a MAOI. I added it to Parnate without sequalae. However, you don't get any therapeutic benefits from bupropion monotherapy, so it might not make sense to do this.Bupropion augmented with it before but no luck. So I think I would try Lithium First
> Adding low dosages of lithium 300-600 is worthy of consideration. I glean benefit from 300 mg. If lithium is to help, it should demonstrate efficacy within two weeks. More often than not, it takes only 3-10 days to show results.
>
> Have you already tried adding nortriptyline to Nardil? If so, what dosage of nortriptyliine did you use? Did you check your blood-levels?
>Nortrip made my BP Trip
> I have experienced a partial response from combining Effexor and nortriptyline. I like this treatment.
>
> For some people, desvenlafaxine works better than venlafaxine. I won't even guess as to why this should be. I know someone for whom this is true. Desvenlafaxine may not be a "me too" patent extender after all.
>
> You could add Abilify and/or Lamictal as augmentors of Nardil.
>
I would still say Lithium, but Abilify could be second, it makess me tired though> The "-acetams" might help with cognition. However, I have not seen anything suggestive of them producing robust antidepressant effects.
>
You mean like anicetam and pircetam,,,, as soon as I get some$ thats wwhat I'm getting> If you are still freaking-out, just try to hang in there for now. Distraction sometimes helps. If you are in crisis, you might want to contact your doctor. Perhaps he would have you take an anxiolytic temporarily. You have demonstrated responsivity to medication in the past. It is unlikely that you are now unresponsive to all treatments. It is my guess that you would do well to remain on an effective treatment indefinitely.
>
> Don't forget about rTMS.Whats RTMS?
>
>
> - Scott
Posted by FrequentFryer on February 4, 2012, at 6:07:08
In reply to Re: Help Please SLS + the Elite Veterans. » SLS, posted by Phillipa on February 3, 2012, at 10:16:51
Scratch your itch then take long deep breaths while flexing your muscles with ur eyes clothes thinking about awsome rainbows and stuff. Or just take a handfull of valiume, (kidding)... I just try to have positive internal talk. Talk to myself like a good friend
Posted by FrequentFryer on February 4, 2012, at 6:12:54
In reply to Re: Help Please SLS + the Elite Veterans. » Phillipa, posted by FrequentFryer on February 4, 2012, at 6:07:08
Also do you guys think heavy alcohol use during the onset (and after) of an anti-D is bad?
Posted by papillon2 on February 4, 2012, at 23:21:05
In reply to Re: Help Please SLS + the Elite Veterans. » papillon2, posted by FrequentFryer on February 4, 2012, at 5:33:02
> Dont worry I am well aware of the interactions with MAOI's what's an EDS?
Was auto corrected from AEDs - anti-epileptic drugs / anti-convulsants, e.g. Epilim, Lamictal.
> However I believe Mirtazapine should only be for anorexics and Nortrip I tried with Nardil 1nc but I think it put my blod preasure way up, but now I have BP pilss to counteract tha... AAAAAAAAAAhhhhhhhhhhhhOh man, as a recovered anorexic I recommend that anyone with a history of an eating disorder stay the hell away from Remeron (or Zyprexa for that matter). Majorly triggering and anxiety-inducing...... but otherwise a pretty good anti-depressant. Shame about the Nortrip.
Posted by jono_in_adelaide on February 5, 2012, at 18:56:46
In reply to Help Please SLS + the Elite Veterans., posted by FrequentFryer on February 3, 2012, at 3:37:14
Have you tried effexor 150mg in the morning and avanza (remeron) 30mg at night?
It is reputed to be a very effective combo
Posted by phidippus on February 8, 2012, at 16:32:28
In reply to Help Please SLS + the Elite Veterans., posted by FrequentFryer on February 3, 2012, at 3:37:14
>. I don't think I have Bi-polar but should I chuck >.some Lithium into the mix with the Nardil to see >what happens before I play with other stuff >(Nortriptaline didn't help).
If you are battling depressive symptoms or fluctuating mood, this might be helpful.
>But do you think 225mg venlafaxine + a decent >amount of Bupropion might help.
If buproprion didn't help before, why would it help now? Try Focalin instead.
>Have you guys ever tried pircitam / >aniniercitam?? they any good?
Piricitim is great with coffee-sharpens the senses. Levetiracetam is a great anti-convulsnat with mood stabilizing effects and cognitive boosting abilities.
Eric
Posted by FrequentFryer on February 13, 2012, at 3:10:51
In reply to Re: Help Please SLS + the Elite Veterans. » FrequentFryer, posted by phidippus on February 8, 2012, at 16:32:28
> >. I don't think I have Bi-polar but should I chuck >.some Lithium into the mix with the Nardil to see >what happens before I play with other stuff >(Nortriptaline didn't help).
>
> If you are battling depressive symptoms or fluctuating mood, this might be helpful.
>
> >But do you think 225mg venlafaxine + a decent >amount of Bupropion might help.
>
> If buproprion didn't help before, why would it help now? Try Focalin instead.Focacin sounds like a stim,, prolly not even available in AU... I want slow release release methylanphenidate or D-amphetamine, but my psych wants me to do urine tests and go to group.... which I could do but Im gonna look 4 a different shrink
>
> >Have you guys ever tried pircitam / >aniniercitam?? they any good?
>
> Piricitim is great with coffee-sharpens the senses. Levetiracetam is a great anti-convulsnat with mood stabilizing effects and cognitive boosting abilities.
>
> Eric
This is the end of the thread.
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