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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 42. Go back in thread:
Posted by SLS on November 22, 2012, at 7:09:34
In reply to Re: In Aruba and feeling fine... Addendum. » SLS, posted by Twinleaf on November 21, 2012, at 8:03:20
> Thanks for updating us. It's so good to hear that those two drugs are working so very well! Do you have any side effects from the current level of prazosin?
Diminished sex-drive is the only side effect that I have experienced. however, it has recovered a bit as my depression has begun to remit. I don't get dizzy, even at 20 mg/day and with Parnate on board. I don't know what my BP is, though.
> Would you consider reducing or eliminating any of your other medications at some point?
My impatience betrayed me. I won't bore you with the details, but my mood has remained somewhat labile, despite restarting minocycline. What I like to call "mood drift" is likely to be a frequent phenomenon for me as I continue treatment. I am going to try to discontinue minocycline again. I don't like the prescribing protocol that makes it necessary to see my doctor once a month for a new script without refills.
I might then try to withdraw Lamictal, but I doubt I will remain well if I do. My best guess at this point is that I will need six drugs to achieve and maintain remission. That kind of sucks, but I am so grateful that remission is in sight.
- Scott
Posted by SLS on November 22, 2012, at 7:18:44
In reply to Re: In Aruba and feeling fine... Addendum., posted by Phillipa on November 21, 2012, at 9:01:42
> Scott so glad to hear you are on vacation. But surprised you can handle the stress of airports and travel.
I am responding to treatment. I am feeling and functioning significantly better. Otherwise, it would be an overwhelming experience for me. I have travelled by air during times of severe depression. It was hell.
- Scott
Posted by Phillipa on November 22, 2012, at 8:32:15
In reply to Re: In Aruba and feeling fine... Addendum. » Phillipa, posted by SLS on November 22, 2012, at 7:18:44
Scott from watched on TV I sure give you credit it looks horrible. Sure has changed since I used to fly. I'm betting you have that Carribean Tan. Use your sunscreen which I know you know. Are you doing any snorkeling? Phillipa
Posted by Phillipa on November 22, 2012, at 22:58:27
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 22, 2012, at 7:09:34
Scott I missed this post. If you can continue to get the Rx for minocycline despite a return visit and it's working why would you not want to return each month? This would also let your doc assess his opinion of your progress? Phillipa
Posted by SLS on November 23, 2012, at 12:32:10
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 22, 2012, at 7:09:34
> My impatience betrayed me. I won't bore you with the details, but my mood has remained somewhat labile, despite restarting minocycline. What I like to call "mood drift" is likely to be a frequent phenomenon for me as I continue treatment. I am going to try to discontinue minocycline again. I don't like the prescribing protocol that makes it necessary to see my doctor once a month for a new script without refills.
I am doing pretty darned well after three days without minocycline. I am not going to run back to it if I feel my mood drift. If I experience an acute relapse into severe depression, I would consider taking a 200 mg loading dose of minocycline in the hopes that it would help me get home okay. Otherwise, I am committed to going without it. I am still enjoying Aruba, and look forward to enjoying myself for the rest of my life, albeit with the otherwise normal situational mood reactions that come while navigating the realities of life.
- Scott
Posted by SLS on November 23, 2012, at 15:37:03
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 23, 2012, at 12:32:10
It appears that I will be staying in Aruba for another week. Feeling better! Woohoo!
I just need to check that I packed enough medication. I'm pretty sure I did.
- Scott
Posted by Phillipa on November 23, 2012, at 20:28:31
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 23, 2012, at 15:37:03
Scott what's the secret to two weeks in Aruba? Share? Phillipa
Posted by SLS on November 24, 2012, at 6:31:14
In reply to Re: In Aruba and feeling fine... Addendum. » SLS, posted by Phillipa on November 23, 2012, at 20:28:31
> Scott what's the secret to two weeks in Aruba? Share? Phillipa
Drugs. Positive attitude. Patience.
- Scott
Posted by SLS on November 24, 2012, at 6:40:39
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 23, 2012, at 12:32:10
I am on my fourth day without minocycline, and have not experienced any acute depressive mood swings. There is some mood drift, but I have come to expect this as part of the pathway to remission. I will continue with my present treatment regime, as it appears that I have ascertained the optimum dosages of a set of drugs that work for me. At this time, I doubt that any other set of currently available drugs would produce a robust antidepressant response. I am very lucky that I had a doctor who pushed prazosin down my throat.
- Scott
Posted by Willful on November 24, 2012, at 10:58:08
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 24, 2012, at 6:40:39
It's great to hear that your response is still so clear and palpable. I hope it's something you come to take for granted and don't think about, except in the way we all remember that without our meds, we would be in a really different place.
I too am very grateful to my pdoc for having the fortitude to try various things with me, and for being very flexible and well-informed
Posted by Phillipa on November 24, 2012, at 20:36:21
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 24, 2012, at 6:40:39
No more antibiotics? I have to wonder if a latent infection was gotten rid of by the minocycline helping you to get better. Phillipa
Posted by SLS on November 25, 2012, at 6:13:47
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 24, 2012, at 6:40:39
Just a quickie.
I am happy with the way I am feeling without the minocycline.
Just to recap, I began taking minocycline a few months ago in an effort to accelerate the rate of improvement that I gleaned from adding prazosin 12 mg/day. It worked. However, I then discovered that I felt significantly better when I increased the dosage of prazosin to 20 mg/day. It was a logical move for me to discontinue the minocycline to see if I still needed it. I was not hesitant to restart it if I were to deteriorate. Unfortunately, my desire to feel well while on vacation prompted me to restart the minocycline when I felt even the slightest bit worse. So, I discontinued minocycline and restarted it twice because my impatience and need to remain improved. However, my logic got the best of me, so I discontinued minocycline a third time an committed to not restarting it unless I deteriorated such that I would not be able to function well enough to get home via air travel. Despite some mood drift, I have remained more than well enough to enjoy the rest of my vacation. In this state, I will have no trouble making it home.
Yay!
Feeling better and more confident that I am to achieve remission within a year. I know that sounds like a long time, but I was a very sick puppy, and there is an enormous amount of ground to cover.
My best regards to everyone.
- Scott
Posted by Teresa167 on November 26, 2012, at 21:13:00
In reply to Re: In Aruba and feeling fine... Addendum., posted by SLS on November 25, 2012, at 6:13:47
>Hi Scott,
Just a question:
why did you discountinued Monocycline if it was helping you?Does Prazosin has the antidepressant effect on you?
Thanks,
Teresa
Posted by SLS on November 27, 2012, at 7:03:31
In reply to Re: In Aruba and feeling fine... Addendum., posted by Teresa167 on November 26, 2012, at 21:13:00
Hi Teresa.
> >Hi Scott,
>
> Just a question:
> why did you discountinued Monocycline if it was helping you?The main reason that I discontinued minocycline is that I don't want to take a drug that I don't really need. There would be no reason to risk developing side effects from long-term use. Increasing the dosage of prazosin has helped greatly, and might be sufficient. Also, I have a problem getting refills. My doctor wants me to come in every month for a new prescription. If I do not feel MUCH better in a few weeks, I will start minocycline again to see if it helps.
Prazosin feels exactly like an antidepressant to me. The improvement it is producing seems to be lasting for a long time.
Are you depressed? Do you have anxiety? What drugs are you taking?
My diagnosis is bipolar disorder, depressive subtype.
Currently, I am taking:
Parnate
nortriptyline
Lamictal
lithium
Abilify
Prazosin
- Scott
Posted by SLS on December 2, 2012, at 7:17:17
In reply to Re: In Aruba and feeling fine... Addendum. » Teresa167, posted by SLS on November 27, 2012, at 7:03:31
My time in Aruba draws to a close. I have enjoyed my stay here. The weather has been great, and each day concludes with a beautiful sunset. I would say that I have had my fill, though. Time to come home. Thankfully, I am feeling well enough to travel. Today will be a long one, but I doubt that I will feel overwhelmed at any point.
Better living through polypharmacy...
I thank everyone on Psycho-Babble for being themselves.
- Scott
Posted by ed_uk2010 on December 2, 2012, at 13:04:00
In reply to Time to come home., posted by SLS on December 2, 2012, at 7:17:17
Hi Scott,
Very pleased to hear how well you're doing on the higher dose of prazosin. Will you stay at 20mg or try a higher dose?
ed
Posted by ChicagoKat on December 2, 2012, at 13:55:55
In reply to Time to come home., posted by SLS on December 2, 2012, at 7:17:17
I'm glad you had such a nice time in Aruba Scott, but that you feel ready to come home now.
And more than anything I am so glad you are getting better.
I am doing my best to join you in that state!
Loved what you said 'better living through polypharmacy'
Have a safe trip,
Kat
Posted by SLS on December 3, 2012, at 8:36:04
In reply to Re: Time to come home. » SLS, posted by ed_uk2010 on December 2, 2012, at 13:04:00
> Hi Scott,
Hi Ed !!!
It is so great to see you again!
> Very pleased to hear how well you're doing on the higher dose of prazosin.
Thanks. I remain greatly improved after having increased the dosage of prazosin from 12 mg/day to 20 mg/day. I doubt that I will need to go any higher. I could possibly get away with with a lower dosage, but because there are no side effects other than reduced libido, I thought it might expedite things to go right to the maximum dosage recommended for hypertension rather than experiment with 15 - 18 mg/day. Admittedly, it is not terribly scientific to titrated so quickly by "feel", but I seem to be doing well with it. I wanted to give myself the best chance of using prazosin to achieve remission. This stuff really works for me. It feels like a very clean antidepressant. My response to prazosin should be viewed in the context of my childhood history of psychosocial stress, possibly leading to developmental PTSD, along with the totality of my current medication regime.
Currently:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 20 mg/day
- Scott
Posted by SLS on December 3, 2012, at 8:52:13
In reply to Re: Time to come home. » SLS, posted by ChicagoKat on December 2, 2012, at 13:55:55
> I'm glad you had such a nice time in Aruba Scott, but that you feel ready to come home now.
>
> And more than anything I am so glad you are getting better.
>
> I am doing my best to join you in that state!I do believe that you will get there. Your brain has demonstrated responsivity to medication, even if only transiently. The neuronal machinery and circuitry are still functional. It is the hypothetical dysregulation of these components that needs remediation. "Thermostats" need to be reset. You might find success in combining medication with a neurostimulatory therapy like rTMS (repetitive transcranial magnetic stimulation) or perhaps even MST (magnetic seizure therapy).
It might be best to consider your illness as lying along the bipolar spectrum. Could you list your history of mood-stabilizer administration, including combinations and dosages along with your reactions to them?
- Scott
Posted by ed_uk2010 on December 3, 2012, at 12:04:58
In reply to Re: Time to come home. » ed_uk2010, posted by SLS on December 3, 2012, at 8:36:04
Hi Scott,
>My response to prazosin should be viewed in the context of my childhood history of psychosocial stress.....
I was thinking of your negative reaction to mirtazapine and other alpha-2 autoreceptor antagonists. Do you think this could predict a positive response to alpha-1 antagonists such as prazosin?
Posted by SLS on December 3, 2012, at 18:25:10
In reply to Re: Time to come home. » SLS, posted by ed_uk2010 on December 3, 2012, at 12:04:58
Hi Ed.
> > My response to prazosin should be viewed in the context of my childhood history of psychosocial stress.....
> I was thinking of your negative reaction to mirtazapine and other alpha-2 autoreceptor antagonists. Do you think this could predict a positive response to alpha-1 antagonists such as prazosin?That is an absolutely brilliant question. I never considered it. You might have isolated a very important association that could be used clinically to identify people who might be prazosin responders.
Nice.
- Scott
Posted by ed_uk2010 on December 4, 2012, at 8:30:01
In reply to Re: Time to come home. » ed_uk2010, posted by SLS on December 3, 2012, at 18:25:10
>That is an absolutely brilliant question. I never considered it. You might have isolated a very important association that could be used clinically to identify people who might be prazosin responders.
I could be completely wrong, it just seemed logical :)
Posted by SLS on December 5, 2012, at 21:02:08
In reply to Time to come home., posted by SLS on December 2, 2012, at 7:17:17
I have been home for three days, and I continue to feel significantly better. Apparently, the increase in the dosage of prazosin allowed me to discontinue the minocylcine while maintaining an antidepressant response. I do believe that minocycline can produce a robust therapeutic response based upon my rapid improvement upon its introduction. However, I cannot attest to its persistence of effect.
From what I have learned recently, I am thinking that combining three different substances that modulate glutamatergic neurotransmission might work synergistically to produce an antidepressant response:
1. Lamictal
2. Minocycline
3. N-acetylcysteine (NAC)Berk M, et al. recently reported that NAC is more effective than placebo when treating both unipolar and bipolar depression. Post RM commented that it was his belief that the glutamatergic properties of NAC were more important than its antioxidant properties for its exerting an antidepressant effect. It can take as long as three months for NAC to produce results.
- Scott
Posted by Phillipa on December 6, 2012, at 20:26:20
In reply to Home., posted by SLS on December 5, 2012, at 21:02:08
Scott seriously do you feel the minocycline could have killed some bacteria that was making you sick. A long ago tick bite or something similar? That would explain the robust response. Phillipa
Posted by SLS on December 7, 2012, at 4:47:08
In reply to Re: Home. » SLS, posted by Phillipa on December 6, 2012, at 20:26:20
> Scott seriously do you feel the minocycline could have killed some bacteria that was making you sick.
No. I don't think so.
You might want to review my post regarding the properties of minocycline that could account for its observed antidepressant effect. Apparently, being an antibiotic is not necessary for its efficacy in treating depression.
http://www.dr-bob.org/babble/20120803/msgs/1023257.html
I am gravitating towards the notion that minocyclne squelches glutamatergic hyperactivity, and that this is an important mechanism by which this drug exerts its antidepressant effect. That it is also neuroprotective and anti-inflammatory can only help, but I should think that these effects would take longer to produce improvements in depression. I'm not sure, though. I have seen two people report feeling much better in less than a week of beginning minocycline.
Are you thinking about taking minocycline? It seems like a logical choice for you. It would help keep Lyme in check and exert an antidepressant effect at the same time. I experienced no persistent side effects with minocycline. I think I had some dry mouth early on.
- Scott
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