![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by AlexCanada on August 15, 2012, at 21:48:13
Hi. List of meds I've tried are at the bottom along with which have worked best even further.
Anyway... I sometimes feel I am really running out of options. It started over 10 years ago when I was a relatively normal yet extremely intelligent, creative, emotional (in a positive way), very active minded, day dreaming 17 year old. I was able to enjoy many things which life had to offer despite some social anxiety issues (regardless if I had acne or not). I was prescribed Accutane (mega dose of vitamin A) for moderate acne. And no, I was not one of those depressed kids just because of my appearance. I had very good self esteem. Unknown to me the dose prescribed was 3 times greater than what would be normally recommended for my body weight. I did not know the dangers which are now well documented on the internet and gradually started to feel worse, I had no clue why. Was losing interest, was becoming tired, felt mentally sluggish, and things just seemed ''dark''. Eventually I felt it had to be the Accutane. By the time I stopped (had much protest from my parents) it was too late. It built up enough in my system and I kept feeling worse and worse until it hit a baseline of what I could describe as being part of the walking dead. Each day was extremely painful and if I believed in heaven I would have easily not put up with it.
Emotionless, monotone, no interest, no pleasure, severe burning sensations in my head, rapid heartbeat with chest pains, dark desaturated vision, tremendous anxiety, hard to think, lethargic, felt like a zombie, every day was painful to be alive. If you could even consider it being alive.
Now it is over 10 years later and I am still feeling terrible but not nearly as horrendous as how it was during those those dark early days of constant pain. The burning pains have subsided quite a bit. It is more an empty life now than a painful one.
My recent symptoms have been: Severely poor long term memory and ability to retain new knowledge, Antero Grade Memory Loss, Poor Cognition, Lack of emotions, Anhedonia, Dysphoria, Mind feeling blocked/cloudy, Severe lack of enjoyment, Lack of drive/motivation/desire/sense of reward, Difficulty relating to others and feel bit like a zombie, Severe difficulty being social (also partially due to inability to relate), Anxiety (on and off), Low energy, Virtually no sex drive.My symptoms are full blown melancholic. I often even have low appetite but not lately. I currently take Parnate 20mg (dropped it just recently from 27.5mg since it was better on lower dose), Valium 2.5mg 3-4 times a day, ritalin 2.5 3-4 times a day, Rhodiola Rosea 500-750mg a day (I plan to stop taking this tomorrow), gingko biloba 360mg a day, Korean Ginseng 1500mg a day (plan to likely stop taking this, used to help), and Gapapentin (Nourotin) 100-200mg once in a while (few times a week maybe) (usually improves my mood and many symptoms but tolerance is quick and withdrawal can be harsh), and Provigil 50-100mg a day (might stop taking this, cognition boost but may be compounding dysphoria, higher doses also seem to cause a crash effect where I could feel very sad in the evening).
I likely would not be writing this message without the aid of Gabapentin today. You may wonder why I take such low doses of medications well I am very sensitive to meds and what be ''low'' to others is usually the right dose for me. 10mg Paxil worked relatively well for me for at least a few years but anything higher and I'd be constantly sedated. Higher dose parnate also causes much sedation and cognitive impairment. The parnate does not work as it used to. I really think it has lost much of it's effect. So I need to try something else soon. Overall with a bit of a brief break a few times I have been on Parnate for about 2.5-3 years.
Would pristiq be a good choice? My inability to enjoy anything is my biggest issue aside from poor cognition and often low emotional capacity. Rarely does anything bring me pleasure. Each day is another empty day. I need these Melancholic issues dealt with.
Regarding what I currently take are there any suggestions of what not to take? I understand under Medscape there are 10 interactions with the list above but I been grasping at straws here in terms of my health. I don't have much money and am getting tired of throwing my money away when 80% of the medications/suppliments I have tried have done little if anything to help and many have even made me worse. But I am willing to do what it takes to give me some sort of life back. Paxil used to along with Ativan + Ritalin a long time ago but Pax pooped out. And Ritalin/Dexedrine do not work as much as they used to. In fact it's possible the long term use may be causing additional dysphoria.
It is often very difficult for me to research all this. My memory problems are severe. The difficulty in retaining new information has been one of the biggest obstacles since I became poisoned by accutane but I suspect that specifically may have been caused by ECT since I used to be able to research quite well prior to ECT. Bilateral ECT is capable of causing long lasting memory problems as evidenced by studies as recent as 2010. But I digress.
I just need some ideas. A full list of what I have tried and further below the effects of the meds are listed.
Gabapentin can be exceptional in it's ability to alleviate so many of my symptoms and even produce some level of interest! but... rapid tolerance. So despite dopamine based medications historically working well for me this Seratonin based med has shown me hope that something else may work as well.
Please offer any advice, insight, ideas that you possibly can. For melancholic or my poor cognition, my horrible memory... anything please.
Best Medications tried: Ritalin/Dex (especially first weeks), Parnate (first few months especially), Paxil (some resemblence of normalicy and integration into society for few years). Valium/Ativan (some mood improvement + anti-anxiety), Gabapentin (Improvement of almost all symptoms including emotions and cognition, but tolerance builds quickly, black eye druggie appearance)Treatments Tried:
Benzo- Valium, Ativan, Klonopin, Xanax
SSRI- Celexa, Paxil, Zoloft,
SNRI/Other/Alternative- Wellbutrin, Effexor, Stablon, Remeron, Lithium, Adrafinil, Gabapentin, Narproxen, Vivarint, Buspar, Trivistal LA, ECT, rTMS, Reboxetine, Mirapex,
MAOI- Parnate, Nardil
Stimulant- Ritalin, Dexedrine,
Anti-Psychotics- Zyprexa, Risperidal, Abilify (as a low dose add-on), Seroquel,
Natural/Herbal- Rhodiola Rosea, Omega 3, Omega Complex, Korean Ginseng, Magnesium Glycinate, Royal Jelly, Niacin, Gingko Biloba, Bee Pollen, L-Arginine, Resveratrol, D3, Maca Root,Treatment Results:
Worse: Celexa (gradual worsening of depression and burning pain), Effexor (rapid worsening of depression and burning pain), Abilify (rapid worsening of depression when taken w Parnate), Cymbalta (gradual worsening of depression), Seroquel, ECT (Severely damaged my long term memory and overall cognition perminently), Nortriptyline, Lithium,
Better: Risperidal (some ability to enjoy things but overall would still be largely lacking), Parnate, Ritalin (first time this or Dexedrine was taken I was able to feel a bit like my old self, ability to experience pleasure, positive outlook, return of old hobbies, Was able to appreciate being alive), Dexedrine (similar to ritalin), Valium (some mood improvement, some anxiety improvement, most benzos have had similar effect), Ativan (was more social on this than other benzos while also on Paxil), Rhodiola Rosea (herbal similar to an MAOI) (A small miracle for mood, energy, cognition, general well being, would still be lacking pleasure. Has lost much effect over time), Gabapentin (tremendous cognitive improvement, imagination, more emotions, less cloudy thought process, feeling of greater intellectual capacity. Some improvement to mood, ability to be social. Although rapid tolerance onset, inconsistent, ironically sometimes cognitive impairment.), Vivarint (some mood improvement, massive improvement to sex drive),
Mixed Results: Remeron (sluggish on low doses, more active on higher doses, very mild mood improvement, impulsive spending), Zyprexa (some mood improvement, lot of lethargy, cognitive slowness, food tasted wonderful), Stablon, Provigil (increased cognition but unclear if compounds dysphoria)
Negligible or Unsure: Zoloft, Nardil, Adrafinil, Narproxen, Buspar, rTMS (could not access any tangible improvement), Reboxetine, Mirapex, Piribedil, Klonopin,
Posted by Phillipa on August 15, 2012, at 23:36:03
In reply to Severe Melancholic. My story. Please help., posted by AlexCanada on August 15, 2012, at 21:48:13
Alex I can offer no advise. But I'd like you know that I think of you a lot as clearly remember when I read your post when new on babble myself and what Accutane did to you. It's horrible. Aren't there lawsuits as surely you deserve something to help with obtaining the very best of help. Phillipa
Posted by Lou Pilder on August 16, 2012, at 6:41:58
In reply to Severe Melancholic. My story. Please help., posted by AlexCanada on August 15, 2012, at 21:48:13
> Hi. List of meds I've tried are at the bottom along with which have worked best even further.
>
> Anyway... I sometimes feel I am really running out of options. It started over 10 years ago when I was a relatively normal yet extremely intelligent, creative, emotional (in a positive way), very active minded, day dreaming 17 year old. I was able to enjoy many things which life had to offer despite some social anxiety issues (regardless if I had acne or not). I was prescribed Accutane (mega dose of vitamin A) for moderate acne. And no, I was not one of those depressed kids just because of my appearance. I had very good self esteem. Unknown to me the dose prescribed was 3 times greater than what would be normally recommended for my body weight. I did not know the dangers which are now well documented on the internet and gradually started to feel worse, I had no clue why. Was losing interest, was becoming tired, felt mentally sluggish, and things just seemed ''dark''. Eventually I felt it had to be the Accutane. By the time I stopped (had much protest from my parents) it was too late. It built up enough in my system and I kept feeling worse and worse until it hit a baseline of what I could describe as being part of the walking dead. Each day was extremely painful and if I believed in heaven I would have easily not put up with it.
>
> Emotionless, monotone, no interest, no pleasure, severe burning sensations in my head, rapid heartbeat with chest pains, dark desaturated vision, tremendous anxiety, hard to think, lethargic, felt like a zombie, every day was painful to be alive. If you could even consider it being alive.
>
> Now it is over 10 years later and I am still feeling terrible but not nearly as horrendous as how it was during those those dark early days of constant pain. The burning pains have subsided quite a bit. It is more an empty life now than a painful one.
>
> My recent symptoms have been: Severely poor long term memory and ability to retain new knowledge, Antero Grade Memory Loss, Poor Cognition, Lack of emotions, Anhedonia, Dysphoria, Mind feeling blocked/cloudy, Severe lack of enjoyment, Lack of drive/motivation/desire/sense of reward, Difficulty relating to others and feel bit like a zombie, Severe difficulty being social (also partially due to inability to relate), Anxiety (on and off), Low energy, Virtually no sex drive.
>
> My symptoms are full blown melancholic. I often even have low appetite but not lately. I currently take Parnate 20mg (dropped it just recently from 27.5mg since it was better on lower dose), Valium 2.5mg 3-4 times a day, ritalin 2.5 3-4 times a day, Rhodiola Rosea 500-750mg a day (I plan to stop taking this tomorrow), gingko biloba 360mg a day, Korean Ginseng 1500mg a day (plan to likely stop taking this, used to help), and Gapapentin (Nourotin) 100-200mg once in a while (few times a week maybe) (usually improves my mood and many symptoms but tolerance is quick and withdrawal can be harsh), and Provigil 50-100mg a day (might stop taking this, cognition boost but may be compounding dysphoria, higher doses also seem to cause a crash effect where I could feel very sad in the evening).
>
> I likely would not be writing this message without the aid of Gabapentin today. You may wonder why I take such low doses of medications well I am very sensitive to meds and what be ''low'' to others is usually the right dose for me. 10mg Paxil worked relatively well for me for at least a few years but anything higher and I'd be constantly sedated. Higher dose parnate also causes much sedation and cognitive impairment. The parnate does not work as it used to. I really think it has lost much of it's effect. So I need to try something else soon. Overall with a bit of a brief break a few times I have been on Parnate for about 2.5-3 years.
>
> Would pristiq be a good choice? My inability to enjoy anything is my biggest issue aside from poor cognition and often low emotional capacity. Rarely does anything bring me pleasure. Each day is another empty day. I need these Melancholic issues dealt with.
>
> Regarding what I currently take are there any suggestions of what not to take? I understand under Medscape there are 10 interactions with the list above but I been grasping at straws here in terms of my health. I don't have much money and am getting tired of throwing my money away when 80% of the medications/suppliments I have tried have done little if anything to help and many have even made me worse. But I am willing to do what it takes to give me some sort of life back. Paxil used to along with Ativan + Ritalin a long time ago but Pax pooped out. And Ritalin/Dexedrine do not work as much as they used to. In fact it's possible the long term use may be causing additional dysphoria.
>
> It is often very difficult for me to research all this. My memory problems are severe. The difficulty in retaining new information has been one of the biggest obstacles since I became poisoned by accutane but I suspect that specifically may have been caused by ECT since I used to be able to research quite well prior to ECT. Bilateral ECT is capable of causing long lasting memory problems as evidenced by studies as recent as 2010. But I digress.
>
> I just need some ideas. A full list of what I have tried and further below the effects of the meds are listed.
>
> Gabapentin can be exceptional in it's ability to alleviate so many of my symptoms and even produce some level of interest! but... rapid tolerance. So despite dopamine based medications historically working well for me this Seratonin based med has shown me hope that something else may work as well.
>
> Please offer any advice, insight, ideas that you possibly can. For melancholic or my poor cognition, my horrible memory... anything please.
>
>
> Best Medications tried: Ritalin/Dex (especially first weeks), Parnate (first few months especially), Paxil (some resemblence of normalicy and integration into society for few years). Valium/Ativan (some mood improvement + anti-anxiety), Gabapentin (Improvement of almost all symptoms including emotions and cognition, but tolerance builds quickly, black eye druggie appearance)
>
> Treatments Tried:
> Benzo- Valium, Ativan, Klonopin, Xanax
> SSRI- Celexa, Paxil, Zoloft,
> SNRI/Other/Alternative- Wellbutrin, Effexor, Stablon, Remeron, Lithium, Adrafinil, Gabapentin, Narproxen, Vivarint, Buspar, Trivistal LA, ECT, rTMS, Reboxetine, Mirapex,
> MAOI- Parnate, Nardil
> Stimulant- Ritalin, Dexedrine,
> Anti-Psychotics- Zyprexa, Risperidal, Abilify (as a low dose add-on), Seroquel,
> Natural/Herbal- Rhodiola Rosea, Omega 3, Omega Complex, Korean Ginseng, Magnesium Glycinate, Royal Jelly, Niacin, Gingko Biloba, Bee Pollen, L-Arginine, Resveratrol, D3, Maca Root,
>
> Treatment Results:
>
> Worse: Celexa (gradual worsening of depression and burning pain), Effexor (rapid worsening of depression and burning pain), Abilify (rapid worsening of depression when taken w Parnate), Cymbalta (gradual worsening of depression), Seroquel, ECT (Severely damaged my long term memory and overall cognition perminently), Nortriptyline, Lithium,
>
> Better: Risperidal (some ability to enjoy things but overall would still be largely lacking), Parnate, Ritalin (first time this or Dexedrine was taken I was able to feel a bit like my old self, ability to experience pleasure, positive outlook, return of old hobbies, Was able to appreciate being alive), Dexedrine (similar to ritalin), Valium (some mood improvement, some anxiety improvement, most benzos have had similar effect), Ativan (was more social on this than other benzos while also on Paxil), Rhodiola Rosea (herbal similar to an MAOI) (A small miracle for mood, energy, cognition, general well being, would still be lacking pleasure. Has lost much effect over time), Gabapentin (tremendous cognitive improvement, imagination, more emotions, less cloudy thought process, feeling of greater intellectual capacity. Some improvement to mood, ability to be social. Although rapid tolerance onset, inconsistent, ironically sometimes cognitive impairment.), Vivarint (some mood improvement, massive improvement to sex drive),
>
> Mixed Results: Remeron (sluggish on low doses, more active on higher doses, very mild mood improvement, impulsive spending), Zyprexa (some mood improvement, lot of lethargy, cognitive slowness, food tasted wonderful), Stablon, Provigil (increased cognition but unclear if compounds dysphoria)
>
> Negligible or Unsure: Zoloft, Nardil, Adrafinil, Narproxen, Buspar, rTMS (could not access any tangible improvement), Reboxetine, Mirapex, Piribedil, Klonopin,A_C,
You wrote,[...Please help..runnung out of options..Accutane..the walking dead..like a zombie..painful to be alive...10 years after..still feeling terrible..an empty life now..currently take(list of mind-altering chemicals)...each day is another empty day...medications..have even made me worse...I am willing to do what it takes to give me some sort of life back...the long term use (of mind-altering stimulants) may be causeing additional dysphoria...my memory problems are severe...caused by ECT...I justs need some ideas...please offer any advice...
Posted by SLS on August 16, 2012, at 7:38:38
In reply to Severe Melancholic. My story. Please help., posted by AlexCanada on August 15, 2012, at 21:48:13
Some people respond to imipramine or clomipramine who do not respond to nortriptyline.
Do you feel worse in the morning?
Do you experience early morning awakenings?
Do you have psychomotor retardation? How would you describe it?
Do you experience aggitation? How would you describe it?
Don't forget about lithium and T3 as augmenters of tricyclics. I would try the lithium first. People sometimes respond within a few days at a relatively low dosage.
You did a good job detailing your response pattern to different treatments.
- Scott
Posted by SLS on August 16, 2012, at 7:47:16
In reply to Lou's response- » AlexCanada, posted by Lou Pilder on August 16, 2012, at 6:41:58
How do you define the term "mind-altering"?
What are the properties of a medication that would lead you to characterize it as being mind-altering?
Are major depresive disorder (MDD) and bipolar disorder (BD) mind-altering illnesses?
- Scott
Posted by Lou Pilder on August 16, 2012, at 8:18:43
In reply to Re: Lou's response- » Lou Pilder, posted by SLS on August 16, 2012, at 7:47:16
> How do you define the term "mind-altering"?
>
> What are the properties of a medication that would lead you to characterize it as being mind-altering?
>
> Are major depresive disorder (MDD) and bipolar disorder (BD) mind-altering illnesses?
>
>
> - ScottScott,
What has been revealed to me concerning {mind-altering} in relation to chemicals that induce such a state, is a topic that I appreciate that you have innitiated a discussion concerning that.
What is in comparison is the {natural mind} compared to the {drug-induced}altered mimd.
Let us call the {natural mind by the letter P
Let us call the drug induced mind by the letter S
Now the natusral mind could be referred to as the mind that one is born with. This mind is a {flesh} mind, as being that we are born with this mind in the flesh. This mind in other languages is referred to as the {carnal} mind.
more...
Lou
Posted by SLS on August 16, 2012, at 8:33:05
In reply to Lou's reply-koncarne » SLS, posted by Lou Pilder on August 16, 2012, at 8:18:43
> > How do you define the term "mind-altering"?
> >
> > What are the properties of a medication that would lead you to characterize it as being mind-altering?
> >
> > Are major depresive disorder (MDD) and bipolar disorder (BD) mind-altering illnesses?> What has been revealed to me concerning {mind-altering} in relation to chemicals that induce such a state, is a topic that I appreciate that you have innitiated a discussion concerning that.
> What is in comparison is the {natural mind} compared to the {drug-induced}altered mimd.
How would one recognize an altered mind? What are the symtoms?
> Now the natusral mind could be referred to as the mind that one is born with.
So, then, you would describe schizophrenia, depressive disorder, and bipolar disorder as being the "natural mind"? What about autism? What about Down syndrome?
Would you leave these conditions untreated in order to preserve the "natural mind"?
> more...
I look forward to your answering these questions.
Do you have any questions that you would like to ask me?
- Scott
Posted by papillon2 on August 16, 2012, at 12:31:16
In reply to Re: Lou's reply-koncarne » Lou Pilder, posted by SLS on August 16, 2012, at 8:33:05
Hi Alex,
I just came online to answer your question (posed in another thread) about what has helped me with my melancholic depression, but it seems that with a couple of exceptions you have tried everything I have and more.
My current regime is:
Nortriptyline 100mg
Lamotrigine (Lamictal) 200mg
Melatonin 4mg to help regulate my disturbed circadian rhythm
Various supplements and Aspirin to manage Nortriptyline related cardiac issues.Of these, I see you have not tried Lamictal. I take it to augment my anti-depressant and because studies suggest it can delay episodes of bipolar depression in people with bipolar II. We're hoping it might do the same for unipolar depression.
I'm not fully in remission, so my psychiatrist has been talking about trying Ritalin, Ketamine or rTMS. Ketamine is showing great promise as a treatment for severe and treatment-resistant depression and it may be suitable for you. Here's an article about it if you are up to reading it, otherwise you could print it out to take to your doctor: http://www.psychiatrictimes.com/mdd/content/article/10168/2090154
You mentioned Pristiq. I question whether it would be of any additional benefit to you over Effexor given its similar mechanism of action and the severity of your depression. Many people, like me, find that a broad spectrum anti-depressant such as a TCA or MAOI is necessary for melancholc depression. SSRIs and SNRIs just don't seem to do enough. As Scott has posted, there are other tricyclics you could try beyond Nortriptyline. So that's another thing to consider.
For your memory and cognitive problems, there's a non-medication treatment called cognitive remediation (rehabilitation) therapy. I haven't personally tried it and I don't know anyone who has, but I've been reading good things about it. It might help you manage your symptoms if not improve them.
Layman's description:
"Cognitive Remediation Therapy (CRT) is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning."If you do a google search you'll mostly find studies involving schizophrenia patients, but it's also being used in cases of severe depression as well as traumatic brain injury, dementia and anorexia nervosa. So it has a wide range of applications. In a similar vein, I wonder if occupational therapy might also be helpful.
My psychiatrist has been exploring the potential there being a medical problem compounding my depression, making it harder to treat. So far I have been to a sleep specialist, had a sleep study done and consulted a endocrinologist. Next on the list is an immunologist to check for an auto-immune disease as these can cause fatigue and cognitive problems. These might be areas for you to explore should your doctor find it appropriate. I'd definitely get a sleep study done if nothing else. Sleep disorders are renowned for causing fatigue and cognitive problems.
I find lists helpful, so here's a summary of ideas you could raise with your doctor:
(1) Lamotrigine (Lamictal) to augment your anti-depressant
(2) Ketamine -- this I suspect would do more for you than
Lamictal
(3) A tricyclic anti-depressant other than Nortriptyline
(3) Cogntive Remediation Therapy or Occupational Therapy
(4) Seeing other specialists to rule out medical problems which could be compounding your depression, e.g. a sleep disorder.Your distress and desperation is palpable from your writing. 10 years with severe melancholic depression with very little relief must be gut-wrenchingly brutal. I admire the tenacity and fighter in you. With further treatment options still available (and new ones being developed), I wholeheartedly believe that there is reason for you to continue holding out hope for some relief. So hang in there, Alex, and be kind to yourself.
Papillon
Posted by jono_in_adelaide on August 16, 2012, at 19:56:06
In reply to Severe Melancholic. My story. Please help., posted by AlexCanada on August 15, 2012, at 21:48:13
Try Effexor plus Remeron
Effexor 150-300mg in the morning
Remeron 30-45mg at bedtime
Valium 5mg prn
Posted by Lou Pilder on August 16, 2012, at 20:37:37
In reply to Lou's reply-koncarne » SLS, posted by Lou Pilder on August 16, 2012, at 8:18:43
> > How do you define the term "mind-altering"?
> >
> > What are the properties of a medication that would lead you to characterize it as being mind-altering?
> >
> > Are major depresive disorder (MDD) and bipolar disorder (BD) mind-altering illnesses?
> >
> >
> > - Scott
>
> Scott,
> What has been revealed to me concerning {mind-altering} in relation to chemicals that induce such a state, is a topic that I appreciate that you have innitiated a discussion concerning that.
> What is in comparison is the {natural mind} compared to the {drug-induced}altered mimd.
> Let us call the {natural mind by the letter P
> Let us call the drug induced mind by the letter S
> Now the natusral mind could be referred to as the mind that one is born with. This mind is a {flesh} mind, as being that we are born with this mind in the flesh. This mind in other languages is referred to as the {carnal} mind.
> more...
> LouScott,
Now we have a natural mind and a drug-induced altered mind. Yet there is another mind.
It has been revealed to me that we are different from the animals. This difference is that we have a {spiritual-mind} whereas animals do not. This spiriatual mind is within us and we can actuate the carnal mind or the spiritual mind. But the spiritual mind is like a seed and needs water and light for it to germinate. This 'water" and this "light" I am prohibited from posting about fully here due to prohibitions posted to me by Mr. Hsiung.
Now this may make more sense when what I have been posting here is examined. I have been posting about how one can overcome adddiction and depression by {human achievement} or by {divine accomplishment}. The {human achievement} is with the carnal mind, and by divine accomplishment with the spiritual mind.
Now if you add a drug to the carnal mind, there are particular events that could follow as alterations of the mind, such as thinking about killing one's self and/or others, even mass-murder, that have been revealed to me, and addiction, life-ruining conditions and death.
Now it has been revealed to me that we were once spiritual beings and then transformed into carnal beings at birth. With this transformation, the spirit is retained as a seed. I came here to tell others how this seed can germinate and flourish into a healing power so that one can overcome addiction and depression and death. You see, it has been revealed to me that one in depression/addiction is in a wine-press. And I know the one that treads it. And when one has their spirit born from the seed within them, they receive a new heart, a new spirit, a new mind so that the one treading the wine-press makes them free. The freedom from depression and addiction is accomplished by the impregnating of the water and the light, which is truth. And it is the truth that makes one free.
Lou
more...
Posted by SLS on August 17, 2012, at 2:57:10
In reply to Re: Severe Melancholic. My story. Please help., posted by papillon2 on August 16, 2012, at 12:31:16
Hi.
> Various supplements and Aspirin to manage Nortriptyline related cardiac issues.
What are the issues?
What supplements do you use to address them?
- Thanks.
Posted by AlexCanada on August 17, 2012, at 21:29:58
In reply to Re: Severe Melancholic. My story. Please help. » AlexCanada, posted by SLS on August 16, 2012, at 7:38:38
I feel worse early in the day. Mornings can vary depending on my sleep schedule. Usually I feel worse after waking but also early afternoon. Evenings I tend to feel a bit better and middle of the night often feel even better. Also I notice I feel usually worse during the hours after parnate doses. But much of that might be the sedation.
I used to wake up quite early in the mornings. My sleep is a bit inconsistent and depends on my current meds. a few weeks ago I def kept waking up really early such as 3am. When I was on just ritalin and low dose valium I would often sleep a lot without waking for many hours.
Psychomotor retardation... absolutely. Often extremely limited ability to think, slow through process, thoughts can be cut off abruptly, can forget what I was just thinking about, often difficult to construct intelligent sentences and then I notice idiotic mistaks afterwards, feel extremely intellectually compromised, slow thinking, indecisive at times, difficult to speak intelligently and be able to properly articulate myself, often extremely poor imagination except during night time, long term memory problems, severe antero grade memory loss (difficult retaining new information), sluggish, slowed speech, and sometimes very difficult to comprehend and process information, sometimes difficult to even read. I often feel that something is ''blocked'' and I just can't think...
Do not feel there is aggitation.
I have tried lithium before, it may have been with paxil. it didn't seem to do much of anything and i believe i felt more sluggish. possibly my dose was too high. i don't remember.
The lithium... do you recommend it on it's own (with valium + ritalin) or as an add-on to an anti-dep?
What is T3?
And Imipramine/Clomipramine are they known for cognitive impairment on the same or similar severity compared to other anti-deps? But... if they can work for melancholic then my cognitive issues could be very much alleviated regardless.
Just not sure what is left but pristiq, imi/clom and possibly a TCA...
Rhodiola worked better when I was not on parnate. They likely don't mix well. I may try Rhod with a dif class med.
> Some people respond to imipramine or clomipramine who do not respond to nortriptyline.
>
> Do you feel worse in the morning?
>
> Do you experience early morning awakenings?
>
> Do you have psychomotor retardation? How would you describe it?
>
> Do you experience aggitation? How would you describe it?
>
> Don't forget about lithium and T3 as augmenters of tricyclics. I would try the lithium first. People sometimes respond within a few days at a relatively low dosage.
>
> You did a good job detailing your response pattern to different treatments.
>
>
> - Scott
Posted by AlexCanada on August 17, 2012, at 22:47:58
In reply to Re: Severe Melancholic. My story. Please help., posted by papillon2 on August 16, 2012, at 12:31:16
Hi. Thanks for the suggestions. I have actually tried Lamictal this year. There are few meds I'm sure I forgot to list. Lamictal helped improve my interest a little bit, and it wiped out anxiety really well but it made me feel more stupid than I ever have on any other medication. I could not think clearly in a reasonable manner. Thinking is difficult enough much of the time but it really compounded my thought process. I was even more slowed down and my mind would keep cutting off whenever I'd try to think of something. I could not tolerate such an effect. The ''Lamictal Stupid'' syndrome is well documented online and it's unfortunate that it has such an effect on me.
I am possibly willing to give pristiq a chance because I may not have given effexor enough time. The issue was worsening of dep and anxiety and it was during my darkest days and i probably felt like screaming if the doctors at the hospital had kept me on it. But... with my baseline a bit improved I could perhaps handle such a medication and attempt to give it a decent trial period. I mention Pristiq because articles keep mentioning that it is approved for Melancholic.
I am interested in a possible TCA though.
Ketamine I have researched and unfortunately if it only lasts for 7-10 days then it is not something i'd want to look into just yet but i am glad they are putting new medications into trails which are based upon the ketamine research.
I'm wondering... if Lamictal had some interest restoration and gave some small ability to enjoy things... why would that possibly be? And what might be similar? But I hope without the severe cognitive side effects.
Regarding TCA's... any cognitive side effects do they often go away if they deal with the core melancholic symptoms? So many meds dumb me down but I am already in a very dumbed down state right now. I'm hoping a TCA might be able to restore my cognitive impairment and other issues despite their possible side effects.
What can I expect in terms of TCA's generally? such as maybe clomipramine? I don't remember what happened with nortripline.
> Hi Alex,
>
> I just came online to answer your question (posed in another thread) about what has helped me with my melancholic depression, but it seems that with a couple of exceptions you have tried everything I have and more.
>
> My current regime is:
> Nortriptyline 100mg
> Lamotrigine (Lamictal) 200mg
> Melatonin 4mg to help regulate my disturbed circadian rhythm
> Various supplements and Aspirin to manage Nortriptyline related cardiac issues.
>
> Of these, I see you have not tried Lamictal. I take it to augment my anti-depressant and because studies suggest it can delay episodes of bipolar depression in people with bipolar II. We're hoping it might do the same for unipolar depression.
>
> I'm not fully in remission, so my psychiatrist has been talking about trying Ritalin, Ketamine or rTMS. Ketamine is showing great promise as a treatment for severe and treatment-resistant depression and it may be suitable for you. Here's an article about it if you are up to reading it, otherwise you could print it out to take to your doctor: http://www.psychiatrictimes.com/mdd/content/article/10168/2090154
>
> You mentioned Pristiq. I question whether it would be of any additional benefit to you over Effexor given its similar mechanism of action and the severity of your depression. Many people, like me, find that a broad spectrum anti-depressant such as a TCA or MAOI is necessary for melancholc depression. SSRIs and SNRIs just don't seem to do enough. As Scott has posted, there are other tricyclics you could try beyond Nortriptyline. So that's another thing to consider.
>
> For your memory and cognitive problems, there's a non-medication treatment called cognitive remediation (rehabilitation) therapy. I haven't personally tried it and I don't know anyone who has, but I've been reading good things about it. It might help you manage your symptoms if not improve them.
>
> Layman's description:
> "Cognitive Remediation Therapy (CRT) is a cognitive rehabilitation therapy developed at King's College in London designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning."
>
> If you do a google search you'll mostly find studies involving schizophrenia patients, but it's also being used in cases of severe depression as well as traumatic brain injury, dementia and anorexia nervosa. So it has a wide range of applications. In a similar vein, I wonder if occupational therapy might also be helpful.
>
> My psychiatrist has been exploring the potential there being a medical problem compounding my depression, making it harder to treat. So far I have been to a sleep specialist, had a sleep study done and consulted a endocrinologist. Next on the list is an immunologist to check for an auto-immune disease as these can cause fatigue and cognitive problems. These might be areas for you to explore should your doctor find it appropriate. I'd definitely get a sleep study done if nothing else. Sleep disorders are renowned for causing fatigue and cognitive problems.
>
> I find lists helpful, so here's a summary of ideas you could raise with your doctor:
> (1) Lamotrigine (Lamictal) to augment your anti-depressant
> (2) Ketamine -- this I suspect would do more for you than
> Lamictal
> (3) A tricyclic anti-depressant other than Nortriptyline
> (3) Cogntive Remediation Therapy or Occupational Therapy
> (4) Seeing other specialists to rule out medical problems which could be compounding your depression, e.g. a sleep disorder.
>
> Your distress and desperation is palpable from your writing. 10 years with severe melancholic depression with very little relief must be gut-wrenchingly brutal. I admire the tenacity and fighter in you. With further treatment options still available (and new ones being developed), I wholeheartedly believe that there is reason for you to continue holding out hope for some relief. So hang in there, Alex, and be kind to yourself.
>
> Papillon
Posted by Lou Pilder on August 18, 2012, at 13:35:07
In reply to Lou's reply-wtrovlyph, posted by Lou Pilder on August 16, 2012, at 20:37:37
> > > How do you define the term "mind-altering"?
> > >
> > > What are the properties of a medication that would lead you to characterize it as being mind-altering?
> > >
> > > Are major depresive disorder (MDD) and bipolar disorder (BD) mind-altering illnesses?
> > >
> > >
> > > - Scott
> >
> > Scott,
> > What has been revealed to me concerning {mind-altering} in relation to chemicals that induce such a state, is a topic that I appreciate that you have innitiated a discussion concerning that.
> > What is in comparison is the {natural mind} compared to the {drug-induced}altered mimd.
> > Let us call the {natural mind by the letter P
> > Let us call the drug induced mind by the letter S
> > Now the natusral mind could be referred to as the mind that one is born with. This mind is a {flesh} mind, as being that we are born with this mind in the flesh. This mind in other languages is referred to as the {carnal} mind.
> > more...
> > Lou
>
> Scott,
> Now we have a natural mind and a drug-induced altered mind. Yet there is another mind.
> It has been revealed to me that we are different from the animals. This difference is that we have a {spiritual-mind} whereas animals do not. This spiriatual mind is within us and we can actuate the carnal mind or the spiritual mind. But the spiritual mind is like a seed and needs water and light for it to germinate. This 'water" and this "light" I am prohibited from posting about fully here due to prohibitions posted to me by Mr. Hsiung.
> Now this may make more sense when what I have been posting here is examined. I have been posting about how one can overcome adddiction and depression by {human achievement} or by {divine accomplishment}. The {human achievement} is with the carnal mind, and by divine accomplishment with the spiritual mind.
> Now if you add a drug to the carnal mind, there are particular events that could follow as alterations of the mind, such as thinking about killing one's self and/or others, even mass-murder, that have been revealed to me, and addiction, life-ruining conditions and death.
> Now it has been revealed to me that we were once spiritual beings and then transformed into carnal beings at birth. With this transformation, the spirit is retained as a seed. I came here to tell others how this seed can germinate and flourish into a healing power so that one can overcome addiction and depression and death. You see, it has been revealed to me that one in depression/addiction is in a wine-press. And I know the one that treads it. And when one has their spirit born from the seed within them, they receive a new heart, a new spirit, a new mind so that the one treading the wine-press makes them free. The freedom from depression and addiction is accomplished by the impregnating of the water and the light, which is truth. And it is the truth that makes one free.
> Lou
> more...Scott,
Now let's look at more concerning the minds here. One is the drug-induced mind-altered carnal mind.
The question concerning mind-altering goes back thousands of years. Then, some people wanted to alter their minds with drugs to go into a hallucinatory state of mind. There were plants that could induce a hallucinatory state such as particular mushrooms and other plants. I am prohibited from posting here by the prohibitions posted to me here by Mr. Hsiung as to what the scriptures that the Jews use that show what is prescribed to those taking mind-altering drugs and the fate of those that traffic in those drugs being as to the makers of the drugs or the ones that give those drugs to others. Be advised that one could go to the admin board here and see more concerning this prohibition to me and the rationale that Mr. Hsiung uses to make that prohibition to me. One could also see how Judiasm is (redacted by respondent) by Mr. Hsiung as I think could save the lives of people taking these drugs as well as what the bible says concerning the prescription of eternal destiny. People then could make up their own minds of what Mr Hsiung, and also his deputies, think {support} means.
Now this mind-altering thousands of years ago was also to alter the thinking of the one taking the drug in other ways than to hallucinate. One way was to create rage and a murderous mind-set into a person. One drug was hashish which is a word that comes from another word and where we get the word {assassin} from. A lot of psychoptropic drugs now are agreed upon by the FDA that they can induce suicidal and possibly homocidal thinking. And another way a drug can induce a mind-altered state is to induce psychotic thinking. A lot of drugs have listed in their PI that the drug can cause psychosis and hallucinations. Now in the psychotic state, if one is in a community that leads others to think that Jews are inferior, one could have delusional thinking and think that they are one in a master-race and seek out to murder Jews, thinking that it would be good for the community as a whole, and this happened before 1933 and continues to happen after 1945. You see, sometimes a community's leaders leads its people to think that Jews are inferior to some others, or that people other than Jews are inferior to those others and then the people that are the "others" can have a (false) induced thinking of superiority toward the people that are not them which could put Jews and others that are not them, in a situation where they could become victims of anti-Semitic violence or anti-other victims of violence.
Now there are other ways that psychiatric drugs can induce a mind-altered state.
more...
Lou
Posted by papillon2 on August 19, 2012, at 4:05:23
In reply to Re: Severe Melancholic. My story. Please help. » papillon2, posted by SLS on August 17, 2012, at 2:57:10
> Hi.
>
> > Various supplements and Aspirin to manage Nortriptyline related cardiac issues.
>
> What are the issues?
>
> What supplements do you use to address them?Tachycardia, palpitations and chest pain. A full list of my supplements is here: http://www.dr-bob.org/babble/20120803/msgs/1023105.html
But it's only the 2-3g of high-potency fish oil which helps with the cardiac side effects, along with aspirin.They were suggested by a cardiologist who wasn't certain they would help, but noted that they were good for overall heart health. I wasn't totally convinced until my chest hurt like hell one day, my heart was going bonkers and I realized I had forgotten to take my aspirin and fish oil for a few days. The same thing occurred when I forgot again later. I don't forget them anymore!
I still have (slightly improved) tachycardia, but no major chest pain or palpitations so long as I take the fish oil and aspirin. Otherwise it is extremely uncomfortable. I wouldn't be able to tolerate 100mg Nortriptyline, that's for sure.
Is it worth it? Yes.
Posted by papillon2 on August 19, 2012, at 7:07:36
In reply to Lamictal and also TCA's..., posted by AlexCanada on August 17, 2012, at 22:47:58
> Hi. Thanks for the suggestions. I have actually tried Lamictal this year... The ''Lamictal Stupid'' syndrome is well documented online and it's unfortunate that it has such an effect on me.
What was your Lamictal dose? Some people who experience cognitive impairment on Lamictal find it goes away on a lower dose. 200mg is considered the max therapeutic dose in Australia. Some people report cognitive problems over this amount.
> I am possibly willing to give pristiq a chance because I may not have given effexor enough time. The issue was worsening of dep and anxiety and it was during my darkest days and i probably felt like screaming if the doctors at the hospital had kept me on it. But... with my baseline a bit improved I could perhaps handle such a medication and attempt to give it a decent trial period. I mention Pristiq because articles keep mentioning that it is approved for Melancholic.
Oh, ok. I was wondering if each med had been given an adequate trial.
I had a 7-year partial-remission with Effexor, though my melancholic symptoms weren't as bad.
> Ketamine I have researched and unfortunately if it only lasts for 7-10 days then it is not something i'd want to look into just yet but i am glad they are putting new medications into trials which are based upon the ketamine research.
I was thinking Ketamine might give you an initial boost which could be sustained by other medications. Like what they do with ECT. I am only hypothesizing here, I don't know how it works in this regard. The researchers might not know either!
> Regarding TCA's... any cognitive side effects do they often go away if they deal with the core melancholic symptoms?
My cognitive symptoms improved on Nortriptyline with each dose increase. I have lingering problems, but I think this is from residual depression rather than the medication. I guess you'll only know if you try it.
> What can I expect in terms of TCA's generally? such as maybe clomipramine? I don't remember what happened with nortripline.
I don't know enough about clomipramine to comment on it.
With TCAs you can generally expect a more robust anti-depressant effect. It's older, rougher medication, so unfortunately you can also expect worse anti-chlorinergic side effects than those that come with SSRIs or SNRIs. For me, some of the side effects abated within one month of each dose increase while others persisted. Your mileage may vary.
TCAs are also much more likely to be lethal in overdose than SSRIs/SNRIs. If suicidal ideation is a problem, you can ask your doctor to prescribe the medication such that the pharmacist will only give you a limited supply at a time.
> I have tried lithium before, it may have been with paxil. it didn't seem to do much of anything and i believe i felt more sluggish. possibly my dose was too high. i don't remember.
Finding the right dose is really important with Lithium. I was a complete zombie when my blood serum level was .8. (my psychiatrist was aiming for .4 but forgot to take my weight into account, sound familiar?!).
> The lithium... do you recommend it on it's own (with valium + ritalin) or as an add-on to an anti-dep?
For treatment-resistant depression Lithium is usually an add-on to an anti-depressant. It has a synergistic effect. I don't know how it interacts with Ritalin.
I am unable to weigh in on some of your other comments/questions, e.g. whether there is a med which will increase your level of interest in things like Lamictal did without the cognitive problems. I just don't have the knowledge or experience, but someone else might.
Take care,
Papillon
Posted by SLS on August 19, 2012, at 7:21:40
In reply to Re: Severe Melancholic. My story. Please help. » SLS, posted by papillon2 on August 19, 2012, at 4:05:23
What brand of fish oil do you use?
What is the EPA/DHA ratio?
I would love to be able to take fish oil. My triglycerides are extremely high, presumably from taking Abilify. Unfortunately, Carlson's fish oil makes my depression worse. I suspect that it is the DHA component that is the culprit.
I might try OmegaBrite fish oil. It is almost 100% EPA. I am waiting until my minocycline trial is resolved before taking anything that might affect my mood adversely.
Thanks for taking the time to answer my questions.
- Scott
Posted by papillon2 on August 19, 2012, at 8:03:59
In reply to Re: Severe Melancholic. My story. Please help. » papillon2, posted by SLS on August 19, 2012, at 7:21:40
> What brand of fish oil do you use?
Blackmores, specifically this one: http://www.blackmores.com.au/products/omega-daily
(they have a few different preparations in the range)
> What is the EPA/DHA ratio?
EPA 351.7 mg
DHA 248.3 mg> I would love to be able to take fish oil. My triglycerides are extremely high, presumably from taking Abilify. Unfortunately, Carlson's fish oil makes my depression worse. I suspect that it is the DHA component that is the culprit.
I did a lot of research and specifically chose capsules that were higher in EPA than DHA, so I must have received some information that EPA was more important for mood and/or brain function. The other detail which factored into my decision was how much EPA and DHA there was per 1g fish oil, so I could take less capsules.
> I might try OmegaBrite fish oil. It is almost 100% EPA. I am waiting until my minocycline trial is resolved before taking anything that might affect my mood adversely.
Wise move. It could also get very confusing!
> Thanks for taking the time to answer my questions.
I am pleased to assist. :-)
Papillon
Posted by jono_in_adelaide on August 19, 2012, at 20:29:07
In reply to Re: Severe Melancholic. My story. Please help. » papillon2, posted by SLS on August 19, 2012, at 7:21:40
It might be worth taking a fibrate if your triglycerides are high. They are cheap, safe and effective.
Posted by Phillipa on August 19, 2012, at 21:07:31
In reply to Re: Severe Melancholic. My story. Please help., posted by jono_in_adelaide on August 19, 2012, at 20:29:07
Sometimes from what I read meds can cause more problems than they correct. Phillipa
Posted by SLS on August 20, 2012, at 3:26:46
In reply to Re: Severe Melancholic. My story. Please help., posted by Phillipa on August 19, 2012, at 21:07:31
> Sometimes from what I read meds can cause more problems than they correct. Phillipa
SOMETIMES.
- Scott
Posted by SLS on August 20, 2012, at 3:27:34
In reply to Re: Severe Melancholic. My story. Please help., posted by jono_in_adelaide on August 19, 2012, at 20:29:07
> It might be worth taking a fibrate if your triglycerides are high. They are cheap, safe and effective.
What are examples of fibrates?
Thanks for your help.
- Scott
This is the end of the thread.
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