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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jono_in_adelaide on December 27, 2012, at 22:11:14
Hello mate, I've been trying to think of suggestions to offer you (as I'm sure are SLS and many others)
It would probably be a big help if you could list down the drugs you have tried, and give a brief 1 sentance version of how you responded (felt better, felt worse, too many side effects etc)
I'm sure that there is a drug or combination of drugs and therapy out there that will be able to help you, just a matter of hitting on what exactly it is
cheers
Jonathan
Posted by g_g_g_unit on December 28, 2012, at 7:15:39
In reply to GGG Unit, posted by jono_in_adelaide on December 27, 2012, at 22:11:14
Thank you so much, Jono .. I really appreciate your concern. Well, here goes nothing. Please bear in mind my psychiatrist strongly believes I am a slow-metabolizer and thus far more prone to side-effects at standard doses than your average bear.
SSRIs:
Lexapro (tried up to 20mg) .. GOOD: improved physical side-effects of depression (e.g. leaden paralysis) BAD: caused apathy, emotional blunting, worsened ADD and completely lost any sense of will/drive .. I vividly remember spending like 30 minutes debating with myself in an effort to force myself to leave the house and run some errands.
Luvox (tried up to 100mg) .. GOOD: helped anxiety, best SSRI for sleep, BAD: similar sfx to Lexapro, plus restless leg syndrome
Prozac .. GOOD: activating, BAD: akathisia, couldn't sleep
Zoloft .. GOOD: helped cognition and ADD slightly at just 25mg, BAD: felt very restless, anxious, OCD quite severely worsened, poor sleep
Nortriptyline .. GOOD: improved ADD, BAD: too activating for sleep (at just 25mg a day .. prescribed for that purpose, prior to ADD dx.)
clomipramine .. GOOD: nothing, BAD: agitation, akathisia, worsened sleep
Strattera .. GOOD: had quite consistent effect on alertness and mental energy, BAD: became more agitated and anxious as doctor pushed me up to "adult" doses (prior to slow-metabolizer theory); also had weird effect on sleep where I would ritualistically wake up 3 hours into the night.
Neurontin .. GOOD: *cured* my hyper-vigilance and agoraphobia, BAD: worsened apathy, felt quite dulled mentally and socially
Dexedrine .. GOOD: can have good effect on stress-response, motivation, confidence, sometimes improves attention, BAD: effect can be erratic .. sometimes just feel sleepy, and also can grow a bit agitated and short-tempered with continual use
Nardil .. GOOD: motivating, helped anhedonia, etc., BAD: trouble sleeping, began to feel anxious on higher doses 60mg+, though only remained on 90mg for 3 weeks, so don't know if the activation would have passed .. gave up because I couldn't sleep
Parnate .. GOOD: improved ADD, motivation, drive .. also had an effect I've never experienced on any other AD where I would feel this wonderful sense of warmth and joy that felt completely organic (i.e. no euphoria or 'high'), though it would only ever occur at night. I have no idea why. During the day, I was driven but a bit emotionally empty.. BAD: increased anxiety and OCD, worsened sleep quality
Seroquel: GOOD: none, really .. BAD: causes akathisia, even at like 12.5mg
Zyprexa: GOOD: thing it was a bit more motivating .. BAD: increased anxiety and OCD in combination with 20mg of Lexapro
Mirtazapine: GOOD: helped sleep at 15mg .. BAD: worst drug ever for my OCD at 30mg, became dysphoric and suicidal
Benzos: mixed bad .. really can't track any consistent effect .. sometimes they calm me, sometimes I get a paradoxical reaction. Last night I took 2mg of clonazepam to induced sleep and felt like Michael Jackson; tonight I took 2mg again, and feel wired and vigilant 2 hours later, so it's really hard to make a definite judgement on how they effect my anxiety.
Posted by SLS on December 28, 2012, at 8:45:18
In reply to Re: GGG Unit » jono_in_adelaide, posted by g_g_g_unit on December 28, 2012, at 7:15:39
> Mirtazapine: GOOD: helped sleep at 15mg .. BAD: worst drug ever for my OCD at 30mg, became dysphoric and suicidal
You might be a prazosin responder.
NE alpha-2 receptor antagonists affect me very badly and might indicate hyperactivity in certain noradrenergic circuits. If this is true, then, prazosin should reduce depression. In the amygdala, prazosin would reduce anxiety. In the nucleus accumbens, prazosin would elevate mood, enhance reward, and reduce anhedonia. This is pretty theoretical stuff. You won't know if prazosin will help until you try it. It is a very clean drug with the exception of reduced libido. Startup side effects include dizziness and somnolence, but these things disappear within a week as long as you titrate gradually.
I am not convinced that you are a "slow metabolizer" of every drug you try. I think it is more likely that you just have a brain that is sensitive to change.
- Scott
Posted by Prefect on December 28, 2012, at 11:41:16
In reply to Re: GGG Unit » g_g_g_unit, posted by SLS on December 28, 2012, at 8:45:18
GGG,
Were you anxious/agoraphobic first and developed depression afterwards, or was it the opposite? Or all at the same time?
Posted by SLS on December 28, 2012, at 14:10:51
In reply to Re: GGG Unit, posted by Prefect on December 28, 2012, at 11:41:16
> GGG,
>
> Were you anxious/agoraphobic first and developed depression afterwards, or was it the opposite? Or all at the same time?Great question.
- Scott
Posted by g_g_g_unit on December 29, 2012, at 0:22:20
In reply to Re: GGG Unit, posted by Prefect on December 28, 2012, at 11:41:16
> GGG,
>
> Were you anxious/agoraphobic first and developed depression afterwards, or was it the opposite? Or all at the same time?In a nutshell:
Inattentive ADD (though went unrecognized, due to being a strong performer academically)
--> Stress of college + ADD = OCD outbreak
--> OCD leads to first episode of Major Depression after 3 years
--> Depression continues for 5 years and grows into increased social avoidance, poor stress tolerance and constant anxiety/hypervigilance/agoraphobia
Posted by Phillipa on December 29, 2012, at 9:31:10
In reply to Re: GGG Unit » Prefect, posted by g_g_g_unit on December 29, 2012, at 0:22:20
So basically stress equaled depression for you? Were you always ADD as a child? Phillipa
Posted by Prefect on December 29, 2012, at 12:04:40
In reply to Re: GGG Unit » Prefect, posted by g_g_g_unit on December 29, 2012, at 0:22:20
GGG Unit,
1. Were you formally diagnosed with ADD? Because anxiety/depression can cause concentration problems. My anxiety has at times cause periods of derealization where I had trouble even following simple conversations.
2. I understand you're currently on no meds, correct? Are you stepping outside at all? And if you are, do you take a benzo for the AG or just do it unmedicated?
Posted by ed_uk2010 on December 29, 2012, at 13:23:28
In reply to Re: GGG Unit » g_g_g_unit, posted by SLS on December 28, 2012, at 8:45:18
>You might be a prazosin responder.
Good idea :) Also, I wonder whether prazosin would work for GGG as an augmenting agent to nortriptyline, Strattera or other NE reuptake inhibitors and reduce the insomnia and overstimulation that occured. Might also augment Parnate but would certainly have to beware of orthostatic hypotension.
GGG, did you have any hypotension or dizziness on Parnate of any of the other meds you've tried? Is your blood pressure normal at present?
>NE alpha-2 receptor antagonists affect me very badly and might indicate hyperactivity in certain noradrenergic circuits.
I feel restless but also extremely drowsy on mirtazapine at 'therapeutic' AD doses. Low doses are just sedating. Not pleasant!
Posted by SLS on December 29, 2012, at 21:26:48
In reply to Re: GGG Unit » SLS, posted by ed_uk2010 on December 29, 2012, at 13:23:28
> > You might be a prazosin responder.
> Good idea :) Also, I wonder whether prazosin would work for GGG as an augmenting agent to nortriptyline, Strattera or other NE reuptake inhibitorsYou've been doing your homework.
According to one lab model of depression, prazosin enhanced the antidepressant effect of desipramine, but not Prozac. Using another model, Prozac was effective, too. I would be more inclined to try a NRI like desipramine as you suggest.
> and reduce the insomnia and overstimulation that occured.
Yes.
> Might also augment Parnate but would certainly have to beware of orthostatic hypotension.
For me, the dizziness produced by the addition of prazosin to Parnate was fleeting. However, I started treatment at 1 mg/day given at night to reduce the chances of dizziness from occurring during the day. I did this for two days, and then increased by 1 mg every two days in divided doses until I reached 6 mg/day. At that point, I was able to accelerate titration up until 20 mg/day. I have since found that 15 mg/day is ideal for me. 20 mg/day produced somnolence and sedation. Prazosin should be dosed 3 times a day. During the first week, I experienced some somnolence and dizziness. Both side effects disappeared completely. The only side effect that remains is reduced sexual libido.
If you don't mind my asking, what medications are you currently taking, and how are you feeling?
- Scott
Posted by g_g_g_unit on December 29, 2012, at 21:53:52
In reply to Re: GGG Unit, posted by Prefect on December 29, 2012, at 12:04:40
> GGG Unit,
>
> 1. Were you formally diagnosed with ADD? Because anxiety/depression can cause concentration problems. My anxiety has at times cause periods of derealization where I had trouble even following simple conversations.Yeah, I've been formally diagnosed with ADD.
>
> 2. I understand you're currently on no meds, correct? Are you stepping outside at all? And if you are, do you take a benzo for the AG or just do it unmedicated?No, currently not on any meds. I'll step outside if something *really* needs to be done -- bills paid etc. -- and will occasionally visit friends (maybe once a week). If I do something like see friends, I'll take a benzo.
Posted by Prefect on December 29, 2012, at 23:11:02
In reply to Re: GGG Unit » Prefect, posted by g_g_g_unit on December 29, 2012, at 21:53:52
GGG, have you ever received cognitive behavioral therapy?
Posted by jono_in_adelaide on January 1, 2013, at 23:22:36
In reply to Re: GGG Unit, posted by Prefect on December 29, 2012, at 23:11:02
Hey GGG - I have been away for a few days, i have a few ideas after reading your list, and I'll post them tonight
J
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