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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 201. Go back in thread:
Posted by Dinah on September 1, 2011, at 8:12:45
In reply to Re: 40% » Phillipa, posted by SLS on September 1, 2011, at 7:31:33
I think I've grown to appreciate the incremental approach to wellness. Taking little bites out of a problem from various angles. 40% is something to be pleased with. And it gives you a base from which to try other things that might be helpful that might not have been helpful without that 40%.
Specifically, what would you like to be better? Can you break down which elements have gotten maybe more than 40% better, and which perhaps less?
Posted by SLS on September 1, 2011, at 12:18:26
In reply to Re: 40% » SLS, posted by Dinah on September 1, 2011, at 8:12:45
> I think I've grown to appreciate the incremental approach to wellness. Taking little bites out of a problem from various angles. 40% is something to be pleased with.
The degree of relative wellness I have attained is nice to experience. I do not take it for granted. However, it would be nice to have covered a 40% gain in 12 weeks rather than 12 months. I accept it, though, as any stable improvement is in itself a miracle. I simply would rather that my rate of recovery be somewhere other than at the pole of a bell curve.
> And it gives you a base from which to try other things that might be helpful that might not have been helpful without that 40%.
I hadn't thought of it that way.
My doctor tends to think that things should be happening faster, and has thought to continue to try new treatments. I elected to leave well enough alone. It is serendipitous that I should have discovered the length of time necessary for me to respond to treatment. I had resigned myself to taking the same four drugs and settling for a lifetime of severe depression. After four months of an unchanged depression, I suddenly began to improve. This was towards the end of November, 2010. I then added lithium two months later based upon its theoretical mechanisms of action. It almost immediately reduced the oscillations in mood that I was experiencing.
> Specifically, what would you like to be better?Motivation, energy, cognition, and memory.
> Can you break down which elements have gotten maybe more than 40% better, and which perhaps less?Not really. I feel that everything improves at the same time at the same magnitude.
Thanks, Dinah. I appreciate your insightful questions and perspectives.
- Scott
Posted by Phillipa on September 1, 2011, at 19:55:54
In reply to Re: 40% » Phillipa, posted by SLS on September 1, 2011, at 7:31:33
Sorry Scott poor wording as I consider it very slow. Was more or less asking what you attributed the slowness to other than the length of your illness. If you ever wish to research a med research requip as an old poster here is on low levels of it with a few other low doses of things. He was suicidal at one point got ECT on all the Maois. Today married a child and law practice. We talk daily. I once had to have him committed via long distance telephone to his pdoc as was about to shoot self. True story. But hope this gives you even more hope of a full recovery. Phillipa
Posted by Lamdage on September 5, 2011, at 21:30:50
In reply to Re: 40% » SLS, posted by Phillipa on September 1, 2011, at 19:55:54
Hey Scott, its good to hear you are improving!
May i ask for how much of your lifetime you have been depressed and from what age on?
I find it sad that most people get help so late in their illness.. If there was less stigmatization people wouldn't have to hit the lowest of rock bottom before they get treatment. It seems quite common from what I've seen and i am in the same boat since i have been depressed from VERY early on in childhood.
A question on the Lamictal: Did it affect any of your memory/cognition symptoms negatively?
Thanks
Posted by SLS on September 6, 2011, at 10:23:59
In reply to Re: Scott, posted by Lamdage on September 5, 2011, at 21:30:50
> Hey Scott, its good to hear you are improving!
Thanks. :-)
> May i ask for how much of your lifetime you have been depressed and from what age on?
10 years - mild
15 years - moderate
17 years - severeNow 51 years.
> A question on the Lamictal: Did it affect any of your memory/cognition symptoms negatively?I'm okay at 200mg. Anything above this dosage produces brain-fog and cognitive / memory impairments without any discernible additional improvement.
> ThanksYou're welcome.
- Scott
Posted by Lamdage on September 7, 2011, at 4:51:21
In reply to Re: Scott » Lamdage, posted by SLS on September 6, 2011, at 10:23:59
So i assume you didn't get treatment for way too long.. Its a very interesting topic, how depression and anxiety are so hardwired in the brain and what changes lead to improvement.
New conditioning, chemical changes, maybe even new nerve endings etc? Will definitely do some googling :)
Posted by Lamdage on September 7, 2011, at 5:11:17
In reply to Re: Scott, posted by Lamdage on September 7, 2011, at 4:51:21
And of course sh*tty psychological patterns :/
Posted by SLS on September 7, 2011, at 13:46:01
In reply to Re: Scott » Lamdage, posted by SLS on September 6, 2011, at 10:23:59
40% was nice for a few days. Unfortunately, it didn't last. I remain at a 25% improvement as of two days ago. After being on Nardil for a whole year, this is wholly inadequate. I don't feel very much different than I did a year ago. I made an appointment to see my doctor tomorrow. I would like to discontinue Nardil and replace it with either Pristiq or Effexor.
I would like to thank everyone for their help and support over the years.
I haven't given up.
- Scott
Posted by SLS on September 7, 2011, at 13:49:19
In reply to Re: Scott, posted by Lamdage on September 7, 2011, at 4:51:21
> So i assume you didn't get treatment for way too long..
I was first diagnosed and treated for MDD in 1982 at age 22.
- Scott
Posted by floatingbridge on September 7, 2011, at 16:14:21
In reply to 40% down to 25%, posted by SLS on September 7, 2011, at 13:46:01
> 40% was nice for a few days. Unfortunately, it didn't last. I remain at a 25% improvement as of two days ago. After being on Nardil for a whole year, this is wholly inadequate. I don't feel very much different than I did a year ago. I made an appointment to see my doctor tomorrow. I would like to discontinue Nardil and replace it with either Pristiq or Effexor.
>
> I would like to thank everyone for their help and support over the years.
>
> I haven't given up.
>
>
> - ScottWell, shista, Scott.
Have you tried either?
Please let anyone here know ways we can support you through the wash and start up and any other way.
fb
Posted by SLS on September 7, 2011, at 16:54:21
In reply to Re: 40% down to 25% » SLS, posted by floatingbridge on September 7, 2011, at 16:14:21
> > 40% was nice for a few days. Unfortunately, it didn't last. I remain at a 25% improvement as of two days ago. After being on Nardil for a whole year, this is wholly inadequate. I don't feel very much different than I did a year ago. I made an appointment to see my doctor tomorrow. I would like to discontinue Nardil and replace it with either Pristiq or Effexor.
> >
> > I would like to thank everyone for their help and support over the years.
> >
> > I haven't given up.
> >
> >
> > - Scott
>
> Well, shista, Scott.
>
> Have you tried either?
>
> Please let anyone here know ways we can support you through the wash and start up and any other way.Thanks.
- Scott
Posted by Zonked on September 7, 2011, at 20:58:51
In reply to 40% down to 25%, posted by SLS on September 7, 2011, at 13:46:01
Scott, I don't understand why given all your conventional treatment failures you haven't been given opiods. To me, it's inexcusable. What is your MD's justification? How much more do you need to suffer? You're entitled to a decent quality of life. Sure, there are drawbacks, but what does it matter now? Cycling you through mildly effective or ineffective treatments seems ludicrous to me at this point. Especially when there are things sitting on American pharmacy shelves RIGHT NOW which way help you. I am not blaming you, but the system. Why won't your doc give you bupe, stimulants or oxycontin? If he's concerned about potential abuse, couldn't he start you out with a small quantity and see you a bit more frequently at first? I hope it's not that he's afraid of the DEA. That's not reason for you to suffer. Sorry if I sound a bit frustrated... it's with a medical system that likely can return you to a normal level of functioning but hasn't because of drug addicts. It doesn't seem right.
Posted by Phillipa on September 7, 2011, at 20:59:00
In reply to 40% down to 25%, posted by SLS on September 7, 2011, at 13:46:01
Think has anything to do with the daylight hours? Less light? Maybe a light box would help? Phillipa
Posted by Lamdage on September 8, 2011, at 3:06:42
In reply to Re: 40% down to 25% » SLS, posted by Phillipa on September 7, 2011, at 20:59:00
Scott sorry to hear that. Let us know what you and your doc are considering now!
Posted by Solstice on September 8, 2011, at 7:47:58
In reply to 40% down to 25%, posted by SLS on September 7, 2011, at 13:46:01
> 40% was nice for a few days. Unfortunately, it didn't last. I remain at a 25% improvement as of two days ago. After being on Nardil for a whole year, this is wholly inadequate. I don't feel very much different than I did a year ago. I made an appointment to see my doctor tomorrow. I would like to discontinue Nardil and replace it with either Pristiq or Effexor.
>
> I would like to thank everyone for their help and support over the years.
>
> I haven't given up.
Scott -Your courageous and steadfast 'fighting the fight' is an inspiration. During my times in the valley of it, I've often been a big baby and toyed with the idea of giving up.
As I've been reading your threat, I've become increasingly interested in how you go about rating where you are at a given point (0% vs 15%, 25%, 40%). I read where one of these included being able to drive, but unable to work. It makes sense to me that various specific characteristics of functioning would be a great way to assess whether one is at 25%.. vs 50%.. vs 75%.
Have you constructed a list of characteristics of functioning that helps you determine your level of functioning? For example, I guess at the social level, there would be complete withdrawal, vs. being able to tolerate receiving phone calls from certain people, vs. willing & able to place phone calls to certain people, vs. being able to tolerate receiving phone calls from people who are not in the inner circle, vs. being willing to go out and participate in various types of social interaction (i.e. it's one thing to go to Sonic with a trusted friend and eat in the car at the drive-thru, vs. going out with a group for a big meal at Logan's Steakhouse). Anyway, do you have behavioral functioning characteristics categorized in such a way that they end up putting you at a certain percentage of functioning? What it brings to mind for me is the Glascow Coma Scale for assessing level of coma.
Solstice
Posted by Solstice on September 8, 2011, at 8:36:03
In reply to Re: 40% down to 25%, posted by Solstice on September 8, 2011, at 7:47:58
> > 40% was nice for a few days. Unfortunately, it didn't last. I remain at a 25% improvement as of two days ago. After being on Nardil for a whole year, this is wholly inadequate. I don't feel very much different than I did a year ago. I made an appointment to see my doctor tomorrow. I would like to discontinue Nardil and replace it with either Pristiq or Effexor.
> >
> > I would like to thank everyone for their help and support over the years.
> >
> > I haven't given up.
>
>Scott -
Your courageous and steadfast 'fighting the fight' is an inspiration. During my times in the valley of it, I've often been a big baby and toyed with the idea of giving up.
As I've been reading your (s/b *thread*), I've become increasingly interested in how you go about rating where you are at a given point (0% vs 15%, 25%, 40%). I read where one of these included being able to drive, but unable to work. It makes sense to me that various specific characteristics of functioning would be a great way to assess whether one is at 25%.. vs 50%.. vs 75%.
Have you constructed a list of characteristics of functioning that helps you determine your level of functioning? For example, I guess at the social level, there would be complete withdrawal, vs. being able to tolerate receiving phone calls from certain people, vs. willing & able to place phone calls to certain people, vs. being able to tolerate receiving phone calls from people who are not in the inner circle, vs. being willing to go out and participate in various types of social interaction (i.e. it's one thing to go to Sonic with a trusted friend and eat in the car at the drive-thru, vs. going out with a group for a big meal at Logan's Steakhouse). Anyway, do you have behavioral functioning characteristics categorized in such a way that they end up putting you at a certain percentage of functioning? What it brings to mind for me is the Glascow Coma Scale for assessing level of coma.
Solstice
>
Posted by Dinah on September 16, 2011, at 21:16:07
In reply to 40% down to 25%, posted by SLS on September 7, 2011, at 13:46:01
There was a two week difference between your post saying you were at 40% and your post saying you'd gone down to 25%. Is it possible to segregate permanent change from the natural ups and downs of any illness? If you've felt well for a while on this medication, is it possible that this is a dip rather than a decline?
I'm also wondering if you have felt good on a medication for an extended length of time, or if you only felt like it was really working for the first little while you were on it? Is it possible that it's the shock of a change in brain chemistry that makes you feel good for a while? I think on any medication there's a drift back to setpoint. I definitely find this with Provigil. Now I have to take my morning Provigil to avoid sleeping all day. It doesn't feel like it initially did.
Posted by Dinah on September 16, 2011, at 21:31:34
In reply to Re: 40% down to 25% » SLS, posted by Dinah on September 16, 2011, at 21:16:07
I was musing that it may be that it's less a medication or cocktail you need, but to keep your brain chemicals in a desirable state of flux? A pattern of shifting medications?
I have no idea what I'm talking about here, as my brain craves stability and flux makes me nuts. But I think I remember you describing a pattern of feeling good on medications for only a little while. And since, again if I understand correctly, melancholia rather than agitation and anxiety is the problem it might be healthy for you to seek that state that no matter how pleasant I find it is very risky and unhealthy for me.
Posted by zonked on September 16, 2011, at 22:29:37
In reply to Re: 40% down to 25% » SLS, posted by Dinah on September 16, 2011, at 21:16:07
>Is it possible that it's the shock of a change in brain chemistry that makes you feel good for a while? I think on any medication there's a drift back to setpoint. I definitely find this with Provigil. Now I have to take my morning Provigil to avoid sleeping all day. It doesn't feel like it initially did.
Homeostasis is a bitch. I think an under-researched (or at least under-acknowledged) problem in psychiatry is tolerance/adaptation and how the body seems to try it's DAMNDEST to get people back to their set points.
Posted by SLS on September 17, 2011, at 9:11:37
In reply to Re: 40% down to 25% » SLS, posted by Dinah on September 16, 2011, at 21:16:07
Hi Dinah.
> There was a two week difference between your post saying you were at 40% and your post saying you'd gone down to 25%. Is it possible to segregate permanent change from the natural ups and downs of any illness?
I think I understand what you are saying. Were I to keep a daily mood chart, it is possible that any differences between your two scenarios would be revealed. That I still experience a depression that is considered to be severe (although less severe than in the past) is unacceptable when alternate treatments exist.
> If you've felt well for a while on this medication, is it possible that this is a dip rather than a decline?
It really doesn't matter to me which of the two it is. I rate myself now as being only slightly better than a year ago. Of course, this is better than nothing. If Nardil had not been a MAOI, I could simply add other drugs to it, and have a reduced risk of relapsing. Unfortunately, this is not the case, as the two medications I am to try are serotonin reuptake inhibitors, which if they were to be mixed with Nardil would most certainly provoke serotonin syndrome.
> I'm also wondering if you have felt good on a medication for an extended length of time,
Yes. 100% for 6 months in 1987 on a treatment regime of Parnate and desipramine.
> ...or if you only felt like it was really working for the first little while you were on it?
Yeah, I got that more robust improvement during the first few weeks of Nardil treatment.
> Is it possible that it's the shock of a change in brain chemistry that makes you feel good for a while?
I guess there must be some degree of disruption of homeostasis forced by the drug being used in order to provoke an antidepressant response.
> I think on any medication there's a drift back to setpoint. I definitely find this with Provigil. Now I have to take my morning Provigil to avoid sleeping all day. It doesn't feel like it initially did.
That stinks. Have you already been through the stimulants? I suppose there is a chance that Nuvigil could effectively replace Provigil. Knowing that Risperdal functions as a 5-HT2a receptor antagonist leads me to wonder if using nortriptyline might provide you with similar benefit and with less daytime sedation or sleepiness. Perhaps you don't need any dopamine receptor antagonists at all. Just a thought or two...
Have you ever tried Geodon? It is the most antidepressant-like of the APs. It can be stimulating. Unfortunately, it is a very unpredictable drug that is hard to categorize. You need to start at 40mg per day as a minimum dosage to avoid the emergence of anxiety. If it produces somnolence, profound brain-fog, and cognitive blunting early in treatment, it probably will not be of any use, and you could discontinue it immediately should these things appear and persist for a few days.
I don't see any reason why you would have to discontinue Riserdal to perform any of these trials.
Getting back to me, I can remember where I was and what I was doing when I experienced robust improvements in my depressive condition. This includes periods of time lasting but for a few hours; so profound is the difference in experience. I guess it's like someone who is blind from birth suddenly gaining sight for a few minutes. The experience is unmistakeable as a change in his perception of the universe, and will never be forgotten.
- Scott
Posted by FrustratedMama on September 17, 2011, at 9:51:09
In reply to Re: 40% down to 25% » Dinah, posted by SLS on September 17, 2011, at 9:11:37
Getting back to me, I can remember where I was and what I was doing when I experienced robust improvements in my depressive condition. This includes periods of time lasting but for a few hours; so profound is the difference in experience. I guess it's like someone who is blind from birth suddenly gaining sight for a few minutes. The experience is unmistakeable as a change in his perception of the universe, and will never be forgotten.
I COMPLETELY AGREE SCOTT! I am thinking of you and really hope you see these days again soon and that they outlast the days that aren't so bright.
Posted by SLS on September 17, 2011, at 10:08:52
In reply to Re: 40% down to 25% » SLS, posted by FrustratedMama on September 17, 2011, at 9:51:09
> Getting back to me, I can remember where I was and what I was doing when I experienced robust improvements in my depressive condition. This includes periods of time lasting but for a few hours; so profound is the difference in experience. I guess it's like someone who is blind from birth suddenly gaining sight for a few minutes. The experience is unmistakeable as a change in his perception of the universe, and will never be forgotten.
>
> I COMPLETELY AGREE SCOTT! I am thinking of you and really hope you see these days again soon and that they outlast the days that aren't so bright.That was worth a tear or two. Thank you.
I haven't seen you in a long while. How have you been?
- Scot
Posted by Dinah on September 17, 2011, at 13:12:33
In reply to Re: 40% down to 25% » Dinah, posted by SLS on September 17, 2011, at 9:11:37
For me, my problems generally stem from agitation and anxiety - perhaps some bipolarish tendencies. While Provigil may not cause wakefulness like it used to, it has the huge advantage of not causing anxiety or agitation in me.
Nortryptiline was as very bad for me as Effexor and Wellbutrin. I have concluded that norepinephrine is something that doesn't agree with me.
I'm happy enough with my current mix, although I think I'd like to take a holiday from Provigil and then go back to it. If I ever have the leisure to sleep all day for a few weeks. I'd love for it to work like it used to.
I wonder if those experiences you perceive as normal are something that can realistically be expected for a long period of time, since the longest period you've experienced them is six months. It occurs to me it might be something akin to the mild hypomania I often get with medications. For me, it's not a good thing because my set point has so much anxiety and agitation. I'm better off avoiding it, even if it feels good. But if your set point is the flat melancholic type of depression it might be what makes you feel so good. The problem is, I've never found it possible to maintain that state over time. For me, that's a good thing, for you perhaps not. Is there any way nonmedication way to improve a life with a lower set point? Maybe one of the treatments that provide disruption to the brain, perhaps not ECT but that trms is it? - the one that Twinleaf successfully used?
Posted by Phillipa on September 17, 2011, at 19:36:02
In reply to Re: 40% down to 25% » SLS, posted by Dinah on September 17, 2011, at 13:12:33
The three day blip. Where the meds seem to work well for three days and then switch back. Maybe the "normal" of yesterday isn't the normal of today? But Scott wasn't it the doc that said he wasn't satisfied with your progress? If you were he can't feel how you feel. Just wondering Phillipa
Posted by SLS on September 17, 2011, at 23:02:33
In reply to Re: 40% down to 25%, posted by Phillipa on September 17, 2011, at 19:36:02
> The three day blip. Where the meds seem to work well for three days and then switch back. Maybe the "normal" of yesterday isn't the normal of today? But Scott wasn't it the doc that said he wasn't satisfied with your progress? If you were he can't feel how you feel. Just wondering Phillipa
Yeah. My doctor wanted to jump in several months ago and make treatment changes. He wasn't at all happy with the degree of improvement I was reporting. My silly little optimistic brain decided that if I were to just wait long enough - perhaps another year - I would feel at least 50% better. I think I could return to work at that level of improvement. The 40% blip was nice for a few days. However, as I dropped to 25% and settled back to 35% again, I could not justify leaving my treatment regime unchanged.
It took me 7 days to taper and discontinue Nardil. I experience substantial variations in my depression throughout the day. There were a few hours today when I felt as if I fully relapsed. I'm not doing too bad now, but I expect to deteriorate as time passes and MAO activity recovers. With a little luck, I won't relapse completely by the time Viibryd starts to work.
I can start Viibryd 9 days from now. However, my prescription plan has denied coverage. So the game begins.
- Scott
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