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Dr. Bob is Robert Hsiung, MD,
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Posted by desolationrower on January 23, 2009, at 13:04:47
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 23, 2009, at 7:17:16
despite your self-report you seem quite affable.
-d/r
Posted by Phillipa on January 23, 2009, at 20:11:44
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 23, 2009, at 7:17:16
As Nike says Just Do it. Excercise that is know you loved in the past. Phillipa
Posted by bulldog2 on January 24, 2009, at 14:11:29
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 23, 2009, at 7:17:16
> > Scott don't fade call the pdoc. I mean it. Love Phillipa
>
> I am following doctor's orders.
>
> I am not a happy camper, though.
>
> I have to wait 2 weeks before I see the doctor next. What frustration! He wanted me to be on 200mg for 2 weeks and then get a blood level of desipramine. Meanwhile, I have trouble getting myself to do anything except post repeatedly on this website. I'm going to push myself to go to the gym, even though I know my workouts are going to suck. We'll see.
>
> If I were to pop 2 extra pills today, I would feel great tomorrow. It is taking me a lot of self-discipline not to do so.
>
> I have faded, but I am not feeling awful. I am stable at this point.
>
> Disbelievers, watch out!
>
>
> - Scott
>Scott your the man. You have the willpower and discipline to get this done.
Posted by JadeKelly on January 24, 2009, at 18:42:29
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 23, 2009, at 7:17:16
As I was saying....
Posted by JadeKelly on January 24, 2009, at 19:14:02
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 23, 2009, at 7:17:16
Scott,
Glad you are stable and being a patient patient.
Your advice, that you are currently applying to yourself, is paying off for me exponentially :-)
I found a Phychiatrist-Pharm who was combining Parnate, desipramine and stims 15 years ago.
I told him I'd done some research and he gave me the "speech". He pulled my chair over to his and said" I could explain all the neuro-science that will go into the plan I have for you but you need to trust me, okay? I have a plan for you and I need to know that you will not change it AT ALL.
He spoke with me for 1 1/2 hours.
He had me at "I have a plan".
~Jade, be greedy and go for it all, that Jade haha
Posted by Vincent_QC on January 26, 2009, at 7:26:23
In reply to Re: I want to switch from nortriptyline to desipramine, posted by JadeKelly on January 24, 2009, at 19:14:02
> Scott,
>
> Glad you are stable and being a patient patient.
>
> Your advice, that you are currently applying to yourself, is paying off for me exponentially :-)
>
> I found a Phychiatrist-Pharm who was combining Parnate, desipramine and stims 15 years ago.
>
> I told him I'd done some research and he gave me the "speech". He pulled my chair over to his and said" I could explain all the neuro-science that will go into the plan I have for you but you need to trust me, okay? I have a plan for you and I need to know that you will not change it AT ALL.
>
> He spoke with me for 1 1/2 hours.
>
> He had me at "I have a plan".
>
> ~Jade, be greedy and go for it all, that Jade haha
>
>What is the "plan" exactly??? And why i'm not able to find a good Phychiatrist-Pharm in the Quebec province (Canada), like the one you have? lol Mine don't want to add a small dose of Trazodone on my MAOI drug to help me to sleep...so forget about a combo with other stimulant or anything else... That's suck since I change often of Doctors and Psychiatrist and no ones offer to me NEW solutions...I'm always the ones who proposed new drugs or different drugs often use off-label for social anxiety... I wonder why all the Psychiatrists in the Canada, at least in Quebec province, have nothing to offer new when is time to talk about social anxiety...? I thin the Pharmaceutical industry surrounded them too much...since they promote "new" product, more expensive but with no "evidence" and "proof" of a good results on social anxiety...Anyway...
Posted by SLS on January 29, 2009, at 14:32:09
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by Vincent_QC on January 26, 2009, at 7:26:23
Rats.
I spoke to my doctor on the phone today, hoping that he would let me increase the dosage of desipramine. He said no. He said that he wanted to see the results of the blood test for desipramine levels first. Logical. I then asked him if he were worried about cardiac side effects. That didn't seem to be his problem, but he demonstrated to me that he is very afraid of using this drug in combination with Parnate. I now have my doubts that he is going to prescribe the 300mg I need. I have been on that dosage before.
I might have to start planning to see another doctor if mine refuses to increase the dosage of desipramine. I'll either see my old doctor in Princeton or see the doctor at Columbia in NYC that I once had a consultation with. I would place myself on the 300mg before hand.
- Scott
Posted by Jadekelly on January 29, 2009, at 19:02:32
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 29, 2009, at 14:32:09
Scott,
I thought that's what the blood test was for. So you could go up on the desiprimine. That stinks.
Vince, (and Scott) my new PDoc's plan, as unbelievable as it is, is to get me up to 30mg Ritalin with the 70mg Parnate, by tomorrow, see him again in a week, not sure if/ how many more increases. If that doesn't get me to 100% he says he does use....desiprimine. I'll see him every two weeks until ?????
Scott, he's the one at JH that I posted info above a while ago. 10-15 years ago he was using those three drugs together. I start therapy next week as well. To work on my "stuff". I'm ready now.
Good Luck,
Jade
Posted by Phillipa on January 29, 2009, at 20:36:11
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on January 29, 2009, at 14:32:09
Scott you do what you gotta do. Phillipa ps good luck convincing this one but you're not that far away.
Posted by Vincent_QC on January 30, 2009, at 9:38:59
In reply to Re: Scott + Vince » SLS, posted by Jadekelly on January 29, 2009, at 19:02:32
> Scott,
>
> I thought that's what the blood test was for. So you could go up on the desiprimine. That stinks.
>
> Vince, (and Scott) my new PDoc's plan, as unbelievable as it is, is to get me up to 30mg Ritalin with the 70mg Parnate, by tomorrow, see him again in a week, not sure if/ how many more increases. If that doesn't get me to 100% he says he does use....desiprimine. I'll see him every two weeks until ?????
>
> Scott, he's the one at JH that I posted info above a while ago. 10-15 years ago he was using those three drugs together. I start therapy next week as well. To work on my "stuff". I'm ready now.
>
> Good Luck,
>
> Jade
>
>Hi Jade!
Good...I hope the addition of a higher dose of Ritalin will help you ;-) CBT will also help a lot I think, if you have the energy to do it of course... ;-)For now, MY plan is not as positive than you...
I never get an answer from the compagny who promote and sell the Marplan (MAOI)...Validus...They never answer to me, even if I e-mail them 2 times since more than 1 week...I just wanted basic info like the price and how to import it to the Canada...They seem to not be very friendly with that process or they don't care about the Canadian residents or market...Anyway, it's in the schedule F of drugs that I can import (3 months supply) by mail in the Canada...The Canadian Border are not suppose to keep the drugs...since it's permit as an importation here...
For the Emsam or the oral Selegiline, I will not try it...since I read a lot of old threads about the effect of the oral and the patch Selegiline...It will not help a lot for my social phobia and my anxiety....Yeah, I need to have more energy, but I don't want to increase my anxiety...
So for the PLAN...I will ask for the Nardil again, because it's Gaba-energic (or something like this...agonist and not antagonist...I learn my lesson now...I argue with another member of the Babble site about Gaba-B drugs...anyway...), and I will ask maybe just to add a real small dose of oral Selegiline, since it give some energy...I will not be able to get the Ritalin with the Nardil, since my PDoc is really not into combo or cocktail drugs mix...He prefer to work on one thing at the time...SO I guess I will be left only with the Nardil...start it at a very low dose, 15mg week...increase at 30 after 2 weeks...and be able to reach the 90mg just in 3 months...He is also very slow on the increasement of the dosage...I hate that but well I have no choice...
At the same time, I will bring to him the informations I found about the importation of the Marplan in the Canada, he will be able maybe to do all the things for me...we will see before the price of it...I read somewhere that a 10mg Marplan pills is something like 2$...since the effective dosage is 60mg, it will cost 12$ day...for me that's expensive, since with the public insurrance in the Quebec province, we don'T pay for drugs in the approved list ...Nardil is free, oral Selegeline is free also...but we have a limited choice...Ritalin regular is cover but not the SR version...Celexa is free but the Cipralex (Lexapro) is not cover...Effexor-XR is cover, but not the new Cymbalta...
So that's it...for now, I have to wait until next tuesday before I See my Pdoc again, I just sleep all day long, no energy at all, I use the maximum dose of Valium I can (20mg minimum/day) just to be able to calm down a little bit...and at night I need to double my dosage of Seroquel to be able to sleep (so 2 x 25mg)... I have only 2 pills left in my bottle and I can't have a refil of my prescription before the 7 february...I can't call my Family doctor office, since they don't take call...before I Was able to talk to my Doctor at anytime, now I can't...I see him only the 16 february so I will ask at this time to double my dosage of Seroquel..but for now I will have to buy cheap allergy medecine to help to sleep at night...I try some Unisom, the Xtra strenght version, they do nothing on me...Anyway that's another story...
I'm a lot frustrated cause I can't do progress and work on my CBT...I'm not able to find the energy at daytime to go outside the house and make my exposure time in social events...(Shopping center for now)...And i'm also a lot frustrated because I'm left without AD to help me now... That's too bad I Return my box of Nardil to the drugstore 2 months ago...I had a lot of them so it will be a good option to begin it before my appointment with the PDoc next week...but now I have to wait , again...and all the long process it will take to reach the 90mg...it will be very long...
Well that's it...that's a hard time for me...I never felt this way before...I feel not very stable...And my blood pressure never return to the normal after my adventure with the Parnate...strange no??? I'm always at the 140/90 stage... I wonder why...before it was always low...
I will have to investigate for this also...ask for blood test and others things like that...
Well, for now I have to go, but I wish you a good luck with your PLAN...I really hope it will work ok!!! I will think of you ;-)
Take care!
Vincent ;-)
Posted by SLS on February 4, 2009, at 8:14:02
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on January 29, 2009, at 20:36:11
> Scott you do what you gotta do. Phillipa ps good luck convincing this one but you're not that far away.
Still at 200mg of desipramine.
I'm hanging in there. My deterioration has leveled off. Strategic use of caffeine has helped. I am going to try to pick up my lab results today. I don't trust the lab to fax it to my doctor before Friday's appointment. He won't raise the dosage without that lab report.
- Scott
Posted by SLS on February 4, 2009, at 15:34:58
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on February 4, 2009, at 8:14:02
> > Scott you do what you gotta do. Phillipa ps good luck convincing this one but you're not that far away.
>
> Still at 200mg of desipramine.
>
> I'm hanging in there. My deterioration has leveled off. Strategic use of caffeine has helped. I am going to try to pick up my lab results today. I don't trust the lab to fax it to my doctor before Friday's appointment. He won't raise the dosage without that lab report.Got it!
Woohoo!
My desipramine level is low enough to warrant dosage increases.
My desipramine level: 99ng/ml
Reference range: 100-300ng/mlPhew!
- Scott
Posted by Phillipa on February 4, 2009, at 20:16:11
In reply to Re: I want to switch from nortriptyline to desipramine » Phillipa, posted by SLS on February 4, 2009, at 8:14:02
Well how did it come out the blood levels? Love Phillipa
Posted by SLS on February 6, 2009, at 18:10:37
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on February 4, 2009, at 20:16:11
Well, as I expected, my doctor raised my dosage of desipramine from 200mg to 250mg. I know that I need 300mg. However, if I were sitting in his chair, I would probably do exactly the same thing. So...
Now I have to wait another three weeks before he will consider raising the dosage again. I think he will if I need it. At least, that's the impression I got from him today. I will just have to be patient. I am not really suffering all that much. I am grateful for that.
- Scott
Posted by Phillipa on February 6, 2009, at 21:40:26
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on February 6, 2009, at 18:10:37
Scott that's good news and I agree he will when he's ready and if levels aren't too high. Congrats!!!!! Love Phillipa
Posted by SLS on March 1, 2009, at 19:32:24
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by Phillipa on February 6, 2009, at 21:40:26
Well, my doctor agreed to increase my dosage of desipramine from 250mg to 300mg. I did this as of Wednesday. I have not "sprung back" to the robust antidepressant response I once had. I am not too happy with having been significantly under-dosed for over two months. I still expect to recover, but it might be weeks or months before my system regains the ground lost. The receptors (or whatever) have been allowed too much time to revert back to their pathological conditions.
I am not doing well.
- Scott
Posted by Phillipa on March 1, 2009, at 21:08:55
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 1, 2009, at 19:32:24
Scott oh no not good. Something is going around as feel horrible. Everything has turned on me med wise. How long do you feel it will take to regain what you lost? Love Jan
Posted by JadeKelly on March 1, 2009, at 21:54:51
In reply to Re: I want to switch from nortriptyline to desipramine, posted by SLS on March 1, 2009, at 19:32:24
> Well, my doctor agreed to increase my dosage of desipramine from 250mg to 300mg. I did this as of Wednesday. I have not "sprung back" to the robust antidepressant response I once had. I am not too happy with having been significantly under-dosed for over two months. I still expect to recover, but it might be weeks or months before my system regains the ground lost. The receptors (or whatever) have been allowed too much time to revert back to their pathological conditions.
>
> I am not doing well.
>
>
> - ScottHi Scott,
I am sorry you aren't getting the response you hoped for. Thats stinks when you've waited so long just to have to wait longer. But it has only been days, you never know. The brain does funny things :-)
The good news is that he agreed to go to 300mg. So at least you have something to look forward to. So in the end, you will have all you wanted. Not bad. I will be thinking of you and hoping you are feeling well again soon. I have faith it will not be long.
From start to finish, I waited 3 months for a response to Parnate. The longest time a deeply depressed person has been willing wait (I'll have to check guiness book of records).
I don't know many people who could have convinced me to do that. I am grateful I did not spend that time enduring failure after failure on other meds.
Having faith that relief is in sight is the next best thing to remission. Feel better soon.
~Jade aka patient patient
Posted by SLS on March 2, 2009, at 8:16:23
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 1, 2009, at 21:54:51
Hi Jade.
> I am sorry you aren't getting the response you hoped for. Thats stinks when you've waited so long just to have to wait longer. But it has only been days, you never know. The brain does funny things :-)
Yes. Tell me about it.
> The good news is that he agreed to go to 300mg. So at least you have something to look forward to. So in the end, you will have all you wanted. Not bad. I will be thinking of you and hoping you are feeling well again soon. I have faith it will not be long.
I was basically allowed to relapse for 2 months. I just thought that I could recapture some kind of improvement within days of reaching 300mg. I am beginning to have doubts that it will work at all. At this point, there is no trend in improvement to give me confidence in success.
> Having faith that relief is in sight is the next best thing to remission.
Definitely. It helps to promote patience. I don't have as much faith today as I did yesterday. I am going to try not to focus too heavily on my hour by hour mood status.
> Feel better soon.
Thanks. I'm doing what I can.
> ~Jade aka patient patient
I will try to be a patient patient, too.
Thanks.
- Scott
Posted by garnet71 on March 2, 2009, at 10:40:36
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 2, 2009, at 8:16:23
Sorry you are not feeling well. I know you've tried everything, but am not sure if this drug was a possibility during your trials. This may be a long shot, and the study is over two years old; however, I've never seen discussions here regarding this possibility:
http://www.nih.gov/news/pr/aug2006/nimh-07b.htm
You've probably seen this already, but I wanted to share it just in case you may have missed it.
Hang in there!
Posted by garnet71 on March 2, 2009, at 10:45:56
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
I moved the post so that others could see/discuss the article I posted for Scott.
Posted by SLS on March 2, 2009, at 11:02:01
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
Posted by JadeKelly on March 2, 2009, at 21:53:34
In reply to Re: I want to switch from nortriptyline to desipramine » JadeKelly, posted by SLS on March 2, 2009, at 8:16:23
> Hi Jade.
>
> > I am sorry you aren't getting the response you hoped for. Thats stinks when you've waited so long just to have to wait longer. But it has only been days, you never know. The brain does funny things :-)
>
> Yes. Tell me about it.
>
> > The good news is that he agreed to go to 300mg. So at least you have something to look forward to. So in the end, you will have all you wanted. Not bad. I will be thinking of you and hoping you are feeling well again soon. I have faith it will not be long.
>
> I was basically allowed to relapse for 2 months. I just thought that I could recapture some kind of improvement within days of reaching 300mg. I am beginning to have doubts that it will work at all. At this point, there is no trend in improvement to give me confidence in success.
>
> > Having faith that relief is in sight is the next best thing to remission.
>
> Definitely. It helps to promote patience. I don't have as much faith today as I did yesterday. I am going to try not to focus too heavily on my hour by hour mood status.
>
> > Feel better soon.
>
> Thanks. I'm doing what I can.
>
> > ~Jade aka patient patient
>
> I will try to be a patient patient, too.
>
> Thanks.
>
>
> - ScottHi Scott,
That really stinks that you were allowed to relapse for months. I'm sure its extremely frustrating. I'm glad for you though that you've been able to find Doc's that will even practice out-side the box. I know that doesn't help right now when you feel like hel*.
What I wanted to ask you, didn't you tell me once that, at least with Parnate, you had to wait 6 weeks from the point you reach a therapeutic dose? Meaning, is it possible, that you are having to wait the same time anyone one would from their therapeutic dose (for desipramine, whatever that is)? If thats true, maybe you will have to wait that period added to when you hit 300mg, not with in days of hitting it. Just a thought.
I seem to be feeling that I need to keep titrating to keep same effect, I felt fine last visit so stayed at 80mg Par and 60mg Rit. I can't imagine going much higher than that. He does use Desipramine, but I don't have the knowledge to question his decisions. Any idea what he might do next? So far its been steady increases of Parnate and Ritalin. He seemed surprized that I had responded so fast/well. That surprized me. Now I think it was a day or two after that when I felt it slipping a bit. (Not anything like before).
Just thought I'd take your mind back to Doc mode for a distraction. I'm thoughtful that way.
Please don't rethink your decision; use all those patience skills you've tought yourself and others.
I'm sure its just a matter of time :-)~Jade
Posted by Ron Hill on March 3, 2009, at 4:21:23
In reply to Scott, posted by garnet71 on March 2, 2009, at 10:40:36
Garnet,
Thanks for posting the link.
In case anyone wants the full text of the study, here's the link:
http://archpsyc.ama-assn.org/cgi/content/full/63/8/856
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild OCPD
300 mg/day Trileptal
200 mg/day Lamictal
250 mg/day Keppra
60 mg/day Nardil------------------------------
> I've never seen discussions here regarding this possibility:
> http://www.nih.gov/news/pr/aug2006/nimh-07b.htm
Posted by SLS on March 3, 2009, at 8:00:08
In reply to Re: I want to switch from nortriptyline to desipramine » SLS, posted by JadeKelly on March 2, 2009, at 21:53:34
I am tempted to say, "Phew, that was a close one".
I am feeling somewhat better this morning.
I paid bills and did some other paperwork. I vacuumed my apartment for the first time in over a year. Thank God, I might be more functional in order to take care of my ailing grandmother. Her daughter (my mother) has all but abandoned her. I really need to make things happen.
I anticipate a very variable mood for the next week or so. Thereafter, I will probably experience periodic worsenings on the way towards remission. That's just the way it is. Even at full remission, there may be times when there is a mild medication breakthrough. I like to call these partial worsenings "recessions" rather than "depressions".
Oh yeah, I am beginning to experience insomnia. This has always been a good prognosis side effect for me. I am excited about this. I know this sounds weird, but I hope the insomnia continues. I'll deal with it using Ativan, if my doctor allows it.
- Scott
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