![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by SLS on December 17, 2022, at 15:52:14
I am shocked and dismayed by what I *perceive* to be a negative reaction of the entire Psycho-Babble community. I hope my suspicions are unfounded, but I dont like the way the board looks. For the few posting members who have remained as regular participants in Psycho-Babbles waning years, I have seen a single post in days. I think this is a reaction to what I have posted over the last few weeks.
No matter. I am not looking to be anyones friend. I have plenty. My goal
I must tentatively come to a few conclusions:
1. My writing voice must have seemed overly enthusiastic, pedantic, pontificating, and assertive. I used too many exclamation marks. I was perhaps too optimistic for some people, which is perfectly understandable. Hope is sometimes a curse.
2. In my opinion, the majority of the people who continue to post on Psycho-Babble have evolved over time to have the absolute worst treatment behaviors. These people have been sabotaging their treatment for years and years. If they continue down the paths that they have chosen, they will likely die depressed and without respite.
I hope that it is only my tone / writing voice that people reject or are otherwise offended by. Is my ego too strong for some of you folks? Nevertheless, I know that the content of my words is invaluable, and likely not to be seen again by any of you. I didnt get well by changing my treatment every few days. I never used Effexor as a PRN. I reject the type of self-medication that evolved on Psycho-Babble over the years. In my estimation, it has wasted years of peoples lives.
Dont waste any more.
Remission is not found in knowing how histones are affected by lithium so as to effect neuroprotection, especially in neurodegenerative diseases. Remission is not found by studying the modulatory effect of lithium on second-messenger cascades facilitated by the activity of transmembrane G-proteins, which in turn control the rate of adenyl-cyclase phosphorylation to form cyclic AMP (cAMP) from ATP.
Right?
Speaking for myself, studying these things didnt help me one bit.
Knowing the neurophysiology of low-dosage lithium administration had nothing to do with my decision to try it. Lithium worked for me, despite my ignorance of lithium pharmacology. I just opened my mouth and swallowed lithium pills.
Imagine that?
I swallowed my first pill in the Spring of 1982. It was a course of imipramine monotherapy that reached a dosage of 450 mg/day. Over the top?
I got lucky in finding remission, but only while following the clinical guidelines and using the insights of notable doctors that I spoke to along the way. Over the course of decades, I picked the brains of some of the best. Up until I found remission, I followed a treatment course / philosophy that took into consideration the clinical wisdom that I was exposed to over the course of 4 decades. I did not follow amateur armchair neuroscientists with nothing to offer you *clinically*.
What does CLINICALLY mean?
Definition:
1. In a way that relates to the observation and treatment of actual patients rather than theoretical or laboratory studies.
2. Of, relating to, or conducted in or as if in a clinic such as: involving direct observation of the patient. clinical diagnosis: based on or characterized by observable and diagnosable symptoms.
My advice to you is to study pure neuroscience less and clinical application more find out how to actually get well. Clinicians spend their time testing treatments on real people. They are much more concerned with discovering treatments that work than being concerned with knowing how they work. In 2022, does anyone really know?Who here knows what the accepted next step was to a failed course of Parnate by the research team at Columbia Presbyterian in 1982? Does this clinical protocol have any value today, or is it too old even though it worked?
I saw a Psycho-Babble member exclaim that there are no new drugs. First of all, thats not true. Even if it were, of what consequence is that to me, who attained remission using drugs that were available in 1996? In fact, all but one of them were available in the 1970s. Too old?
Lucky for me that I remained unconcerned with the approval date of psychotropic medications.
I was privileged to be exposed to the following doctors:1.Baron Shopsin
2.Frederick Quitkin
3.Robert Post
4.Patrick McGrath
5.Andrew Nierenberg
6.William Z. PotterAlong with very smart people who are not as well-known.
* Dr. Baron Shopsin was the protégé of Nathan Klein the father of psychopharmacology - while they were both performing their ground-breaking research at NYU. Shopsin wrote a ton of literature about lithium before it was approved. Actually, he helped R. R. Fieve get lithium approved by the FDA. The FDA was very resistant to this at first. These two men and their colleagues in the fledgling field of psychopharmacology brought lithium to America. Shopsin, among other things, helped describe a new diagnosis schizoaffective disorder. He proudly showed me his published book about this illness. Im sure that I would not have understood it.
Shopsin was way ahead of curve with the study of investigational serotonergic drugs from France. None of the pro-serotonergic agents that he used on me were ever submitted to the FDA for approval. Trazodone was actually the first (non-selective) serotonin reuptake inhibitor. I was treated with it in 1982, a year after it was approved. This was while I was at Columbia Presbyterian as a subject in their clinical research program. At dosages used to treat depression, I found trazodone to be a very dirty drug. It has been reported to both agonize (stimulate) and antagonize (block) various 5-HT receptors along with its serotonin reuptake properties. Trazodone acts at both postsynaptic and presynaptic 5-HT receptors. Its effects as a ligand at receptor binding sites are varied.
What I don't like about trazodone is that it is metabolized in the body into mCPP. Trazodone is a very dirty drug. Among its properties are the blockade of acetylcholine receptors ubiquitous in the hippocampus (memory center). THEORETICALLY, it can be argued that the anticholinergic properties of trazodone would actually enhance its therapeutic potential. Sadly, trazodone is a poor antidepressant as demonstrated *clinically*. It has some use in insomnia and anxiety, but thats about it as far as positive therapeutic psychiatric effects are concerned.
I miss Baron Shopsin, although our relationship ended up being strained later on. He had a mind that was particularly well-suited to operate in a frontier that had very little scientific guidance to develop treatment principles. I ate it up. I was one of the first people in the US to take a selective serotonin reuptake inhibitor. I was probably the only one to take a pure serotonin releaser (much like fenfluramine). These drugs were available to me 3-4 years before fluoxetine (Prozac) was approved. I took 3 serotonergic investigational compounds that I doubt more than a handful of psychiatrists had access to. The 3 investigational 5-HT drugs I tried (in order) were:
Pharmuka 5-HT drug series:
1. Mixed 5-HT reuptake inhibitor and releaser Indalpine.
2. Selective 5-HT reuptake (transporter) inhibitor - SSRI.
3. Pure 5-HT releaser (presynaptic)Only indalpine made it to market, and that was exclusively in France. I dont know why it was discontinued, but my guess is lack of efficacy in treating depression. It did have some anxiolytic effects, though. I found it to be a crappy antidepressant. It just made me yawn. Im not sure, but yawning might be a startup side-effect that emerges only during the first exposure to a SSRI.
One of the last things Dr. Shopsin said to me before moving to Indianapolis was to ask me to perform research intended to expose the unethical relationship between pharmaceutical companies and the FDA. I doubt he would have listed me as co-author, though. His ego was too big. Shopsin said that I do better work than his medical school students at NYU who were blessed with 170 IQ. My mistake was to tell him mine. At the time, I really didnt think 170 was stratospheric. I was genuinely naïve. Things between us deteriorated after that. He went on to tell me that he wasnt sure why I was so refractory to treatment. However, he said that my receptors were f*ck*d-up. When he left for Indianapolis, I was forced to find another doctor. On his last day, I chased him as he was pulling out of the parking lot with is Maserati. This was in 1986. He rolled down his window, and said but one word to me Periactin. Then he drove off. Periactin is cyproheptadine a drug primarily used as an antihistamine. However, its serotonergic actions were ignored. I never tried cyproheptadine, but my guess is that Shopsin thought its underappreciated serotonergic properties would help me.
I miss Baron Shopsin. He had a mind that was particularly well-suited to operate in a frontier of medicine that had very little scientific guidance to develop treatment principles. My access to him proved to be an invaluable resource to my future treatment decisions.
Sorted from the earliest date.
https://pubmed.ncbi.nlm.nih.gov/?term=shopsin+lithium&sort=pubdate&sort_order=asc&size=200
For some reason, Shopsin told me that lithium successfully treats neuroblastoma. That was in 1984. I didnt understand the significance of this at the time, but I never forgot what he said. I never looked into it until recently. I snickered and shook my head after performing a search on PubMed.
I found Malcolm Kaswan of Beth Israel. He was never a big name in the field. He did have a private practice, though. He actually brought me very close to full remission by combining tranylcypromine (Parnate) 60 mg/day + desipramine (Pamelor) 150 mg/day. It took about 2 months to get there once I began to see the first signs of improvement. Unfortunately, a delusional mania emerged in me after 6 months of a stable remission. The mania was predominantly dysphoric. It was not much fun. Kaswan had me discontinue treatment entirely. After almost exactly 2 months, I relapsed. Unfortunately, Prozac was approved by the time I saw him again. A new toy. After Prozac proved worthless to me, Kaswan refused to put me back on the drugs that got me well the first time. It made clinical sense at the time, though. So, I was forced to:
1. Suffer an anergic depression with psychomotor retardation and cognitive impairments - just like before. It was a severe depression that I would suffer with and battle against for the next 33 years. I NEVER allowed myself to make a plan or perform Google searches to find out the most effective formulas to successfully commit suicide *.
2. Find another doctor willing to try Parnate + desipramine.
3. Return to Parnate + desipramine.
4. This treatment would never again work.
* I would like to introduce here the term I came up with that I find to be more accurate when describing many but not the majority of suicides. I would certainly exclude acts of impulse:
auto-euthanasia
Lesson for TRD: Never discontinue or otherwise f*ck around with a treatment that works for you. You might not respond to it a second time.
* The bottom line is that I learned from the first two generations of psychopharmacologists. I doubt there are too many people here on Psycho-Babble who were a part of the advent of biological psychiatry. If so, I hope they weigh in.
Jeffrey Apter treated me between 1990 and 2000. He was an assistant professor at Princeton. I was his patient between 1990 and 2000. He was perhaps the most aggressive psychopharmacologists that I encountered. He was very comfortable putting me on a combination of:
1.Parnate (tranylcypromine) - MAOI
2.Pamelor (desipramine) - TCA
3.Ritalin (methylphenidate -or- Dexedrine (amphetamine)
4.Parlodel (bromocriptine)
5.T4 thyroid supratherapeutic dosages.Good luck finding a doctor who would be willing to replicate this treatment regime for you.
One day, I came in to see Dr. Apter in a hypomanic state that was precipitated by a change made in my treatment. I'm guessing it was 1997. I told him that "we" had figured out depression, and that the next frontier would be Alzheimer's Disease. Later, Dr. Apter asked me to help him write a paper on buspirone. However, he had not taken into consideration that the severity of my depression made that impossible. I had to remind him that I was no better that day than I was when first I walked through his door. After so many years, I think it might have been a sort of desensitization process for him. Thats perfectly understandable. Maybe switching doctors occasionally would obviate this.
I once asked Dr. Apter what he thought of physostigmine well before it was approved to treat Alzheimers Disease. Physostigmine (Antilirium) is an acetylcholine acetylcholinesterase inhibitor, which is analogous to a MAOI, but spares acetylcholine rather a monoamine. I had been keeping up with Alzheimer's Disease and the advent of drugs to treat it since the early 1980s while I was researching my own illness at the Rutgers medical school library. Back then, Alzheimer's was a disease that not many people knew about. I remember thinking that it was a weird and hideous disease, but not at all common. I was fascinated and horrified at the same time, but I didnt feel people in general had anything to worry about. That was the consensus of experts at the time. Then, modern medicine helped people live into their 90s. This was a different situation entirely. I think that Aricept (donepezil) is the most often prescribed of these drugs. There are less than a handful of cholinesterase inhibitors. Namenda (memantine) plays the role the go-to adjunct if Aricept monotherapy fails to work well enough. I really dont know why scientists thought a drug that blocks NMDA glutamatergic would be clinically useful. However, memantine might possess an as of yet undiscovered pharmacological property. Unfortunately, the consensus among neurologists today is that these drugs really dont work. Sad. My mother contracted Alzheimers. The combination of Aricept (donepezil) and Namenda (memantine) was inert. However, Aricept caused her to lose her sense of taste, or made food taste different and unpalatable taste perversion. I had her doctor take her off both drugs. Perhaps her greatest pleasure was the taste of food. I refused to take this away from her when the drug that caused the taste perversion was useless.
I began taking lithium over 10 years ago. I experienced a very real, but mild improvement within 6 hours. After several months of taking an inadequate regime, I decided to keep it onboard for only one reason. I wanted to reduce my risk of getting Alzheimers Disease. People with a history of unipolar or bipolar depression are *much* more likely to develop Alzheimers. There is a plethora of papers to be found on PubMed describing lithium as having the property of reducing the risk of getting Alzheimers. I first encountered this literature 20 years ago.
Does anyone know how lithium does this?
Who actually gives a damn?
By the way, this prophylactic effect of lithium occurs at dosages far lower than the lowest dose available. I stuck with 300 mg/day because that is the dosage that produced the mild improvement. At low dosages, 300-450 mg/day, lithium usually does not produce any long-lasting side effects. There will likely be some mild psychiatric side effects, including sedation, brain fog, and passivity (not to be confused with apathy). These are the things that will probably disappear by 2 weeks.
Why do I need 300 mg/day of lithium to produce an improvement in my bipolar depression when I relapse at 450 mg/day? (Lithium also works for unipolar depression, most often as an adjunct). Okay, time for a pharmacology lesson. Lithium has a bimodal response curve. People who present with depression only, including bipolar depression, improve at low dosages. However, high dosages (up to 1500 mg/day) are necessary to treat bipolar mania and as prophylaxis of bipolar mania - and possibly a necessary component when treating ultra-rapid cyclicity. This is a *clinical* observation. A pharmacological observation shows that lithium also has a bimodal distribution curve when looking at glutamatergic activity.Lithium: Bimodal clinical observations and pharmacology:
Low dosages = Successful treatment of depression.
Low dosages = Increased glutamate release.
Low dosages = Increased brain activity.* Low glutamate activity is associated with depression.
-------------
High dosages = Successful treatment of depression.
Low dosages = Increased glutamate release.
High dosages = Increased brain activity.* High glutamate activity is associated with depression.
---------------------------------------------------------------------
20 years after I moved on from Dr. Apter to Matthew Smith at NYU, Apter found a way to make a fortune. I was surprised that he had had such entrepreneurial savvy. He shifting his career from clinical psychiatry to founding a company that performed clinical trials that were paid for by pharmaceutical companies (by the head). He owes me money. He opened his clinical trial operation by focusing exclusively on Alzheimer's Disease. Im reluctant to bust his chops, though. I still have a good relationship with him.
I felt a sense of urgency to convey to Psycho-Babble what I had learned from true experts along my journey. Once I responded to treatment, I had access to the memories of my treatment history and the insights of the first two generations of psychopharmacologists. I listed many of them by name here. I was finally able to put together the knowledge, experience, and clinical gems that I was taught by these people. In 1992, when I was a research inpatient at the National Institutes of Health (NIH), I began to witness in the newest generation of biological psychiatrists the loss of the insights of the doctors who treated me outright or with whom I had consultations.
Too many people on Psycho-Babble appear to not allow medical doctors manage their treatment. *No* doctor would ever contemplate prescribing Effexor for intermittent use as a palliative PRN. The first important piece of expert advice that I received came from Columbia Presbyterian. They advised me to avoid pulsing antidepressants. Of course, this is something seen commonly on Psycho-Babble. *No* doctor would keep giving their patient the same drugs over and over again and expect different results. I know that the efforts of every single member of Psycho-Babble are brave and noble. They demonstrate great compassion and altruism. However, they also demonstrate a woeful lack of education and insight regarding the *clinical* applications of the information they find on PubMed. Remission is not found in knowing how histones are affected by lithium so as to effect neuroprotection, especially in neurodegenerative diseases.
Right?
My advice is that you spend more time researching clinical methods of treatment that result in remission rather than researching the role of adenyl cyclase in producing second-messenger cascades. Pay attention to the old along with the new. With the exception of lamotrigine, the rest of the drugs used in my treatment regime were available in the 1970s. Lamotrigine came out in 1996. I tried it as soon as it was approved. Why? Because the seizure disorder unit at the NIH told the clinical pharmacology department that a whole bunch of their patients taking lamotrigine reported that their depression improved dramatically. Their improvement was probably short-lived, though. They didnt tell my unit that, though, probably because their patients hadnt been treated with lamotrigine for very long when they reported the phenomenon Dr. Potter.
So, all of the drugs that I am currently responding to were available in 1996. I was 36 at the time. Isnt that a kick in the *ss? Instead, I struggled for another 24 years until finally, at age 60, I was freed from the bondage of bipolar depression. I doubt very much I would have found remission by using Effexor periodically for a few days as a palliative PRN, and never taking an antidepressant for more than 2 weeks. To do this is absolutely insane. This would be immediately clear to you were you to have had the privilege to be treated by some of the best minds in the field.
SMART: To achieve remission, I used a strategy that I have already described on Psycho-Babble numerous times.
LUCK: Over ten years ago, I decided to continue taking lithium in order to reduce my risk of getting Alzheimers Disease. I used 300 mg/day for prophylaxis. Dosages of lithium far lower than this have been reported as being effective. So, it turns out that had I not been taking lithium in the background, I would not have achieved remission two years ago. It was surely inadvertent.
Sometimes quite often, actually - serendipity plays a role that is just as important as the decisions of your physician.
For those of you who want to enhance your chances of finding a successful treatment for their treatment-resistant depression, you might find some value in what I have written over the last few weeks. If you are not receptive now, perhaps you will be a year from now. You might as well go back over the last few weeks and copy my posts to your computer.
I havent decided whether or not to post on the board anymore. If anyone wants to converse with me, you can use Babblemail. No one else will know.
I will not be writing anything so comprehensive and post it on Psycho-Babble again. This must include those posts of mine that are scattered around the board.
If Im wrong about everything, I apologize in advance. I suppose its possible.
Good luck.
I am shocked and dismayed by what I *perceive* to be a negative reaction of the entire Psycho-Babble community. I hope my suspicions are unfounded, but I dont like the way the board looks. For the few posting members who have remained as regular participants in Psycho-Babbles waning years, I have seen a single post in days. I think this is a reaction to what I have posted over the last few weeks.No matter. I am not looking to be anyones friend. I have plenty. My goal
I must tentatively come to a few conclusions:
1. My writing voice must have seemed overly enthusiastic, pedantic, pontificating, and assertive. I used too many exclamation marks. I was perhaps too optimistic for some people, which is perfectly understandable. Hope is sometimes a curse.
2. In my opinion, the majority of the people who continue to post on Psycho-Babble have evolved over time to have the absolute worst treatment behaviors. These people have been sabotaging their treatment for years and years. If they continue down the paths that they have chosen, they will likely die depressed and without respite.
I hope that it is only my tone / writing voice that people reject or are otherwise offended by. Is my ego too strong for some of you folks? Nevertheless, I know that the content of my words is invaluable, and likely not to be seen again by any of you. I didnt get well by changing my treatment every few days. I never used Effexor as a PRN. I reject the type of self-medication that evolved on Psycho-Babble over the years. In my estimation, it has wasted years of peoples lives.
Dont waste any more.
Remission is not found in knowing how histones are affected by lithium so as to effect neuroprotection, especially in neurodegenerative diseases. Remission is not found by studying the modulatory effect of lithium on second-messenger cascades facilitated by the activity of transmembrane G-proteins, which in turn control the rate of adenyl-cyclase phosphorylation to form cyclic AMP (cAMP) from ATP.
Right?
Speaking for myself, studying these things didnt help me one bit.
Knowing the neurophysiology of low-dosage lithium administration had nothing to do with my decision to try it. Lithium worked for me, despite my ignorance of lithium pharmacology. I just opened my mouth and swallowed lithium pills.
Imagine that?
I swallowed my first pill in the Spring of 1982. It was a course of imipramine monotherapy that reached a dosage of 450 mg/day. Over the top?
I got lucky in finding remission, but only while following the clinical guidelines and using the insights of notable doctors that I spoke to along the way. Over the course of decades, I picked the brains of some of the best. Up until I found remission, I followed a treatment course / philosophy that took into consideration the clinical wisdom that I was exposed to over the course of 4 decades. I did not follow amateur armchair neuroscientists with nothing to offer you *clinically*.
What does CLINICALLY mean?
Definition:
1. In a way that relates to the observation and treatment of actual patients rather than theoretical or laboratory studies.
2. Of, relating to, or conducted in or as if in a clinic such as: involving direct observation of the patient. clinical diagnosis: based on or characterized by observable and diagnosable symptoms.
My advice to you is to study pure neuroscience less and clinical application more find out how to actually get well. Clinicians spend their time testing treatments on real people. They are much more concerned with discovering treatments that work than being concerned with knowing how they work. In 2022, does anyone really know?Who here knows what the accepted next step was to a failed course of Parnate by the research team at Columbia Presbyterian in 1982? Does this clinical protocol have any value today, or is it too old even though it worked?
I saw a Psycho-Babble member exclaim that there are no new drugs. First of all, thats not true. Even if it were, of what consequence is that to me, who attained remission using drugs that were available in 1996? In fact, all but one of them were available in the 1970s. Too old?
Lucky for me that I remained unconcerned with the approval date of psychotropic medications.
I was privileged to be exposed to the following doctors:1.Baron Shopsin
2.Frederick Quitkin
3.Robert Post
4.Patrick McGrath
5.Andrew Nierenberg
6.William Z. PotterAlong with very smart people who are not as well-known.
* Dr. Baron Shopsin was the protégé of Nathan Klein the father of psychopharmacology - while they were both performing their ground-breaking research at NYU. Shopsin wrote a ton of literature about lithium before it was approved. Actually, he helped R. R. Fieve get lithium approved by the FDA. The FDA was very resistant to this at first. These two men and their colleagues in the fledgling field of psychopharmacology brought lithium to America. Shopsin, among other things, helped describe a new diagnosis schizoaffective disorder. He proudly showed me his published book about this illness. Im sure that I would not have understood it.
Shopsin was way ahead of curve with the study of investigational serotonergic drugs from France. None of the pro-serotonergic agents that he used on me were ever submitted to the FDA for approval. Trazodone was actually the first (non-selective) serotonin reuptake inhibitor. I was treated with it in 1982, a year after it was approved. This was while I was at Columbia Presbyterian as a subject in their clinical research program. At dosages used to treat depression, I found trazodone to be a very dirty drug. It has been reported to both agonize (stimulate) and antagonize (block) various 5-HT receptors along with its serotonin reuptake properties. Trazodone acts at both postsynaptic and presynaptic 5-HT receptors. Its effects as a ligand at receptor binding sites are varied.
What I don't like about trazodone is that it is metabolized in the body into mCPP. Trazodone is a very dirty drug. Among its properties are the blockade of acetylcholine receptors ubiquitous in the hippocampus (memory center). THEORETICALLY, it can be argued that the anticholinergic properties of trazodone would actually enhance its therapeutic potential. Sadly, trazodone is a poor antidepressant as demonstrated *clinically*. It has some use in insomnia and anxiety, but thats about it as far as positive therapeutic psychiatric effects are concerned.
I miss Baron Shopsin, although our relationship ended up being strained later on. He had a mind that was particularly well-suited to operate in a frontier that had very little scientific guidance to develop treatment principles. I ate it up. I was one of the first people in the US to take a selective serotonin reuptake inhibitor. I was probably the only one to take a pure serotonin releaser (much like fenfluramine). These drugs were available to me 3-4 years before fluoxetine (Prozac) was approved. I took 3 serotonergic investigational compounds that I doubt more than a handful of psychiatrists had access to. The 3 investigational 5-HT drugs I tried (in order) were:
Pharmuka 5-HT drug series:
1. Mixed 5-HT reuptake inhibitor and releaser Indalpine.
2. Selective 5-HT reuptake (transporter) inhibitor - SSRI.
3. Pure 5-HT releaser (presynaptic)Only indalpine made it to market, and that was exclusively in France. I dont know why it was discontinued, but my guess is lack of efficacy in treating depression. It did have some anxiolytic effects, though. I found it to be a crappy antidepressant. It just made me yawn. Im not sure, but yawning might be a startup side-effect that emerges only during the first exposure to a SSRI.
One of the last things Dr. Shopsin said to me before moving to Indianapolis was to ask me to perform research intended to expose the unethical relationship between pharmaceutical companies and the FDA. I doubt he would have listed me as co-author, though. His ego was too big. Shopsin said that I do better work than his medical school students at NYU who were blessed with 170 IQ. My mistake was to tell him mine. At the time, I really didnt think 170 was stratospheric. I was genuinely naïve. Things between us deteriorated after that. He went on to tell me that he wasnt sure why I was so refractory to treatment. However, he said that my receptors were f*ck*d-up. When he left for Indianapolis, I was forced to find another doctor. On his last day, I chased him as he was pulling out of the parking lot with is Maserati. This was in 1986. He rolled down his window, and said but one word to me Periactin. Then he drove off. Periactin is cyproheptadine a drug primarily used as an antihistamine. However, its serotonergic actions were ignored. I never tried cyproheptadine, but my guess is that Shopsin thought its underappreciated serotonergic properties would help me.
I miss Baron Shopsin. He had a mind that was particularly well-suited to operate in a frontier of medicine that had very little scientific guidance to develop treatment principles. My access to him proved to be an invaluable resource to my future treatment decisions.
Sorted from the earliest date.
https://pubmed.ncbi.nlm.nih.gov/?term=shopsin+lithium&sort=pubdate&sort_order=asc&size=200
For some reason, Shopsin told me that lithium successfully treats neuroblastoma. That was in 1984. I didnt understand the significance of this at the time, but I never forgot what he said. I never looked into it until recently. I snickered and shook my head after performing a search on PubMed.
I found Malcolm Kaswan of Beth Israel. He was never a big name in the field. He did have a private practice, though. He actually brought me very close to full remission by combining tranylcypromine (Parnate) 60 mg/day + desipramine (Pamelor) 150 mg/day. It took about 2 months to get there once I began to see the first signs of improvement. Unfortunately, a delusional mania emerged in me after 6 months of a stable remission. The mania was predominantly dysphoric. It was not much fun. Kaswan had me discontinue treatment entirely. After almost exactly 2 months, I relapsed. Unfortunately, Prozac was approved by the time I saw him again. A new toy. After Prozac proved worthless to me, Kaswan refused to put me back on the drugs that got me well the first time. It made clinical sense at the time, though. So, I was forced to:
1. Suffer an anergic depression with psychomotor retardation and cognitive impairments - just like before. It was a severe depression that I would suffer with and battle against for the next 33 years. I NEVER allowed myself to make a plan or perform Google searches to find out the most effective formulas to successfully commit suicide *.
2. Find another doctor willing to try Parnate + desipramine.
3. Return to Parnate + desipramine.
4. This treatment would never again work.
* I would like to introduce here the term I came up with that I find to be more accurate when describing many but not the majority of suicides. I would certainly exclude acts of impulse:
auto-euthanasia
Lesson for TRD: Never discontinue or otherwise f*ck around with a treatment that works for you. You might not respond to it a second time.
* The bottom line is that I learned from the first two generations of psychopharmacologists. I doubt there are too many people here on Psycho-Babble who were a part of the advent of biological psychiatry. If so, I hope they weigh in.
Jeffrey Apter treated me between 1990 and 2000. He was an assistant professor at Princeton. I was his patient between 1990 and 2000. He was perhaps the most aggressive psychopharmacologists that I encountered. He was very comfortable putting me on a combination of:
1.Parnate (tranylcypromine) - MAOI
2.Pamelor (desipramine) - TCA
3.Ritalin (methylphenidate -or- Dexedrine (amphetamine)
4.Parlodel (bromocriptine)
5.T4 thyroid supratherapeutic dosages.Good luck finding a doctor who would be willing to replicate this treatment regime for you.
One day, I came in to see Dr. Apter in a hypomanic state that was precipitated by a change made in my treatment. I'm guessing it was 1997. I told him that "we" had figured out depression, and that the next frontier would be Alzheimer's Disease. Later, Dr. Apter asked me to help him write a paper on buspirone. However, he had not taken into consideration that the severity of my depression made that impossible. I had to remind him that I was no better that day than I was when first I walked through his door. After so many years, I think it might have been a sort of desensitization process for him. Thats perfectly understandable. Maybe switching doctors occasionally would obviate this.
I once asked Dr. Apter what he thought of physostigmine well before it was approved to treat Alzheimers Disease. Physostigmine (Antilirium) is an acetylcholine acetylcholinesterase inhibitor, which is analogous to a MAOI, but spares acetylcholine rather a monoamine. I had been keeping up with Alzheimer's Disease and the advent of drugs to treat it since the early 1980s while I was researching my own illness at the Rutgers medical school library. Back then, Alzheimer's was a disease that not many people knew about. I remember thinking that it was a weird and hideous disease, but not at all common. I was fascinated and horrified at the same time, but I didnt feel people in general had anything to worry about. That was the consensus of experts at the time. Then, modern medicine helped people live into their 90s. This was a different situation entirely. I think that Aricept (donepezil) is the most often prescribed of these drugs. There are less than a handful of cholinesterase inhibitors. Namenda (memantine) plays the role the go-to adjunct if Aricept monotherapy fails to work well enough. I really dont know why scientists thought a drug that blocks NMDA glutamatergic would be clinically useful. However, memantine might possess an as of yet undiscovered pharmacological property. Unfortunately, the consensus among neurologists today is that these drugs really dont work. Sad. My mother contracted Alzheimers. The combination of Aricept (donepezil) and Namenda (memantine) was inert. However, Aricept caused her to lose her sense of taste, or made food taste different and unpalatable taste perversion. I had her doctor take her off both drugs. Perhaps her greatest pleasure was the taste of food. I refused to take this away from her when the drug that caused the taste perversion was useless.
I began taking lithium over 10 years ago. I experienced a very real, but mild improvement within 6 hours. After several months of taking an inadequate regime, I decided to keep it onboard for only one reason. I wanted to reduce my risk of getting Alzheimers Disease. People with a history of unipolar or bipolar depression are *much* more likely to develop Alzheimers. There is a plethora of papers to be found on PubMed describing lithium as having the property of reducing the risk of getting Alzheimers. I first encountered this literature 20 years ago.
Does anyone know how lithium does this?
Who actually gives a damn?
By the way, this prophylactic effect of lithium occurs at dosages far lower than the lowest dose available. I stuck with 300 mg/day because that is the dosage that produced the mild improvement. At low dosages, 300-450 mg/day, lithium usually does not produce any long-lasting side effects. There will likely be some mild psychiatric side effects, including sedation, brain fog, and passivity (not to be confused with apathy). These are the things that will probably disappear by 2 weeks.
Why do I need 300 mg/day of lithium to produce an improvement in my bipolar depression when I relapse at 450 mg/day? (Lithium also works for unipolar depression, most often as an adjunct). Okay, time for a pharmacology lesson. Lithium has a bimodal response curve. People who present with depression only, including bipolar depression, improve at low dosages. However, high dosages (up to 1500 mg/day) are necessary to treat bipolar mania and as prophylaxis of bipolar mania - and possibly a necessary component when treating ultra-rapid cyclicity. This is a *clinical* observation. A pharmacological observation shows that lithium also has a bimodal distribution curve when looking at glutamatergic activity.Lithium: Bimodal clinical observations and pharmacology:
Low dosages = Successful treatment of depression.
Low dosages = Increased glutamate release.
Low dosages = Increased brain activity.* Low glutamate activity is associated with depression.
-------------
High dosages = Successful treatment of depression.
Low dosages = Increased glutamate release.
High dosages = Increased brain activity.* High glutamate activity is associated with depression.
---------------------------------------------------------------------
20 years after I moved on from Dr. Apter to Matthew Smith at NYU, Apter found a way to make a fortune. I was surprised that he had had such entrepreneurial savvy. He shifting his career from clinical psychiatry to founding a company that performed clinical trials that were paid for by pharmaceutical companies (by the head). He owes me money. He opened his clinical trial operation by focusing exclusively on Alzheimer's Disease. Im reluctant to bust his chops, though. I still have a good relationship with him.
I felt a sense of urgency to convey to Psycho-Babble what I had learned from true experts along my journey. Once I responded to treatment, I had access to the memories of my treatment history and the insights of the first two generations of psychopharmacologists. I listed many of them by name here. I was finally able to put together the knowledge, experience, and clinical gems that I was taught by these people. In 1992, when I was a research inpatient at the National Institutes of Health (NIH), I began to witness in the newest generation of biological psychiatrists the loss of the insights of the doctors who treated me outright or with whom I had consultations.
Too many people on Psycho-Babble appear to not allow medical doctors manage their treatment. *No* doctor would ever contemplate prescribing Effexor for intermittent use as a palliative PRN. The first important piece of expert advice that I received came from Columbia Presbyterian. They advised me to avoid pulsing antidepressants. Of course, this is something seen commonly on Psycho-Babble. *No* doctor would keep giving their patient the same drugs over and over again and expect different results. I know that the efforts of every single member of Psycho-Babble are brave and noble. They demonstrate great compassion and altruism. However, they also demonstrate a woeful lack of education and insight regarding the *clinical* applications of the information they find on PubMed. Remission is not found in knowing how histones are affected by lithium so as to effect neuroprotection, especially in neurodegenerative diseases.
Right?
My advice is that you spend more time researching clinical methods of treatment that result in remission rather than researching the role of adenyl cyclase in producing second-messenger cascades. Pay attention to the old along with the new. With the exception of lamotrigine, the rest of the drugs used in my treatment regime were available in the 1970s. Lamotrigine came out in 1996. I tried it as soon as it was approved. Why? Because the seizure disorder unit at the NIH told the clinical pharmacology department that a whole bunch of their patients taking lamotrigine reported that their depression improved dramatically. Their improvement was probably short-lived, though. They didnt tell my unit that, though, probably because their patients hadnt been treated with lamotrigine for very long when they reported the phenomenon Dr. Potter.
So, all of the drugs that I am currently responding to were available in 1996. I was 36 at the time. Isnt that a kick in the *ss? Instead, I struggled for another 24 years until finally, at age 60, I was freed from the bondage of bipolar depression. I doubt very much I would have found remission by using Effexor periodically for a few days as a palliative PRN, and never taking an antidepressant for more than 2 weeks. To do this is absolutely insane. This would be immediately clear to you were you to have had the privilege to be treated by some of the best minds in the field.
SMART: To achieve remission, I used a strategy that I have already described on Psycho-Babble numerous times.
LUCK: Over ten years ago, I decided to continue taking lithium in order to reduce my risk of getting Alzheimers Disease. I used 300 mg/day for prophylaxis. Dosages of lithium far lower than this have been reported as being effective. So, it turns out that had I not been taking lithium in the background, I would not have achieved remission two years ago. It was surely inadvertent.
Sometimes quite often, actually - serendipity plays a role that is just as important as the decisions of your physician.
For those of you who want to enhance your chances of finding a successful treatment for their treatment-resistant depression, you might find some value in what I have written over the last few weeks. If you are not receptive now, perhaps you will be a year from now. You might as well go back over the last few weeks and copy my posts to your computer.
I havent decided whether or not to post on the board anymore. If anyone wants to converse with me, you can use Babblemail. No one else will know.
I will not be writing anything so comprehensive and post it on Psycho-Babble again. This must include those posts of mine that are scattered around the board.
If Im wrong about everything, I apologize in advance. I suppose its possible.
Good luck.
Posted by SLS on December 17, 2022, at 18:23:28
In reply to Consider the source. Goodbye., posted by SLS on December 17, 2022, at 15:52:14
Correction:
I think there will be several more to come. I didn't proofread my composition well enough.
----------------------------------
Lithium: Bimodal clinical observations and pharmacology:
Low dosages = Successful treatment of depression.
Low dosages = Increased glutamate release.
Low dosages = Increased brain activity.* Low glutamate activity is associated with depression.
High dosages = Successful acute treatment of bipolar mania, prophylaxis against manic and depressive phases of bipolar disorder, and an agent to reduce rapid-cyclicity.
High dosages = Reduced glutamate release.
High dosages = Reduced brain activity.* High glutamate activity is associated with depression.
----------------------------------
Posted by SLS on December 17, 2022, at 19:38:33
In reply to Consider the source. Goodbye. - Correction #1, posted by SLS on December 17, 2022, at 18:23:28
This is frustrating and embarrassing. I apologize.
----------------------------------
* High glutamate activity is associated with mania (not depression).At high dosages, lithium reduces glutamate release, thus reducing mania.
----------------------------------
Posted by gman22 on December 18, 2022, at 19:09:06
In reply to Consider the source. Goodbye., posted by SLS on December 17, 2022, at 15:52:14
SLS your advice and expertise here is priceless. I've anonymously read your post for over 15 years, maybe 20. I have taken your advice and asked my doctors for treatments bases upon your knowledge shared here. It may have well saved my life.
Please stay here, and if not send me your contact info.
Tim
Posted by Michael on December 18, 2022, at 23:09:22
In reply to Re: Consider the source. Goodbye., posted by gman22 on December 18, 2022, at 19:09:06
> SLS your advice and expertise here is priceless. I've anonymously read your post for over 15 years, maybe 20. I have taken your advice and asked my doctors for treatments bases upon your knowledge shared here. It may have well saved my life.
> Please stay here, and if not send me your contact info.
> TimThis is the first time in probably a decade that Ive checked in here. I think I was first here over 20 years ago.
In any case, Tim got it right.
Thanks Scott, for your input & feedback over the last couple decades.
(btw Scott - was looking for your psych & assoc. drugs charts - those still around anywhere?)
Oh - and Im glad to hear that you finally found some more relief. Been a long journey. ✌️
Posted by SLS on December 18, 2022, at 23:24:57
In reply to Re: Consider the source. Goodbye., posted by gman22 on December 18, 2022, at 19:09:06
> SLS your advice and expertise here is priceless. I've anonymously read your post for over 15 years, maybe 20. I have taken your advice and asked my doctors for treatments bases upon your knowledge shared here. It may have well saved my life.
> Please stay here, and if not send me your contact info.
> Tim
Tim,Your words warm my heart.
Thank you.
Perhaps I'll do the work to gather and condense the various posts of mine that I've put up during the last few weeks. They contain what I think are worthy pearls of wisdom that I learned from the first two generations of psychopharmacologists. The wisdom isn't mine. It belongs to the doctors and researchers who I encountered over the last 40 years. Well, some of them are mine. I like to make sure that my ego gets stroked from time to time. My fiance does a great job of it. I'm getting spoiled. The important stuff is scattered among multiple posts. I never thought I would go this far in posting what I consider to be material that is way past due to be made available on Psycho-Babble.
People who have ceased posting are either communicating through Babblemail to boycott Psycho-Babble, or they are too stunned to know what to say. Either scenario makes sense, but I would much rather know that everyone has been out doing their Christmas shopping.
Bizarre. Really bizarre.
I cannot guarantee that any of my suggestions will bring anyone remission from their mood disorder. However, I can guarantee that jumping around between antidepressants every other week while imbibing herbs won't.
The people who refuse to continue posting are the ones who are in most need of reading about the clinical practice of real psychopharmacology - the stuff that changes lives.
Most people who get well while posting on Psycho-Babble disappear. They have fresh, new lives to lead - fun and rewarding. I know. People here don't. That's why I came back while being fortunate enough to attain remission, for however long that lasts, and challenge people to research ways to get well - the practice of clinical psychiatry - rather than spend all of their time researching the minutia of brain biology. Look at the success rate of the people who play with drugs as if they know how to use them. They don't. This is most obvious in the case of the most intellectually gifted individual on the board (not me) and his now using Effexor intermittently as a PRN; a practice that is at best palliative and at worst reinforcing treatment refractoriness. He may know more than the clinicians he sees about protein kinase-C, but he doesn't know how to run a simple drug trial on himself that has any chance of producing a genuine antidepressant response. I don't know that I have ever seen him stick with a drug for the minimum 2-4 weeks. Maybe he has. I can't know everything he does and doesn't do. I know only what he writes. Would you stop taking a drug that gave you a 75% improvement. I wouldn't. He did.
Enough said.
I hope this person reads this because he is the person I really want to see get well, despite our history of mutual antagonism.
So...
Sorry to burden you with all of that.
Maybe we can attract people willing to think like patients instead of doctors.
Harsh stuff.
I decided that I don't have the time to coddle the stubborn ones for a year in order to get them to follow clinical advice rather than act on personal theories.
I just don't.
I will be posting a revision of my "Consider the Source" post. It grew long and turned out to be more of a narrative essay. Since I now have access to memories of my treatment history, and a recovery of critical thinking that had been buried for by depression since age 17. I had to wait 43 years to see it unearthed at age 60 when I began to respond to a new treatment regime. Despite this, my proofreading really sucks. The first version contained embarrassing errors.
Tim - Get well and stay well.
I remain indignant.
- Scott
Posted by SLS on December 19, 2022, at 1:47:59
In reply to Re: Consider the source. Goodbye., posted by Michael on December 18, 2022, at 23:09:22
> > SLS your advice and expertise here is priceless. I've anonymously read your post for over 15 years, maybe 20. I have taken your advice and asked my doctors for treatments bases upon your knowledge shared here. It may have well saved my life.
> > Please stay here, and if not send me your contact info.
> > Tim
>
> This is the first time in probably a decade that Ive checked in here. I think I was first here over 20 years ago.
>
> In any case, Tim got it right.
>
> Thanks Scott, for your input & feedback over the last couple decades.
>
> (btw Scott - was looking for your psych & assoc. drugs charts - those still around anywhere?)
>
> Oh - and Im glad to hear that you finally found some more relief. Been a long journey. ✌️
Hi, gman22.Your post is equally heartening - and surely unexpected. Believe it or not, your two posts truly justify the time and effort I devoted here. Your affirmations are priceless, and I will surely remember them.
Thanks, guys.
Regarding my drug chart, I took it down for a variety of reasons. One reason is that it is so woefully outdated, it is obsolete. I remember putting the thing together. It took forever. Whenever I pull it up on my browser, I can hardly believe its length.
- Scott
Posted by NKP on December 19, 2022, at 14:11:29
In reply to Re: Consider the source. Goodbye. » Michael, posted by SLS on December 19, 2022, at 1:47:59
I, too, have found your advice to be very valuable.
The poster that you refer to, may simply not be posting because he is going through a difficult time. A month or two back, he also stopped posting for a few weeks, when he was going through a difficult time.
Posted by SLS on December 20, 2022, at 12:31:35
In reply to Re: Consider the source. Goodbye., posted by NKP on December 19, 2022, at 14:11:29
> I, too, have found your advice to be very valuable.
>
> The poster that you refer to, may simply not be posting because he is going through a difficult time. A month or two back, he also stopped posting for a few weeks, when he was going through a difficult time.
Hi, NKPI don't think it's the same person, but your point is well-taken. My passions have been too intense here recently, so I will take your cue and cool down.
I think my writing here has been counterproductive over the last few days. Too much anger. As silly as it sounds, I want to bring everyone else with me. I went about it the wrong way. However, I am beyond certain that there has to be a major shift in focus if there is to be any chance of that happening.
I wanted to accomplish this quickly because I didn't anticipate posting very much at all from now on. Engagement rings, weddings, buying houses, and the usual stuff people do in the absence of depression. I might relapse 10 seconds from now. If I were to, I would no longer have access to the clear thinking and functional memory that enabled me write all this stuff. Depression is a walking death - a hideously altered state of consciousness. Even as I write this, I pray to God that I never relapse. My relapsing is not outside the realm of possibilities. However, my chances of maintaining remission are much better if I keep taking my medication exactly the same way for as long as I live. Getting to remission involved 4-6 week trials managed by a person who administers treatment for a living. What I see on Psycho-Babble is the most under-informed and un-intelligent approach to treating an illness for which there is the potential of being treated to remission. However, there is almost no potential to respond to the self-medication that most members of the Psycho-Babble community engage in. Things here have evolved over time to afford people a less potential to get well than what we saw when this site opened 25 years ago. I have no statistics to prove this, though. There is an archive to years worth of history of posts on Psycho-Babble. It would be interesting to review them to see how the collective mentality evolved over time.
Lots of names disappeared as a result of the LP debacle. However, for many that continued to post, a sizeable number are gone. People often leave the Psycho-Babble community when they respond well enough to treatment. They simply have no need and no time - engagement rings, weddings, buying houses, and the usual stuff people do in the absence of depression.
I guess I should really post this separately.
- Scott
Posted by undopaminergic on December 25, 2022, at 11:28:39
In reply to Consider the source. Goodbye., posted by SLS on December 17, 2022, at 15:52:14
>
> On his [Baron Shopsin's] last day, I chased him as he was pulling out of the parking lot with is Maserati. This was in 1986. He rolled down his window, and said but one word to me Periactin. Then he drove off. Periactin is cyproheptadine a drug primarily used as an antihistamine. However, its serotonergic actions were ignored. I never tried cyproheptadine, but my guess is that Shopsin thought its underappreciated serotonergic properties would help me.
>Cyproheptadine (Periactin) is a powerful 5-HT2A antagonist. One of its uses is as an antidote to serotonin syndrome. Another use is as a hypnotic. I tried it myself for the latter.
-undopaminergic
Posted by undopaminergic on December 25, 2022, at 12:09:08
In reply to Re: Consider the source. Goodbye. » NKP, posted by SLS on December 20, 2022, at 12:31:35
>
> Lots of names disappeared as a result of the LP debacle.
>For those of us who haven't experienced it, what was the LP debacle?
-undopaminergic
Posted by undopaminergic on December 25, 2022, at 12:11:58
In reply to Consider the source. Goodbye. - Correction #1, posted by SLS on December 17, 2022, at 18:23:28
> Correction:
>
> I think there will be several more to come. I didn't proofread my composition well enough.
>You are right. I read the whole post, and what bothered me most was your repeating a *very* substantial portion of the writing. It included (but was not limited to) your anecdotes about Baron Shopsin.
-undopaminergic
Posted by undopaminergic on December 25, 2022, at 12:21:39
In reply to Consider the source. Goodbye., posted by SLS on December 17, 2022, at 15:52:14
> I am shocked and dismayed by what I *perceive* to be a negative reaction of the entire Psycho-Babble community. I hope my suspicions are unfounded, but I dont like the way the board looks. For the few posting members who have remained as regular participants in Psycho-Babbles waning years, I have seen a single post in days.
>If you say so. It is true of me. I was following the football (soccer) world cup (sometimes watching 2 or even 3 90-minute+ matches a day) and continuing my practice of taking walks. I'm still trying to catch up with Psychobabble.
As a matter of fact, you advised me to spend less time on Psychobabble and thinking about my treatment, and to live my life as normal. So I was following your advice without trying, or even before reading it.
> I think this is a reaction to what I have posted over the last few weeks.
>You think people have been failing to post *because* of something *you* did?
-undopaminergic
This is the end of the thread.
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