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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Tomatheus on February 13, 2015, at 13:52:35
In reply to Re: med change, posted by Escapee on February 13, 2015, at 13:31:49
Good luck with the changes, Escapee.
Tomatheus
Posted by Escapee on February 13, 2015, at 15:39:32
In reply to Re: med change » Escapee, posted by Tomatheus on February 13, 2015, at 13:52:35
Posted by Escapee on February 14, 2015, at 8:21:21
In reply to Re: med change, posted by Escapee on February 13, 2015, at 13:31:49
> Well I seen my pdoc today. He couldn't prescribe any nootropics. Didn't think he could.
> No tianeptine tho he said he could order it from abroad if I was willing to pay.
>
> Anyway, we made one change today. Swapped amitriptyline for trimipramine. I've tried trimipramine before but was on a different combo at the time. I go back in 6 weeks. I will keep the trimipramine as long as it hasn't worsened any of my depressive symptoms. And then, after a blood test that shows no abnormalities we will add lithium. See what happens.
>
> EscapeeAlso changed from quetiapine 50mg slow-release to 100mg instant release. Thats what I had first time round. I seem to remember it being somewhat more mood-lifting. Interestingly, he has also switched other patients from slow to instant release, as requested by the patient. Hmm.. wonder what's going on there? Perhaps the slow-release is better suited to people taking much larger doses?
Posted by phidippus on March 2, 2015, at 13:29:11
In reply to med change, posted by Escapee on February 11, 2015, at 10:21:56
I'm going to assume you suffer from depression and some pretty heavy depression at that.
I wouldn't recommend T hormone therapy. Anecdotal evidence suggests it can cause cancer. That and you don't want a thyroid storm.
Tianeptine is a terrible choice. It has a 3 hour half life and all it does is agonize opioid receptors while acting as a weak serotonin uptake enhancer.
The only thing I can recommend you is Ketamine. Another novel suggestion would be nicotine patches (studies have shown nicotine alleviates depression).
Eric
Posted by Escapee on March 2, 2015, at 15:39:57
In reply to Re: med change » Escapee, posted by phidippus on March 2, 2015, at 13:29:11
> I'm going to assume you suffer from depression and some pretty heavy depression at that.
>
> I wouldn't recommend T hormone therapy. Anecdotal evidence suggests it can cause cancer. That and you don't want a thyroid storm.
>
> Tianeptine is a terrible choice. It has a 3 hour half life and all it does is agonize opioid receptors while acting as a weak serotonin uptake enhancer.
>
> The only thing I can recommend you is Ketamine. Another novel suggestion would be nicotine patches (studies have shown nicotine alleviates depression).
>
> EricI can get pure ket £10 gram down the road. The suggestion is a joke.
I'm to have checked thyroid, liver, renal function tests. Also a full blood count, C reactive protein, B12 and folate, vit D, calcium and phosphate tests. Since I have switched to quetiapine instant-release 100mg morn It is much more powerful, at least it feels so. In a good way.
But the trimipramine switch is going rocky. I stopped 100mg amitryptyline and strait on to 100mg trimipramine. The last 2 weeks were fine. A perfect swap. But I've only been taking 50mg night coz the pharmacy was low and I've been away 2 weeks. Since Sat night I went to 100mg and am sleeping most of the time. No energy. Depression has hit me hard too, presumably from stopping the ami. Perhaps I should stay at 50mg for a while. Probably hasn't even kicked in yet.
Was my pdoc (Neuro-psychopharmacologist) who recommended trying thyroid. He has seen me for 10yrs. I dont think he would suggest it without a good reason. Other than a patient, what's your medical qualifications? I ask because there are people on here that might take you're recommendations as gospel and take your suggestions to the next step. Perhaps even by themselves. Be careful how wacky your suggestions are, or at least own them as your own and state it. And of course WE ARE ALL DIFFERENT.
Thanks for the comments.
Posted by phidippus on March 3, 2015, at 0:40:41
In reply to Re: med change » phidippus, posted by Escapee on March 2, 2015, at 15:39:57
The Ketamine suggestion wasn't a joke. We have clinics here who offer ketamine infusions for the treatment of depression. About 800 bucks a pop.
Studies show Ketamine acts rapidly and effectively in the treatment of depression. Some publications have noted that ketamine can be succesful in treating depression resistant to other treatments, even ECT.
Eric
Posted by Escapee on March 3, 2015, at 6:07:20
In reply to Re: med change » Escapee, posted by phidippus on March 3, 2015, at 0:40:41
I guess if I say that I can get it anyway and cheap, he might let me try. But I'm in the UK. Using the term 'bucks' tells me U dont live here. I have heard of it's use in depression, but 800 bucks a shot? Sounds expensive and as there are still many alternatives it would be a step before ECT (tho I'd rather die than have ECT. Psychic healing sounds more approachable).
Posted by Escapee on March 17, 2015, at 16:20:30
In reply to med change, posted by Escapee on February 11, 2015, at 10:21:56
Well I didn't last long on the trimipramine (swapped over from amitryptyline). 4 weeks is all. Severity in depression increased. Bad dreams and uncomfortable hypnagogic state in the morning. Streams of tears everyday at any time. I know it could have been the ami withdrawal but with 4 weeks on trimipramine did nothing. Only made things worse.
Anyway, I'm back onto 100mg amitryptyline at night.
I've had the results of blood tests too which my pdoc wanted done before putting me on lithium. 2 abnormalities. Slightly high thyroid function, and slightly raised statins. My diabetes team can work with the statins but I wonder what's causing the overactive thyroid. Can I still go onto lithium? And what, if anything will he give me to re-balance my thyroid?
Escapee.
Posted by Escapee on March 28, 2015, at 9:02:48
In reply to Update, posted by Escapee on March 17, 2015, at 16:20:30
Well I'm now on lithium. 400mg at night. I'll check back in 1-2 weeks to let people know how it goes.
Posted by Escapee on June 16, 2015, at 16:25:01
In reply to Re: Update, posted by Escapee on March 28, 2015, at 9:02:48
Posted by Escapee on June 16, 2015, at 16:26:32
In reply to Re: Update (nm), posted by Escapee on June 16, 2015, at 16:25:01
> Well I'm now on lithium. 400mg at night. I'll check back in 1-2 weeks to let people know how it goes.
Reporting back.
End of March I began lithium 400mg. Nothing happened until little over 2 weeks ago. I thought it had kicked in. Felt a definite 'something'. Mildly psychostimulating and in a good mood.Seemed to forget about anxiety too. That lasted 3-4 days. Then it dissapeared. That was 2 weeks ago. Had a blood sample taken today so my pdoc should see the results when I see him Friday.
Was that an early sign that it could work? Why did it fade away? He told me that he will start me on a low dose- 400mg/day. So I guess that he will up the dose as long as my blood samples show no bad effects. Extremely depressed & pessimistic, severe anxiety just putting the rubbish/garbage out. I'm a complete mess. And I have to get the bus to my app on Friday. I might even have to have a drink before my appointment just to get there. Or maybe 5mg clonazepam will do it.
Such is life.
Posted by Escapee on July 2, 2015, at 9:39:00
In reply to Re: Update, posted by Escapee on June 16, 2015, at 16:26:32
> Reporting back.
> End of March I began lithium 400mg. Nothing happened until little over 2 weeks ago. I thought it had kicked in. Felt a definite 'something'. Mildly psychostimulating and in a good mood.Seemed to forget about anxiety too. That lasted 3-4 days. Then it dissapeared. That was 2 weeks ago. Had a blood sample taken today so my pdoc should see the results when I see him Friday.
> Was that an early sign that it could work? Why did it fade away? He told me that he will start me on a low dose- 400mg/day. So I guess that he will up the dose as long as my blood samples show no bad effects. Extremely depressed & pessimistic, severe anxiety just putting the rubbish/garbage out. I'm a complete mess. And I have to get the bus to my app on Friday. I might even have to have a drink before my appointment just to get there. Or maybe 5mg clonazepam will do it.
> Such is life.OK. Now I've been on 600mg lithium and have been slowly raising the quetiapine from 100-200mg. Today I hit that 200mg.
NOTHING YET!
Of course my depression (like the majority of sufferers) is at least slightly situational. Sitting infront of the PC, not going out is asking for trouble. But what else to do?
Anxiety has alsob increased. I'm very tempted to lower or stop the bupropion. At least give it a try.
Escapee
Posted by SLS on July 2, 2015, at 12:51:34
In reply to Re: Re-Update, posted by Escapee on July 2, 2015, at 9:39:00
> OK. Now I've been on 600mg lithium
Are you using lithium as a mood stabilizer, or, rather, as an augmenter to antidepressants?
> and have been slowly raising the quetiapine from 100-200mg. Today I hit that 200mg.
Even for depression, I think you need to reach 400 mg/day. I'm not sure, though.
> NOTHING YET!
I'm sorry to hear that.
> Anxiety has alsob increased. I'm very tempted to lower or stop the bupropion. At least give it a try.
That sounds reasonable. Anxiety, agitation, and anger are not infrequent side effects with Wellbutrin. I'm beginning to think that it should not be used very often when significant anxiety is present.
Have you tried any anticonvulants? Lamictal?
What about Abilify? It is especially helpful when added to Lamictal if bipolar depression is present. Otherwise, it might help in combination with antidepressants.
Regarding antipsychotics, I am not sold on Seroquel and Latuda for depression. I have seen good results with Saphris, though. Having said that, I cannot guarantee you that Seroquel and Latuda won't work - meaning that you probably should not exclude these drugs from consideration.
Good luck.
- Scott
Posted by Escapee on July 2, 2015, at 19:12:17
In reply to Re: Re-Update » Escapee, posted by SLS on July 2, 2015, at 12:51:34
> > OK. Now I've been on 600mg lithium
>
> Are you using lithium as a mood stabilizer, or, rather, as an augmenter to antidepressants?
>
> > and have been slowly raising the quetiapine from 100-200mg. Today I hit that 200mg.
>
> Even for depression, I think you need to reach 400 mg/day. I'm not sure, though.
>
> > NOTHING YET!
>
> I'm sorry to hear that.
>
> > Anxiety has alsob increased. I'm very tempted to lower or stop the bupropion. At least give it a try.
>
> That sounds reasonable. Anxiety, agitation, and anger are not infrequent side effects with Wellbutrin. I'm beginning to think that it should not be used very often when significant anxiety is present.
>
> Have you tried any anticonvulants? Lamictal?
>
> What about Abilify? It is especially helpful when added to Lamictal if bipolar depression is present. Otherwise, it might help in combination with antidepressants.
>
> Regarding antipsychotics, I am not sold on Seroquel and Latuda for depression. I have seen good results with Saphris, though. Having said that, I cannot guarantee you that Seroquel and Latuda won't work - meaning that you probably should not exclude these drugs from consideration.
>
> Good luck.
>
>
> - ScottThanks for ur input Scott. I have TRD & Social Phobia. Perhapse I'd fit the criteria for Avoidant. I used to put alot of time and effort researching and being part of the decision on what med to take. I've given up now. I let my doc do the work. Anyway when It comes to stabilisers and augmentors I have little knowledge on them. I trust my doctor. Always have, and the doc I had before (Prof. David Nutt). Both are 'leaders' of thier team of psych docs. There are alot of avenues still to try yet. But I sticking tight to my dosing right now. If I cann't trust my doc....?
Anyway thanks for your suggestions. I will take note and look them up. Ask my doc what he thinks
Posted by Escapee on July 31, 2015, at 13:46:25
In reply to Re: Re-Update » SLS, posted by Escapee on July 2, 2015, at 19:12:17
Saw my doc again. 6 week gap.
He told me to stop the lithium (cut to 200mg for 5 day then stop.
Then up the quetiapine to 250/day
Oh, and He moved my isocarboxazid pils from 90mg to 100mg.
Oh, that lithium gives me a horrid dry mouth.SKP
Posted by SLS on July 31, 2015, at 14:00:24
In reply to Re: Re-Update » Escapee, posted by Escapee on July 31, 2015, at 13:46:25
> Saw my doc again. 6 week gap.
> He told me to stop the lithium (cut to 200mg for 5 day then stop.
> Then up the quetiapine to 250/day
> Oh, and He moved my isocarboxazid pils from 90mg to 100mg.
> Oh, that lithium gives me a horrid dry mouth.
>
> SKPGood luck.
Please check in every now and then. I am very interested to see how well you do.
Thanks.
- Scott
Posted by Escapee on August 1, 2015, at 8:08:37
In reply to Re: Re-Update » Escapee, posted by SLS on July 31, 2015, at 14:00:24
So to round up daily:
Doc's taken me off lithium altogether.
Quetiapine 250mg (night)
isocarboxazid (100mg at night which is a change from all in the morn)
clonazepam 4mg (2mg morning & 2 at late afternoon)
amitriptyline 100mg (night)
bupropion 300mg SR (150mg morn & 150mg late afternoon
He said next time we can think about what to do with the bupropion. Even said "see if we can give you something to give you a boost". He's also still curios about thyroid hormone T3 and how it mighthelp. He even might go with cortisone for 2 weeks. Find out whats next in 6 weeks.
At least I don't need blood tests for lithium.any more! :)
Posted by SLS on August 1, 2015, at 8:17:05
In reply to Re: Re-Update, posted by Escapee on August 1, 2015, at 8:08:37
> So to round up daily:
> Doc's taken me off lithium altogether.
> Quetiapine 250mg (night)
> isocarboxazid (100mg at night which is a change from all in the morn)
> clonazepam 4mg (2mg morning & 2 at late afternoon)
> amitriptyline 100mg (night)
> bupropion 300mg SR (150mg morn & 150mg late afternoon
> He said next time we can think about what to do with the bupropion. Even said "see if we can give you something to give you a boost". He's also still curios about thyroid hormone T3 and how it mighthelp. He even might go with cortisone for 2 weeks. Find out whats next in 6 weeks.
> At least I don't need blood tests for lithium.any more! :)You have an excellent doctor.
- Scott
Posted by Escapee on August 1, 2015, at 8:41:36
In reply to Re: Re-Update » Escapee, posted by SLS on August 1, 2015, at 8:17:05
Posted by Escapee on August 2, 2015, at 9:41:10
In reply to Re: Re-Update, posted by Escapee on August 1, 2015, at 8:08:37
> isocarboxazid (100mg at night which is a change from all in the morn)
Got that wrong! My doc wrote a quick note (forgot about it). Still take isocarboxazid still all in the morning but increase to 105mg? I think he was thinking phenelzine as iso only comes in 10mg pills. So I'll make that 110mg/day :)
Posted by SLS on August 2, 2015, at 9:51:41
In reply to Re: Re-Update, posted by Escapee on August 2, 2015, at 9:41:10
> > isocarboxazid (100mg at night which is a change from all in the morn)
>
> Got that wrong! My doc wrote a quick note (forgot about it). Still take isocarboxazid still all in the morning but increase to 105mg? I think he was thinking phenelzine as iso only comes in 10mg pills. So I'll make that 110mg/day :)Do you still dream with Marplan?
Any dizziness?
- Scott
Posted by Escapee on August 2, 2015, at 10:42:04
In reply to Re: Re-Update » Escapee, posted by SLS on August 2, 2015, at 9:51:41
> > > isocarboxazid (100mg at night which is a change from all in the morn)
> >
> > Got that wrong! My doc wrote a quick note (forgot about it). Still take isocarboxazid still all in the morning but increase to 105mg? I think he was thinking phenelzine as iso only comes in 10mg pills. So I'll make that 110mg/day :)
>
> Do you still dream with Marplan?
>
> Any dizziness?
>
>
> - ScottHi Scott. No I no longer have frequent nightmares or vivid dreams. Still get the odd one or 2 but try to think nothing of it.
No dizziness either, but only increased from 90 - 110mg today. I kind of expect some urine retention but I've ordered a herbal supplement Saw Palmetto which has worked wonders for urine retention in the past. Almost works immediately.
Posted by SLS on August 2, 2015, at 11:03:15
In reply to Re: Re-Update » SLS, posted by Escapee on August 2, 2015, at 10:42:04
> > > > isocarboxazid (100mg at night which is a change from all in the morn)
> > >
> > > Got that wrong! My doc wrote a quick note (forgot about it). Still take isocarboxazid still all in the morning but increase to 105mg? I think he was thinking phenelzine as iso only comes in 10mg pills. So I'll make that 110mg/day :)
> >
> > Do you still dream with Marplan?
> >
> > Any dizziness?
> >
> >
> > - Scott
>
> Hi Scott. No I no longer have frequent nightmares or vivid dreams. Still get the odd one or 2 but try to think nothing of it.
>
> No dizziness either, but only increased from 90 - 110mg today. I kind of expect some urine retention but I've ordered a herbal supplement Saw Palmetto which has worked wonders for urine retention in the past. Almost works immediately.
>If PTSD is a problem, and Marplan does not work well enough, you might want to consider adding prazosin. Prazosin is an old antihypertensive drug that was found to help treat the nightmares, insomnia, anxiety, and depression associated with PTSD.
- Scott
Posted by Escapee on August 2, 2015, at 11:24:45
In reply to Re: Re-Update » Escapee, posted by SLS on August 2, 2015, at 11:03:15
Hi. Thankfull I do not suffer with PTSD. Unless you count my entire life as a trauma? Feels that way sometimes. No, Hand-in-hand with the depression I have severe & unpredictable Social Phobia. Some days worse than others. My doc's also hesitant to increase my clonazepam. I'm currently on 4mg/day and I know I can go much higher. I have asked him about gabapentin, gabatril & pregablin for additional help with anxiety. He didn't say much. He's more interest in getting me off the lithium and see me after I've been on the higher doses of iso and quetiapine.
Posted by SLS on August 2, 2015, at 12:14:32
In reply to Re: Re-Update » SLS, posted by Escapee on August 2, 2015, at 11:24:45
Look up "developmental trauma".
Google:
https://www.google.com/?gws_rd=ssl#q=%22developmental+trauma%22
High-dose prazosin for PTSD:
http://www.ncbi.nlm.nih.gov/pubmed/24490030
- Scott
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