![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by brynb on December 26, 2012, at 12:26:00
I was doing ok (well, sort of ok; more like up and down), and I'm back in a hole. Depressed as ever. All I can do is sleep. I was on lithium, Lexapro, Subutex and Librium, but now I'm down to just Lexapro, Tramadol and Librium. I feel like I've tried everything (except MAOIs--with the exception of macoblamide and emsam), and it's probably in my head, but I feel like my pdoc is losing patience with me.
I'm really sensitive to a lot of meds, especially those that hit norepinephrine. Most mood stabilizers haven't been great, either. I also don't like APs; they all make me feel strange in one way or another. I'm at the end of my rope. I'm so tired of depression ruining my life. I'm 38 and the only work I do is freelance from home (which I can barely do because I just want to sleep); I used to teach, but I can't/don't take jobs anymore as I'm too unpredictable and unreliable. My family is sick of me being this way and it's really gotten to my mother--she's beyond upset and concerned and it inevitably leads to fights.
Any suggestions? Anyone know of good mood disorder pdocs in the NYC area? I can't deal with this any longer.
Thanks in advance.
-b
Posted by Hugh on December 26, 2012, at 12:41:28
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
Neurofeedback might be worth a try. Here are two clinicians who have practices in Manhattan, and have good reputations:
Mark Smith, LCSW
140 West 79th St. #2B
Phone: 212-591-2830
Licensed clinical social worker. Neurofeedback and psychotherapy for children and adults.Merlyn Hurd, Ph.D.
88 University Place, 8th Floor
New York, New York 10003
Phone: 212-807-8690
Cell: 917-405-8168
Posted by Phil on December 26, 2012, at 13:03:40
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
I did a search for the top psychopharmacologists in NY. This guy and a few others came up.
Posted by Phillipa on December 26, 2012, at 13:15:24
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
Bry the top notch docs are in your area what happened? Phillipa
Posted by brynb on December 26, 2012, at 13:21:20
In reply to Re: What to do?? » brynb, posted by Phillipa on December 26, 2012, at 13:15:24
Thanks to all above with your responses, they are super helpful =). I'm going to follow-up.
-b
Posted by brynb on December 26, 2012, at 13:25:30
In reply to Re: What to do??, posted by brynb on December 26, 2012, at 13:21:20
Posted by brynb on December 26, 2012, at 13:29:39
In reply to Re: What to do?? » brynb, posted by Phillipa on December 26, 2012, at 13:15:24
hi phillipa-
one would think, right? i'm working with a guy now who has a good reputation, but he's more an addiction specialist rather than a mood disorder specialist. and i pay out of pocket, no less! i don't have insurance, though none of the good docs here take it anyway!
it doesn't make sense--one would think that in a city saturated with pdocs, you'd find good ones everywhere, but no...thanks, phillipa.
b
Posted by Lou Pilder on December 26, 2012, at 13:47:19
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
> I was doing ok (well, sort of ok; more like up and down), and I'm back in a hole. Depressed as ever. All I can do is sleep. I was on lithium, Lexapro, Subutex and Librium, but now I'm down to just Lexapro, Tramadol and Librium. I feel like I've tried everything (except MAOIs--with the exception of macoblamide and emsam), and it's probably in my head, but I feel like my pdoc is losing patience with me.
>
> I'm really sensitive to a lot of meds, especially those that hit norepinephrine. Most mood stabilizers haven't been great, either. I also don't like APs; they all make me feel strange in one way or another. I'm at the end of my rope. I'm so tired of depression ruining my life. I'm 38 and the only work I do is freelance from home (which I can barely do because I just want to sleep); I used to teach, but I can't/don't take jobs anymore as I'm too unpredictable and unreliable. My family is sick of me being this way and it's really gotten to my mother--she's beyond upset and concerned and it inevitably leads to fights.
>
> Any suggestions? Anyone know of good mood disorder pdocs in the NYC area? I can't deal with this any longer.
>
> Thanks in advance.
>
> -bb,
You wrote,[...I'm back in a hole.Depressed as ever...I'm at the end of my rope...I can't deal with this any longer...]
Posted by Phil on December 26, 2012, at 14:50:34
In reply to Re: What to do?? » Phillipa, posted by brynb on December 26, 2012, at 13:29:39
Saturated is right! I couldn't believe how many when I started searching.
This guy was talked about quite a bit in the past but you might have to sell your soul to pay for an appointment. May be worth a phone call but the first guy looks pretty good to me.
Posted by brynb on December 26, 2012, at 15:17:14
In reply to Re: What to do?? » brynb, posted by Phil on December 26, 2012, at 14:50:34
> Saturated is right! I couldn't believe how many when I started searching.
>
> This guy was talked about quite a bit in the past but you might have to sell your soul to pay for an appointment. May be worth a phone call but the first guy looks pretty good to me.
>
> http://www.psycom.net/ikg.htmlThanks, Phil! I feel like I've heard of him or at least know of him. And he's in my part of town, which makes it even better. I really appreciate your help!
-b
Posted by brynb on December 26, 2012, at 15:39:45
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
I'd love some input on MAOIs. I've tried emsam (way too stimulating for me) and Moclobemide (did nothing). It seems a lot of people on this forum do well with Nardil and Parnate. Perhaps I need to reassess and try one of these.
Thoughts?
Posted by SLS on December 26, 2012, at 15:46:43
In reply to Re: Maybe an MAOI?, posted by brynb on December 26, 2012, at 15:39:45
> I'd love some input on MAOIs. I've tried emsam (way too stimulating for me) and Moclobemide (did nothing). It seems a lot of people on this forum do well with Nardil and Parnate. Perhaps I need to reassess and try one of these.
>
> Thoughts?
Moclobemide made me feel worse than anything I have ever taken. Emsam had no positive effect on me. It made me somewhat irritable. Nardil and Parnate have worked magic for me at one time or another.The following are the dosage ranges that most people respond to:
Parnate 40-80 mg/day
Nardil 60-90 mg/day
- Scott
Posted by brynb on December 26, 2012, at 16:01:37
In reply to Re: Maybe an MAOI? » brynb, posted by SLS on December 26, 2012, at 15:46:43
> Moclobemide made me feel worse than anything I have ever taken. Emsam had no positive effect on me. It made me somewhat irritable. Nardil and Parnate have worked magic for me at one time or another.
>
> The following are the dosage ranges that most people respond to:
>
> Parnate 40-80 mg/day
> Nardil 60-90 mg/day
>
>
> - ScottThanks, Scott. I appreciate your knowledge and experience.
Which (in your opinion) is better for depression that is a hybrid of melancholic and atypical with anxiety and dysphoria? It's not clear whether I'm MDD or bipolar, if it matters.
Thanks,
b
Posted by jono_in_adelaide on December 26, 2012, at 17:43:21
In reply to Re: Maybe an MAOI? » SLS, posted by brynb on December 26, 2012, at 16:01:37
Given that you have anxiety, I'd probably try Nardil first, and then Parnate second.
Either of these can be combined with nortriptyline to encance their effect if needed.
As you possibly have bipolar, I'd definatly add a mood stabaliser to the mix less these potent antidepressants switch you to mania
Adding a low dose atypicl can help the mix as well, by their actions at the various seretonin receptors
Posted by Phillipa on December 26, 2012, at 20:12:41
In reply to Re: Maybe an MAOI?, posted by brynb on December 26, 2012, at 15:39:45
Bryn in my opinion if emsam was too stimulating I'd pass on the Maoi's at least for now. Phillipa
Posted by jono_in_adelaide on December 26, 2012, at 23:01:59
In reply to Re: Maybe an MAOI?, posted by jono_in_adelaide on December 26, 2012, at 17:43:21
Oh, DO NOT under any circumstances take tramadol with an MAOI or for 2 weeks after stopping an MAOI
After re reasing your story, I'd definatly try Nardil witl maybe lamactil as a mood stabaliser.
You say that you're med sensetive, and I accept that, but you may beed to accept that in order to relive a condition that is ruining your life, you miht need to suck it up on some annoying side effects
Posted by brynb on December 27, 2012, at 13:50:35
In reply to Re: Maybe an MAOI?, posted by jono_in_adelaide on December 26, 2012, at 23:01:59
Thanks, Jono. I'll ask my pdoc about Nardil (even though he hasn't gotten back to me yet). I'm aware of the dangerous interaction with Tramadol, thanks for the head's up. I'm just nervous about all of the interactions that occur w/ Nardil (being an MAOI). Also, I know I'd have to do a washout, and that alone is frightening. It's tough enough already.
I have a lot to think about. Thanks again.
Posted by brynb on December 27, 2012, at 22:54:11
In reply to What to do??, posted by brynb on December 26, 2012, at 12:26:00
Anyone do well on either of these?
Posted by SLS on December 27, 2012, at 23:12:18
In reply to Pristiq or Viibryd anyone??, posted by brynb on December 27, 2012, at 22:54:11
> Anyone do well on either of these?
A friend of mine is in remission as a result of combining Pristiq with Wellbutrin.
Others have described doing better on Pristiq than they had on Effexor.
No one here seems to take Viibryd. I experienced a transient improvement on it. Someone else reported it as being effective for depression and OCD. He has not posted in several months. Perhaps this is a sign that he is continuing to do well. I hope so.
- Scott
Posted by brynb on December 27, 2012, at 23:43:07
In reply to Re: Pristiq or Viibryd anyone?? » brynb, posted by SLS on December 27, 2012, at 23:12:18
> > Anyone do well on either of these?
>
> A friend of mine is in remission as a result of combining Pristiq with Wellbutrin.
>
A friend of mine is on Pristiq; she takes it every other night, and not for depression.> Others have described doing better on Pristiq than they had on Effexor.
>
If Effexor wasn't good for me, is it safe to say Pristq won't be either?> No one here seems to take Viibryd. I experienced a transient improvement on it. Someone else reported it as being effective for depression and OCD. He has not posted in several months. Perhaps this is a sign that he is continuing to do well. I hope so.
>
I remember--Eric/Phiddipus (sp?). Haven't seen him here in awhile, but I remember he liked it. I don't know anything about Viibryd.
>
Thanks, Scott.
Posted by SLS on December 28, 2012, at 5:17:20
In reply to Re: Pristiq or Viibryd anyone?? » SLS, posted by brynb on December 27, 2012, at 23:43:07
> If Effexor wasn't good for me, is it safe to say Pristq won't be either?
In what ways was Effexor not good for you?
What was your highest dosage of Effexor?
There are a few people reporting their responding better to Pristiq than they did to Effexor. However, if you didn't feel even the slightest bit of improvement with Effexor, I wouldn't put Pristiq at the top of the list.
> > No one here seems to take Viibryd. I experienced a transient improvement on it. Someone else reported it as being effective for depression and OCD. He has not posted in several months. Perhaps this is a sign that he is continuing to do well. I hope so.
> I remember--Eric/Phiddipus (sp?).Yes. That is who I was referring to.
> Haven't seen him here in awhile, but I remember he liked it. I don't know anything about Viibryd.
Phiddipus was convinced that Viibryd was an effective treatment for his OCD. I don't know what to make of the drug. Like I mentioned, it did help me for a little while for treating my bipolar depression. I guess Viibryd can be considered to be a clean SSRI with anxiolytic properties. However, I question how frequently people respond to it. I just don't see others here taking it. I haven't spoken to my doctor about his experiences with it. Viibryd (vilazodone) is in someways similar to gepirone, which was rejected by the FDA for depression. Still, Viibryd might be worth a try if you have few remaining options. If you try it and it doesn't work, be sure to taper it gradually so as to prevent a withdrawal rebound depression.
- Scott
Posted by brynb on December 28, 2012, at 12:12:21
In reply to Re: Pristiq or Viibryd anyone?? » brynb, posted by SLS on December 28, 2012, at 5:17:20
> In what ways was Effexor not good for you?It was a long time ago, but I believe it made my anxiety worse and made me very nauseas.
> What was your highest dosage of Effexor?I think it the lowest dose. (Does 3 mg sound right?)
> There are a few people reporting their responding better to Pristiq than they did to Effexor. However, if you didn't feel even the slightest bit of improvement with Effexor, I wouldn't put Pristiq at the top of the list.
>
That makes sense.> > > No one here seems to take Viibryd. I experienced a transient improvement on it. Someone else reported it as being effective for depression and OCD. He has not posted in several months. Perhaps this is a sign that he is continuing to do well. I hope so.
>
> > I remember--Eric/Phiddipus (sp?).
>
> Yes. That is who I was referring to.
>
> > Haven't seen him here in awhile, but I remember he liked it. I don't know anything about Viibryd.
>
> Phiddipus was convinced that Viibryd was an effective treatment for his OCD. I don't know what to make of the drug. Like I mentioned, it did help me for a little while for treating my bipolar depression. I guess Viibryd can be considered to be a clean SSRI with anxiolytic properties. However, I question how frequently people respond to it. I just don't see others here taking it. I haven't spoken to my doctor about his experiences with it. Viibryd (vilazodone) is in someways similar to gepirone, which was rejected by the FDA for depression. Still, Viibryd might be worth a try if you have few remaining options. If you try it and it doesn't work, be sure to taper it gradually so as to prevent a withdrawal rebound depression.
>
I wonder why there aren't many reports on Viibryd. I think I respond best to mild, "clean" meds (ie Lexapro) and certainly those that very effectively nail depression and anxiety. I have a bottle of 10 mg Nortriptyline here, and I'm thinking of adding it to my Lexapro at night (my pdoc originally wanted this for me, but I didn't feel well from the Nortriptyline, so that plan was aborted). As he hasn't returned my most recent call, I'm taking matters into my own hands. I'm off Lithium (with his approval) and only on Lexapro and Librium.I'm calling him again but also placing some calls in to other pdocs as I might need to make a change. It's just such a pain and an arduous task, going over my history, and all the meds, and the same story again and again and again. I just can't accept this way of functioning anymore. I'm not "living." I'm barely getting by. It kills me to see how sad and upset my parents are due to my suffering.
I want a Dx. I don't know if I'm MDD w/OCD and GAD or Bipolar or what. I don't know that it matters but perhaps it could help point me in the right direction. I want some semblance of a "normal" life. Meaning, I want to get up and function and not wonder whether I'll be able to get out of bed in the morning or not. I'm a 38-year old woman and I always thought I'd find the right partner, have a child. I try to think positively and believe in the power of positive thought and creating our own realities, but that only takes me so far. I also need help from the right med(s). It's been going on too long. I'm unemployed, have no more unemployment pay left, and wouldn't consider for a minute taking a regular job. I'm unreliable. The last 10 years I've had a problem with absenteeism. You can't call in "crazy" to work. I'm rambling, I'm sorry, I just still feel young enough to achieve some of my goals and desires, and at the same time, I feel old and defeated and as if I missed out on so much.
Anyway, thanks Scott. You always give helpful feedback.
-b
Posted by SLS on December 28, 2012, at 14:10:08
In reply to Re: Pristiq or Viibryd anyone?? » SLS, posted by brynb on December 28, 2012, at 12:12:21
> > In what ways was Effexor not good for you?
> It was a long time ago, but I believe it made my anxiety worse and made me very nauseas.
Hmm. Did you abort the trial in the first week? I became profoundly nauseous after my very first dose. I don't remember anxiety, but that is a possible startup side effect of many SRI drugs that can disappear within the first week.
Do you recall experiencing anxiety with Lexapro? It would have appeared briefly between days 14 and 21 of treatment.
> > What was your highest dosage of Effexor?
> I think it the lowest dose. (Does 3 mg sound right?)
Possibly 37.5 mg/day, which would have been a starting dose using the IR (Not the XR). The lowest dose of XR is 75 mg. I don't like to give up on Effexor until 300 mg/day is reached.
> > There are a few people reporting their responding better to Pristiq than they did to Effexor. However, if you didn't feel even the slightest bit of improvement with Effexor, I wouldn't put Pristiq at the top of the list.
> That makes sense.
Perhaps. However, you really cannot make a determination on the efficacy of Effexor because you didn't take it for long enough or at a therapeutic dosage. If you have the option of taking Pristiq, I would consider it. People report that it can be smoother than Effexor with respect to side effects. You could then add several other drugs to it, including nortriptyline, Wellbutrin, Abilify, Lamictal, Remeron, lithium, etc. I maintained a partial response to Effexor + nortriptyline a few years ago. Pristiq + nortriptyline might work for you, but you would have to use nortriptyline at either a low dosage of 75 mg/day or a high dosage of 150 mg/day. It depends upon your metabolism, and this can be determined using blood tests. I don't know about Wellbutrin. It makes anxiety worse and can aggravate OCD for some people.
- Do you ruminate?
- Do you have melancholic thoughts throughout the day, everyday?
- Is morning your worst time of day?
- Do you have early morning awakenings / insomnia?
- Are you either agitated or profoundly slowed-down?
- Do you have reduced appetite?> I wonder why there aren't many reports on Viibryd. I think I respond best to mild, "clean" meds (ie Lexapro) and certainly those that very effectively nail depression and anxiety. I have a bottle of 10 mg Nortriptyline here, and I'm thinking of adding it to my Lexapro at night (my pdoc originally wanted this for me, but I didn't feel well from the Nortriptyline, so that plan was aborted). As he hasn't returned my most recent call, I'm taking matters into my own hands. I'm off Lithium (with his approval) and only on Lexapro and Librium.
Why did you take lithium? Why did you discontinue lithium? How much were you taking?
I can empathize and commiserate with your thoughts and feelings regarding how your life has unfolded. 38 is still young. I can honestly say that from the perspective of a 52-year young person. It may be that your biology will be less than cooperative in achieving a pregnancy without some medical intervention. You can always adopt children. I had always wanted to have 2 biological and 1 adopted children. Apparently, it was not to be. I may yet meet someone who already has children. At this point, I really don't know what will be right for me. I still cannot help but to smile whenever I watch children operate. They are a true joy.
Take things one step at a time. Gather more information. Bring in literature for your doctor to evaluate. Find out the limits of what your doctor is willing to do for you. How willing he is to utilize MAO inhibitors makes for a good litmus test. Consult with more doctors if necessary. And try, try, try to have patience with drug trials. I have a great deal of trouble with this myself.
I understand how tiring it is to constantly be reciting your medical history to a new doctor. I type up my medical history and send a copy in advance to any doctor whom I am to consult with. Of course, I bring in a another copy just in case the first one gets lost or remains unread.
It is actual very probable that you will find a treatment that works for you. It sounds as if there are many things that you have yet to try. Polypharmacy works. The permutations of drug combinations is virtually limitless. I doubt that you have come close to exhausting them.
It is okay to feel depressed about being so chronically and severely ill. This will pass. It is understandable that you should feel demoralized, helpless, and hopeless. However, the facts indicate that you are far from being defeated. Hope exists in the uncertainty to be found in those treatments you have yet to try and those that have yet to be discovered. Know that some of those undiscovered treatments will include the use of old drugs in new ways. I respond to prazosin (an old anthypertensive) and minocycline (an old antibiotic). These two drugs operate in the brain in ways that are unrelated to their original indications.
Uncertainty. It is a fact that you cannot be certain that you are doomed. There are far too many paths that you have yet to explore.
I don't have the energy to proofread this.
:-)
You'll get there.
- Scott
Posted by brynb on December 28, 2012, at 15:02:06
In reply to Re: Pristiq or Viibryd anyone?? » brynb, posted by SLS on December 28, 2012, at 14:10:08
> Hmm. Did you abort the trial in the first week? I became profoundly nauseous after my very first dose. I don't remember anxiety, but that is a possible startup side effect of many SRI drugs that can disappear within the first week.I did abort the trial relatively quickly. I have a low threshold for discomfort. I'm also only 5'4 and about 110 lbs, so I feel like meds really affect me (for better or worse).
>Do you recall experiencing anxiety with Lexapro? It would have appeared briefly between days 14 and 21 of treatment.
I don't think I had anxiety with Lexapro (or, prior to it, Celexa).
> - Do you ruminate?
Yes, often if not always.
> - Do you have melancholic thoughts throughout the day, everyday?
Yes, pretty much all of the time.
> - Is morning your worst time of day?
Sometimes it is. It used to be the worst time for me; I would awake around 5-6 am with a sense of impending doom and in a panic. It's less like that now; I seem to fluctuate throughout the day. I'm extremely sensitive to the change of light to dark and vice versa, as well as daylight savings time.
> - Do you have early morning awakenings / insomnia?
I used to have horrible early morning awakenings. I've always had insomnia. My insomnia now takes on various forms (I'll sleep for two hours then be up the rest of the night, or I can't fall asleep, and the sometimes I just don't go to sleep at all).
> - Are you either agitated or profoundly slowed-down?
I am agitated often. Very often. At times, I am very lethargic--I feel like I move as slow as molasses.
> - Do you have reduced appetite?
In the past (really several years ago), I didn't eat at all due to anxiety. This is when my depression was more melancholic. I don't pay much attention to food in general--I eat to survive, and I don't eat much.
I feel like my depression has morphed into a cross between melancholic and atypical. (If I truly understand each one.)
>
> Why did you take lithium? Why did you discontinue lithium? How much were you taking?My pdoc put me on lithium to augment the AD effect of Lexapro and address the frequency and severity of my depressive episodes (about 3-5 per year varying in length and severity). In between them I'm still just so-so. The highest dose I took (of lithium) was 450, but we landed at 300. I stopped because I realized I gained about 15 pounds on it within 6 months without any dietary changes and I didn't feel I was benefiting much from it. I also became ill about a month ago--I developed a serious case of acute full-body edema and cellulitis. I'm still getting over it.
>
> I can empathize and commiserate with your thoughts and feelings regarding how your life has unfolded. 38 is still young. I can honestly say that from the perspective of a 52-year young person. It may be that your biology will be less than cooperative in achieving a pregnancy without some medical intervention. You can always adopt children. I had always wanted to have 2 biological and 1 adopted children. Apparently, it was not to be. I may yet meet someone who already has children. At this point, I really don't know what will be right for me. I still cannot help but to smile whenever I watch children operate. They are a true joy.Thank you. I agree. Like I said, I believe getting well is a combo of things (be it therapy, meds, etc.) but especially positive thinking and finding joy in life. I intend to try my hardest to do this. As a woman, naturally, biologically I worry about how much time I have left. I suppose in a way I've put my wishes and desires into the universe, and what's meant to be will be.
>
> Take things one step at a time. Gather more information. Bring in literature for your doctor to evaluate. Find out the limits of what your doctor is willing to do for you. How willing he is to utilize MAO inhibitors makes for a good litmus test. Consult with more doctors if necessary. And try, try, try to have patience with drug trials. I have a great deal of trouble with this myself.
>
> I understand how tiring it is to constantly be reciting your medical history to a new doctor. I type up my medical history and send a copy in advance to any doctor whom I am to consult with. Of course, I bring in a another copy just in case the first one gets lost or remains unread.
>
That's a great idea--thanks!!> It is actual very probable that you will find a treatment that works for you. It sounds as if there are many things that you have yet to try. Polypharmacy works. The permutations of drug combinations is virtually limitless. I doubt that you have come close to exhausting them.
Very true.
>
> It is okay to feel depressed about being so chronically and severely ill. This will pass. It is understandable that you should feel demoralized, helpless, and hopeless. However, the facts indicate that you are far from being defeated. Hope exists in the uncertainty to be found in those treatments you have yet to try and those that have yet to be discovered. Know that some of those undiscovered treatments will include the use of old drugs in new ways. I respond to prazosin (an old anthypertensive) and minocycline (an old antibiotic). These two drugs operate in the brain in ways that are unrelated to their original indications.
>
> Uncertainty. It is a fact that you cannot be certain that you are doomed. There are far too many paths that you have yet to explore.Well said =)!
> I don't have the energy to proofread this.
>
> :-)
>
> You'll get there.
>
>
> - ScottThanks again,
b
Posted by Phillipa on December 28, 2012, at 18:08:45
In reply to Re: Pristiq or Viibryd anyone?? » brynb, posted by SLS on December 27, 2012, at 23:12:18
Yes he is I talk to him on facebook if referring to Eric Phiddipus? I think he added something though? Phillipa
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