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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 317. Go back in thread:
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.
Posted by SLS on December 30, 2011, at 20:41:51
In reply to Re: Adding Parnate and prazosin. » europerep, posted by Phillipa on December 30, 2011, at 18:40:37
> In defense of Scott who I feel is capable and probably out somewhere as he is feeling good right now...
Yes!!!
Good surmise. I went to a movie - "War Horse". My mind has not been this active in over 20 years. I really enjoyed the movie and appreciated its complexity.
- Scott
Posted by SLS on December 30, 2011, at 20:44:22
In reply to Re: TRD and Buprenorphine and McLean » emmanuel98, posted by Phillipa on December 30, 2011, at 20:31:06
> Seriously two days? Is this common? Phillipa
Parnate has some very interesting amphetamine-like properties. I don't doubt that a stimulant-effect can arrive well before an antidepressant-effect does.
- Scott
Posted by SLS on December 30, 2011, at 20:47:48
In reply to TRD and Buprenorphine and McLean, posted by emmanuel98 on December 30, 2011, at 19:01:12
> 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.
My doctor has the same sentiments regarding buprenorphine. I have discussed this with him on three occasions. He is not impressed with the paucity of data and anecdotes on its use for depression.
I don't doubt the people who report getting relief from buprenorphine.
- Scott
Posted by Phillipa on December 30, 2011, at 20:50:15
In reply to Re: TRD and Buprenorphine and McLean » Phillipa, posted by SLS on December 30, 2011, at 20:44:22
Scott so glad you are feeling well saw the movie. I'm guessing from your other response to me that anxiety isn't a factor in vegetative depression. And you are stimulating your brain with all this new activity maybe this is turning the switch to normalicy for you back on. What is normal? Different for us all. Phillipa
Posted by SLS on December 30, 2011, at 20:59:20
In reply to Re: TRD and Buprenorphine and McLean » SLS, posted by Phillipa on December 30, 2011, at 20:50:15
> And you are stimulating your brain with all this new activity maybe this is turning the switch to normalicy for you back on.
That's what I am hoping.
Thanks.
- Scot
Posted by SLS on December 30, 2011, at 21:30:24
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on December 30, 2011, at 20:41:51
> > In defense of Scott who I feel is capable and probably out somewhere as he is feeling good right now...
> Yes!!!
>
> Good surmise. I went to a movie - "War Horse". My mind has not been this active in over 20 years. I really enjoyed the movie and appreciated its complexity.Oh, and I had popcorn and ice cream. It was a good day.
- Scott
Posted by sigismund on December 30, 2011, at 23:21:14
In reply to Re: Adding Parnate and prazosin., posted by SLS on December 30, 2011, at 21:30:24
The Prazosin must be an important part of it then?
Who knows, I guess.
Posted by SLS on December 31, 2011, at 6:05:39
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on December 30, 2011, at 23:21:14
> The Prazosin must be an important part of it then?
>
> Who knows, I guess.Exactly. Prazosin is absolutely effective in reducing nightmares and sleep disturbance in PTSD. We'll have to see how effective it is for treating MDD and BD.
It is my intention to attempt a brief discontinuation of prazosin at some point in order to ascertain its role in producing the improvement that I am now enjoying. It is important to me that I not take a drug that I don't need, especially since it might make the hypotension that Parnate produces worse. I would like to report my results to the fine folks of Psycho-Babble. It is a personal experiment that might have implications for the treatment choices of others. It would be nice if prazosin turns out to be a viable adjunct to antidepressants in the treatment of TRD. I am not worried about not being able to recapture the response to prazosin. I will restart it at the slightest hint of relapse.
Currently:Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 3 mg
- Scott
Posted by europerep on December 31, 2011, at 7:19:17
In reply to TRD and Buprenorphine and McLean, posted by emmanuel98 on December 30, 2011, at 19:01:12
The study most often cited when talking about buprenorphine and TRD is the one by Alec Bodkin, Jonathan Cole et al. with both in- and out-patients at McLean. I know for a fact that doctors at McLean still occasionally buprenorphine for difficult-to-treat depression, not without some success.
Posted by europerep on December 31, 2011, at 7:22:45
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on December 30, 2011, at 20:37:17
> 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.
Well, that was before the article on buprenorphine and TRD was even published.
> I apologize.
That is not at all the point here. I said before that I didn't make my comments to make you feel bad. I am trying to point out to you what appears to me as an irrational mode of decision-making.
> PS - I am currently responding to treatment. We'll see how long it lasts this time.Needless to say, I wish you good luck with that.
Posted by europerep on December 31, 2011, at 7:24:16
In reply to Re: Adding Parnate and prazosin. » europerep, posted by Phillipa on December 30, 2011, at 18:40:37
> 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
Could you please write in entire phrases that make sense, at least when you are replying to one of my posts? I have given up decrypting your elliptical posts. Don't forget that not all members here are native English speakers.
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