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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 317. This is the beginning of the thread.
Posted by SLS on December 29, 2011, at 6:55:56
I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD, if it even exists in me. I thought it was worth a shot. Certainly, childhood abuse and neglect contributed to the evolution of my depressive illness.
I added Parnate on Monday. I am titrating as quickly as I can while avoiding the development of hypotension. The prazosin might work synergistically with Parnate to significantly reduce my blood pressure. We'll have to see. 30 mg is a small dose of prazosin. There is room to increase it.
So...
I'm feeling better than I should be. Yesterday, I met some family and friends at a hotel bar. I was comfortable, gregarious, and talkative. My mind was very active. I really enjoyed myself for the first time in many years.
Two things are different about my current regime compared to the last time I took Parnate lithium and prazosin. I wonder
Currently:
Parnate 40 mg (titrating rapidly)
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 30 mgWish me luck! I could sure use it.
- Scott
Posted by Phillipa on December 29, 2011, at 9:52:33
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Scott of course I wish you nothing but luck. How did you arrive at the prazosin? Gregarious in a bar? Wow that is a change. Congrats on that for sure. Phillipa
Posted by SLS on December 29, 2011, at 11:36:32
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on December 29, 2011, at 9:52:33
> How did you arrive at the prazosin?
It was my doctor's idea. I'll need to pick his brain a bit more to find out what his train of thought was in arriving at his decision. I got a good one for sure. I doubt that too many doctors would have thought to try prazosin on me. I can't be sure that it is the prazosin that is helping right now. I will at some point attempt to discontinue it to see if it is necessary that I take it. If I begin to deteriorate, I'll know why.
Prazosin is sometimes helpful for people with PTSD. Is there any PTSD involved in your case?
- Scott
Posted by Phillipa on December 29, 2011, at 12:37:26
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on December 29, 2011, at 11:36:32
Scott if from the age of two being told you were the reason for your Mother's illness by her and how I kept making her sick all her life by breaking a mirror when young, letting the cat bring a bird into the house as it's bad luck was to her is PTSD yes. Then being left alone to care for self and raise self as she was in hospital all the time and no one knew where I was as no one was home to know or care is PTSD then yes. Then the death age 17 and me responsible for making arrangements and then trying to fulfill her last wishes to be buried with her wedding and engagement ring and giving them to the undertaker and then a few years later having said undertaker say he gave them back to my father is PTSD yes. But I did get to Germany to meet her only living relatives her life long dream. I did it for her with European husband I wasn't sick at all then. And above I read how can't let husband paint the room fear of what???? Makes no sense at all. Minipress is the med. But you got out to a bar with friends and enjoyed yourself. I must admit I'm jelous for real as if only I could do same. I did take lopressor once at 25mg to as that pdoc at time said to prepare my body for 10mg of paxil? Meds are strange and I'm just glad it's working. I do care. Jan/Phillipa
Posted by Phillipa on December 29, 2011, at 12:41:58
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on December 29, 2011, at 11:36:32
Posted by ed_uk2010 on December 29, 2011, at 13:18:37
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
>I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD
What dose are you on Scott? Do you mean 3 mg? What strength of tablets/capsules do you have?
Posted by SLS on December 29, 2011, at 15:07:51
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on December 29, 2011, at 12:37:26
> Then being left alone to care for self and raise self as she was in hospital all the time and no one knew where I was as no one was home to know or care is PTSD then yes.
Neglect can be just as damaging to the psyche as physical abuse.
Lopressor (metaprolol) is a NE beta receptor blocker. Prazosin is a NE alpha-1 receptor blocker. Both drugs cross the blood-brain barrier. However, one cannot predict the psychotropic effects that prazosin will have based upon one's experience with Lopressor.
Do you have nightmares?
PTSD can have profound effects on sleep.
> I do care. Jan/Phillipa
Ditto.
- Scott
Posted by SLS on December 29, 2011, at 15:30:44
In reply to Re: Adding Parnate and prazosin., posted by Phillipa on December 29, 2011, at 12:41:58
> Do you have nightmares?
>
> PTSD can have profound effects on sleep.
I guess you knew this already. I just read your subsequent post.
- Scott
Posted by Phillipa on December 29, 2011, at 15:38:34
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on December 29, 2011, at 15:30:44
Yes nightmares now didn't used to til started aging. Seems I just blew what had happened in life off when younger and had all the diversions of kids and nursing. No diversions now. Thanks for caring. Jan/Phillipa
Posted by SLS on December 29, 2011, at 15:47:27
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on December 29, 2011, at 13:18:37
> >I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD
>
> What dose are you on Scott? Do you mean 3 mg? What strength of tablets/capsules do you have?
Yes. Good catch. 1 mg capsules. 3 mg/day.Thanks.
- Scott
Posted by Bob on December 29, 2011, at 19:47:02
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
> I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD, if it even exists in me. I thought it was worth a shot. Certainly, childhood abuse and neglect contributed to the evolution of my depressive illness.
>
> I added Parnate on Monday. I am titrating as quickly as I can while avoiding the development of hypotension. The prazosin might work synergistically with Parnate to significantly reduce my blood pressure. We'll have to see. 30 mg is a small dose of prazosin. There is room to increase it.
>
> So...
>
My doctor will not allow me to try Parnate while I have nortriptyline on board. Unfortunately I don't think I'd survive a complete washout just to find out if it would work or not. I would also have to stop the sertraline as well of course.He did say he's had some success with prazosin specifically for preventing or reducing nightmares.
> I'm feeling better than I should be. Yesterday, I met some family and friends at a hotel bar. I was comfortable, gregarious, and talkative. My mind was very active. I really enjoyed myself for the first time in many years.
>
> Two things are different about my current regime compared to the last time I took Parnate lithium and prazosin. I wonder
>
> Currently:
>
> Parnate 40 mg (titrating rapidly)
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 30 mg
>
> Wish me luck! I could sure use it.
>
>
> - Scott
Posted by floatingbridge on December 29, 2011, at 21:01:17
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Wishing you steady good luck, Scott.
Posted by SLS on December 29, 2011, at 21:03:25
In reply to Re: Adding Parnate and prazosin. » SLS, posted by floatingbridge on December 29, 2011, at 21:01:17
> Wishing you steady good luck, Scott.
Thanks.
:-)
- Scott
Posted by SLS on December 29, 2011, at 21:19:27
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on December 29, 2011, at 19:47:02
Hi Bob.
> My doctor will not allow me to try Parnate while I have nortriptyline on board.
I'm sorry to hear that.
Adding the MAOI to ongoing TCA treatment is the preferred method for establishing the combination.
Would your doctor be amenable to conferring with another doctor regarding combination treatment? Massachusetts General Hospital has a referral service you might take advantage of.
http://www.massgeneral.org/psychiatry/
- Scott
Posted by Bob on December 30, 2011, at 11:19:44
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on December 29, 2011, at 21:19:27
> Hi Bob.
>
> > My doctor will not allow me to try Parnate while I have nortriptyline on board.
>
> I'm sorry to hear that.
>
> Adding the MAOI to ongoing TCA treatment is the preferred method for establishing the combination.
>
> Would your doctor be amenable to conferring with another doctor regarding combination treatment? Massachusetts General Hospital has a referral service you might take advantage of.
>
> http://www.massgeneral.org/psychiatry/
>
>
> - Scott
That's a great idea. Have you ever used that service by chance?Thanks!
Posted by SLS on December 30, 2011, at 11:40:14
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on December 30, 2011, at 11:19:44
> > Would your doctor be amenable to conferring with another doctor regarding combination treatment? Massachusetts General Hospital has a referral service you might take advantage of.
> >
> > http://www.massgeneral.org/psychiatry/> That's a great idea. Have you ever used that service by chance?
No, but I have dealt with the staff there. Andy Neirenberg is particularly smart and compassionate. He specializes in TRD. Also, Sporn and Fava.
- Scott
Posted by SLS on December 30, 2011, at 13:35:40
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
> I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD, if it even exists in me. I thought it was worth a shot. Certainly, childhood abuse and neglect contributed to the evolution of my depressive illness.
>
> I added Parnate on Monday. I am titrating as quickly as I can while avoiding the development of hypotension. The prazosin might work synergistically with Parnate to significantly reduce my blood pressure. We'll have to see. 30 mg is a small dose of prazosin. There is room to increase it.
>
> So...
>
> I'm feeling better than I should be. Yesterday, I met some family and friends at a hotel bar. I was comfortable, gregarious, and talkative. My mind was very active. I really enjoyed myself for the first time in many years.
>
> Two things are different about my current regime compared to the last time I took Parnate lithium and prazosin. I wonder
>
> Currently:
>
> Parnate 40 mg (titrating rapidly)
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 30 mg
>
> Wish me luck! I could sure use it.
I am feeling MUCH better. This is not normal for me at all. Something is working. However, it has been only a few days in this improved state. I'm sure many of you know that I will sometimes respond robustly to a new treatment, but for no longer than three days. My brain is incredibly efficient at maintaining its pathological homeostasis. I'm not yet beyond this three-day window. I am trying not to become overly-optimistic as I always seem to when I begin to respond to treatment. My optimism is illogical, but it can't be helped. :-)
- Scott
Posted by europerep on December 30, 2011, at 14:13:50
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on December 30, 2011, at 11:40:14
> No, but I have dealt with the staff there. Andy Neirenberg is particularly smart and compassionate. He specializes in TRD. Also, Sporn and Fava.
Hold on a sec, you are from Massachusetts, and yet you haven't even talked to the guys at McLean hospital who did the work on buprenorphine in TRD?
I'm going to stop commenting on your threads because, as I said, it is extremely frustrating to watch. I am seriously wondering whether you have some subconscious element that actually doesn't want you to get better. Now you are entertaining thoughts on DBS, instead of taking a look at other, rational pharmacological alternatives. From an outsider perspective, this whole thing looks very strange. I guess there's some stuff I don't know and so on. Still, as I said, it's really frustrating.
Posted by Bob on December 30, 2011, at 14:26:19
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on December 30, 2011, at 14:13:50
> > No, but I have dealt with the staff there. Andy Neirenberg is particularly smart and compassionate. He specializes in TRD. Also, Sporn and Fava.
>
> Hold on a sec, you are from Massachusetts, and yet you haven't even talked to the guys at McLean hospital who did the work on buprenorphine in TRD?
>
> I'm going to stop commenting on your threads because, as I said, it is extremely frustrating to watch.You do sound frustrated.
I am seriously wondering whether you have some subconscious element that actually doesn't want you to get better.
Wow... I don't know about that. I'd say it's a good thing you aren't actually treating anyone (I hope).
Now you are entertaining thoughts on DBS, instead of taking a look at other, rational pharmacological alternatives.
So people who try something like DBS are irrational? And eveyone like Scott who doesn't do a complete washout and stick with just one med doesn't really want to get better?
From an outsider perspective, this whole thing looks very strange. I guess there's some stuff I don't know and so on. Still, as I said, it's really frustrating.
>
>
Posted by europerep on December 30, 2011, at 15:12:04
In reply to Re: Adding Parnate and prazosin. » europerep, posted by Bob on December 30, 2011, at 14:26:19
That message was confusing, but I think I got the gist of it.
Note that I am not saying that people who don't respond to treatments don't want to get better. I am saying that it looks very strange to me that Scott tries literally dozens of drug combinations that all mediate their action through 5HT/NE/DA, but doesn't even try to find a doctor who might be willing to look for options outside the usual treatment schemes. And this is all the more confusing when he has the experts on those treatments practicing in his state.
Maybe you take offense at the fact that I'm not going to be the 765th person on here to with Scott "good luck" with his next step. I am questioning his decision-making because, in my eyes, it seriously warrants questioning.
However, I have made my point, which is why I said that I won't make further comments in threads on his treatment.
Posted by ed_uk2010 on December 30, 2011, at 17:33:54
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on December 29, 2011, at 15:47:27
> > >I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD
> >
> > What dose are you on Scott? Do you mean 3 mg? What strength of tablets/capsules do you have?
>
>
> Yes. Good catch. 1 mg capsules. 3 mg/day.
>
> Thanks.
>
>
> - Scott30mg is not unheard of but it's not much used in practice! Certainly not initially.
Posted by Phillipa on December 30, 2011, at 18:40:37
In reply to Re: Adding Parnate and prazosin. » Bob, posted by europerep on December 30, 2011, at 15:12:04
In defense of Scott who I feel is capable and probably out somewhere as he is feeling good right now which must be a wonderful feeling for him that from posts over the years I think don't know as fact that he has consulted many specialists and maybe this isn't his state? I'm sure he will clarify when available to. Phillipa
Posted by emmanuel98 on December 30, 2011, at 19:01:12
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on December 30, 2011, at 14:13:50
> Hold on a sec, you are from Massachusetts, and yet you haven't even talked to the guys at McLean hospital who did the work on buprenorphine in TRD?
>
I was in McLean for three weeks two-and-a-half years ago and asked the psychiatrist about buprenorphine. My husband and I both thought it was the only thing likely to work for me. She said she would consult on it, but never mentioned it to me. As it turned out, I started on parnate and got out of bed within 48 hours after being in a vegetative state for two months.So who at McLean has done research on buprenorphine and TRD? Is it very recent? My p-doc there seemed very good and up on all the latest treatments.
Posted by Phillipa on December 30, 2011, at 20:31:06
In reply to TRD and Buprenorphine and McLean, posted by emmanuel98 on December 30, 2011, at 19:01:12
Seriously two days? Is this common? Phillipa
Posted by SLS on December 30, 2011, at 20:37:17
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on December 30, 2011, at 14:13:50
> > No, but I have dealt with the staff there. Andy Neirenberg is particularly smart and compassionate. He specializes in TRD. Also, Sporn and Fava.
>
> Hold on a sec, you are from Massachusetts, and yet you haven't even talked to the guys at McLean hospital who did the work on buprenorphine in TRD?Don't be too quick to reach conclusions. I do not live in Massachusetts, and I have already seen the folks at McLean - 20 years ago.
> I'm going to stop commenting on your threads because, as I said, it is extremely frustrating to watch.
I thought I was the one who said it must be frustrating to read my threads.
> I am seriously wondering whether you have some subconscious element that actually doesn't want you to get better.
I have heard this from some people.
> Now you are entertaining thoughts on DBS, instead of taking a look at other, rational pharmacological alternatives.
Well, right now I am in the middle of trying a pharmacological alternative.
> From an outsider perspective, this whole thing looks very strange.
Yes, to an outsider.
> I guess there's some stuff I don't know and so on. Still, as I said, it's really frustrating.
I apologize.
- Scott
PS - I am currently responding to treatment. We'll see how long it lasts this time.
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