![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 38. Go back in thread:
Posted by Christ_empowered on August 17, 2022, at 19:10:24
In reply to Re: Venlafaxine is not an SSRI » linkadge, posted by SLS on August 17, 2022, at 12:18:44
I seem to recall reading that Effexor was originally marketed to doctors as "Prozac with kick," so the more energizing/less apathetic-making aspect seems to have been a selling point way back when.
I dread ever having to deal with an ssri again, personally. Sometimes useful when agitation and such hit, but then when that simmers down, its just...too much, not sustainable long term.
Posted by NKP on August 18, 2022, at 2:23:47
In reply to Re: Venlafaxine is not an SSRI, posted by Christ_empowered on August 17, 2022, at 19:10:24
The first time I took venlafaxine, I could not sleep* for two nights. Sertraline and citalopram never did that to me. So I agree.
* I did technically sleep, but it was a poor quality sleep, like never quite properly falling asleep, constantly feeling like I was just dozing off without falling asleep.
Posted by undopaminergic on August 19, 2022, at 5:12:58
In reply to Re: Venlafaxine is not an SSRI, posted by Christ_empowered on August 17, 2022, at 19:10:24
> I seem to recall reading that Effexor was originally marketed to doctors as "Prozac with kick," ...
>I think it was "Prozac with a punch".
-undopaminergic
Posted by beckett2 on August 20, 2022, at 23:07:37
In reply to Venlafaxine is not an SSRI, posted by linkadge on August 17, 2022, at 10:19:15
What Scott said about Pristiq matches my experience. The effects and side-effect profile were much less buzzy. Utimately, Pristq and Effexor both aggravated a mixed bipolar mood. However, if you do reasonably well on Effexor, it could be worth a try. The sexual side effects were the same for both in my case.
Posted by Christ_empowered on August 21, 2022, at 17:22:34
In reply to Re: Venlafaxine is not an SSRI » linkadge, posted by beckett2 on August 20, 2022, at 23:07:37
do you really think you need an antidepressant? I don't know your mood zone, but (as I'm sure you know, already) there are other ways to brighten mood, deal with anxiety and agitation, etc.
I really don't think everyone benefits from antidepressants, even when they go for different classes. maybe...buspirone? high doses can be helpful alone, and can help generate a response where there wasn't one before augmentation. less toxic than lithium or atypicals.
Posted by beckett2 on August 21, 2022, at 22:01:01
In reply to Re: Venlafaxine is not an SSRI, posted by Christ_empowered on August 21, 2022, at 17:22:34
> do you really think you need an antidepressant? I don't know your mood zone, but (as I'm sure you know, already) there are other ways to brighten mood, deal with anxiety and agitation, etc.
>
> I really don't think everyone benefits from antidepressants, even when they go for different classes. maybe...buspirone? high doses can be helpful alone, and can help generate a response where there wasn't one before augmentation. less toxic than lithium or atypical.Hey, C_e,
I take trintellix, and after two decades on and off AD's, imagine I'll be on them for life. I have bipolar ll. Right now I take ketamine at home, and it's amazing. If I'd had this as the first-line treatment, an AD might never have been necessary. That'll become an option for the younger generation. A study on depression and adolescents showed ketamine as the first treatment to be very promising.
Thanks for asking! I also take lamotrigine, and that works really well.
Posted by SLS on August 22, 2022, at 12:27:03
In reply to Re: Venlafaxine is not an SSRI » Christ_empowered, posted by beckett2 on August 21, 2022, at 22:01:01
Hi, Beckett2
I hope you don't mind my asking you a few questions regarding ketamine:
1. What route do you use for taking ketamine?2. What dosage are you taking?
3. How often do you take ketamine?
4. How long did it take for you to experience an improvement with ketamine?
5. Do you experience any dissociation immediately after taking ketamine?
6. What dosage of lamotrigine are you taking?
7. What brand of generic lamotrigine are you taking?
It makes a certain amount of sense to me that combining lamotrigine and ketamine would produce a synergy in reducing glutamatergic activity. Separately, both drugs reduce glutamate neural activity, albeit via different mechanisms.1. Ketamine - NMDA glutamate receptor antagonist.
2. Lamotrigine - Glutamate release inhibition.
Beckett2 - Although this combination of drugs is working well for you to treat depression, it seems counterintuitive to me when taking into consideration the efficacy of lithium to treat depression literature when considering the many reports that low dosages of lithiumI tried intranasal ketamine. It had no effect on me, even at twice the recommended dose. I should have experienced some degree of dissociation, but I didn't. In retrospect, I think the compounding pharmacy might not have prepared the drug properly.
- Scott
Posted by SLS on August 22, 2022, at 12:27:17
In reply to Re: Venlafaxine is not an SSRI » Christ_empowered, posted by beckett2 on August 21, 2022, at 22:01:01
Hi, Beckett2
I hope you don't mind my asking you a few questions regarding ketamine:
1. What route do you use for taking ketamine?2. What dosage are you taking?
3. How often do you take ketamine?
4. How long did it take for you to experience an improvement with ketamine?
5. Do you experience any dissociation immediately after taking ketamine?
6. What dosage of lamotrigine are you taking?
7. What brand of generic lamotrigine are you taking?
It makes a certain amount of sense to me that combining lamotrigine and ketamine would produce a synergy in reducing glutamatergic activity. Separately, both drugs reduce glutamate neural activity, albeit via different mechanisms.1. Ketamine - NMDA glutamate receptor antagonist.
2. Lamotrigine - Glutamate release inhibition.
Beckett2 - Although this combination of drugs is working well for you to treat depression, it seems counterintuitive to me when taking into consideration the efficacy of lithium to treat depression literature when considering the many reports that low dosages of lithiumI tried intranasal ketamine. It had no effect on me, even at twice the recommended dose. I should have experienced some degree of dissociation, but I didn't. In retrospect, I think the compounding pharmacy might not have prepared the drug properly.
- Scott
Posted by linkadge on August 22, 2022, at 18:25:50
In reply to Re: Venlafaxine is not an SSRI » Christ_empowered, posted by beckett2 on August 21, 2022, at 22:01:01
Yeah. It's sad the damage that depression does when inadequately treated. I've ruined my career, friendships and relationship opportunities repeatedly. It becomes harder to change these things over time. People who know me are baffled by why I'm not married and why I am nowhere in my career. There was a lot of promise, but mental health issues can destroy all of that.
Linkadge
Posted by SLS on August 22, 2022, at 19:16:33
In reply to Re: Venlafaxine is not an SSRI » Christ_empowered, posted by beckett2 on August 21, 2022, at 22:01:01
What I was trying to say is that the antidepressant response you experience is, on an extremely simplistic level, counterintuitive when considering the recent work with lithium and glutamate activity. That work reports a bimodal action of lithium on glutamate activity based upon dosage. At low dosages, lithium promotes an increase in glutamate activity. At higher dosage, lithium reduces glutamate activity. Glutamate is the most ubiquitous excitatory neurotransmitter. At lower dosages, lithium can have an antidepressant effect, but not an antimanic effect.
So, the question is, why do the actions of lamotrigine and ketamine to reduce glutamate activity produce an antidepressant effect when the low dosages of lithium known to exert an antidepressant effect increase glutamate activity.
Man's models of how the brain works are full of contradictions. Of course, the workings of the brain has no real contradictions. It knows very well how it works.
I think your combining lamotrigine and ketamine is a great idea.
- Scott
Posted by Jay2112 on August 22, 2022, at 21:32:46
In reply to Re: Venlafaxine is not an SSRI, posted by linkadge on August 22, 2022, at 18:25:50
> Yeah. It's sad the damage that depression does when inadequately treated. I've ruined my career, friendships and relationship opportunities repeatedly. It becomes harder to change these things over time. People who know me are baffled by why I'm not married and why I am nowhere in my career. There was a lot of promise, but mental health issues can destroy all of that.
>
>
> LinkadgeI am in a similar boat, and I think we may be in close age-range. If I give the impression that my depression is "knocked out", that is far from true. My GAD and PTSD are a little more under control, but the black dog, I doubt it will ever go away. I feel older, slower, often robbed of vocabulary. No romantic relationships.....damn this is hard to talk about. But, once in a while, a glimpse. Still....just.....still.... Plus, I am trying hard to get some semblance of a career. Trying.....but....still.
Jay
Posted by linkadge on August 23, 2022, at 12:56:36
In reply to Re: Venlafaxine is not an SSRI » linkadge, posted by Jay2112 on August 22, 2022, at 21:32:46
Yeah. If you're ever in the Barrie, Ontario area let me know. I'm 39. It might be worth chatting over a cup of coffee or something.
Linkadge
Posted by beckett2 on August 24, 2022, at 16:14:12
In reply to I should learn how to proofread better. » beckett2, posted by SLS on August 22, 2022, at 19:16:33
> What I was trying to say is that the antidepressant response you experience is, on an extremely simplistic level, counterintuitive when considering the recent work with lithium and glutamate activity. That work reports a bimodal action of lithium on glutamate activity based upon dosage. At low dosages, lithium promotes an increase in glutamate activity. At higher dosage, lithium reduces glutamate activity. Glutamate is the most ubiquitous excitatory neurotransmitter. At lower dosages, lithium can have an antidepressant effect, but not an antimanic effect.
>
> So, the question is, why do the actions of lamotrigine and ketamine to reduce glutamate activity produce an antidepressant effect when the low dosages of lithium known to exert an antidepressant effect increase glutamate activity.
>
> Man's models of how the brain works are full of contradictions. Of course, the workings of the brain has no real contradictions. It knows very well how it works.
>
> I think your combining lamotrigine and ketamine is a great idea.
>
>
> - Scott
>I really don't know. Lithium was not a good medication for me. The suicidal ideations were gone, which is remarkable, but my depression was almost as bad. Plus I have a twitch in one thumb to this day.
My understanding is Ketamine is a dirty drug. Is it? Also, I'm likely in a subset of people who had bipolar depression and fibromyalgia onset together. Interestingly, a recent study observed people with a history of childhood trauma responded more robustly.
I take troches (lozenges) at home. About what, 30-40% have no response? Also, yes, I have mild dissociation. On good days, it's very pleasant.
I hope you're still doing well. No matter the treatment, it's always a struggle to some degree. Speaking for myself at least.
Posted by SLS on August 27, 2022, at 9:12:54
In reply to Re: I should learn how to proofread better. » SLS, posted by beckett2 on August 24, 2022, at 16:14:12
Hi, Beckett2.
The point that I have been trying to emphasize is that if you are treating depression in the absence of mania, low dosages are sometimes the bullseye, whereas increasing the dosage above some threshold can actually make you feel worse. It seems that I have been unsuccessful.My sweet-spot for lithium dosage is 300 mg/day. If I take so much as one more 150 mg/day pill, I relapse. 450 mg/day is above my therapeutic window for low-dosage lithium treatment. 20 years ago, Harvard conducted a study of adding low-dosge lithium to an ongoing trial of Prozac 60 mg/day. They defined "low dosage" as being in the range of 300-600 mg/day. The dosage for responders was heavily weighted at 300 mg/day, which, again, yields a therapeutically robust response. If I discontinue lithium, I relapse about 48 hours later. At no time did any dosage above 300 mg/day make me feel better. I reacted to higher dosages by failing to glean an antidepressant response and actually suffereing an exacerbation of depression along with cognitive numbness, emotional flattening, and mild to moderate apathy. People in the arts - music and visual - report losing their creativity at full "therapeutic" dosages. The higher dosages are indeed more efficacious, but for bipolar mania or rapid cyclicity. My own opinion is that (ultra)-rapid-cyclicity, regardless of which mood state predominates, indicates lithium treatment using high-dosages.
An additional benefit of using low dosages of lithium is that side-effects are greatly reduced, including the more toxic thyroid and kidney damage. Side effects are dosage-dependent.
If you haven't yet tried a low-dosage lithium treatment, I suggest that you not abandon lithium until you do. I suggest starting at the lower end of the dosage range - 300 mg/day. I think it makes sense to begin lithium treatment at 150 mg/day. If it is going to work, you should see an improvement by day 7. If there is no response after a minimum of a week, then it makes sense to increase the dosage of lithium to 300 mg/day. Give this dosage a longer trial. Although you would probably respond within a week if it's the right dosage, I would give it a full two weeks, especially if you are beginning treatment by decreasing the dosage of ongoing lithium therapy. It is not a question of lithium's half-life or other pharmacokinetic dynamics. It is a question of waiting for the brain to find a stable dynamic equilibrium from which to move forward.
- Scott
Posted by undopaminergic on August 27, 2022, at 11:07:34
In reply to Re: I should learn how to proofread better. » beckett2, posted by SLS on August 27, 2022, at 9:12:54
I got a promising effect from lithium orotate once, but once only. I took some amount of powder and I did not weigh it. So, I think I should make an effort to try out lithium more systematically. But as of this time, it is not an easy drug for me to acquire.
-undopaminergic
Posted by beckett2 on August 28, 2022, at 18:40:10
In reply to Re: I should learn how to proofread better. » beckett2, posted by SLS on August 27, 2022, at 9:12:54
> Hi, Beckett2.
>
>
> The point that I have been trying to emphasize is that if you are treating depression in the absence of mania, low dosages are sometimes the bullseye, whereas increasing the dosage above some threshold can actually make you feel worse. It seems that I have been unsuccessful.
>
> My sweet-spot for lithium dosage is 300 mg/day. If I take so much as one more 150 mg/day pill, I relapse. 450 mg/day is above my therapeutic window for low-dosage lithium treatment. 20 years ago, Harvard conducted a study of adding low-dosge lithium to an ongoing trial of Prozac 60 mg/day. They defined "low dosage" as being in the range of 300-600 mg/day. The dosage for responders was heavily weighted at 300 mg/day, which, again, yields a therapeutically robust response. If I discontinue lithium, I relapse about 48 hours later. At no time did any dosage above 300 mg/day make me feel better. I reacted to higher dosages by failing to glean an antidepressant response and actually suffereing an exacerbation of depression along with cognitive numbness, emotional flattening, and mild to moderate apathy. People in the arts - music and visual - report losing their creativity at full "therapeutic" dosages. The higher dosages are indeed more efficacious, but for bipolar mania or rapid cyclicity. My own opinion is that (ultra)-rapid-cyclicity, regardless of which mood state predominates, indicates lithium treatment using high-dosages.
>
> An additional benefit of using low dosages of lithium is that side-effects are greatly reduced, including the more toxic thyroid and kidney damage. Side effects are dosage-dependent.
>
> If you haven't yet tried a low-dosage lithium treatment, I suggest that you not abandon lithium until you do. I suggest starting at the lower end of the dosage range - 300 mg/day. I think it makes sense to begin lithium treatment at 150 mg/day. If it is going to work, you should see an improvement by day 7. If there is no response after a minimum of a week, then it makes sense to increase the dosage of lithium to 300 mg/day. Give this dosage a longer trial. Although you would probably respond within a week if it's the right dosage, I would give it a full two weeks, especially if you are beginning treatment by decreasing the dosage of ongoing lithium therapy. It is not a question of lithium's half-life or other pharmacokinetic dynamics. It is a question of waiting for the brain to find a stable dynamic equilibrium from which to move forward.
>
>
> - Scott
>
>Thanks Scott. 300 mg is a great supplementation. That was my starting dosage, and my suicidal ideation melted away. Usually, ime, medication does not work that fast and dramatically.
I'm alright for now. Lithium and I parted not on the best of terms. Lamotrigine is a big help, too. Lithium is something I recommend to people struggling with suicidal ideation. Surprisingly, it doesn't seem to be offered enough. I don't know why.
There's more science to the function, say, in brain health. That's beyond my scientific knowledge.
Posted by Lamdage22 on August 29, 2022, at 7:00:53
In reply to Re: I should learn how to proofread better. » SLS, posted by beckett2 on August 28, 2022, at 18:40:10
Lithium is something I recommend to people struggling with suicidal ideation. Surprisingly, it doesn't seem to be offered enough. I don't know why.
>
> There's more science to the function, say, in brain health. That's beyond my scientific knowledge.I can second that. I see it more as a mineral than a medication. The medications containing natural compounds are the best. Should make you think.
Posted by SLS on August 29, 2022, at 11:31:55
In reply to Lithium for depression, posted by undopaminergic on August 27, 2022, at 11:07:34
> I got a promising effect from lithium orotate once, but once only. I took some amount of powder and I did not weigh it. So, I think I should make an effort to try out lithium more systematically. But as of this time, it is not an easy drug for me to acquire.
Why is it hard to acquire?
- Scott
Posted by SLS on August 29, 2022, at 11:46:48
In reply to Re: I should learn how to proofread better., posted by Lamdage22 on August 29, 2022, at 7:00:53
> Lithium is something I recommend to people struggling with suicidal ideation. Surprisingly, it doesn't seem to be offered enough. I don't know why.
> >
> > There's more science to the function, say, in brain health. That's beyond my scientific knowledge.
>
> I can second that. I see it more as a mineral than a medication. The medications containing natural compounds are the best. Should make you think.
Lithium is a mineral in that it appears naturally in the Earth's crust.Just because lithium is a naturally-occurring mineral rather than a complicated organic molecule, doesn't make it any less a drug. Compare the RDA of lithium in milligrams to the amount used in medicinal preparations. I would treat lithium as a drug if it is ingested in supra-nutritional amounts.
Sometimes, I think low dosages of lithium are a sort of aspirin for the brain.
- Scott
Posted by undopaminergic on August 29, 2022, at 12:44:53
In reply to Re: I should learn how to proofread better., posted by Lamdage22 on August 29, 2022, at 7:00:53
> The medications containing natural compounds are the best. Should make you think.
>Absolutely. Cocaine, scopolamine, caffeine... even some synthetics like heroin (diacetylmorphine) and aspirin (acetylsalicylic acid) are derived from natural compounds.
Does anyone know whether selegiline (l-deprenyl) is actually a natural compound derived from ephedra?
-undopaminergic
Posted by undopaminergic on August 29, 2022, at 13:00:45
In reply to Re: Lithium for depression » undopaminergic, posted by SLS on August 29, 2022, at 11:31:55
> > I got a promising effect from lithium orotate once, but once only. I took some amount of powder and I did not weigh it. So, I think I should make an effort to try out lithium more systematically. But as of this time, it is not an easy drug for me to acquire.
>
>
> Why is it hard to acquire?
>I'm hospitalised and otherwise live with my parents who have been known to go through my mail and steal my drugs, including "harmless" ones like guanfacine and piracetam. In hospital, especially a mental one, you'd think lithium would be easy to get hold of, and that is perhaps true if you are diagnosed with bipolar disorder, but they insist I have schizophrenia (subtype unspecified) and they mostly ignore not only my depression but my manic episodes as well. I do get lamotrigine however. Different doctors have different favourites or "familiars" that they will prescribe without hesitation. So far I've not run into any lithium fans.
I might take up the idea again with my prescribers, who, for that matter, are subject to change with little or no notice. In the process I might have to convince them that lithium is useful in depression in amounts lesser than those needed for mania. Do you have references to some scientific articles or textbooks that I might show them?
-undopaminergic
Posted by Lamdage22 on August 30, 2022, at 2:56:10
In reply to Re: I should learn how to proofread better. » Lamdage22, posted by SLS on August 29, 2022, at 11:46:48
> > Lithium is something I recommend to people struggling with suicidal ideation. Surprisingly, it doesn't seem to be offered enough. I don't know why.
> > >
> > > There's more science to the function, say, in brain health. That's beyond my scientific knowledge.
> >
> > I can second that. I see it more as a mineral than a medication. The medications containing natural compounds are the best. Should make you think.
>
>
> Lithium is a mineral in that it appears naturally in the Earth's crust.
>
> Just because lithium is a naturally-occurring mineral rather than a complicated organic molecule, doesn't make it any less a drug. Compare the RDA of lithium in milligrams to the amount used in medicinal preparations. I would treat lithium as a drug if it is ingested in supra-nutritional amounts.
>
> Sometimes, I think low dosages of lithium are a sort of aspirin for the brain.
>
>
> - ScottStill nature came up with the molecule.
Posted by SLS on August 30, 2022, at 7:41:10
In reply to Re: I should learn how to proofread better., posted by undopaminergic on August 29, 2022, at 12:44:53
> > The medications containing natural compounds are the best. Should make you think.
> >
>
> Absolutely. Cocaine, scopolamine, caffeine... even some synthetics like heroin (diacetylmorphine) and aspirin (acetylsalicylic acid) are derived from natural compounds.
How so? That's a hell of a destructive statement, in my less-than-humble opinion.I might be dead were it not for "unnatural" compounds. For me, "natural" herbs and nutriceuticals are inert. In fact, calcium supplements exacerbated my condition within an hour. Comments?
Didn't you once argue that classifying drugs is arbitrary? Natural vs Unnatural? Please demonstrate that this dichotomy isn't arbitrary.
Your statement carries great weight, and might dissuade some people from choosing a treatment that will give them their lives back. You never seem to take this into consideration when you submit statements like the one at the top of this post.
Please support your statement.
Thank you.
- Scott
Posted by SLS on August 30, 2022, at 8:01:17
In reply to Re: Lithium for depression, posted by undopaminergic on August 29, 2022, at 13:00:45
> > > I got a promising effect from lithium orotate once, but once only. I took some amount of powder and I did not weigh it. So, I think I should make an effort to try out lithium more systematically. But as of this time, it is not an easy drug for me to acquire.
> >
> >
> > Why is it hard to acquire?
> >
>
> I'm hospitalised and otherwise live with my parents who have been known to go through my mail and steal my drugs, including "harmless" ones like guanfacine and piracetam. In hospital, especially a mental one, you'd think lithium would be easy to get hold of, and that is perhaps true if you are diagnosed with bipolar disorder, but they insist I have schizophrenia (subtype unspecified) and they mostly ignore not only my depression but my manic episodes as well. I do get lamotrigine however. Different doctors have different favourites or "familiars" that they will prescribe without hesitation. So far I've not run into any lithium fans.
>
> I might take up the idea again with my prescribers, who, for that matter, are subject to change with little or no notice. In the process I might have to convince them that lithium is useful in depression in amounts lesser than those needed for mania. Do you have references to some scientific articles or textbooks that I might show them?
>
> -undopaminergic
Have you ever been on lithium before?Lithium oratate seems to be worthless from what I've observed here. Lithium carbonate is dirt-cheap.
Have you ever been on lithium before? If so, did it help? I am an advocate of low dosages of lithium for depression as long as there are no spontaneous manias. However, if I understand your words, you do have spontaneous manias. The minimum blood level of lithium to treat bipolar mania is 0.6 mEq/L.
Why do you think lithium is worth trying?
Why would any psychiatrist reject lithium as a treatment alternative for treatment-resistant bipolar mania? I consider your doctors' refusal to prescribe lithium to be tantamount to medical malpractice. Get assertive. Tell them that you would prefer not to leave the hospital against medical advice (AMA) just to try lithium. I think that would do the trick.
- Scott
Posted by SLS on August 30, 2022, at 8:02:17
In reply to Re: I should learn how to proofread better., posted by Lamdage22 on August 30, 2022, at 2:56:10
> > > Lithium is something I recommend to people struggling with suicidal ideation. Surprisingly, it doesn't seem to be offered enough. I don't know why.
> > > >
> > > > There's more science to the function, say, in brain health. That's beyond my scientific knowledge.
> > >
> > > I can second that. I see it more as a mineral than a medication. The medications containing natural compounds are the best. Should make you think.
> >
> >
> > Lithium is a mineral in that it appears naturally in the Earth's crust.
> >
> > Just because lithium is a naturally-occurring mineral rather than a complicated organic molecule, doesn't make it any less a drug. Compare the RDA of lithium in milligrams to the amount used in medicinal preparations. I would treat lithium as a drug if it is ingested in supra-nutritional amounts.
> >
> > Sometimes, I think low dosages of lithium are a sort of aspirin for the brain.
> >
> >
> > - Scott
>
> Still nature came up with the molecule.
And?
- Scott
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.