![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 54. Go back in thread:
Posted by zazenducke on April 26, 2012, at 8:54:35
In reply to Re: i cant even smile. » zazenducke, posted by SLS on April 26, 2012, at 8:45:58
> > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
>
>
> You really ought to read the literature that you cite.
>
>
> - ScottI did read what I cited. I didn't read what I cited listed as reference :)
Posted by SLS on April 26, 2012, at 9:15:20
In reply to Re: i cant even smile., posted by zazenducke on April 26, 2012, at 8:54:35
> > > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
> > You really ought to read the literature that you cite.
I read the literature that you provided the following link to as a citation.
http://www.medicinenet.com/desipramine/page2.htm
> I did read what I cited. I didn't read what I cited listed as reference :)
Apparently, not closely enough.
"SIDE EFFECTS: The most commonly encountered side effects associated with desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss..."
Nothing personal. Just trying to be accurate.
Do you think that I am a bully?
- Scott
Posted by SLS on April 26, 2012, at 9:16:31
In reply to Re: i cant even smile., posted by zazenducke on April 26, 2012, at 8:54:35
Have a nice day.
:-)
- Scott
Posted by zazenducke on April 26, 2012, at 9:33:21
In reply to Re: i cant even smile. » zazenducke, posted by SLS on April 26, 2012, at 9:15:20
> > > > It lists a reference as FDA prescribing information. Do you not trust this source? Why?
>
> > > You really ought to read the literature that you cite.
>
> I read the literature that you provided the following link to as a citation.
>
> http://www.medicinenet.com/desipramine/page2.htm
>
> > I did read what I cited. I didn't read what I cited listed as reference :)
>
> Apparently, not closely enough.
>
> "SIDE EFFECTS: The most commonly encountered side effects associated with desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss..."
>
> Nothing personal. Just trying to be accurate.
>
> Do you think that I am a bully?
>
>
> - ScottScott I don't understand what point you are trying to make. Do YOU think you are a bully? I have no opinion. You know yourself much better than I do. I am just pointing out that
desipramine can cause weight gain which is what the quote you produced says.
Posted by ron1953 on April 26, 2012, at 11:41:48
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 9:33:21
It's sad enough having professionals who play doctor and prescribe medications (often with dubious results) in a trial-and-error fashion, but sadder still that there are folks on the internet who are so delusional and/or arrogant as to think they have expertise in the same foggy area. If someone on this site doesn't trust their doctor, perhaps they should question the entire paradigm instead of taking advice from a stranger in the cloud.
Posted by Willful on April 26, 2012, at 12:04:56
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 25, 2012, at 17:34:17
I also agree 100% that some activating drugs-- parnate, amphetamines, ritalin, emsam, rilutek etc-- can have a calming effect.
It may seem contradictory, but they seem to increase ability to concentrate, andto reduce agitation.
Maybe not for everyone, and maybe not at every phase of the drugs, but in general, especially if you;re acclimated to them, and don't get a high or a low phase.
Posted by Willful on April 26, 2012, at 12:15:25
In reply to Re: i cant even smile., posted by ron1953 on April 26, 2012, at 11:41:48
why should we question the paradigm of trying to treat illness with the best available treatments?
Do you prefer that we ourselves remain completely in the dark? do you think we're incapable of reading and drawing inferences. Doctors do their best. And I don't feel that least bit foggy about the knowledge that I"ve acquired in this area. I don't know as much as a doctor-- especially a good one-- but so? I shouldn't have an opinion if I"ve read the literature?
I don't really get your point. We question the paradigm. Then what? It's not the paradigm that matters anyway, it's whether the treatments are helping people. And how to improve their helpfulness. And in case you haven't noticed, researchers are trying.
shall we sit here helplessly insisting nirvana descend? Predicting doom for anyone who dares try a less-then-guaranteed treatment? feel sorry for ourselves because it isn't different? curse our parents physiology and our own? what?
Posted by b2chica on April 26, 2012, at 12:21:22
In reply to Re:sdf, posted by papillon2 on April 25, 2012, at 22:56:36
thank you pappillon2.
i cant believe your post made me cry.
i feel like i'm acting like a baby cuz i'm not doing what i should. but ps. i cried at walgreens last night picking up my adderall rx...not even sure why.
ive decided to up zyprexa tonight.i dont even want to talk to pdoc so i txt'd him to tell him im upping dose after 5 weeks of crap.
i came in to work today to see 300 emails all saying FO. apparently someone stole my email address and using it as a reply for a spam. i'm tired of getting told to f#ck off, and what a terrible person i am. i know they arent really talking to me. but i'm feeling it today. just not what i needed.
so fyi to everyone. if you get a bank scam email. dont bother replying.its doubtful its their email for return.:`(
Posted by b2chica on April 26, 2012, at 12:24:25
In reply to Re: i cant even smile. » SLS, posted by zazenducke on April 26, 2012, at 9:33:21
Posted by sleepygirl2 on April 26, 2012, at 12:32:46
In reply to please dont fight. i'm sorry i started this thread (nm), posted by b2chica on April 26, 2012, at 12:24:25
It's not your fault b2chica, that others are in conflict. No reason to feel sorry, just had to say...
Take care,
sleepy
Posted by ron1953 on April 26, 2012, at 12:55:09
In reply to Re: i cant even smile., posted by Willful on April 26, 2012, at 12:15:25
I'm sorry if my post upset you, and do feel free to ignore my opinions - it's not personal.
If the "best treatment out there" doesn't work, some may choose to stop beating a dead horse. If it works, great; but if it doesn't, doesn't there come a time to stop and reassess the situation?
Some of us weren't born with the "happy gene", and we endure a lifelong struggle trying to be like the ones who were, perhaps never accepting the fact that it'll never happen.
If drug treatment makes the difference between being functional and non-functional, then it would seem "successful" in my opinion, but if it's about being "happy", and has been a multi-year pursuit, then maybe it's time to consider both acceptance of the "condition" and to seek other forms of "therapy", whether it be meditation, exercise, religion, peer support, hobbies, diet, etc., etc., etc..
Maybe there is no there there.
Posted by Alexei on April 26, 2012, at 13:50:32
In reply to Re: i cant even smile. » Alexei, posted by SLS on April 25, 2012, at 17:50:23
> The same is true of combining Parnate and desipramine. Traditionally, one either begins taking both drugs at the same time or establishes the desipramine first. Personlly, I have added desipramine to ongoing Parnate therapy without adverse effect. There is some indication that for TRD cases, the combination of Parnate and desipramine is more effective than either one alone. Because Parnate alone is capable of precipitating spontaneous hypertensive reactions, it is prudent to monitor blood pressure for the first few days when desipramine is added.
>
> http://apt.rcpsych.org/content/4/6/320.full.pdf
>
> "Combining TCAs and MAOIs
> The combination of TCAs and MAOIs has been in
> use since the 1960s when the efficacy of this
> regime was first strongly advocated. Although the
> combination of MAOIs and TCAs is reported to be
> hazardous, the risks of significant interaction can
> be minimised if reasonable precautions are
> taken. These include avoiding imipramine and
> APT(1998),vol.4,p.324 Coiveti
> clomipramine, and starting the drugs together at low
> dose or adding the MAOI cautiously to established
> TCA treatment (see Chalmers &Cowen, 1990).
> In patients not selected for treatment resistance
> the combination of MAOIs and TCAs does not
> appear to confer additional therapeutic benefit over
> either drug used alone. However, Sethna (1974)
> carried out an open study of MAOI-TCA treatment
> in 12 patients with depression who had failed to
> respond to either TCAs or MAOIs given separately
> (or electroconvulsive therapy (ECT) in 10 cases). At
> follow-up periods of 7-24 months, nine subjects
> were reported to be without significant depressive
> symptomatology. Most of these subjects had chronic
> non-melancholic depression with prominent
> anxiety symptoms.
> In addition to these series, case reports continue
> to appear where it seems well documented that a
> patient has failed to respond to either a TCA or an
> MAOI given alone, but achieves a good clinical
> response when both drugs are used together (Tyrer
> & Murphy, 1990). Therefore, although controlled
> evidence is lacking, it seems likely that individual
> patients with refractory depression are helped by
> MAOI-TCA combinations. Generally, the adverse
> effects of the combination are no worse than with
> either drug alone, although weight gain and
> postural hypotension may be more troublesome.
> Conversely, if an MAOI is given with a TCA such as
> amitriptyline or trimipramine, MAOI-induced
> insomnia may be prevented.
> There is less information about the combination
> of other antidepressants with MAOIs. However,
> trazodone in doses of 50-150 mg is fairly commonly
> used to treat MAOI-induced insomnia and is
> generally well-tolerated (Nierenberg &Keck, 1989)."
>
>
> - ScottThank you for this. The only concern would be postural hypotension.... since both drugs can cause it. Would it be possible to remain on vyvanse?
What would make desipramine the preferred TCA? I know it is one of the most potent NRI's. Could low dose seroquel be used for insomnia?
You can probably notice I'm getting weary of trying to find an ssri/snri that works, lolz. Haven't tried pristiq, though.
Thank you...
Posted by Alexei on April 26, 2012, at 14:02:47
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 26, 2012, at 13:50:32
P.S.... I want to apologize for my last post. I did not realize the topic had changed...
I did not read entire thread...
Posted by SLS on April 26, 2012, at 14:37:54
In reply to please dont fight. i'm sorry i started this thread (nm), posted by b2chica on April 26, 2012, at 12:24:25
Dear B2C,
Any altercations that have occurred along this thread have nothing to do with you or your plight. That is the shame of it. I'm sorry. Perhaps I should have asked to start a separate thread. I don't think I would want to, though. I don't have very much motivation to argue with people just for the sake of argument.
Don't worry. You will smile again. In the meantime, I will do the smiling for you. :-)
Keep posting. Please?
- Scott
Posted by Zyprexa on April 26, 2012, at 18:14:18
In reply to i cant even smile., posted by b2chica on April 25, 2012, at 14:50:32
I suggest going up on perphenazine. Back on it and up the dose. 4-8mg /2-3 times a day. I think it may help with weight. Becuase it makes you tired and you sleep off the weight. It does also help with anxiety. I'm pretty sure of that now.
Why did you go off the perphenazine?
Posted by SLS on April 27, 2012, at 7:05:44
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 26, 2012, at 13:50:32
> Thank you for this. The only concern would be postural hypotension.... since both drugs can cause it.
It helps to hydrate with a fluid that contains electrolytes like Gatorade. For me, the hypotension was worst at the beginning of treatment and mitigated over time. It was well worth the wait.
> Would it be possible to remain on vyvanse?
I don't know about Vyvanse, but I have tried Dexedrine along with Parnate and desipramine. There were no adverse effects.
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
"Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression"
http://www.ncbi.nlm.nih.gov/pubmed/3997787
I wish I could find the full text.
http://www.dr-bob.org/tips/split/TCAs-+-MAOIs.html
> What would make desipramine the preferred TCA?I was making reference to using desipramine when weight-gain is a concern. For me, nortriptyline produces a better antidepressant response than desipramine. However, the first time I entered a period of extended remission, it was the result of treatment using a Parnate + desipramine combination.
> I know it is one of the most potent NRI's. Could low dose seroquel be used for insomnia?
I can't think of any reason why not.
http://www.theannals.com/content/40/3/567.full
Interestingly, high dosages of Seroquel result in a certain amount of NE reuptake inhibition via an active metabolite.
- Scott
Posted by Alexei on April 27, 2012, at 8:13:07
In reply to Re: i cant even smile. » Alexei, posted by SLS on April 27, 2012, at 7:05:44
> Interestingly, high dosages of Seroquel result in a certain amount of NE reuptake inhibition via an active metabolite.
>
> - Scott
How high a dose are you thinking? 200-300mg?
Thank you for all the links. I'm finding seroquel is a drug that covers a lot of ground.... Insomnia, anxiety, controlling OCD and mania.
And it works well as an antidepressant.... as good as abilify, IMHO.
Posted by bleauberry on April 27, 2012, at 17:47:06
In reply to i cant even smile., posted by b2chica on April 25, 2012, at 14:50:32
> i make vailed attempts at passersby but my mouth cant even make a smile without getting shaky like i haven't used those muscles in a year.
Yeah, dang, I've been through stages where it was that bad too. Horrible. Part of mine was a zyprexa related cycling thing. I felt best in evening a couple hours after dose, a bizarre waking anxiety that would go away in a couple hours, and a dreary day until the next dose. Weird. I'm convinced it is actually adrenal issues treatable with herbs and diet, and that somehow zyprexa exaggerates that particular chemistry. Because my daily patterns on zyprexa were exactly what I saw on my 4 sample 24 hour cortisol test. In other words while zyprexa is really good at treating anxiety in general, it is not good for treating that kind of anxiety and in fact maybe makes it worse.
>
> since starting back on zyprexa ive had about equal time good and bad, with feeling worst about 11-5 or 7 at night. best in the morning.
>> i started menses today and i think it has dropped me Terribly low.
> cant concentrate at work and i'm under deadline that i feel is piling up by the second.
> my memory s#cks.
> feeling gray and tingly in my mind.Cortisol is only one of several major hormones and I know how it felt, feels, so sure I am on board with the idea that hormones can whack mood all over the map. I think that's where the adaptogen herbs can do a good job. Rhodiola rosea, eleuthero, ashwaghanda, probably the three best in my opinion. In my experience with them, rhodiola has the most prominent and rapid antidepressant and antianxiety action. All of them really take months up to a year to do their stuff but they also have immediate effects and in that regard I think rhodiola is my first pick.
>
> i'm sure its due to menses, however i also stopped taking my perphenazine. Even though it was so little should i have continued to take it? was it somehow helping with depression too? i was placed on it for anxiety thats why low dose (2mg am and 4mg pm).If I'm not mistaken, perphenazine at very low doses is sort of similar to amisulpride at low doses...dopamine stimulation being more prominent than dopamine blunting, though both are happening. And so, like amisulpride, it has potential in depression and anxiety. Regardless, yeah, the recent stoppage of it would probably cause some moderate to severe discomfort for a few days to a couple weeks maybe as the body adjusts to not having that molecule.
>
> i just want to curl up in bed and stare at the wall. i might call in sick tomorrow... i dont know that i'm any good here.
>
> any suggestions.I know it sucks, believe me I know, but no matter how in the dumps you are tomorrow...and maybe you won't be...go to work. One minute at a time. Really hard and the clock seems to go too slow so it helps me to get as immersed into something as I can and just focus on that and block out everything else. Anyway, I see depression as a tool of the demons and I'm not going to let them win a battle without a fight.
> PS i am NOT upping zyprexa to 10. i've already gained 15lbs but now able to control appetite better and i can get up to exercise. if i go to 10 my appetite increases AND i wont beable to wake up in the morning.
> so please dont suggest that....please.
>Over the 8 years I was on zyprexa I refused to go any higher. Most of the time 5mg was good. A couple times I tried higher doses at 7.5 and 10 but those doses didn't agree with me. People do fine or really good with 10mg, but I'm not one of them. I knew the longterm risks and consequences of antipsychotics and I was very aware of it and I also knew that complications were correlated with the size of the dose and the length of time. I couldn't really control the length of time since I din't have a crystal ball to predict future, but I figured it would be a while, years maybe, so the part I could control was the dose which stayed at 5mg. But that's just my story shared for comparison that's all.
It seems like depression has its grasp stronger than other symptoms, is that right? If so then the only course of action is to focus immediately on ways to enhance/support mood specifically, starting with and hopefully being fine with a few easy health food store items. Maybe medication is perceived as an immediate choice then my opinion would be to go for the norepinephrine+serotonin balanced approaches. That's because I think they work faster than other meds when they work, they work more often, and the response is more robust and long lasting. Such as combos of zoloft or prozac with nortriptyline or desipramine; savella by itself or combined with any other common antidepressant; clomipramine. Maybe the simple addition of prozac. I know first hand because it worked well for years for me, there is a special synergy between prozac and zyprexa. It's different than either med alone and the end result is more than the parts combined. Anyway, good potential with that combination and well researched.
Hang in there. I'm not having a bad day today but when I do have bad days you described them very well so just wanted you to know someone else can relate.
Posted by SLS on April 27, 2012, at 23:09:33
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 27, 2012, at 8:13:07
> > Interestingly, high dosages of Seroquel result in a certain amount of NE reuptake inhibition via an active metabolite.
> How high a dose are you thinking? 200-300mg?More like 400 mg. However, Seroquel begins to show antidepressant properties at dosages as low as 150 mg. It is difficult to ascribe its antidepressant effect solely to NE reuptake inhibition.
http://thelastpsychiatrist.com/2010/02/how_seroquel_xr_works_part_1.html
- Scott
Posted by Alexei on April 28, 2012, at 6:40:58
In reply to Re: i cant even smile. » Alexei, posted by SLS on April 27, 2012, at 23:09:33
> More like 400 mg. However, Seroquel begins to show antidepressant properties at dosages as low as 150 mg. It is difficult to ascribe its antidepressant effect solely to NE reuptake inhibition.
>
> http://thelastpsychiatrist.com/2010/02/how_seroquel_xr_works_part_1.html
>
>
> - ScottThank you. The Last Psychiatrist is a great site. Do you have any experience with seroquel? I would think it makes no sense to take abilify and seroquel at the same time... sort of redundant.... plus more of the AAP side effects.
(From bleauberry) .... "Such as combos of zoloft or prozac with nortriptyline or desipramine; savella by itself or combined with any other common antidepressant; clomipramine."
I've come to think these combos are more effective than the newer, more marketed snri's such as effexor and cymbalta.
Posted by papillon2 on April 28, 2012, at 7:36:27
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 28, 2012, at 6:40:58
b2, how are you?
Papillon
Posted by bleauberry on April 28, 2012, at 8:37:40
In reply to Re: i cant even smile. » SLS, posted by Alexei on April 28, 2012, at 6:40:58
>
> (From bleauberry) .... "Such as combos of zoloft or prozac with nortriptyline or desipramine; savella by itself or combined with any other common antidepressant; clomipramine."
>
> I've come to think these combos are more effective than the newer, more marketed snri's such as effexor and cymbalta.
>
>Yeah, me too. That is partially based on just what my eyes have casually anecdotally observed over the years, and on experiences of others such as Dr Gillman for one example.
One reason the existing SNRIs don't measure up, imo, is because they really aren't SNRIs. It's more of a marketing ploy than an accurate name. Cymbalta ratio of serotonin to norepinephrine is 9:1....not much NE there. I think prozac actually increases NE in the brain more than the snris do and it isn't even a snri. Effexor is 30:1. Savella is the closest to a true SNRI at a ratio of 2:3.
With any med however, the ratio is fixed. That's where combos come in handy.
Posted by europerep on April 28, 2012, at 11:13:14
In reply to Re: i cant even smile. » Alexei, posted by bleauberry on April 28, 2012, at 8:37:40
> With any med however, the ratio is fixed.
That's not true actually. At low doses, venlafaxine has less NE reuptake inhibition than fluoxetine, but venlafaxine becomes a SNRI at doses of 300mg and upwards.
Posted by SLS on April 28, 2012, at 12:08:33
In reply to Re: i cant even smile. » bleauberry, posted by europerep on April 28, 2012, at 11:13:14
> > With any med however, the ratio is fixed.
>
> That's not true actually. At low doses, venlafaxine has less NE reuptake inhibition than fluoxetine, but venlafaxine becomes a SNRI at doses of 300mg and upwards.You are probably right. This must be what happens when one continues to raise the dosage beyond the point where the SERT binding sites have become saturated with the drug.
Who really knows all the ways in which venlafaxine differs from drugs like sertraline and nortriptyline. The bottom line is to observe what works in real life. Effexor works. My impression is that Savella is not as effective as Effexor in terms of the percentage of people achieving remission. To my knowledge, there is only one study comparing the efficacies of Effexor and Savella. The two drugs were reported to be equally effective at a dosage of 200 mg. Knowing the dosage is important because Effexor becomes fully effective at dosages of 300 mg and higher, while there is no evidence that milnacipran is any more effective at dosages above 200 mg. The manufacturer of Savella lists 200 mg as the maximum dosage while that of Effexor lists the maximum of this drug at 375 mg. It was never a fair fight. It can be inferred from this study that Effexor is more effective than Savella as the rate of response increases substantially when dosages of Effexor are brought up to 300 mg or more, but not when dosages of Savella are increased.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854083/
- Scott
Posted by europerep on April 28, 2012, at 13:57:56
In reply to Re: i cant even smile., posted by SLS on April 28, 2012, at 12:08:33
Interesting link there!
I find it interesting not only because of the actual findings, but also because I didn't know milnacipran was available in France. You really never know what the French are up to next. On the one hand, they still prescribe the old MAOI iproniazid, on the other hand they introduce new drugs like milnacipran before they are available elsewhere.
So anyhow, thanks for the link.
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.