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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by zonked on July 22, 2016, at 12:32:17
Scott, I call upon you (and others) when I'm in dire straights. 90mg Nardil, 0.75mg Klonopin, 5mg ambien and 3mg melatonin for a mostly unsatisfying sleep.
I know what this is. It's been longer than two weeks now - very little energy, lots of anxiety, little concentration, going through the motions, even seeing my family wasn't pleasurable. Nor would winning the lottery.
Anhedonia.
Psychology (I'm immersed in it, really) isn't helping me much. Here we go with the no, exercise isn't helping, opposite action isn't helping - those things all help when I'm at a decent baseline. They become inaccessible during a relapse of major depression.
I was recently re-assessed for ADHD and no longer meet criteria. I am frustrated.
I know a stimulant (in this case, Focalin XR) would provide the boost I need. I have tried other things and am too terrified to try antipsychotics. It's going to stay that way. Not interested in ECT.
I don't know how to go into the office and say, this is what I need to feel NORMAL without sounding like a crackhead.
Sigh.
z
Posted by SLS on July 22, 2016, at 16:49:08
In reply to Relapse of depression while on Nardil - SLS plz., posted by zonked on July 22, 2016, at 12:32:17
> Scott, I call upon you (and others) when I'm in dire straights. 90mg Nardil, 0.75mg Klonopin, 5mg ambien and 3mg melatonin for a mostly unsatisfying sleep.
If you can get the depression under control, then it will be worth being more aggressive in treating the insomnia.
> I know what this is. It's been longer than two weeks now - very little energy, lots of anxiety, little concentration, going through the motions, even seeing my family wasn't pleasurable. Nor would winning the lottery.
>
> Anhedonia.
>
> Psychology (I'm immersed in it, really) isn't helping me much. Here we go with the no, exercise isn't helping, opposite action isn't helping - those things all help when I'm at a decent baseline. They become inaccessible during a relapse of major depression.
>
> I was recently re-assessed for ADHD and no longer meet criteria. I am frustrated.
>
> I know a stimulant (in this case, Focalin XR) would provide the boost I need. I have tried other things and am too terrified to try antipsychotics. It's going to stay that way. Not interested in ECT.I don't think that it is yet time to consider ECT.
For depression, several people I know have used Focalin with greater success than Ritalin or Concerta. I used it briefly with some good effect. I was not responsive to other stimulants.
I have always had more success with MAOI + TCA (desipramine or nortriptyline) than with either one alone. For unipolar depression, you can try adding low-dose lithium (300-600 mg/day). If it is going to help, you will know rather quickly (3-14 days).
What is the downside of asking for treatment alternatives that your doctors might be resistant to prescribing? If he refuses to prescribe any drug for off-label use, it might be time to see someone else. In the meantime, you can start your discussion of using Focalin by telling him that you fully understand that he, as a doctor, would have concerns regarding addiction. However, ...
Although adding Focalin to Parnate or Nardil helps me with anergia and cognition, it does not help with the any other aspect of depression. By comparison, nortriptyline produces a true antidepressant response that manifests as a global in improvement.
What you might consider is to add nortriptyline to Nardil now, and switch from Nardil to a SNRI like Effexor or Cymbalta. You could then add Wellbutrin.
Nardil
Add low-dose lithium
Add nortriptyline
D/C Nardil
Start Effexor
Add Wellbutrin
D/C Wellbutrin
D/C nortriptylilne
Add RemeronAlternately, you can swap out Nardil for Parnate now, and then add low-dose lithium and/or TCA.
Based upon my personal experience, I would add lithium to Nardil first, and then add nortriptyline if necessary. Start at the lowest possible dosage and increase gradually. You might want to start taking it at bed time to prevent daytime somnolence. Your dosage will probably be 75-150 mg/day. You can have blood-tests performed to help guide you. The blood level of nortriptyline should be 50-150 ng/ml. If you go over 150 ng/ml, you might actually lose the response. This is called a therapeutic window, and is unique among the TCAs.
Eventually, you might need to attack insomnia more aggressively. Don't let insomnia be the thing that makes you give up on an effective treatment.
- Scott
Posted by Horse on July 22, 2016, at 22:50:42
In reply to Relapse of depression while on Nardil - SLS plz., posted by zonked on July 22, 2016, at 12:32:17
Hey zonked, I'm sorry you're not feeling well. You've been through a lot these past few years.
Requesting Focalin is completely reasonable. Even if you do not 'have' adhd 'now', the symptoms are there, and you know how to treat them. If you don't have or can't build a bond of trust with your doctor, maybe your situation would allow you to find another. You know the warning signs of abuse, and I'm hoping your doctor can have some faith in your self awareness.
Could a friend or sponser (SmartRecovery?) can come along for support, even if they wait outside the office.
Best wishes
Posted by zonked on July 23, 2016, at 9:44:51
In reply to Relapse of depression while on Nardil - SLS plz., posted by zonked on July 22, 2016, at 12:32:17
Whoops. My phobia of new doctors was unwarranted.
Apparently, my psychiatrist disagreed with the psychologist's interpretation of my ADHD results (I got a piece of paper on in the mail which said I didn't meet criteria for ADHD) -- the ambiguity was very small, so ADHD is still on my chart.
This is a relief for two reasons:
1. It means I will get treatment for my ADHD symptoms
2. I have had fantastic results with Focalin XR before as an augmentation agent, for ADHD and to take the lion's punch out of depression symptoms I have remaining.
I should start 10mg Focalin XR/day next week, and I also see him late next week for follow-up and titration up if necessary.
Thanks all:
Z
Posted by Horse on July 23, 2016, at 12:35:43
In reply to Re: Doing better, adding Focalin XR » zonked, posted by zonked on July 23, 2016, at 9:44:51
Great news. Btw, I like your phrasing of 'the lion's punch'.
Glad you'll be getting the help you need. Your doc sounds like an ok guy :)
This is the end of the thread.
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