![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by Lamdage22 on November 1, 2017, at 5:42:47
Hi dr-bob friends,
i think that my diagnosis is BS. I wasnt psychotic since 2012 when i took Nardil. So how am i schizo-affective now? They are blaming me and labeling me for something that the medication did to me.
Posted by SLS on November 1, 2017, at 8:33:28
In reply to I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 1, 2017, at 5:42:47
> Hi dr-bob friends,
>
> i think that my diagnosis is BS. I wasnt psychotic since 2012 when i took Nardil. So how am i schizo-affective now? They are blaming me and labeling me for something that the medication did to me.---------------------------------------
Just a few questions:
You might not have anything wrong with you at all, but...
Why did you start taking medication in the first place?
Do you experience depression or anxiety? Currently? At what age did these things first emerge? What came first - anxiety or depression?
Do you have a history of childhood abuse or neglect?
Can you describe in detail what you experienced when you were psychotic?
Besides Nardil, what else were you taking when you became psychotic?
How long were you treated with Nardil before you became psychotic?
How long did the psychosis last for?
Were you given antipsychotics to treat the psychosis? Which ones? How long did they take to work?
There is a type of bipolar illness that presents as chronic depression except for episodes of mania that are brought on by antidepressants. (See DSM 5).
If you don't have psychosis, then why do you continue to take two antipsychotics? (Of course, it might be that you haven't had a relapse into psychosis precisely because you continue to take antipsychotics).
Why is one antipsychotic not sufficient to treat your illness currently?
These are just some of the questions that your doctors should be asking themselves.
One question that I would have for them is how were they able to differentiate bipolar manic psychosis from schizoid psychosis?
What happens when you take higher dosages of Effexor? What is the highest dosage you have taken and for how long did you take it?
What happens when you take lithium carbonate?
Why are you taking such a high dosage of Seroquel? Why are you taking it in the first place?
- Scott
Posted by Lamdage22 on November 1, 2017, at 9:22:28
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 1, 2017, at 8:33:28
> > Hi dr-bob friends,
> >
> > i think that my diagnosis is BS. I wasnt psychotic since 2012 when i took Nardil. So how am i schizo-affective now? They are blaming me and labeling me for something that the medication did to me.
>
> ---------------------------------------
>
> Just a few questions:
>
> You might not have anything wrong with you at all, but...
>
> Why did you start taking medication in the first place?I have something wrong with me. Depression and (social) anxiety.
> Do you experience depression or anxiety? Currently? At what age did these things first emerge? What came first - anxiety or depression?
Yes. At the age of 4 or 3. My parents divorced at age 5.
> Do you have a history of childhood abuse or neglect?
Yes both.
> Can you describe in detail what you experienced when you were psychotic?
My father doesnt want me to find out what he did to me and he rather wants to lock me away. That was the first psychosis.
> Besides Nardil, what else were you taking when you became psychotic?
Mostly neuroleptics.
> How long were you treated with Nardil before you became psychotic?
4-5 weeks.
> How long did the psychosis last for?
Not very long 1-2 months. I was on Nardil several times.
> Were you given antipsychotics to treat the psychosis? Which ones? How long did they take to work?
They worked immediately except once where i withdrew them apruptly. There it took 3 months.
> There is a type of bipolar illness that presents as chronic depression except for episodes of mania that are brought on by antidepressants. (See DSM 5).
>
> If you don't have psychosis, then why do you continue to take two antipsychotics? (Of course, it might be that you haven't had a relapse into psychosis precisely because you continue to take antipsychotics).Thats possible but the opposite is also possible. I take them because i got used to them.
> Why is one antipsychotic not sufficient to treat your illness currently?
Because i was treated too aggressively after the last psychosis made by Parnate.
> These are just some of the questions that your doctors should be asking themselves.
>
> One question that I would have for them is how were they able to differentiate bipolar manic psychosis from schizoid psychosis?No idea.
> What happens when you take higher dosages of Effexor? What is the highest dosage you have taken and for how long did you take it?
I dont want to take higher dosages.
> What happens when you take lithium carbonate?
i gain 2 pounds a day.
> Why are you taking such a high dosage of Seroquel? Why are you taking it in the first place?
I was put on meds aggressively in 2012. They just gave like 5 antipsychotics.
> - Scott
>
>
>
Posted by Lamdage22 on November 1, 2017, at 11:28:54
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 1, 2017, at 9:22:28
Fact is we dont know for sure and i think that the label they give me should reflect that.
Posted by Lamdage22 on November 1, 2017, at 12:28:32
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 1, 2017, at 8:33:28
> There is a type of bipolar illness that presents as chronic depression except for episodes of mania that are brought on by antidepressants. (See DSM 5).Do you really think the DSM is so accurate and scientific?
Posted by SLS on November 1, 2017, at 14:18:33
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 1, 2017, at 12:28:32
I'm glad that you took the time to answer so many questions. Maybe someone will see something in your answers that will help you.
I'm sorry that you had such a difficult childhood.
> > There is a type of bipolar illness that presents as chronic depression except for episodes of mania that are brought on by antidepressants. (See DSM 5).
> Do you really think the DSM is so accurate and scientific?
Pretty much. I think a lot of people here would be surprised by just how exacting the DSM 5 is for diagnosing mental illnesses. Unfortunately, the entire manual is not online for free. I have seen bits and pieces of it, though. Ironically, the DSM IV was much better at diagnosing personality disorders than it was at diagnosing mood disorders.
I think we both would agree that your current treatment regime is a mess.
I really think you should consider taking therapeutic dosages of either Effexor or Paxil. You will very likely gain weight with Paxil, however it is not as bad as Zyprexa. I would also urge you to discontinue the lithium oratate. From the scientific literature I've read, it doesn't work and is more toxic than lithium carbonate at dosages necessary to produce similar blood levels. I think this is because the amount of orotic acid liberated with such high dosages is toxic. For you, I don't know that you would benefit from taking high-dosage lithium. You might be able to go without the Seroquel while you are taking Zyprexa. I think Zyprexa is a better anti-manic than is Seroquel. Was the Seroquel initially added for anxiety and insomnia? How did you end up at 950 mg/day?
I would also suggest that you consider the possibility that you can discontinue medication at a faster rate than what you have come to believe. You are not taking a benzodiazepine or opioid. One size doesnt fit all. This is not to say that you wouldnt need to taper the various medications you are on. Effexor can be painful to discontinue if it is not tapered. A reduction of dosage by only 10% every 4-6 weeks is counterproductive in my estimation. One would never be able to continue forward trialing different drugs if they have to take a year to come off of each drug they try.
- Scott
Posted by linkadge on November 1, 2017, at 19:35:15
In reply to I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 1, 2017, at 5:42:47
Hi Lamdage,
This is what I have been telling you for a few years now. If the only incidence of psychosis was in reaction to a single drug, then you need to question that diagnosis.
I'm not saying you are, or aren't. I'm just saying I, personally had a psychotic like reaction to parnate. The MAOIs can serious mess with sleeping patterns. They can also increase levels of PEA (endogenous amphetamine) by inhibiting MAO-B. Elevated PEA has been linked to paranoia and psychotic like reactions.
I too needed Seroquel in reaction to parnate, but after the parnate left my system, I no longer needed the Seroquel. Now, that being said, I was having major anxiety and sleep issues, so the Seroquel did help with that, but I've been AP free for more than a decade now, with no subsequent issues.
I'm not a doctor, but it is ok to question a diagnosis and perhaps seek a 2nd opinion. That is your right. However, do come armed with rational.
Also, if you've taken AP's for an extended period, you might need to withdrawal very slowly so that your dopamine receptors have time to adjust. If you come off too quickly, you can get rebound psychosis, even if you were never psychotic to behind with. Going slowly should avoid this problem.
Again, do consult with a doctor first.
Linkadge
Posted by SLS on November 2, 2017, at 7:39:05
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by linkadge on November 1, 2017, at 19:35:15
> Hi Lamdage,
>
> This is what I have been telling you for a few years now. If the only incidence of psychosis was in reaction to a single drug, then you need to question that diagnosis.Did you read the answers to my questions that Lamdage22 was generous enough to provide? Psychosis (mania?) emerges several times as a reaction to Nardil and Parnate.
One of the qualifiers for a diagnosis of bipolar disorder is that a manic episode triggered by an antidepressant must persist beyond its discontinuation. Although Lamdage22's manias persisted for several months, I neglected to ask whether or not the antidepressant was immediately discontinued once the psychosis emerged.
> If you come off too quickly, you can get rebound psychosis, even if you were never psychotic to behind with. Going slowly should avoid this problem.
How slow?
- Scott
Posted by SLS on November 2, 2017, at 8:05:31
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 1, 2017, at 9:22:28
Hi Lamdage.
Thank you for answering so many questions.
I forgot to ask you: Were the antidepressants that triggered your psychoses discontinued immediately once the psychosis emerged? In other words, were you treated with the MAOI and the antipsychotic at the same time for the entire few months that it took for the psychosis to resolve?
What were the symptoms of your psychosis?
Did you experience auditory or visual hallucinations? What about extreme paranoia? Disorganized thinking and speaking in word-salads?
If you had delusions, what were they?
I agree with Linkadge. You might profit from getting a second opinion.
- Scott
Posted by Lamdage22 on November 2, 2017, at 8:15:01
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 2, 2017, at 8:05:31
My psychiatrist just copied what the psychiatrists before him said. I will answer the question(s) once i am on my computer at home.
Thanks for caring.
Posted by Lamdage22 on November 2, 2017, at 12:12:09
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 2, 2017, at 8:15:01
Hi dr-bob friends,
Phenelzine was not immediately discontinued when psychosis/mania emerged. Instead the diagnosis was changed to schizo "whatever". Dont ask me why. Probably, they make more money if i take Phenelzine and Antipsychotics instead of nothing. I dont want to attack you with anti-psychiatry claims but i do not think that psychiatry is science. My opinion of the DSM and everything else psychiatry is pretty low. If you ask me my diagnosis should be "State after Phenelzine induced psychosis" "Depression" and "social anxiety".
My psychosis was mostly paranoia and the belief that i was not just neglected by my parents but also raped. Some voices but very few and i think that many times someone really said something and i just had kind of an idea of reference there. Ideas of reference where very abundant i must admit.
It is hard to say but i think i did have disorganized thoughts and i did speak word salads.
Be well.
Posted by Lamdage22 on November 2, 2017, at 12:29:25
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 2, 2017, at 12:12:09
My psychiatrist is pretty ok for a psychiatrist. He has never questionend me about the course of my life. He just copied and pasted.
Psychiatric drugs are always a mess. I am not trying anything anymore.
Posted by SLS on November 2, 2017, at 17:37:28
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 2, 2017, at 12:29:25
Hi, Lamdage22,
You have endured a great many torturous experiences, including treatment with psychiatric medications.
In my opinion, you are brave to have provided so much personal information. I know that you are resilient and constructive, and I don't blame you for being skeptical of psychiatry.
I don't want you to take this as any kind of accusation. I am only trying to provide as much information and personal opinions in an effort to help you. Your psychosis appears to be schizoid rather than pure bipolar mania. I can't diagnose you with certainty. I'm not a doctor, but I know just enough to make me dangerous. It appears that you do have schizoaffective disorder. I followed one of my friends who had schizoaffective bipolar type closely. I noticed that her schizoaffective cycle went from normal -> mania -> schizoid psychosis -> depression -> normal. For her, it was anxiety that seemed to trigger the mania. Interestingly, Xanax was capable of ameliorating the cycle by squashing the anxiety. For you, the trigger might be a MAOI. This is only a theory, of course.
Which drugs will you taper first?
- Scott
Posted by Lamdage22 on November 3, 2017, at 3:39:33
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 2, 2017, at 17:37:28
Hi Scott,
i am tapering by feel. I just went from 20mg Zyprexa to 17.5 because i was on 20mg for a long time. BTW i was certainly having OCD traits from Trazodone!! Caused me a lot of trouble.
I may go into a very good clinic for mostly psychotherapy. I may not be able to taper in that clinic. Its unfortunate but you know the deal. Psychiatrists know everything and they decide. I am not staying for more than 8 weeks.
linkadge, what do you think? I will present the info i gave you to my psychiatrist and maybe will ask for a differential diagnosis.
Posted by Lamdage22 on November 3, 2017, at 3:47:31
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 3, 2017, at 3:39:33
yesterday i took only 10mg Zyprexa instead of 17.5 by accident.
Posted by SLS on November 3, 2017, at 12:51:47
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 3, 2017, at 3:39:33
> Hi Scott,
>
> i am tapering by feel.:-)
That's how I do it most of the time. Still, try to be conservative in that you don't want to allow yourself to suffer. I call this the "flexible dosing strategy".
https://www.dr-bob.org/babble/wdrawl/20050214/msgs/457546.html
- Scott
Posted by Lamdage22 on November 3, 2017, at 15:24:10
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 3, 2017, at 12:51:47
My life is kind of torturous but i think i am learning alot of lessons as a result that i would not otherwise learn. I went out into the world pretty naively.
Posted by linkadge on November 3, 2017, at 17:55:17
In reply to Re: I have only been psychotic on Nardil. Never withou » linkadge, posted by SLS on November 2, 2017, at 7:39:05
Hi SLS,
I was referring to rebound psychosis coming off the antipsychotic, not nardil.
As far as how slowly one should withdrawal from an AP, I have no idea. I suppose it depends on the dose, the potency and the duration of treatment.
I read a book by Solomon H. Snyder (Drugs and the Brain) in which he describes a common euphoric reaction to MAOIs.
This is actually how the antidepressant effects of the MAOIs were discovered. Weren't they originally anti-tuberculosis agents? I think I recall reading that patents were experiencing an elevated mood that was incongruent with simply being cured of TB. It was from the euphoric reactions to MAOIs that the drugs were eventually tested for depression.
In comparison, imipramine was originally tried as an antipsychotic, in which it was ineffective. However, it was subsequently tested in depression in which it was effective.
I guess what I am saying, is that MAOIs can cause an abnormally elevated mood, even in mentally healthy people. As such I (personally) would not read too much into a manic or psychotic reaction.
Linkadge
Posted by linkadge on November 3, 2017, at 18:15:24
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 2, 2017, at 12:12:09
Hi Lamdage,
I must admit that your experience was a little similar to mine. I took parnate, and after a few weeks (which I contribute to lack of REM sleep), I stopped being able to filter my internal thoughts / world from my external ones.
So for example, I have some "white lies" / personal secrets in my life which I can usually mentally organize (not to get into details). However, on parnate, I could not tell who knew what about me. For example, my "white lies" / secrets all of a sudden seemed exposed to everybody.
For example, even though I have not disclosed my sexual orientation to family / friends, I felt as if that had been exposed. I had some mild feelings as if my inner thoughts were being exposed (or perhaps 'broadcast').
Another might be the way I felt about other people. It seemed as if those thoughts were "getting out" somehow. As if I, or somebody else had told other people my inner feelings / thoughts.
This is not typical for me. I attribute it to the lack of REM sleep where my brain was unable to process those feelings and integrate the internal / external me.
Also, I had feelings as thought God was peering into my thoughts (some feelings of being judged / moral guilt). The feelings of being judged made me feel pressured to expose certain 'sins'. Again, it felt as though my internal world was being pushed out.
Another feeling I had was that I had entered a new world. Everything looked extremely unfamiliar and, at times, I wondered if I had been transported into a different planet (like a movie or something).
Also, I identify with the ideas of reference. I would say that everything seemed to pertain to me in a ominous way. For example, teachers' comments seemed to be directed specifically to me.
Interestingly though, my depression lifted dramatically on it!
All of this subsided within a few weeks of discontinuation / taking Seroquel.
Interestingly, in the few days stopping parnate, I was absolutely euphoric. All of those thoughts disappeared and I felt universally "forgiven".
Anyhow. That's my experience with parnate. I've never had any experience like that on any other medication. The MAOIs are powerful!
Linkadge
Posted by linkadge on November 3, 2017, at 18:21:22
In reply to Re: I have only been psychotic on Nardil. Never withou » Lamdage22, posted by SLS on November 2, 2017, at 17:37:28
Hi SLS,
To me (and I'm no doctor as well) schizoaffective would need the symptoms to predate treatment with a particular drug.
So for example, if the individual has no history of believing things that aren't true, then I wouldn't put much credence into this symptom should it be 'treatment emergent'.
For example - healthy adults can begin to experience symptoms of psychosis after a day or two of sleep deprivation!
MAOIs can have profound effects on sleep architecture.
Linkadge
Posted by linkadge on November 3, 2017, at 18:36:21
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by Lamdage22 on November 3, 2017, at 3:39:33
>linkadge, what do you think? I will present the >info i gave you to my psychiatrist and maybe will >ask for a differential diagnosis.
Hi Lamdage. I would simply ask for a reconsideration of the diagnosis. Just ask about the possibility that the psychosis was a reaction to this particular medication.
You might discuss the timeline of what symptoms you were having before, during and after treatment with nardil.
Now, I don't have all the information myself. Also, I am not a doctor. I do know that, often doctors can diagnose you based on the symptom du jour. They are not living in your body every day. When you arm yourself with knowledge, you can get better at understanding your symptoms. For example, when you go on Wikipedia, and look up bipolar, depression, schizophrenia, OCD, GAD, schizophrenia etc. which seems to hit home the most?
This being said, you may have a *vulnerability* to this kind of reaction. That doesn't mean you (necessarily) need to be on antipsychotics long term. It may mean that you need to be careful about which drugs you take.
Whatever you do, go slowly, and listen to how you're reacting. Don't be afraid to go back a step, if it's not going how you expect.
For me, I'm not exactly sure what I have. It may be some form of bipolar, but it may also be agitated depression.
In reality thought. There are trillions of different combinations of genetic variations. We don't all have 1 of 4 or 5 diseases!!
Linakdge
Posted by linkadge on November 3, 2017, at 18:46:09
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by linkadge on November 3, 2017, at 18:36:21
Just to add one thing. I know the feeling of wanting to "get off" a drug. Sometimes one starts to feel strongly against a particular drug and wants to get off it ASAP.
If you are on say 20mg of Zyprexa. I (personally) wouldn't get off this any faster than 6 months. For me, it took 2 weeks to really get off 2.5m of Zyprexa.
The slower you go, the more likely you are going to be able to sort things out.
- if I am cycling, is the desire to get off part of a particular mood in the cycle?
- if I get off too quickly the underling illness may return.
- if I get off too quickly I may be in denial about perhaps needing the drug
-if I get off too quickly, new (i.e. withdrawal) symptoms may emerge. These may look like a brand new illness and get me a new (possibly incorrect) diagnosis.
- if I get off too quickly, the adjustment may be too severe, causing me to give up and go back to full dose
The slower you go, the more likely you are to determine whether you are making the right decision or not.
Linkadge
Posted by SLS on November 3, 2017, at 21:27:38
In reply to Re: I have only been psychotic on Nardil. Never withou » SLS, posted by linkadge on November 3, 2017, at 17:55:17
> Hi SLS,
>
> I was referring to rebound psychosis coming off the antipsychotic, not nardil.Yes. I fully understood your concern.
> As far as how slowly one should withdrawal from an AP, I have no idea. I suppose it depends on the dose, the potency and the duration of treatment.
What about for coming off of Seroquel 950 mg/day taken for over a year? What might that look like?
Yes, the history of drug discovery for mental illness involves a great deal of serendipity.
- Scott
Posted by SLS on November 3, 2017, at 22:02:17
In reply to Re: I have only been psychotic on Nardil. Never withou » SLS, posted by linkadge on November 3, 2017, at 18:21:22
> Hi SLS,
>
> To me (and I'm no doctor as well) schizoaffective would need the symptoms to predate treatment with a particular drug.I guess that depends on whether or not you believe that antidepressants can uncover otherwise occult bipolar disorder. In my layman way of thinking, if antidepressants can indeed uncover bipolar disorder, then any schizoid psychosis that follows would indicate something other than uncomplicated bipolar disorder. It would be interesting to talk to a few researchers about this. I am absolutely sure that not all occurrences of mania and psychosis that appear as the result of exposure to chemical substances are evidence of mental illness. I have seen prednisone do this to an elderly woman who had no history of mental illness. She experienced visual and auditory hallucinations while the drug was being administered in the hospital. Fortunately, the psychosis resolved immediately upon the discontinuation of the drug.
- Scott
Posted by Lamdage22 on November 4, 2017, at 9:22:05
In reply to Re: I have only been psychotic on Nardil. Never withou, posted by SLS on November 3, 2017, at 22:02:17
Hi Dr-Bob friends,
i believe i am at risk for tardive dementia. I experience memory loss and difficulty concentrating. I have this since taking more than 300mg Seroquel. I dont know if its getting worse or not but i do know that i rather have diabetes than dementia. I dont like either one but diabetes is not as disabling as dementia.
I hate to weigh one terrible thing with the next like that. Thus my repulsion of meds. I think it should be understandable even to psychiatrists or pro-psychiatry people. They really think that their meds are such a blessing. I dont understand it. I rather suffer from depression or anxiety that i naturally have than from freaky side effects and long-term consequences. I have had enough.
I have had a very difficult time yesterday. Today its much better though. I am not going higher with the Trazodone because i dont even know if it will help. I have been taking 45mg for a week, then went back to 50 and became suicidal. So i dont know if i should go to 55mg or to 45mg. I think i just have to sit this one out.
I have gotten accustomed to taking 0,25 mg Lorazepam at night which i dont like. I took Lorazepam twice last weekend against suicidal thoughts and now it seems my body demands those 0,25mg.
I am thinking about diluting the 0,25 and do my usual 10% less thing. Just not taking it does not seem to work.
Regards,
Lamdage
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.