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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 67. Go back in thread:
Posted by dbc on September 28, 2008, at 20:44:11
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by greywolf on September 28, 2008, at 19:39:27
Poppy pod tea (as in the pods with all the good alkaloids)works amazingly and is in the grey legal area to purchase (check ebay). Yes good old P. Somniferum is still totally legal to buy for flower arranging but strangely enough retailers sell organic ones in incredibly large lots. Clearly people are doing lots of flower arranging. You should all know the danger of ingesting morphine and codeine and know that addiction is an ever looming evil associated with imbibing such a tea.
But saying that opiates are good for depression is a long the same line as saying amphetamine is good for depression.
Lamictal works for me but in a weird way.
Posted by Bob on September 28, 2008, at 23:45:39
In reply to Re: Exotic Meds for Treatment Resistant Depression » Bob, posted by SLS on September 28, 2008, at 6:41:44
> > > My regime comprises the following:
> > >
> > > Parnate
> > > nortriptyline
> > > Lamictal
> > > Abilify
> > > NAC
> > >
> > >
> > > - Scott
>
> > Wow. You've made some major changes to your drug regimen.
>
> I consider it to be a no-lose move. If I don't respond as well to Parnate as I expect to, I might even give Marplan a whirl before returning to Nardil.
>
> > As for the Nardil induced weight gain, don't you think Nortriptyline would cause weight gain in the long run also?
>
> It does, and has. However, I find that I have success at managing my weight through diet with nortriptyline. I have lost 10 pounds in less than two weeks. Nardil is much more stubborn for me.
>
> > I thought pretty much all tricyclics were known for that.
>
> Pretty much. I think amitriptyline is probably the worst. However, I don't think they are universally worse than SSRIs. Desipramine is relatively weight-neutral. The problem with desipramine is that it tends to leave me with residual anhedonia. A pinch of serotonin is probably helpful to me.
>
> Where are you at with things?
>
>
> - Scott
I'm now taking relatively small amounts of Citalopram, Lithium, and Nortriptyline, along with a tiny pinch of Risperdal. I will eventually have to find something to add to this cocktail since I'm not getting a real robust response, but I am getting decent anxiolytic effects.Why do you combine Nortriptyline with the MAOIs? Did your doctor come up with this strategy way back in the first go-'round, or was that your idea? Wouldn't a sufficiently high dose of one or the other alone be sufficient, or is there something special about the combo of both? It seems like a quite unorthodox strategy.
Was the weight gain the only major thing that led you away from Nardil?
One last question... are you able to function sexually on your cocktails? I for one am mostly not able to, especially at fully accepted therapeutic doses.
- Bob
Posted by SLS on September 29, 2008, at 7:46:19
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by Bob on September 28, 2008, at 23:45:39
Hi Bob.
I was first place on a combination of MAOI + TCA in 1983 by the research team at Columbia University. Unfortunately, they were too sheepish to increase the dosage of Nardil beyond 45mg. I responded briefly. Subsequently, another doctor tried Parnate 60mg + desipramine 150mg. It worked.
It took some effort to have my current doctor combine MAOIs and TCAs. This time it would be nortriptyline that I was to use as the TCA. I chose it because it produced a better response when combined with Effexor than did desipramine.
My switch from Nardil to Parnate was motivated by my not maintaining a full remission with Nardil, although I was still making progress. It was just happening too slowly. I have nothing to lose except for 50 pounds, as long as nortriptyline doesn't put up too much of a fight.
> One last question... are you able to function sexually on your cocktails?
Yes, although my "performance" has been somewhat diminished, and reaching orgasm difficult. For the times I have been on Nardil, I found that the ability to reach orgasm returns after a few months - even at 90mg.
What dosages of medication are you taking?
- Scott
Posted by Bob on September 29, 2008, at 21:33:51
In reply to Re: Exotic Meds for Treatment Resistant Depression » Bob, posted by SLS on September 29, 2008, at 7:46:19
> Hi Bob.
>
> I was first place on a combination of MAOI + TCA in 1983 by the research team at Columbia University. Unfortunately, they were too sheepish to increase the dosage of Nardil beyond 45mg. I responded briefly. Subsequently, another doctor tried Parnate 60mg + desipramine 150mg. It worked.
>
> It took some effort to have my current doctor combine MAOIs and TCAs. This time it would be nortriptyline that I was to use as the TCA. I chose it because it produced a better response when combined with Effexor than did desipramine.I did a little research about MAOI's mixed with tricyclics, and couldn't find anything newer than the early eighties. What is the theory behind why these combinations would be advantageous? A couple articles did mention certain combos that seemed to be quite toxic.
Why did you stop the trial of Effexor with Desipramine?
>
> My switch from Nardil to Parnate was motivated by my not maintaining a full remission with Nardil, although I was still making progress. It was just happening too slowly. I have nothing to lose except for 50 pounds, as long as nortriptyline doesn't put up too much of a fight.
>
Is Parnate weight neutral?
> > One last question... are you able to function sexually on your cocktails?
>
> Yes, although my "performance" has been somewhat diminished, and reaching orgasm difficult. For the times I have been on Nardil, I found that the ability to reach orgasm returns after a few months - even at 90mg.
>
> What dosages of medication are you taking?
I'm on low doses of everything as I've had a history of extreme sensitivity to meds, which was greatly exacerbated by ECT a few years ago. Anyway... Notriptyline 30mg, Citalopram 20mg, Eskalith CR 225mg, and .25mg Risperdal.>
>
> - Scott
Posted by NewQuestions on September 30, 2008, at 13:12:06
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by dbc on September 28, 2008, at 20:44:11
Were you always treatment resistent or did something work for a while and then stop?
Posted by bleauberry on September 30, 2008, at 17:17:23
In reply to Exotic Meds for Treatment Resistant Depression, posted by glenni on September 27, 2008, at 5:11:48
Exotic meds for depression? Ok. How about the antibiotic Doxycycline. How about the lead/mercury chelator DMSA. I think too often we look only at the brain and fail to consider there is something else going on in the body that is impacting the brain. Like a chronic critter infection or low level metal toxicity. The absolute best I've ever felt was when on either of the above meds. They were short bursts and maybe a hint of better things to come, but certainly blew away any of the 30+ psych meds I've ever tried.
Other than that, look at stuff that doesn't make sense. Really. Not kidding. If all the stuff that makes sense doesn't work, then logic says you gotta look somewhere else because there is something else going on that you haven't identified yet.
And of course combinations abound. Maybe someone did not do well with zoloft or remeron, but did great when they tried them together? Prozac lousy, zyprexa lousy, but both together great? Ya know? Those kinds of things happen all the time. How about the guy who was bedridden for two years, was on prozac and ritalin, and then was woken from the dead to a brand new life as soon as memantine was added. Stuff happens like that.
Posted by Ant-Rock on September 30, 2008, at 19:40:15
In reply to Exotic Meds for Treatment Resistant Depression, posted by glenni on September 27, 2008, at 5:11:48
Exotic Meds you ask?
Have had TRD since 1990. Iv'e tried many many meds as well as Transcranial magnetic stimulation.
Not to mention therapy.The only time I've felt real relief has been from the following: GHB, Parnate(the first time briefly worked), Vicodin, Amisulpride, Ritalin/adderal briefly worked.
GHB when used responsibly was a wonderful temporary solution to my depression. Of course, it's not available any more.
I started coming and registered to this board in 1998-99,at the very beginning. I don't see most of the original posters names anymore, and I sometimes wonder if they have found a solution and moved on, or just accepted the situation and got tired of waiting for a new novel med that actually works.
My2cents.Anthony
Posted by theo on September 30, 2008, at 20:03:02
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by SLS on September 27, 2008, at 5:48:43
I didn't see Deplin. Did your retrial result in nightmares again?
> My regime comprises the following:
>
> Parnate
> nortriptyline
> Lamictal
> Abilify
> NAC
>
>
> - Scott
Posted by Phillipa on September 30, 2008, at 20:23:36
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by Ant-Rock on September 30, 2008, at 19:40:15
I know quite a few I e-mail with who either got better going off meds, or are just working with docs and improving. Phillipa
Posted by Phillipa on September 30, 2008, at 20:24:42
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by theo on September 30, 2008, at 20:03:02
Neither does Ron Hills. Phillipa
Posted by azalea on September 30, 2008, at 20:49:00
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by Ant-Rock on September 30, 2008, at 19:40:15
Xyrem (trade name for GHB) is currently marketed in the US by Jazz Pharmaceuticals.
>
> GHB when used responsibly was a wonderful temporary solution to my depression. Of course, it's not available any more.
>
Posted by SLS on October 1, 2008, at 7:21:18
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by Bob on September 29, 2008, at 21:33:51
Hi Bob.
> Why did you stop the trial of Effexor with Desipramine?
I responded only partially to it ~ 25% improvement.
> Is Parnate weight neutral?
I lose weight on it. I'm down over 10 pounds in 2 weeks.
> I'm on low doses of everything as I've had a history of extreme sensitivity to meds, which was greatly exacerbated by ECT a few years ago.
Very interesting. I think I encountered someone else who experienced the same thing.
> Notriptyline 30mg, Citalopram 20mg, Eskalith CR 225mg, and .25mg Risperdal.
You might want to try to sneak the nortriptyline up 10mg at a time. Most people need 75mg.
- Scott
Posted by SLS on October 1, 2008, at 7:23:13
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by NewQuestions on September 30, 2008, at 13:12:06
> Were you always treatment resistent or did something work for a while and then stop?
I have a history of responding to medications for no more than 3 days before abruptly relapsing.
- Scott
Posted by SLS on October 1, 2008, at 7:26:02
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by bleauberry on September 30, 2008, at 17:17:23
Hi BB.
> Exotic meds for depression? Ok. How about the antibiotic Doxycycline.
I tried doxycycline. I was interested in its anti-inflammatory properties along with its antibiotic properties. You need to be on it for quite awhile, but my doctor has had success with it.
- Scott
Posted by SLS on October 1, 2008, at 7:31:52
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by theo on September 30, 2008, at 20:03:02
> I didn't see Deplin. Did your retrial result in nightmares again?
Yes. It is a fascinating phenomenon that I and a few other people have such violent content to our dreams with Deplin. Why not vivid dreams of picking daisies?
For me, Deplin worked great early in treatment, but it very gradually lost its effect. It is often hard to know if something is still helping when it fades so slowly. The test for me was to discontinue Deplin to evaluate my response to it. I felt no different off of it than I did on it.
- Scott
Posted by uncouth on October 1, 2008, at 10:38:15
In reply to Re: Exotic Meds for Treatment Resistant Depression » theo, posted by SLS on October 1, 2008, at 7:31:52
Scott,
was wondering if you could talk about the Abilify and how you settled on 20mg. What sort of experimentation did you do?
im currently on 40mg Parnate, 5mg abilify, 450 Lithobid, and Lunesta/Xanax for sleep.I know abilify is tricky and works differently at different doseages, but are you using it as an a/d adjunct or a mood stabilizer? Did you test different dosages, and how did your subjective experience change as a function of that?
Thanks
uncouth
Posted by Bob on October 1, 2008, at 12:05:00
In reply to Re: Exotic Meds for Treatment Resistant Depression » Bob, posted by SLS on October 1, 2008, at 7:21:18
the same thing.
>
> > Notriptyline 30mg, Citalopram 20mg, Eskalith CR 225mg, and .25mg Risperdal.
>
> You might want to try to sneak the nortriptyline up 10mg at a time. Most people need 75mg.
>
>
> - Scott
>Actually, that is what I'm doing.
Posted by Ant-Rock on October 1, 2008, at 20:17:34
In reply to Re: Exotic Meds for Treatment Resistant Depression » Ant-Rock, posted by azalea on September 30, 2008, at 20:49:00
> Xyrem (trade name for GHB) is currently marketed in the US by Jazz Pharmaceuticals.
>
Thank you for that info Azalea.I think you need a diagnosis of narcolepsy to get a script.
It's a great band-aid anti-depressant, but not a long term solution. It got me through a whole summer of hell a few years back, with no withdrawal of any kind.Thank you again for responding.
Anthony
Posted by SLS on October 4, 2008, at 19:02:39
In reply to Re: Exotic Meds for Treatment Resistant Depression » SLS, posted by uncouth on October 1, 2008, at 10:38:15
Hi.
I tapered the dosage until I relapsed, then titrated back up to the dosage that I felt best at. For me, Abilify serves as both an adjunct antidepressant and an anti-manic mood stabilizer. Once I attain remission, I might try to back off to 10mg.
- Scott
> Scott,
> was wondering if you could talk about the Abilify and how you settled on 20mg. What sort of experimentation did you do?
> im currently on 40mg Parnate, 5mg abilify, 450 Lithobid, and Lunesta/Xanax for sleep.
>
> I know abilify is tricky and works differently at different doseages, but are you using it as an a/d adjunct or a mood stabilizer? Did you test different dosages, and how did your subjective experience change as a function of that?
>
> Thanks
> uncouth
Posted by shasling on October 20, 2008, at 21:06:40
In reply to Re: Exotic Meds for Treatment Resistant Depression » azalea, posted by Ant-Rock on October 1, 2008, at 20:17:34
Xyrem isn't exactly the same thing anyway. They changed the molecular formula just a teensy bit, but it was enough to eliminate the euphoria. Just makes you sleepy.
> > Xyrem (trade name for GHB) is currently marketed in the US by Jazz Pharmaceuticals.
> >
> Thank you for that info Azalea.
>
> I think you need a diagnosis of narcolepsy to get a script.
> It's a great band-aid anti-depressant, but not a long term solution. It got me through a whole summer of hell a few years back, with no withdrawal of any kind.
>
> Thank you again for responding.
>
> Anthony
Posted by utopizen on October 23, 2008, at 21:29:00
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by shasling on October 20, 2008, at 21:06:40
> Xyrem isn't exactly the same thing anyway. They changed the molecular formula just a teensy bit, but it was enough to eliminate the euphoria. Just makes you sleepy.
>???
Who told you this?
Anyhow, no.
As I recall, and so can the entire dorm that evacuated one cold night when some drunk kid pulled a fire alarm, I was so elated on the stuff, I was grinning off into space. While everyone else was sober enough to realize they had just woken up at 3 AM to a fire alarm on a weeknight.
Even the drunk kids were giving me weird looks.
Yes, it'll give you elation, at a high enough dose. Which is the therapeutic dose. Before that dose, you get dysphoria. And insomnia. Fun combo, for a sedative, eh?
Oh, did I mention my friends thought on certain mornings I was so depressed to talk to, it would make a widow at a funeral concerned my mood wasn't as great as hers? The docs call that special number "Morning anxiety."
Also:IT'S CONTRAINDICATED IN DEPRESSION.
You have depression already, and that 8% dysphoria figure suddenly becomes guaranteed at 100% to you. Keep in mind, depressed patients in all of the trials this data comes from are screened out, and do not enter.
Drugs can have a completely different effect on you when you have depression they wouldn't otherwise have.
It will only compound your problem. Period. It's clinically established to aggravate existing cases of depression. It's even black boxed to prevent patients with mood disorders from getting it prescribed, because it's so likely to cause dysphoria in these patients.
DO NOT DO IT. learn from my pathetic stupid waste of a college year.
Posted by utopizen on October 23, 2008, at 22:43:34
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 21:29:00
Just use ECT. 90% Efficacy rate, and for most, it works within a week's time, worst case, within the month.
If I had any idea how pathetically simple it all was, I would have done it, if I had to do it all over again. And I am in remission.
It's not worth the wait, the gambling game, of med trials for years and years.
1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
Posted by greywolf on October 24, 2008, at 20:59:06
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by utopizen on October 23, 2008, at 22:43:34
> 1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
That statement is a gross oversimplification in my view. I've got a great psychiatrist who uses ECT, but is also very forthcoming regarding its short- and long-term risks. Which is why although ECT remains an option for me, he recommended trying VNS surgery first. ECT may have an undeservedly bad rep to a certain extent, but there are practical drawbacks to its use that are well recognized by professionals.
I'm glad it worked well for you. But I'm not sure that it is fair to suggest that people who choose not to go the ECT route are being irrational or hysterical.
Continued good health to you.
Greywolf
Posted by Bob on October 24, 2008, at 21:09:56
In reply to Re: Exotic Meds for Treatment Resistant Depression, posted by greywolf on October 24, 2008, at 20:59:06
> > 1 year is fine. After that, if a doc isn't considering ECT, it's either the patient won't consent, or the doc's rationale is fundamentally grounded by hysteria, and little else. The APA fully supports its safety and efficacy.
>
> That statement is a gross oversimplification in my view. I've got a great psychiatrist who uses ECT, but is also very forthcoming regarding its short- and long-term risks. Which is why although ECT remains an option for me, he recommended trying VNS surgery first. ECT may have an undeservedly bad rep to a certain extent, but there are practical drawbacks to its use that are well recognized by professionals.
>
> I'm glad it worked well for you. But I'm not sure that it is fair to suggest that people who choose not to go the ECT route are being irrational or hysterical.
>
> Continued good health to you.
>
> Greywolf
>
I have to side with Greywolf here. I had 21 treatments of ECT and it was, in retrospect, devastating. Many people are helped by this procedure, but there is a real percentage of people who do not do well with it. I personally believe that a patient should enter into ECT treatments with care and under close supervision. This is one of the problems I think was implicated in my case was that the ECT doctors and my psychiatrist were not very communicative. Unfortunately, people who feel they need ECT are often helpless and vulnerable at this point and I'm not sure how a patient could "manage" their own care.- Bob
Posted by Sigismund on October 24, 2008, at 23:08:25
In reply to Re: Exotic Meds for Treatment Resistant Depression » greywolf, posted by Bob on October 24, 2008, at 21:09:56
This is what my psych said about ECT to me, more or less.
'I was taught that the one treatment that was successful for depression was ECT, and when I was a registrar I ordered it for some patients, and when I taught, I taught the same thing. And it was only later that I realised that I had *never* seen the results I had been told of and told others about.'
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