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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by sacct on August 1, 2016, at 19:44:08
hey, so I have OCD, social anxiety, as well as borderline personality disorder.
as far as meds pretain, I have been on pretty much all the big ones (23 to date). from luvox and prozac, all the mood stabilizers, and pretty much all the atypicals. I know people have good effects, and terrible side effects. but what happens when you have NO effects at all from these meds? no side effects, nothing.
out of all the meds, only 2 meds actually caused effects / side effects. olanzepine and mirtazepine. both were sublingual. one caused rapid weight gain, and one caused infinite depression mood.
I'm just asking. does anyone know what could cause the body to just... not use meds? genetics test said I am an ultrarapid metabolizer of 2d6 and 2c19, but all the meds I have taken orally are not working even at its max dose.
Posted by Christ_empowered on August 1, 2016, at 20:22:39
In reply to no meds working?, posted by sacct on August 1, 2016, at 19:44:08
I don't think Rx meds are the best way to handle personality disorders. Can you do DBT?I don't know about DBT, but I've had to take meds during intensive therapy. Not fun. Back in the day, I think they used low doses of Thorazine. Maybe the combo of some therapy and carefully selected Rx treatments would be helpful?
Posted by SLS on August 1, 2016, at 23:27:32
In reply to no meds working?, posted by sacct on August 1, 2016, at 19:44:08
> hey, so I have OCD, social anxiety, as well as borderline personality disorder.
Did Trileptal help at all with impulse control?
You might profit from treatment with a combination of Trileptal + antipsychotic + anti-OCD. Perhaps something like:
Clomipramine + Trileptal + Saphris
Nardil + Trileptal + Saphris
By the way, Remeron makes my depression worse.
- Scott
Posted by sacct on August 2, 2016, at 2:21:20
In reply to Re: no meds working? » sacct, posted by SLS on August 1, 2016, at 23:27:32
> > hey, so I have OCD, social anxiety, as well as borderline personality disorder.
>
> Did Trileptal help at all with impulse control?
>
> You might profit from treatment with a combination of Trileptal + antipsychotic + anti-OCD. Perhaps something like:
>
> Clomipramine + Trileptal + Saphris
>
> Nardil + Trileptal + Saphris
>
> By the way, Remeron makes my depression worse.
>
>
> - Scott
>trileptal didn't seem to do anything for my impulse control (have an unfortunately bad habit of distorted thinking / overdosing :( ). that was one of the mood stabilizers I was on for the longest. I'm thinking of trying it again.
at the moment, I am on just Geodon 20mg 2x (psychiatrist thinks it should help with distorted thinking and rumination).
as for remeron. glad to know I wasn't alone. it stopped the ever so cycling mood I had and slowed my brain down (plusses), but the depression kept happening and it felt like I was on a sinking ship as it slowly fell
Posted by sacct on August 2, 2016, at 2:21:35
In reply to Re: no meds working?, posted by Christ_empowered on August 1, 2016, at 20:22:39
>
> I don't think Rx meds are the best way to handle personality disorders. Can you do DBT?
>
> I don't know about DBT, but I've had to take meds during intensive therapy. Not fun. Back in the day, I think they used low doses of Thorazine. Maybe the combo of some therapy and carefully selected Rx treatments would be helpful?I think I am doing this right.
I am going through DBT with my therapist this time (3rd time through DBT). I couldn't get into a group because I didn't have the money.
yeah. that is what I am thinking. I am just really wondering why I felt nothing on the meds.
Posted by SLS on August 2, 2016, at 6:41:26
In reply to Re: no meds working? » SLS, posted by sacct on August 2, 2016, at 2:21:20
> > > hey, so I have OCD, social anxiety, as well as borderline personality disorder.
> >
> > Did Trileptal help at all with impulse control?
> >
> > You might profit from treatment with a combination of Trileptal + antipsychotic + anti-OCD. Perhaps something like:
> >
> > Clomipramine + Trileptal + Saphris
> >
> > Nardil + Trileptal + Saphris
> >
> > By the way, Remeron makes my depression worse.> trileptal didn't seem to do anything for my impulse control (have an unfortunately bad habit of distorted thinking / overdosing :( ). that was one of the mood stabilizers I was on for the longest. I'm thinking of trying it again.
You never know what drugs that, although ineffective as monotherapy or in one combination or another, will ultimately prove itself critical in yet another combination. If it doesn't hurt, it might make sense to leave it on board while you try other things. I have done that with lithium, Lamictal, and Abilify while switching antidepressants. Both of these drugs proved critical when I tried to lower the dosage of discontinued them. I'm feeling significantly better since adding Parnate and nortriptyline. With Trileptal, one must be careful of developing hyponatremia (low blood sodium). This is screened for by simple drug tests (electrolytes).
> at the moment, I am on just Geodon 20mg 2x (psychiatrist thinks it should help with distorted thinking and rumination).
It very well might. I think Geodon is a bit unpredictable, though. It helps some people and hurts others. If you find yourself getting hyperactive, you might need to switch to another antipsychotic sooner rather than later. I have seen a few people react very well to Saphris (asenapine) in depression, bipolar mixed-state hypomania, and schizoaffective disorder. It is rather "clean" as far as side effects are concerned, and doesn't seem to produce weight-gain. As much as I like this drug, it could, of course, not work or make you feel worse - just like any other psychotropic drug choice. Saphris works well in people who have paranoia.
Keep trying!
- Scott
Posted by sacct on August 2, 2016, at 7:26:21
In reply to Re: no meds working? » sacct, posted by SLS on August 2, 2016, at 6:41:26
> You never know what drugs that, although ineffective as monotherapy or in one combination or another, will ultimately prove itself critical in yet another combination. If it doesn't hurt, it might make sense to leave it on board while you try other things. I have done that with lithium, Lamictal, and Abilify while switching antidepressants. Both of these drugs proved critical when I tried to lower the dosage of discontinued them. I'm feeling significantly better since adding Parnate and nortriptyline. With Trileptal, one must be careful of developing hyponatremia (low blood sodium). This is screened for by simple drug tests (electrolytes).none of the docs I have seen have been willing to prescribe an MAOI for the resons you expect. what is it like to be on one, especially with the diet?
> It very well might. I think Geodon is a bit unpredictable, though. It helps some people and hurts others. If you find yourself getting hyperactive, you might need to switch to another antipsychotic sooner rather than later. I have seen a few people react very well to Saphris (asenapine) in depression, bipolar mixed-state hypomania, and schizoaffective disorder. It is rather "clean" as far as side effects are concerned, and doesn't seem to produce weight-gain. As much as I like this drug, it could, of course, not work or make you feel worse - just like any other psychotropic drug choice. Saphris works well in people who have paranoia.
>
> Keep trying!yeah, let's see how this goes. I finally fell asleep for the first time in 3 days. I planned on (if I move) not telling my next doc my full list of meds that I have tried to give everything but depakote (liver failure) and olanzepine another shot. fluvox worked until it pooped out rather suddenly.
thank you for everything
>
> - Sacct
Posted by Hello321 on August 2, 2016, at 15:06:34
In reply to no meds working?, posted by sacct on August 1, 2016, at 19:44:08
Did any meds work for you in the past?
Posted by sacct on August 2, 2016, at 15:15:11
In reply to Re: no meds working?, posted by Hello321 on August 2, 2016, at 15:06:34
> Did any meds work for you in the past?
none gave a good effect.
only 3 gave side effects (olanzepine: 20lbs a week weight gain with a bit of clarity. Remeron: stopped mood cycling but left me in deep and sinking depression. Depakote: nothing but liver issues)
the rest had no effect and I got up to their max doses and such
Posted by Chris O on August 3, 2016, at 15:45:29
In reply to no meds working?, posted by sacct on August 1, 2016, at 19:44:08
This may have no relationship to what you are experiencing at all, but I believe it is worth mentioning.
I too feel treatment resistant, especially in terms of my depressive ruminating anxiety with respect to all of the drugs in the benzo and SSRI/SNRI/S-whatever-whatever-I class. My anxiety is fairly unrelenting, especially in terms of feeling I can take care of myself. I am easily overwhelmed by the normal stresses of life.
Another thing I have noticed is that ever since most of the SSRI drugs went generic, I have almost no benefit and no side effects when I take them. I took name brand Prozac, Luvox, Wellbutrin, and Celexa in the late 90s and they all gave me substantial (medium grade) anxiety/depression relief, but with clear side effects. When I those drugs again in the mid-late 2000s, after they had been generi-cized, I got little/no benefit and almost no side effects. It just makes me ponder, no matter what the pharmaceutical industry and psychiatry says, if some generic drugs are not the same as their name brand counterparts. I don't know. Just thinking out loud.
Chris
Posted by sacct on August 4, 2016, at 10:12:47
In reply to Re: no meds working? » sacct, posted by Chris O on August 3, 2016, at 15:45:29
> This may have no relationship to what you are experiencing at all, but I believe it is worth mentioning.
>
> I too feel treatment resistant, especially in terms of my depressive ruminating anxiety with respect to all of the drugs in the benzo and SSRI/SNRI/S-whatever-whatever-I class. My anxiety is fairly unrelenting, especially in terms of feeling I can take care of myself. I am easily overwhelmed by the normal stresses of life.
>
> Another thing I have noticed is that ever since most of the SSRI drugs went generic, I have almost no benefit and no side effects when I take them. I took name brand Prozac, Luvox, Wellbutrin, and Celexa in the late 90s and they all gave me substantial (medium grade) anxiety/depression relief, but with clear side effects. When I those drugs again in the mid-late 2000s, after they had been generi-cized, I got little/no benefit and almost no side effects. It just makes me ponder, no matter what the pharmaceutical industry and psychiatry says, if some generic drugs are not the same as their name brand counterparts. I don't know. Just thinking out loud.
>
> ChrisThat's actually quite interesting. I can believe that being the case. I wonder what has become the difference between the generics vs the name brand levels?
Posted by Chris O on August 4, 2016, at 11:05:48
In reply to Re: no meds working? » Chris O, posted by sacct on August 4, 2016, at 10:12:47
"I wonder what has become the difference between the generics vs the name brand levels?"
Who knows, really, right? I mean, we're all operating on the "honor" system if my understanding is correct. No one really checks anything, and the only we we know if something is "wrong" is when people self report, and even then, there is the sense that those of us suffering from anxiety and depression are just whiny b*tches, so why take our concerns seriously? And especially why take our concerns seriously since many of us are poor? Now, if we are wealthy, and have influence and power, that is another thing. But if we are poor, we are like waste and this ever ug-lifying and self-destruive global corporate oligarchy we live in. Oh, well, I'll just go outside and enjoy the natural world, or what little of it still exists.
Chris
Posted by Baseball55 on August 4, 2016, at 20:45:21
In reply to Re: no meds working? » sacct, posted by Chris O on August 4, 2016, at 11:05:48
The FDA as well as foreign regulators certainly do check that the active ingredients in generics are the same as those in branded drugs.
wonder what has become the difference between the generics vs the name brand levels?"
>
> Who knows, really, right? I mean, we're all operating on the "honor" system if my understanding is correct. No one really checks anything, and the only we we know if something is "wrong" is when people self report, and even then, there is the sense that those of us suffering from anxiety and depression are just whiny b*tches, so why take our concerns seriously? And especially why take our concerns seriously since many of us are poor? Now, if we are wealthy, and have influence and power, that is another thing. But if we are poor, we are like waste and this ever ug-lifying and self-destruive global corporate oligarchy we live in. Oh, well, I'll just go outside and enjoy the natural world, or what little of it still exists.
>
> Chris
Posted by Chris O on August 4, 2016, at 21:42:18
In reply to Re: no meds working? » Chris O, posted by Baseball55 on August 4, 2016, at 20:45:21
Well, I'd like to believe that is true. But I don't. There was an excellent article in the New York Times about two years ago in which the FDA admitted it did not monitor any (any!) generic producing pharmaceutical companies outside of the United States. I can't find the link now, for some reason. It was a long and detailed article.
But it is pretty easy to find links such as the one below that says generic Concerta is not equivalent to name-brand. I think everyone knows about the event with generic Wellbutrin a few years back. With unfettered global neoliberalism as the world's main organizing principle, I don't think we're really operating with any system of checks and balances any more. Just my opinion. Does not mean it might not be reasonable to try a generic version of a drug that helps you. I just feel like the underlying system that produced that drug is a failure.
http://www.nytimes.com/2015/06/17/business/generic-ritalin-drug-not-equivalent-to-the-brand-is-in-use-anyway.html
Posted by SLS on August 5, 2016, at 7:39:02
In reply to Re: no meds working? » Baseball55, posted by Chris O on August 4, 2016, at 21:42:18
I relapsed into a more severe depression when I tried to switch from name brand Lamictal 200 mg/day to generic lamotrigine. I tried two generics: Teva and Mylan. Teva was better than Mylan, but neither worked well at the same dosage used with Lamictal. In retrospect, I think I could have responded well were I to use a slightly higher dosage of the Teva brand. With Mylan, I needed to go up to 500 mg/day in order to get any response at all. However I experienced too many side effects. I don't have an explanation as to why this would occur. Of possible significance, the Teva brand had the same porous consistency as Lamictal. Teva was much harder and not porous.
- Scott
Posted by Chris O on August 5, 2016, at 11:04:30
In reply to Re: no meds working?, posted by SLS on August 5, 2016, at 7:39:02
Thanks for sharing that, Scott. I don't think I've ever heard you share about generics being different from name brand drugs before.
Did your experience with generic Lamictal happen recently? Has it happened with other generic drugs you have tried?
It is terribly unjust that we have to struggle with this issue when trying to treat our depression and anxiety. It's especially unjust (for me, at least), since one of my symptoms is chronic self-doubt. As a result, sifting through whether or not my perceptions (about everything) are "real" or "due to my anxiety" is an endless nightmare.
Chris
Posted by sacct on August 5, 2016, at 11:08:56
In reply to Re: no meds working?, posted by SLS on August 5, 2016, at 7:39:02
> I relapsed into a more severe depression when I tried to switch from name brand Lamictal 200 mg/day to generic lamotrigine. I tried two generics: Teva and Mylan. Teva was better than Mylan, but neither worked well at the same dosage used with Lamictal. In retrospect, I think I could have responded well were I to use a slightly higher dosage of the Teva brand. With Mylan, I needed to go up to 500 mg/day in order to get any response at all. However I experienced too many side effects. I don't have an explanation as to why this would occur. Of possible significance, the Teva brand had the same porous consistency as Lamictal. Teva was much harder and not porous.
>
>
> - Scotthuh. I was on lamotrigine and it did nothing. this is some funky news. could it be that most of the meds had little effect because they were half-*rs*d generics?
intriguing.
Posted by SLS on August 5, 2016, at 15:59:54
In reply to Re: no meds working?, posted by SLS on August 5, 2016, at 7:39:02
> the Teva brand had the same porous consistency as Lamictal.
MYLAN was much harder and not porous.
- Scott
Posted by SLS on August 5, 2016, at 18:25:35
In reply to Re: no meds working? » SLS, posted by sacct on August 5, 2016, at 11:08:56
Hi.
> huh. I was on lamotrigine and it did nothing. this is some funky news.
It turns out that one must finesse the dosage of anticonvulsants (AED) to a much finer degree than most other classes of drugs. This may be because the therapeutic window for these drugs is relatively narrow when treating seizure disorders. Although this is true when treating epilepsy, I don't know to what degree this is true when treating mood disorders.
The FDA says that it is a myth and not true that it allows a 20% - %25 difference in bioavailability in blood levels between name brand and generics. It is more like 3.5% according to what I read. Differences are supposed to be within 1 standard deviation. It is obvious to me that this is enough of a deviation for me to respond differently to various preparations of lamotrigine; Mylan generic being substantially inferior to name brand and Teva brand. That Mylan has been approved for sale by the FDA makes me question the quality of the evaluation of this particular preparation by the FDA rather than the FDA standards themselves.
> could it be that most of the meds had little effect because they were half-*rs*d generics?
I wouldn't worry about this too much.
I think more generics are acceptable than not. Out of the six psychiatric drugs that I take, 5 are generic and work very well. The one exception is lamotrigine.
- Scott
Posted by sacct on August 5, 2016, at 20:24:40
In reply to Re: no meds working? » sacct, posted by SLS on August 5, 2016, at 18:25:35
> Hi.
>
> > huh. I was on lamotrigine and it did nothing. this is some funky news.
>
> It turns out that one must finesse the dosage of anticonvulsants (AED) to a much finer degree than most other classes of drugs. This may be because the therapeutic window for these drugs is relatively narrow when treating seizure disorders. Although this is true when treating epilepsy, I don't know to what degree this is true when treating mood disorders.
>
> The FDA says that it is a myth and not true that it allows a 20% - %25 difference in bioavailability in blood levels between name brand and generics. It is more like 3.5% according to what I read. Differences are supposed to be within 1 standard deviation. It is obvious to me that this is enough of a deviation for me to respond differently to various preparations of lamotrigine; Mylan generic being substantially inferior to name brand and Teva brand. That Mylan has been approved for sale by the FDA makes me question the quality of the evaluation of this particular preparation by the FDA rather than the FDA standards themselves.
>
> > could it be that most of the meds had little effect because they were half-*rs*d generics?
>
> I wouldn't worry about this too much.
>
> I think more generics are acceptable than not. Out of the six psychiatric drugs that I take, 5 are generic and work very well. The one exception is lamotrigine.>
> - ScottYou're probably right. I just think I am fustrated with the meds not working at all. it seems farfethed for the meds to not work at all rather than them working somewhat. or just having side effects.
This is the end of the thread.
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