![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 60 to 84 of 90. Go back in thread:
Posted by Beckett on August 12, 2014, at 22:15:35
In reply to ***possible trigger***, posted by johnLA on August 12, 2014, at 16:34:41
>god I wish john lennon or bob marley were still alive
I miss John Lennon.
During my first hospitalization, the doctor said once someone 'tastes this kind of anxiety and depression', that experiences changes them. I've come to realize, for myself, that I will experience ups and downs. I try not to be frightened or dismayed by the downward turns.
Thanks for posting your progress.
Posted by johnLA on August 14, 2014, at 20:33:54
In reply to going for deep tms..., posted by johnLA on August 3, 2014, at 10:56:55
well, almost half-way done with the 'acute' part of my treatments...
the protocol is 20 treatments for 4 weeks straight, then 2 or 3 times-a-week taper for 2 to 12 weeks. or, even longer.
patience. i'll get to that in a sec.
yesterday i forgot my mouthguard. was a little concerned about that. was pleasantly surprised that i had no problem with my teeth clattering like i did on my first day, and that was at a lower threshold. so, the doc was absolutely correct. one gets acclimated to the strange feeling of the pulses.
positive;
1. i continue to get to treatment and do a few errands each day. this may not sound like much, but after 4+ years of sometimes not leaving the house for days i look at this as a plus. also, i have failed at consistently going to therapy and pdoc appointments in the past. the last 2 days have been a struggle, but i am getting there. that's 9 days in a row of doing something i committed to. that has not happened since i was teaching/before my depression hit. i need to remind myself of this being a positive.
2. some physical activity. as i mentioned before i was very very active at the gym, sea, volleyball, biking, dancing!, walking and more. i am far from that, but i am doing push-ups each day. also, losing a bit of the weight i have put on these past 4 years has been good for my self-esteem. feels good to go down a notch on the belt.
3. personal hygiene. not the best, but better. as mentioned also before i used to take 2 showers a day before depression. sometimes i have gone a week w/out shaving or showering. i had a 4 day run of showers that stopped 2 days ago. i plan on showering tonight! thank-god i have no sense of smell i guess.
4. other activities; not listening to music as much as last week to be honest. but, i did watch 2 movies in the last 2 days. for a guy who use to go the movies at least twice a week i am hoping this is a start back. first movie concentration was good. 2nd movie my mind would drift. i have not been to the movies in almost 2 years.
5. doc said yesterday that 'mood' is usually the last thing to improve with deep tms. usually a slow uptick in activity, return of pleasure, less ruminations, etc. then, mood lifts. she has been right so far on other things she has told me. i am hoping this will be the case. patience.
6. watering my 91 year-old dear mother's rose bush. it has come back to life quickly. i miss her so. she is in greece now living with my sister. i am hoping i can find the strength to go see her. she has been thru so very much. seeing the roses bloom so quickly i hope is symbolic. but, it also reminds me how much i miss her.
7. i actually cooked. lol i never cook. i cooked some halibut. burned it a bit, but i think i will start asking family and friends for simple things to cook. since i can't smell, my taste is diminished. still, a good steak, piece of fish, or any suggestions? may fill some of my time too in a positive way. i hope. cooking for one can be a bummer sometimes though. but, maybe committing to a good piece of meat or fish, say 2x's a week is realistic and not too lonely-ish?
negatives;
1. i want something magical to happen. i want to be like the people that i have heard that have recovered from depression. that can feel again. i mean feel pleasure, love, life. i have had some moments of that. one can't be 'happy' all the time, but the amount of time i spend 'in' depression is still the majority of my thinking. i may be asking for too much. people live with all sorts of conditions.
2. i'm a bit scared to be honest. i mentioned that if this is another failure i will be ok. i hope so. summer is the hardest time for me and the days are already getting shorter. i can feel fall coming. on the plus, i think shorter days will make it more bearable. but, another school year will start without me in a classroom. i am still having dreams almost every night of teaching. it meant so much to me. the longer i stay away from what i had a bit of a gift for, the less i feel i will ever do it again.
3. ruminations. how long can one think about one's personal history? i was always a creature of habit, but after i do my treatment, get something to eat, and do an errand or two it's back to my bedroom and on the computer. argh. habits are hard to break. plus, i was always inside until late afternoon, so i was never big on being outside during the height of the day. even when i went to the beach i enjoyed it at the end of the day. sun can set in greece after 9pm. here in LA it's around 8pm.
4. was hoping for more 'activation' in my daytime hours. again, this has happened a bit just by going to treatments each day. it does break the inertia, but i still feel better when the sun sets.
blah blah blah...
same stuff. sorry.
tomorrow i do a midpoint depression assessment as i did to start. to be honest i do not think there will be much change in my scoring. i guess the positive on that will be if i score 51 again; my old high school and college football number. yay! go team! ;) been a long time since a cheerleader cheered for me. hugh? any chance you could supply a cheer? a 'man' cheer?
sorry for the downbeat. i'm just tired. a good friend and i will be going out for dinner tonight. thank-god i have some people that have not quit on me.
thanks for letting me rant.
john
ps just decided to take a good long shower. thanks again for letting me yak. it helped.
Posted by Phillipa on August 14, 2014, at 20:47:39
In reply to deep tms days 8 and 9 » johnLA, posted by johnLA on August 14, 2014, at 20:33:54
One shower a day is pleanty. I admire you eating fish and meat without smell taste as it kind of makes me sick so I don't. I would love a salad each night but get depressed when can't taste it. So it's chicken, green beans, 1/2 baked potatoe prepared by husband. And in my defense I hadn't cooked since I began working back in 85 since ate at work.
Congrats sounds to me like you are accomplishing a whole lot. Phillipa
Posted by johnLA on August 14, 2014, at 20:57:06
In reply to Re: day 7 deep tms » johnLA, posted by Chris O on August 12, 2014, at 16:50:33
> That was a very insightful and moving self analysis. I don't have time to reply to it now, but I can relate to much of it, in one way or another. Good to know today was a bit better for the deep TMS.
>
> This sentence struck me as particularly humorous:
>
> "...showered now 3 days in a row. good gawd..."
>
> Man, I'm totally there. Sometimes I even sit around in my underwear all day.
>
> Christhanks chris! appreciate you following my progress. and, making me laugh too. cheers.
john
Posted by johnLA on August 14, 2014, at 21:08:31
In reply to Re: ***possible trigger***, posted by Beckett on August 12, 2014, at 22:15:35
> >god I wish john lennon or bob marley were still alive
>
> I miss John Lennon.
>
> During my first hospitalization, the doctor said once someone 'tastes this kind of anxiety and depression', that experiences changes them. I've come to realize, for myself, that I will experience ups and downs. I try not to be frightened or dismayed by the downward turns.
>
> Thanks for posting your progress.thanks beckett.
i loved john lennon so much. deep down i think he knew depression. how wonderful it must have been to deal with it thru his art.
funny/sad; my anhedonia is so severe that not only do i not listen to music that much, but lennon's amazing yearning voice sounds different to me. when i told this to the doc down at uc san diego his eyes went-up. he said let me get my camera. he was a teaching psych as well. this was an intake interview for a ketamine infusion. i think he may have thought that showing this to his students would give them an idea of how a person can change while in depression.
i identified with john lennon because he had many early childhood losses. but, he was a much better fighter than me.
i wrote that bit about lennon and marley because i think there really needs to be a change in mental health. i look at the civil rights movement and i see that the arts and sports were maybe some of the catalyst for change.
maybe robin williams will be more of a start in that direction hopefully.
and! for the record; paul mccartney is my 4th favorite beatle. lol
thanks again beckett for your post.
john
Posted by johnLA on August 14, 2014, at 21:13:57
In reply to Re: deep tms days 8 and 9 » johnLA, posted by Phillipa on August 14, 2014, at 20:47:39
> One shower a day is pleanty. I admire you eating fish and meat without smell taste as it kind of makes me sick so I don't. I would love a salad each night but get depressed when can't taste it. So it's chicken, green beans, 1/2 baked potatoe prepared by husband. And in my defense I hadn't cooked since I began working back in 85 since ate at work.
>
> Congrats sounds to me like you are accomplishing a whole lot. Phillipathanks for the reminder as usual dear phillipa.
yeah, i need to look at the overall picture and realize this is a game of inches. there has been improvement. but; 'i want candy!' now. doesn't work that way with this mental crap.
i did just shower! i'm thinking 1 a day is plenty too. he-he.
going-out to dinner soon...i think i will order what your husband cooks-up every night. tell him thanks. :)
john
Posted by Chris O on August 14, 2014, at 23:48:02
In reply to deep tms days 8 and 9 » johnLA, posted by johnLA on August 14, 2014, at 20:33:54
Three cheers for John!
Awesome and thoughtful post again. No need to reply. Let's hope that even if the deep TMS is not miraculous, it's at least just less of miraculous. I know that's what I hope for every time I take a new med.
Chris
Posted by SLS on August 15, 2014, at 8:12:53
In reply to deep tms days 8 and 9 » johnLA, posted by johnLA on August 14, 2014, at 20:33:54
Hi John.
Thanks for your generous postings. I find them invaluable.
I don't think you could ask for a more optimistic scenario for your response pattern to TMS treatment. Your doctors' description of the order in which the features of depression improve mirrors that seen with a good-prognosis response to drug treatment in more severe cases. My best and longest-lasting remission developed most gradually over the course of two months rather than two weeks. Unfortunately, the doctor elected to discontinue treatment after nine months. I never responded to that same treatment again.
- Scott
Posted by johnLA on August 20, 2014, at 2:03:53
In reply to going for deep tms..., posted by johnLA on August 3, 2014, at 10:56:55
friday marked day 10 of my deep tms treatment.
this also marked the hallway point of the 'acute' phase of my treatment protocol. again, it is 20 treatments over 4 weeks, with a taper of 2 or 3 per week over 2 to 12 weeks or longer.
friday's treatment also included a halfway depression assessment. not sure how i feel about these questionnaires. i am pretty sure i scored probably the same as the first one i took at the beginning of treatment. but, i do know that i have experienced relative improvement over the past 2 weeks. hmmm...
friday night was a very special night. a old/new friend came back into my life after many years. we talked for hours. thanks slim. ;)
i crashed again though over the weekend. pretty bad actually. i ran out of the little klonopin i was on and really felt it by monday. just 3 days w/out the stuff and i was hurting a bit. i really want off that stuff. sigh. i also went almost 2 days without really eating. dumb and lame.
i actually missed monday's treatment. i just couldn't get out of bed. argh. hadn't slept really at all for a couple of days. did not want to move. waiting for night to hit the drugstore to get my k. i surprised myself and went in the afternoon to get the klonopin. god how i hate when my concentration is shot. just that 'buzz' that is so hard to explain to people who have never been thru it. i am so med sensitive. i have been stuck on 2mg of klonopin forever...
i will see the doc on thursday's treatment. i wonder if she will want to 'make-up' monday's missed one over the weekend. she and her assistant are very flexible with scheduling. i guess when you are making $9k per patient you'll be motivated. lol
today was a much better day. made it to treatment and did some errands. did some house cleaning. very few intrusive thoughts. then, my niece came over with a friend and cooked me a fab dinner. what a difference healthy food makes.
we talked for several hours. socialization is tiring, but so critical i realize for my depression. i was able to concentrate fully the whole night. no depression really. i think/hope i will sleep well. i am tired.
a good day today. i'll take it.
i am saying 'yes' to more social engagements. most of them are at night and close to home, but still i am hoping this is a change in the right direction. i spend so much time alone as i mentioned before. it's hard to break that comfort zone i love/hate.
listened to a bit of music today. first time in several days. i'll post one of the songs that really touched me in a following post. it is a john lennon cover. sometimes when his music comes on i have to turn it off due to anhedonia. or, the pain of not feeling his music anymore is too painful. but, today i felt it again. and, i had the windows down singing along. big difference between singing out loud in your car to lennon as compared to madonna. ha!
still, i need/want to fight more. i'm hoping for a miracle as i said. the tech and the doc keep saying many people have gotten better. but, still. how much can any treatment do without a 'push' from ourselves? will everyday be a battle just to get out of bed? i guess i need to slow down and just take it one-day-at-a-time as i have been for the least 4+ years. it's all that some of us can do...
oh yeah, almost forgot; i am showering more...
Posted by johnLA on August 20, 2014, at 2:09:53
In reply to Re: deep tms days 8 and 9 » johnLA, posted by SLS on August 15, 2014, at 8:12:53
> Hi John.
>
> Thanks for your generous postings. I find them invaluable.
>
> I don't think you could ask for a more optimistic scenario for your response pattern to TMS treatment. Your doctors' description of the order in which the features of depression improve mirrors that seen with a good-prognosis response to drug treatment in more severe cases. My best and longest-lasting remission developed most gradually over the course of two months rather than two weeks. Unfortunately, the doctor elected to discontinue treatment after nine months. I never responded to that same treatment again.
>
>
> - Scottthanks scott. i really appreciate your good words. i know this has been a tough summer for you. man i hope this deal works for BOTH of us.
i am so sorry that you had a good combo working and then to have that taken away. you are a true warrior. i think one of my very first posts to you 3+ years ago was this tolstoy quote;
'the greatest warriors are time and patience.'
i would say you are an inspiration to many of us here. keep fighting scott. it helps many of us here.
god bless you scott.
john
Posted by johnLA on August 20, 2014, at 2:29:01
In reply to going for deep tms..., posted by johnLA on August 3, 2014, at 10:56:55
last week after robin william's death i posted a post i made on a news site. i mentioned that i wish lennon and marley were still alive. i guess i wrote that because they seemed to make so much sense out of things when you could be feeling really low. and, i am pretty sure lennon knew a bit about depression.
fate. we greeks believe in it. maybe too much. but, sometimes things happen. like today; i rarely put the radio on as mentioned. heard this version of 'imagine.' thought at first, hmmm...lennon had an unbelievable voice. always yearning, asking, hoping. and, this song is epic. i was not expecting much...
about a third of the way in i was singing. thinking how i would definitely add to this to my 'beatles' unit in my music appreciation class. cried a little. not too much. sad that i am not teaching. but, hopeful that i may again someday.
also, i dedicate this song to scott/sls. i hope you are not offended scott. i mean it in goodwill. hoping some of you others too that are not listening anymore might 'feel' a bit as i did today.
Posted by johnLA on August 20, 2014, at 3:38:32
In reply to Re: deep tms days 8 and 9 » johnLA, posted by SLS on August 15, 2014, at 8:12:53
Posted by SLS on August 20, 2014, at 8:03:14
In reply to Re: deep tms days 8 and 9, posted by johnLA on August 20, 2014, at 2:09:53
Hi John.
Thanks for your kind words.
I spent most of the summer after Memorial Day lying motionless on the couch. I had neither the motivation nor the energy to venture across the room to play on my computer. My system was very much upset when I switched from nortriptyline to desipramine. I have been on desipramine numerous times in the past, but never reacted to it so adversely. Fortunately, after a brief discontinuation and a few dosage manipulations, I am now feeling better.
> i am so sorry that you had a good combo working and then to have that taken away. you are a true warrior. i think one of my very first posts to you 3+ years ago was this tolstoy quote;
>
> 'the greatest warriors are time and patience.'
Perfect.:-)
- Scott
Posted by SLS on August 20, 2014, at 8:09:41
In reply to song i 'felt' today/dedication to scott/sls » johnLA, posted by johnLA on August 20, 2014, at 2:29:01
> https://www.youtube.com/watch?v=MHCPfs6EGCA
One of my favorites. I used to sing it at karaoke.
- Scott
Posted by Phillipa on August 20, 2014, at 18:49:28
In reply to day 10, weekend, day 11 and day 12 of deep tms... » johnLA, posted by johnLA on August 20, 2014, at 2:03:53
Congrats showering more now up and at umm. And do not forget your klonopin!!!! Phillipa
Posted by johnLA on August 31, 2014, at 9:42:36
In reply to Re: deep tms days 8 and 9, posted by johnLA on August 20, 2014, at 2:09:53
well, i have completed 4 weeks of deep tms. yay!
i made it to 18 out of 20 sessions. missed 2 days because i just couldn't move my butt.
i am not cured that is for sure. and, to be honest, i was hoping for more of a response by this point.
the good;
1. moving more. i have literally been almost stuck to my bed for 4 years now. i can't decide if it is laziness, boredom, or depression. i think it is all 3. i was always a bedroom guy. lol but, as i mentioned previously, never like this. still, i have to look at the past 4 weeks and there has been improvement.
i need to give myself credit for getting someplace 90% of the time. this is new. can't forget that.
went to the beach finally a few times. even swam and caught waves for close to 1 hour straight 1 day. i got out of the water and looked at how 'pruned-up' my finger-tips were. many years since that has happened.
doing a bit more socially. still mostly at night. can't seem to like that sun again. i think i mentioned that i was always indoors during the height of the daylight. i am comfy in dark spaces. teaching film history was perfect. :) i always enjoyed the late afternoon sun. still, going to treatment in the middle of the day is like who turned on the stadium lights? not sure if i am agoraphobic. a little stress getting out of the house. i think it is more just i am a creature of habit.
2. music comes and goes. sometimes i can really feel a song. other times i have to turn the music off. often a song will take to me to a sad or regretful place, so i just turn it off. sigh. silence is good/bad.
3. personal hygiene. better, but not showering every day. seems like every 2 or 3 days now. at my worst i was going a week or so w/out showering. good gawd. shaving too comes and goes. i never did shave everyday. still, sometimes i let my beard go for a week. just not my look. a few days looks good actually. he-he.
4. weight. have lost some more since stopping the remeron. not exercising like i had hoped to. i did get a new gym bag! that should arrive soon. my gorgeous gym is just waiting down the road for me to go break a sweat or even start gentle with swimming. still, i think i've lost about 10 pounds. i am about 10 pounds over my regular weight still. diet has been good/bad. been drinking/sipping some high quality fish oil. seems to help my digestion. though i never had a problem there.
the bad;
1. as i said i was hoping for more of a response. the doctor said i will do an 'index' of 30 to 40 treatments before we start tapering. hmmm. she also highly suggested talk therapy. tired of talking about my crap. she mentioned that when people come-out of a depression that they often need help 'grieving' loss. like my career, lost time, what do i do now?, etc. i'd be more willing to do talk therapy again if i felt like i was coming-out of my depression. again, she keeps telling me mood is the last to improve. and, that my scores have dropped a lot on the depression intake. just doesn't feel like it.
2. sleep hygiene. just horrendous. i really wonder if the klonopin has messed me up there? or, the lack of a schedule is causing it? it is daunting not to have to be any place at a given time. this is behavioral i'm thinking. but, i have no motivation to 'do' something. except clean the house and get something to eat. the nightmares will not let up. worse when i use remeron on occasion. really would like to try and get off that klonopin. i never even used to remember my dreams before depression.
3. what happens when we get to 40 treatments and still no response? she is mentioning lamictal. i will see my regular doc next week. i will ask him about that. he has tried more 'activating' meds on me. most have done nothing or made me feel very anxious or out of it. argh. i have not tried a mood stabilizer. we haven't talked why she is recommending it. isn't that more for bipolar 1 and 2? i have been told by a psych doc friend that mood stabilizers can make a depressed person more 'social.' maybe that is what she is thinking. i will need to ask her about why she is suggesting lamictal.
if anybody has anything to say about lamictal, besides the rash, please let me know. i am curious what it might be able to do for me.
so, that is it for now. really wish i had a more positive report.
still wishing and hoping and praying for something magical...
Posted by johnLA on August 31, 2014, at 9:45:27
In reply to Re: song i 'felt' today/dedication to scott/sls » johnLA, posted by SLS on August 20, 2014, at 8:09:41
> > https://www.youtube.com/watch?v=MHCPfs6EGCA
>
> One of my favorites. I used to sing it at karaoke.
>
>
> - Scottlol scott. i used to be a snob about that song and felt that lennon was the 'only' one who should sing it.
good to know you like it too.
Posted by johnLA on August 31, 2014, at 9:47:10
In reply to Re: day 10, weekend, day 11 and day 12 of deep tms... » johnLA, posted by Phillipa on August 20, 2014, at 18:49:28
> Congrats showering more now up and at umm. And do not forget your klonopin!!!! Phillipa
thanks phillipa.
yeah, that friggin' klonopin. want off at some point...
Posted by Beckett on August 31, 2014, at 13:15:16
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
You're half way through? (I'm not sure I understood that correctly.)
Posted by SLS on August 31, 2014, at 14:49:43
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
> if anybody has anything to say about lamictal, besides the rash, please let me know. i am curious what it might be able to do for me.
I came up with a silly idea a number of years ago.
I read that certain glutamate pathways efferent from the thalamus and hippocampus actually inhibited dopamine activity in mesolimbic structures, namely, the nucleus accumbens and the ventral tegmental area. Lamictal reduces glutamate release in both the thalamus and hippocampus, and might therefore act to disinhibit dopamine neurons and increase dopamine release in the nucleus accumbens and ventral tegmental area, regions that participate in reward and mood. I just want to mention that other glutamate pathways act to stimulate dopamine release. That's why it is often better to conceptualize the brain as a network of wires rather than a bucket of chemicals. Where a neuron is routed is at least as important as which neurotransmitter it uses to transduce the message it carries. Remember, the same receptor can be excitatory or inhibitory depending on its location along the cell membrane.
One line of reasoning:
1. There are glutamate neurons arising from the thalamus and hippocampus.
2. These glutamate neurons are routed to two mesolimbic structures that are important for the experience of reward and good mood.
3. The neurons in the mesolimibic structures that are responsible for reward and good mood are driven by dopamine.
3. When the glutamate neurons from the thalamus and hypothalamus are innervated (activated), they inhibit (reduce) the firing rate of the dopamine neurons in the mesolimbic structures.
4. Too much glutamate leads to too little dopamine in this case.
5. Lamotrigine (Lamictal) inhibits the release of glutamate from neurons located in the thalamus and hippocampus. The firing rate of glutamate neurons is therefore reduced. Less glutamate leads to more dopamine.
* This kind of functional relationshop is known as disinhibition.
6. By disinhibiting dopamine neurons via the inhibition of glutamate release by lamotrigine, people may experience an improvement in the severity of their depression as the activity in the nucleus accumbens and ventral tegmental area is increased.
7. Since the ventral tegmental area innervates the prefrontal cortex, it may be that lamotrigine yields an increase in activity here, too. If so, one might expect an improvement in some other aspects of mood and cognitive function. Unfortunately, lamotrigine also blocks sodium channels. The cognitive and memory impairments this produces usually obscures any enhancement in prefrontal cortical activity. There may be other mechanisms that contribute to these cognitive side effects. I haven't looked into it.
- Scott
Posted by Phillipa on August 31, 2014, at 21:04:49
In reply to 4 weeks of deep tms... » johnLA, posted by johnLA on August 31, 2014, at 9:42:36
John to me it sounds like you have a come a long way. I am so glad for you. Phillipa
Posted by johnLA on September 1, 2014, at 10:37:47
In reply to Re: 4 weeks of deep tms..., posted by Beckett on August 31, 2014, at 13:15:16
> You're half way through? (I'm not sure I understood that correctly.)
hi beckett.
yeah, i realize my thread/post was confusing.
the original plan was to do an 'index' of 20 treatments and then, re-evaluate the course of treatment on how i was feeling.
when we started the doc had hoped that by treatment #20 i would be in a place to start tapering or doing maintenance; 2 to 3 tmes per week. for a few weeks or even much longer. similar to ect in some ways.
my depression scores have dramatically improved. yet, i really don't feel that great. again, she has said mood is the last to improve.
the plan is to do 10 more treatments and then start the taper.
as i mentioned i was really hoping to have more of a response by this point.
she is off on vacation so her tech is doing the treatments this week. i will ask about at what point is somebody considered a non-responder. i think i remember the doc saying that she had patients that needed up to 50 treatments in a row before tapering.
thanks for following my thread. let me know if you have any other questions.
john
Posted by johnLA on September 1, 2014, at 10:46:15
In reply to Re: 4 weeks of deep tms... » johnLA, posted by SLS on August 31, 2014, at 14:49:43
wow scott.
i understood about 80% of all that. and, you delivered the info in a very 'gentle' way. i appreciate that greatly.
theory aside;
1. what can lamictal possibly do for a anergic depression? i have heard it can be 'pro-social' in it's action.
2. i have read about the 'dumbing' effect it can cause on cognitive ability. any more info on your end about this?
3. could you explain the sodium channel deal a bit more? you mentioned this causes cognitive impairments.
4. lamictal; worth a try? still, need to talk to her and my regular pdoc. i'm not too sure my regular doc will be keen to use it.
thanks again so much for such a detailed reply.
john
Posted by johnLA on September 1, 2014, at 10:47:12
In reply to Re: 4 weeks of deep tms... » johnLA, posted by Phillipa on August 31, 2014, at 21:04:49
Posted by SLS on September 1, 2014, at 12:38:44
In reply to scott/sls; lamictal ?'s » SLS, posted by johnLA on September 1, 2014, at 10:46:15
> wow scott.
>
> i understood about 80% of all that. and, you delivered the info in a very 'gentle' way. i appreciate that greatly.
>
> theory aside;
>
> 1. what can lamictal possibly do for a anergic depression? i have heard it can be 'pro-social' in it's action.My depression is primarily one of anergia and cognitive impairment along with lack of interest and anhedonia. I find Lamictal to be energizing and antidepressive. At 200 mg/day, I don't think that I experience very much cognitive impairment as a side effect. Since I have been taking Lamictal for quite a few years, I cannot be absolutely sure as to the degree of residual impairments that might still exist. For me, the cost/benefit ratio leans in the direction to continue Lamictal treatment.
> 2. i have read about the 'dumbing' effect it can cause on cognitive ability. any more info on your end about this?
Cognitive impairments produced by Lamictal are dosage-dependent. It makes sense to establish the lowest effective dosage. I would set 200 mg/day as an initial target dosage to titrate up to. Most people find this to be optimal. This will take at least four weeks to attain so as to avoid the precipitation of a rash-reaction. I see most people respond robustly to a dosage range of 150 - 300 mg/day.
> 3. could you explain the sodium channel deal a bit more? you mentioned this causes cognitive impairments.
Sodium ions must be transported in and out of the neuron in order for the neuron to send its message. This is accomplished via the passage of ions through a membrane channel, and must occur rapidly and unimpeded in response to changes in voltage. When these sodium channels are blocked by anticonvulsants like Lamictal, neurons are inhibited from firing (propogating an action-potential). In this case, blocking sodium channels impairs cognitive and memory function.
> 4. lamictal; worth a try?
I think so. It can help in the treatment of both bipolar disorder and unipolar major depressive disorder. However, it seems to me that it produces better results when combined with an antidepressant, atypical antipsychotic, or another anticonvulsant.
> still, need to talk to her and my regular pdoc. i'm not too sure my regular doc will be keen to use it.
What are your doctor's objections to treating you with Lamictal?
- Scott
>
> thanks again so much for such a detailed reply.
>
> john
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