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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 J Kelly on May 26, 2016, at 5:47:07
In reply to Re: MAOI + super high dose AP???, posted by PeterMartin on May 26, 2016, at 1:59:24
> I had a bad psychotic episode after adding Nardil to a cocktail in 2006.
Would you mind sharing what that cocktail was, doses etc., and how long it took to become psychotic?
Thanks,
Jade
Posted by Lamdage22 on May 26, 2016, at 6:56:27
In reply to Re: MAOI + super high dose AP??? » Lamdage22, posted by J Kelly on May 26, 2016, at 5:43:12
> > I have heard of Zyprexa dosages up to 100mgs. Now i cant imagine that i would still be psychotic at that dosage.
>
> I'm now up to 10mg Zyprexa and 1.5mg Klonopin with 75mg Nardil. No psychosis so far (knock on wood).
>
>
> JadeThat sounds good Jade.
Posted by Lamdage22 on May 26, 2016, at 7:23:37
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 6:56:27
I think Wellbutrin is the way to go here. Im not even asking my doctor because he brought up the idea anyway couple months ago.
Posted by Christ_empowered on May 26, 2016, at 8:35:18
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 7:23:37
If you can avoid unusually high doses of AP/AAP drugs, you probably should.
I think Wellbutrin would be helpful. Using neurontin might help, too (I'm clearly not an expert, lol)...my concern right now would be that adding a standard dose of neurontin might be too sedating with everything else you're on.
I was reading...adding Lamictal to ongoing AP/AAP treatment is apparently good for many people. Lamictal is also one of the more tolerable anticonvulsants. In what I read, the authors said that, in their experience, adding lamictal can somehow help keep the neuroleptic dose lower over the long haul. I don't understand the brain, so I don't know what the technical explanation is/was, but...makes sense. Benzodiazepines have also been used to reduce neuroleptic dosages and keep them lower over long term treatment.
Hope this helps.
Posted by Lamdage22 on May 26, 2016, at 8:47:14
In reply to Re: MAOI + super high dose AP???, posted by Christ_empowered on May 26, 2016, at 8:35:18
no lamictal doesnt do anything
Posted by Lamdage22 on May 26, 2016, at 8:47:43
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 8:47:14
I am on the verge of being suicidal
Posted by jonhed on May 26, 2016, at 9:33:42
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 8:47:43
Please let me raise awareness for opioids without getting talked down (moral stuff, i can't translate it from my langue).
My grandfather was diagnosed with schizophrenia back in the 70s and so was my uncle.
I have 3 friends who is diagnosed with schizophrenia in some form and the only thing that have helped them with there suicidal thoughts and(!) with they're paranoia, is opioids.In some countries you can get buprenorphine for treatment resistant depression, it is not that uncommon.
And buprenorphine is very stimulating to + an Kappa-opioid receptor antagonist, which has been proved many times to be very effective against depression.We are going to se more and more new opioid-receptor agonists in a few years.
especially K-opioid ligands, i believe.
Posted by Lamdage22 on May 26, 2016, at 9:38:30
In reply to Re: MAOI + super high dose AP???, posted by jonhed on May 26, 2016, at 9:33:42
> Please let me raise awareness for opioids without getting talked down (moral stuff, i can't translate it from my langue).
>
> My grandfather was diagnosed with schizophrenia back in the 70s and so was my uncle.
> I have 3 friends who is diagnosed with schizophrenia in some form and the only thing that have helped them with there suicidal thoughts and(!) with they're paranoia, is opioids.
>
> In some countries you can get buprenorphine for treatment resistant depression, it is not that uncommon.
> And buprenorphine is very stimulating to + an Kappa-opioid receptor antagonist, which has been proved many times to be very effective against depression.
>
> We are going to se more and more new opioid-receptor agonists in a few years.
>
> especially K-opioid ligands, i believe.When i google Buprenorphin and Depression, i dont come across anything in German. That has me believe that in Germany it is never used for psychiatric stuff:(
Too bad.
Posted by Lamdage22 on May 26, 2016, at 9:43:28
In reply to Re: MAOI + super high dose AP???, posted by Christ_empowered on May 26, 2016, at 8:35:18
> If you can avoid unusually high doses of AP/AAP drugs, you probably should.
Even if it means that i am suicidal?
Posted by Lamdage22 on May 26, 2016, at 13:42:27
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 9:43:28
I havent tried this yet.
But i want to be in a hospital when i try.
Posted by Lamdage22 on May 26, 2016, at 13:57:51
In reply to Wanna try Luvox, posted by Lamdage22 on May 26, 2016, at 13:42:27
> I havent tried this yet.
>
> But i want to be in a hospital when i try.Because at home i get scared and discontinue prematurely.
Posted by Christ_empowered on May 26, 2016, at 16:08:40
In reply to Re: Wanna try Luvox, posted by Lamdage22 on May 26, 2016, at 13:57:51
Luvox has all kindsa drug-drug interactions, and it tends to be sedating.
Why not...lexapro, celexa?
Posted by PeterMartin on May 26, 2016, at 20:27:05
In reply to Re: MAOI + super high dose AP??? » PeterMartin, posted by J Kelly on May 26, 2016, at 5:47:07
> > I had a bad psychotic episode after adding Nardil to a cocktail in 2006.
>
> Would you mind sharing what that cocktail was, doses etc., and how long it took to become psychotic?
>
> Thanks,
>
> Jade
>
>
>It wasn't really a fair trial as I was young and stupid at the time. I had a sorta addiction to pot and that alone can sometimes induce psychosis in me. If I remember it was just Nardil and seroquel but + pot I went off. At that time I had been smoking pot daily since 2003 w.o. any probs so I always attributed the episode to Nardil when it could have been coincidence or MAOIs in general.
Marplan is mild for me but it does do enough to the point I'm not asking my doc for other meds......that's a good sign for me.
Posted by J Kelly on May 27, 2016, at 5:55:11
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 26, 2016, at 8:47:43
> I am on the verge of being suicidal
Lamdage :(
I just saw this. I'm so sorry you are feeling this bad. Can you get an emergency appt with your pdoc? Maybe he can get a little more creative with that prescription pad when he hears how you're feeling. Do you feel like you should go to the hospital?
Ley me know if there is anything I can do for you (research etc).
Hang in there things will get better. I was about to give up also when I found Nardil. You will find something that helps. I just know it.
your friend,
Jade
Posted by J Kelly on May 27, 2016, at 7:10:16
In reply to Re: MAOI + super high dose AP???, posted by jonhed on May 26, 2016, at 9:33:42
> Please let me raise awareness for opioids without getting talked down (moral stuff, i can't translate it from my langue).
>
> My grandfather was diagnosed with schizophrenia back in the 70s and so was my uncle.
> I have 3 friends who is diagnosed with schizophrenia in some form and the only thing that have helped them with there suicidal thoughts and(!) with they're paranoia, is opioids.
>
> In some countries you can get buprenorphine for treatment resistant depression, it is not that uncommon.
> And buprenorphine is very stimulating to + an Kappa-opioid receptor antagonist, which has been proved many times to be very effective against depression.
>
> We are going to se more and more new opioid-receptor agonists in a few years.
>
> especially K-opioid ligands, i believe.My pdoc prescribed Suboxone for me once as I was coming out of a psychotic state. I guess it was for depression or w/d from parnate. I was pretty out of it so I'm not sure. I remember I felt pretty good on it. Not all pdocs can prescribe it.
Jade
Posted by J Kelly on May 27, 2016, at 7:13:29
In reply to MAOI + super high dose AP???, posted by Lamdage22 on May 25, 2016, at 11:31:43
> I have heard of Zyprexa dosages up to 100mgs. Now i cant imagine that i would still be psychotic at that dosage.
So...
Luvox, suboxone, high dose AP, and what about a stim? Ritalin always helps my depression/ADD.
Jade
Posted by J Kelly on May 27, 2016, at 7:20:58
In reply to Re: MAOI + super high dose AP???, posted by PeterMartin on May 26, 2016, at 20:27:05
> > > I had a bad psychotic episode after adding Nardil to a cocktail in 2006.
> >
> > Would you mind sharing what that cocktail was, doses etc., and how long it took to become psychotic?
> >
> > Thanks,
> >
> > Jade
> >
> >
> >
>
> It wasn't really a fair trial as I was young and stupid at the time. I had a sorta addiction to pot and that alone can sometimes induce psychosis in me. If I remember it was just Nardil and seroquel but + pot I went off. At that time I had been smoking pot daily since 2003 w.o. any probs so I always attributed the episode to Nardil when it could have been coincidence or MAOIs in general.
>
> Marplan is mild for me but it does do enough to the point I'm not asking my doc for other meds......that's a good sign for me.
>Hi dose parnate was pulling me out of depression when I became psychotic. Its taken me years to get the courage up to try another MAOI. I'm taking 75mg Nardil plus 10mg Zyprexa. I love the feel of Nardil. I hope I don't have to give it up.
Jade
Posted by Lamdage22 on May 27, 2016, at 7:50:02
In reply to Re: MAOI + super high dose AP??? » PeterMartin, posted by J Kelly on May 27, 2016, at 7:20:58
i want luvox. I am checking into a clinic as i am tired of trialing meds alone at home.
Posted by jonhed on May 27, 2016, at 12:06:52
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 27, 2016, at 7:50:02
I feel with you lamdage22..
Nowadays i can't start up new medicines at home because it always, 100% of the times, end up with me being paranoid and discontinue it after a maximum of 4 days.
That is 4 days without sleep, without food and severe panic attacks.I think you're doing the right thing to check in to a clinic if you have that opportunity, there you are in a safe environment and even with side effects you can still reassure you that if something happens, you are at least in a hospital!
If you decide to do so, i have some tips for you that i want you to consider to talk about your doctor about.(and just as a fellow sufferer, not an expert).
This is just tips, not rules or guidelines.1. Please tell him about the severity of your depression and that you don't want to try things you've already have tried and that you very much like to be a part of the discussion about your medications.
If you want to try a high dose of luvox, then stand your ground!
You have rights to.2. If you don't already have tried it - High dose of amitriptyline, 250mg at least, with quick titration (2-3 weeks).
3. Zyprexa IM 10mg 3 Times in one or two days. That is if you're experience a psychotic depression.
It is in my opinion the far best AAP/AD combination medicine i know.4. As for benzodiazepines in the beginning of an AD treatment, i would suggest nitrazepam 10mg, two times daily, as it is a full agonist of the benzodiazepine receptor and works far better than alprazolam in the short term.
5. Ask your doctor about what he can tell you about "TMS - Transcranial Magnet Stimulation".
I have no experience from it or anything really, but in a few moth i am going to undergo TMS-treatment.
The only thing i know is that it is not acute dangerous and does not require any Anesthesia or convulsions like ECT.6. Ask your doctor about it's experience of nmda-antagonists as adjunct to other medicines that does build up tolerance. Maybe that can help you to maintain the initial antidepressant effect from various anxiolytics without upping the dose.
I've heard that Memantine can be used.
Ask your doctor about Amantadine. I've heard good things about it.7. As last resort, ask your doctor to consider high potency opioids with long half life. Methadone or Buprenorphine.
Even if it's not recommended in your country, he/she can still prescribe whatever he/she wants, for whatever he/she wants.
It's not recommended in sweden either but as i have said, there is some very prominent evidence for it's AD effect.8. Start up CBT-therapy in the long term.
I hope this is to some help for you because i care about all you guys and would not write this just for fun.
It took me one hour due to the fact that i'm not english speaking./J
Posted by jonhed on May 27, 2016, at 17:57:35
In reply to Re: MAOI + super high dose AP???, posted by jonhed on May 27, 2016, at 12:06:52
I am in a medicine induced manic state i believe, therefore i beg you to not be angry at me when i suggests things that are maybe outrageous.
I will try to not write so much in the near future and if i feel this way until Monday i will contact my doctor and tell her about this.Though i will start to try riding out the manic phase over the weekend with lots of sleep and food(if it's possible).
Good luck to you lamdage22 and please keep us updated, couse we are worried.
/J
Posted by Lamdage22 on May 28, 2016, at 4:42:22
In reply to Re: MAOI + super high dose AP???, posted by jonhed on May 27, 2016, at 12:06:52
> I think you're doing the right thing to check in to a clinic if you have that opportunity, there you are in a safe environment and even with side effects you can still reassure you that if something happens, you are at least in a hospital!
Thanks. It is tough.
>
> If you decide to do so, i have some tips for you that i want you to consider to talk about your doctor about.(and just as a fellow sufferer, not an expert).
> This is just tips, not rules or guidelines.
>
> 1. Please tell him about the severity of your depression and that you don't want to try things you've already have tried and that you very much like to be a part of the discussion about your medications.
> If you want to try a high dose of luvox, then stand your ground!
> You have rights to.I will tell them that. Thanks.
>
> 2. If you don't already have tried it - High dose of amitriptyline, 250mg at least, with quick titration (2-3 weeks).I have tried nortriptyline and it has given me a flaccid erection and anorgasmia.
> 3. Zyprexa IM 10mg 3 Times in one or two days. That is if you're experience a psychotic depression.
> It is in my opinion the far best AAP/AD combination medicine i know.I dont think it is psychotic depression though.
> 4. As for benzodiazepines in the beginning of an AD treatment, i would suggest nitrazepam 10mg, two times daily, as it is a full agonist of the benzodiazepine receptor and works far better than alprazolam in the short term.
I taka Lorazepam as needed.
> 5. Ask your doctor about what he can tell you about "TMS - Transcranial Magnet Stimulation".
> I have no experience from it or anything really, but in a few moth i am going to undergo TMS-treatment.
> The only thing i know is that it is not acute dangerous and does not require any Anesthesia or convulsions like ECT.I have already done that with no success.
> 6. Ask your doctor about it's experience of nmda-antagonists as adjunct to other medicines that does build up tolerance. Maybe that can help you to maintain the initial antidepressant effect from various anxiolytics without upping the dose.
> I've heard that Memantine can be used.
> Ask your doctor about Amantadine. I've heard good things about it.Maybe.
> 7. As last resort, ask your doctor to consider high potency opioids with long half life. Methadone or Buprenorphine.
> Even if it's not recommended in your country, he/she can still prescribe whatever he/she wants, for whatever he/she wants.
> It's not recommended in sweden either but as i have said, there is some very prominent evidence for it's AD effect.> 8. Start up CBT-therapy in the long term.
>
> I hope this is to some help for you because i care about all you guys and would not write this just for fun.
> It took me one hour due to the fact that i'm not english speaking.
>
> /JThanks for all the effort. I think telling them that i would like to play a part in the discussion of meds is key.
I hope they will do it.
Posted by Lamdage22 on May 28, 2016, at 4:45:49
In reply to Re: MAOI + super high dose AP???, posted by Lamdage22 on May 28, 2016, at 4:42:22
I think the only reason for them not to give me Luvox would be that it inhibits cyp450 liver metabolism.
The blood level of Zyprexa could be raised.
But i think it is better to raise Zyprexa than to inhibit it.
Dosage can be adjusted slowly i think.
Posted by jonhed on May 28, 2016, at 8:44:15
In reply to Fluvoxamine, posted by Lamdage22 on May 28, 2016, at 4:45:49
I posted something that didn't come up, it was a long text about the cyp450 metabolism and that stuff. where did it go?
I hope it wasn't erased..
I can my metabolism, so i will write it again soon i think..
Posted by jonhed on May 28, 2016, at 9:16:28
In reply to Re: Fluvoxamine, posted by jonhed on May 28, 2016, at 8:44:15
My last Pdoc prescribed us patients, with either diazepam or methadone as medicine, one white grape fruit a day instead of upping the dose when he thought that we had "hit the roof".
He did an dissertation in the subject, Cytochrome P450 enzyme inhibitor and medicines. Something like that.
And when the methadone was at 100 mg daily, respectively 40 mg diazepam daily, he would give us one ecological white grapefruit a day that was to be eaten one hour before medication.
He said that in diazepam, 40 mg is equal to about 47 mg with grape one hour before, but without all the possible side effects with 7 mg more. That is because of diazepam undergoes a great variation of metabolism in your body and when CYP3A4 is inhibited to an extent the active metabolites, such as desmethyldiazepam and oxazepam will be more present but in another way.
I don't remember all off it, don't blame me for that if you know how your memory gets when you eat valium! hehe.And methadone 100 mg + grape = 110mg, same thing there but different metabolism.
But be aware, his dissertation was not about antipsychotics or any other drug.
But i think it is worth mentioning anyway, because if you can raise the serum level without raising your medicines, you will in many cases get rid of the harmful inactive metabolites :-)
In some cases when the substance HAVE to undergo metabolism to become active, this will be very very counterproductive..
I want to mention that last night i got psychosis because i tried to do a cold turkey with zopiclone and nitrazepam (been on it for 4 years), and this was day 10 without zopiclone and day two without any benzodiazepine whatsoever.Damn, now i get it. This is heavy medicines we are dealing with.
I took 15mg zopiclone and the hallucinations faded in 15 minutes.7th juni i will get detox with diazepam for 4-6 weeks, then i will never take another benzo..
But it is important to follow your doctors advice, now i know that!
Hope you're doing better today lamdage22.
Posted by ed_uk2010 on May 29, 2016, at 13:14:58
In reply to Re: MAOI + super high dose AP???, posted by linkadge on May 25, 2016, at 18:12:40
The usual outcome of ultra-high dose Zyprexa is profound weight gain and metabolic derangement, with little difference in efficacy to standard doses of up to 20mg. Sorry :/
This is the end of the thread.
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