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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 Christ_empowered on August 17, 2022, at 20:48:43
ugh. its that time again...
more anxiety, sometimes bordering upon panic. more looping thoughts/ruminations. sleep is off...too much, but spread out in 2 and 3 hour increments. and...
honestly, part of what -gets to me- is how ungrateful I am during times like this. my family is incredibly good to me. I'm labeled and such, but I don't have to deal with what other people with my labels are often subject to (long story...its not that I'm amazingly special, I think of it as being blessed and fortunate).
I take 20 Abilify. now and then, gabapentin, but even baby doses make me feel unable to concentrate and oddly...more emotional, in a dumbed down kind of way? -not fun- so, I generally don't take it.
ssri drugs soothe agitation, but then...I'm overly-soothed. lol. Prozac made me feel oddly apathetic, and then within that apathy...less stable (not truly -unstable-, though).
maybe just...give up? I don't know the data on depression within the context of a more severe label. does it...stop? get better? I don't even know my exact label...
and that's a big problem, because I can't be the only individual with...this "affliction," right? Right. Not that I'm trying to fit into a dsm-label, but...
for -obvious reasons- , it'd be helpful to know what to expect, especially when junk like this hits.
wellbutrin was OK. got jittery on 400mgs way back when, dropped it.
I avoid cymbalta because of previous providers. maybe just...wait for my mood to perk up?
blah. seriously considering amino acids. maybe DLPA?
Posted by SLS on August 18, 2022, at 9:26:45
In reply to antidepressant options?, posted by Christ_empowered on August 17, 2022, at 20:48:43
I am reposting here what I wrote to Linkadge yesterday. I am becoming more and more convinced that too many people on Psycho-Babble are approaching treatment of mental illness too cavalierly. Antidepressants are not PRNs. Yet, many people use them that way. The time scale of PRN usage that I see is measured in weeks rather than in hours. People expect instant improvements rather than recognize that a true remission is achieved only through establishing a new, functional homeostasis with new set-points. This is a process that often takes months rather than weeks to occur. Just because one doesn't experience a perceptible improvement in response to a treatment within 3 weeks doesn't indicate that the treatment won't ultimately produce a robust, long-term healing.
Once you settle on a treatment, try to be patient while you are evaluating its value. If you give each drug trial less than 4 weeks, you will have effectively wasted years without testing a single treatment.
-----------------------------------------------------------------------
"I used to push an idea here over the years that different is different. It is a simple concept, but too often ignored. Many people make treatment decisions based upon the faulty notion that all SSRIs are alike and interchangeable. We now know that this is not true.Another consideration is that humankind has likely not yet elucidated all of the pharmacological properties of every psychotropic drug. Scientists discover new properties of old drugs all the time, as is demonstrated by the repurposing of old drugs for new indications.
I made it a general rule for myself that I not be too smart and predict my reactions to drugs based upon what little man understands about the brain, pharmacology, and physiology in general. For the most part, I did not eliminate any drug from consideration based upon what I believed to be true about its properties. Even if I had, I would still not be able to account for the interindividual differences in the responsiveness to the same drug. Without the ability to explain this, we prove to ourselves that we simply don't know enough to anticipate how we will react to each drug we try. There is simply too little known to be able to predict anything.
If Paxil and Zoloft were identical simply because some human being dubbed both drugs as being "SSRIs", then why will someone respond to one and not the other? That's all you need to know in order to make rational treatment decisions if your mental illness is difficult to treat.
Different is different.
Don't exclude any possibilities by being "too smart". Linkadge, you are plenty smart, but scientists have not provided you with sufficient information to put the puzzle together.
Two last thoughts...
1. Don't "pulse" antidepressants.Your brain doesn't know what the hell is going on. It can't find anything resembling homeostasis from which to navigate gradually towards a true and persistent remission. Your brain is lost. It has no familiar starting point from which to begin its journey. I think you would be better off to no longer make frequent and abrupt changes to what you are assaulting the brain with. That includes herbs and nutriceuticals. Stop taking them. They will only confound the biological dynamics between drug and brain. Besides, they don't do sh*t for you. Try to find a combination of drugs that leaves you with a bearable depression as you give the brain time to establish a homeostasis - any kind of homeostasis. It would be great if you can do this without using an antidepressant in the interim. Taking a "drug holiday" for perhaps 2-3 months might make you much more responsive to the same drugs that had failed to produce an improvement previously.
2. You should expect that the journey from baseline depression to remission will be frustratingly gradual. Expect the journey to take a year or more once you begin to feel the beginnings of an improvement. Give a treatment 3 months to demonstrate the robustness of a response after you begin to improve. If you feel no improvement at all - zero - after 1 month, or you feel worse and can't tolerate side effects, you might be better off aborting the trial at that point. Wait at least two weeks before beginning a new treatment.
Homeostasis.
"
Posted by linkadge on August 18, 2022, at 10:15:56
In reply to Re: antidepressant options? - For everyone..., posted by SLS on August 18, 2022, at 9:26:45
For me, stopping escitalopram wasn't exactly a choice. I felt that it was putting me at greater risk to myself. Also, I don't exactly have the mental health support (here in Canada) to work through such side effects. I am at ~ 4/10 right now. I can't exactly tolerate something takes me down to 0/10.
Linkadge
Posted by Jay2112 on August 18, 2022, at 19:33:54
In reply to Re: antidepressant options? - For everyone... » SLS, posted by linkadge on August 18, 2022, at 10:15:56
> For me, stopping escitalopram wasn't exactly a choice. I felt that it was putting me at greater risk to myself. Also, I don't exactly have the mental health support (here in Canada) to work through such side effects. I am at ~ 4/10 right now. I can't exactly tolerate something takes me down to 0/10.
>
> LinkadgeHi Linkadge:
I don't mean to be a ball-buster..lol..but why can't you get a referral to a psychiatrist? Please don't mind my honesty...but sometimes you have to do *everything* and *anything* to get to an endpoint, such as a shrink. Why not get admitted to the hospital?? Do *whatever* it takes for your happiness and survival. AS I said before...you may have a more complicated diagnosis. Maybe need mood stabalizers...antipsychotics...with your antidepressant.
Like Scott said...you can't take these meds prn. It may take 3 or so months before you reach a homeostasis. I've been on the same complex set of meds for my bipolar II for over seven years now.
I make adjustments, with my pdoc, from time to time. But, that's just the way it is...I accept it pretty much no problem. No, I am not in bliss happy, nor never anxious, and have relapses. But, I have also made some great progress in my life.So....just some thoughts...you can do this..and I remember that great saying.."Happiness is not a fish that you can catch." But, steadiness and calm, more so.
Just IMHO...
Jay
Posted by SLS on August 18, 2022, at 20:17:18
In reply to Re: antidepressant options? - For everyone... » SLS, posted by linkadge on August 18, 2022, at 10:15:56
> For me, stopping escitalopram wasn't exactly a choice. I felt that it was putting me at greater risk to myself. Also, I don't exactly have the mental health support (here in Canada) to work through such side effects. I am at ~ 4/10 right now. I can't exactly tolerate something takes me down to 0/10.
That's not what I suggested.4/10 is not too bad - not that you would want to live that way. I'm glad that each of your conscious moments aren't torturous.
Is there anything you can treat yourself with that doesn't include a classic antidepressant that would keep your head above water for an extended period of time? Well, actually, I guess that's not absolutely necessary. If you can remain at 4/10 for 3 months without making any changes at all, that might serve as a drug-holiday of sorts. I know this is an uncomfortable idea for you, but consider your treatment history. I, myself, am very vulnerable to *Einstein's definition of insanity when it comes to playing with my medications on my own. I'm embarrassed to describe some of the unintelligent things I've done over the years - so I won't. It might take a monumental change in the way you approach treatment in order to optimize your chances of culling a more robust improvement.
It is extremely easy for me to say these things now because I am removed in time from being tortured by a hideous depression. I know very well desperation and impatience. Perhaps you should read what I wrote a few more times, and think of homeostasis as being the one variable that you have neglected. Let your brain catch its breath.
I have never come across a post of yours wherein you listed your medications and dosages. Would you be willing to let people brainstorm your treatment a bit?
I am sad that you don't have access to all of the tools that I do.
One family drugs has been conspicuously absent in your posts over the last 20 years - MAO inhibitors; specifically, Nardil, Marplan, and Parnate. EMSAM is of questionable value at the lowest dosage for depression. One *must* take a minimum dosage of EMSAM that inhibits MAO-A as well as MAO-B. Nardil is easily the best of the three for me. You might want to try Parnate first. It has a stimulant property that I would think is comparable to methylphenidate or amphetamine. Parnate doesn't have a dosage window like Nardil does, and it is usually better tolerated. That doesn't mean that Nardil won't end up being a better drug for you, of course.
I feel strongly about the the things I wrote to you earlier. Maybe just slow down a little?
* Doing the same thing over and over and expecting different results.
- Scott
Posted by SLS on August 19, 2022, at 5:57:08
In reply to Re: antidepressant options? - For everyone... » SLS, posted by linkadge on August 18, 2022, at 10:15:56
Linkadge,
I know that you are reticent about disclosing things about yourself, but a full listing of the substances that you are taking can only increase your chances of success. The few people who continue to post on Psycho-Babble are intelligent and have an impressive armament of information to offer. They are certainly creative.
- Scott
Posted by SLS on August 19, 2022, at 6:29:51
In reply to Re: antidepressant options? - For everyone... » SLS, posted by linkadge on August 18, 2022, at 10:15:56
One last thing.
(I hope you have been reading every word of my posts to you).
If you allow your brain three months to stabilize, not only will you be more responsive to treatment, I think you will be far less likely to incur side effects, especially psychiatric (mental) side effects. Most importantly, this includes severe brain-fog and the anxiety or stress of feeling "wired". I think you will be much less apt to react to so many *different* drugs the same way.
It might take you awhile to internalize these beliefs and treatment strategies if you continue to consider them with an open mind. If you make no changes internally today, maybe you will a year from now. Getting well a year from now is better than going to your grave having never experienced normal consciousness. Doing what I suggested is really a no-brainer.
I have had the good fortune of being able to pick the brains of accomplished psychiatrists / psychopharmacologist over the course of 4 decades. This includes research clinicians from Columbia, NYU, Harvard, and the National Institutes of Health (NIH). Most of them would make the same suggestions to you that I have. I swallowed my first pill in the late Spring of 1982.
Anyway, what you have been doing hasn't produced satisfactory results. That's a lot of years of failure. It's time for you to try something very different.
I will repeat what I said before:
If you never give a treatment at least a month to produce results, you might have wasted years without having effectively tried a single drug. That's heavy-duty.
Of course, it might be that what you have been doing is exactly the optimal treatment strategy that will get you well. Your approach might have a better chance of working than anything and everything that I suggested to you over the last 3 days.
I can't offer you certainty. I'm just not smart enough.
- Scott
Posted by linkadge on August 19, 2022, at 8:25:04
In reply to Re: antidepressant options? - For everyone..., posted by Jay2112 on August 18, 2022, at 19:33:54
Hi Jay,
I am on the wait list. My doctor says expect to be on that wait list for 2+ years.
As far as combinations (mood stabilizers etc) I've been there. I am currently taking lithium, but have taken tegretol, depakote, lamotrigine etc.
>you can't take these meds prn
If a med causes you to feel suicidal, you stop it. What is so complicated about that folks?
Linkadge
Posted by linkadge on August 19, 2022, at 8:28:41
In reply to Re: antidepressant options? - For everyone... » linkadge, posted by SLS on August 19, 2022, at 6:29:51
This is really the wrong board for the kinds of issues I am having.
I don't have any control over the meds that are prescribed to me. I am not a doctor.
Not all doctors take well to medications suggestions from the internet.
Linkadge
Posted by Lamdage22 on August 19, 2022, at 9:55:23
In reply to antidepressant options?, posted by Christ_empowered on August 17, 2022, at 20:48:43
There is a caveat to all of them is what I learned. Thus, I dont even bother like yall do.
Everyone can improve one little thing about themselves, their homes, health or their lives and then the next one.
Posted by Lamdage22 on August 19, 2022, at 9:56:00
In reply to Re: antidepressant options?, posted by Lamdage22 on August 19, 2022, at 9:55:23
SsRi Maoi whatever
Posted by SLS on August 19, 2022, at 19:22:04
In reply to Re: antidepressant options? - For everyone..., posted by linkadge on August 19, 2022, at 8:25:04
> Hi Jay,
>
> I am on the wait list. My doctor says expect to be on that wait list for 2+ years.
>
> As far as combinations (mood stabilizers etc) I've been there. I am currently taking lithium, but have taken tegretol, depakote, lamotrigine etc.
>
> >you can't take these meds prn
>
> If a med causes you to feel suicidal, you stop it. What is so complicated about that folks?
No one here has suggested that you force yourself to continue swallowing a pill that makes you suicidal - at least I didn't. I would be the first to suggest that you discontinue such a drug.Anything I suggest to you is motivated only by my desire to see you finally begin living.
- Scott
Posted by SLS on August 19, 2022, at 19:41:49
In reply to Re: antidepressant options? - For everyone..., posted by linkadge on August 19, 2022, at 8:28:41
> This is really the wrong board for the kinds of issues I am having.
>
> I don't have any control over the meds that are prescribed to me. I am not a doctor.
>
> Not all doctors take well to medications suggestions from the internet.
>
> Linkadge
I can't imagine how any issue regarding your quest for finding an effective treatment for a hideous disease would not be appropriate for this board. Perhaps my imagination isn't that imaginative. Is sharing a list of the substances you are taking inappropriate here?I think I have been misunderstanding your posts for a great many years. I was under the impression that you made frequent changes in your treatment without first consulting your doctor. Was my impression wrong?
Well, I can't think of anything more important to convey to you than what I already have.
I hope you give some thought to treating your brain more intelligently (gently) than I treated mine.
- Scott
Posted by SLS on August 19, 2022, at 19:44:01
In reply to Re: antidepressant options?, posted by Lamdage22 on August 19, 2022, at 9:56:00
Hi, Lamdage.
I'm having no luck trying to figure out what you are trying to convey. Can you perhaps rephrase your statements?
Thanks.
- Scott
Posted by Jay2112 on August 19, 2022, at 20:02:09
In reply to Re: antidepressant options? - For everyone..., posted by linkadge on August 19, 2022, at 8:25:04
> Hi Jay,
Hey Linkadge. I am glad you got back, and I honestly hope you are feeling good.
> I am on the wait list. My doctor says expect to be on that wait list for 2+ years.If you move down here to Niagara, I have gotten clients to a pdoc in 3-4 months, average. (Through their gp of course.) Smaller population density...easier access to services. If you'd be willing to go out of town say once a month? Have you told your doctor you are suicidal? (Even if you aren't, it will get you services faster.
> As far as combinations (mood stabilizers etc) I've been there. I am currently taking lithium, but have taken tegretol, depakote, lamotrigine etc.
But there are others..like Lyrica, Neurontin. Combinations with benzos? Those will dissipate suicidal feelings quite well, until you are used of the antidepressant.
> >you can't take these meds prn
>
> If a med causes you to feel suicidal, you stop it. What is so complicated about that folks?
>
> LinkadgeI GET that Linkadge...I have been there many times. with the restlessness and suicidality. Again, benzos will kill the edge. You have to explain this to your doctor. Benzos are a standard, in starting out antidepressants. Lorazepam is like lightning...it changes night to day. You have to inform your doctor of the suicidal thoughts with starting a.d's.
Just IMHO....(and yes, I am quite bossy with my doctors. It's my body...my choice :)
Jay
Posted by Lamdage22 on August 20, 2022, at 14:28:12
In reply to Re: antidepressant options? » Lamdage22, posted by SLS on August 19, 2022, at 19:44:01
> Hi, Lamdage.
>
> I'm having no luck trying to figure out what you are trying to convey. Can you perhaps rephrase your statements?
>
> Thanks.
>
>
> - ScottI think it is not helpful to cling to the Psychopharmaceuticals are going to fix me, if I just find the miracle med or combo. I just got an entirely different mindset than that. That is what I mean with I dont bother anymore. Even if ones mood is miraculuosly good, if one doesnt fix ones life it wont last. Im not seeing many people on meds with such a good mood in the first place. Now people say they cant fix their life but often they really can. People can sign in here and put enormous amounts of time and energy into finding the right drug. If you believed other things could help you, you could invest differently. One thing at a time. Small steps are better than no steps. You can make steps, you have proven by signing up here and participating.
Now again I hope you dont feel like Im Lou Pildering you, I just wanted to say that I have a different mindset and I am better since I do.
Not sure if I am any different than others here besides not bothering anymore to find the right drug and having hope independent of drugs.
Im not drug free, but free of the idea that they will fix me in the way that I need to be fixed.
Posted by Lamdage22 on August 20, 2022, at 14:31:29
In reply to Re: antidepressant options?, posted by Lamdage22 on August 20, 2022, at 14:28:12
My quotation marks all disappeared.
Posted by SLS on August 20, 2022, at 15:24:56
In reply to Re: antidepressant options?, posted by Lamdage22 on August 20, 2022, at 14:28:12
> > Hi, Lamdage.
> >
> > I'm having no luck trying to figure out what you are trying to convey. Can you perhaps rephrase your statements?
> >
> > Thanks.
> >
> >
> > - Scott
>
> I think it is not helpful to cling to the Psychopharmaceuticals are going to fix me, if I just find the miracle med or combo. I just got an entirely different mindset than that. That is what I mean with I dont bother anymore. Even if ones mood is miraculuosly good, if one doesnt fix ones life it wont last. Im not seeing many people on meds with such a good mood in the first place. Now people say they cant fix their life but often they really can. People can sign in here and put enormous amounts of time and energy into finding the right drug. If you believed other things could help you, you could invest differently. One thing at a time. Small steps are better than no steps. You can make steps, you have proven by signing up here and participating.
>
> Now again I hope you dont feel like Im Lou Pildering you, I just wanted to say that I have a different mindset and I am better since I do.
>
> Not sure if I am any different than others here besides not bothering anymore to find the right drug and having hope independent of drugs.
>
> Im not drug free, but free of the idea that they will fix me in the way that I need to be fixed.
>
I appreciate that you indicated that the beliefs you have about your disease doesn't generalize to everyone else. My personal experience argues against generalizing.
- Scott
Posted by Lamdage22 on August 21, 2022, at 13:45:33
In reply to Re: antidepressant options? » Lamdage22, posted by SLS on August 20, 2022, at 15:24:56
> I appreciate that you indicated that the beliefs you have about your disease doesn't generalize to everyone else. My personal experience argues against generalizing.
>
>
> - ScottI just want to remind sometimes that there is more to mental health than psychopharmaceuticals. It sometimes sounds strange to me how people talk about them here.
I was miserable on the same regimen that I am on now, and I got better. And I too talked and thought about the meds like magicians made them.
Posted by Lamdage22 on August 21, 2022, at 13:55:45
In reply to Re: antidepressant options?, posted by Lamdage22 on August 21, 2022, at 13:45:33
Ok Im going to stop disrupting the discussion. I am not Lou Pilder afterall :)
This is the end of the thread.
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