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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 45 to 69 of 94. Go back in thread:
Posted by SLS on February 4, 2014, at 23:02:58
In reply to Scott (pretty long post), posted by poser938 on February 4, 2014, at 22:11:14
Thanks for replying, Poser.
I'll want to read your post again and see if I can help you in some way. I just wanted you to know that I'm not ignoring you.
My initial thoughts regarding your reaction to food is that you are experiencing an imbalance in your autonomic nervous system (too much sympathetic and/or too little parasympathetic). Do you experience mild heart palpitations after a meal? This might be part of any mood / anxiety illness you may have. However, I think it reasonable to believe that this dysautonomia can be precipitated or exaggerated by exposure to medication. I would be curious to know if your reaction to food is reduced when you reduce your intake of carbohydrates - especially refined carbohydrates.
The treatment your first psychiatrist prescribed to you was an abomination. You, of course, should have been prescribed psychotherapy as your initial treatment before moving on to biological treatments.
Any nausea?
Have you ever tried nortriptyline (Pamelor) or mirtazapine (Remeron)?
- Scott
Posted by poser938 on February 5, 2014, at 17:05:25
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 4, 2014, at 23:02:58
Scott, I THINK what you're describing with reactions to food is what a friend of mine has, that he developed after smoking Marijuana. And he does have heart palpitations.
But, I believe what I have is different. Now, my thoughts are quite blurry at the moment, but I'll try describing it as well as I can. And I do believe this is going to sound "alien". But as I said, my increased sensitivity to foods began while taking 150mgs of Effexor. At the same time I experienced hair loss, as well as muscles in my face tensing up on their own. And I believe they're all related to the same pathway.
And after I quit Effexor and began, and after a few weeks I noticed the benefit of Cyproheptadine on my mood. At this time, my hair actually started falling out a bit faster and the effect of food on my mood became even stronger. And the weirdest thing was, I could eat certain foods, such as meat, and as soon as I swallowed it, my hair would begin falling out in gobs. And at this same time, my whole emotion system felt alive again. And as soon as I'd eat or drink something else, the massive hair loss would stop. And my emotions once again were inhibited.
I also noticed, that I could once again feel the effects of Adderall again, after it had just completely stopped working after my panic attack. But Adder all also increased my hair loss. And I had only tried one dose just to see if I could feel the effects of it again. What my theory is, is that Effexor caused a Dopamine Super sensitivity, and that this Super sensitivity caused a dysregulation in other pathways, as well as making me sensitive to foods.
...................................................
But, anyway. With Mirapex. I'm positive it caused the same thing Adder all did. Basically a shut down of my Dopamine System. And I believe Cyproheptadine worked to fix this because of its 5ht2c Antagonism, and how this disinhibits Dopamine release. Like I've mentioned, over stimulation of Neurotransmitter Systems can result in making these systems unresponsive. Especially in my case and others that may be prone to this.http://en.wikipedia.org/wiki/5HT2C_receptor
I have read about other receptors that pay a role in modulating Dopamine Release. Such as the 5ht1a receptor, so I tried Buspar, and it worsened my situation after a single dose.
I've tried low doses of Amisulpride to block D presynaptic repeptors, and felt no effect from it. I've tried regular doses of a few Atypical Antipsychotics and feel no effect from them. I even had a Pdoc prescribe Flumazenil and experienced zero effect from it. And I no longer feel effects from Adderall. Or from Provigil. Some other meds I've tried that I felt zero effect from were Lamictal and Gabapentin. Ketamine only effects me the same way a high dose of Cough Syrup did. By just making me dizzy.
My main Problem, I do believe is a basic shut down in Dopamine Neuro transmission that was caused by Mirapex. And with this, it is very difficult to help my moods by the foods I eat. What benefits me best is caffeine, like a Coca Cola with a meal consisting of some kind of meat. Refined grains that have been supplemented with B Vitamins make me feel bad. While Whole Grains do not. But my hair no longer falls out faster in response to certain foods, though it still falls out slightly more than it used to. Thankfully its not noticeable.
I know all this is a bit complicated, but its what I've experienced. And I don't know any other way to describe it in detail.
But currently, my idea is to try an SSRI, to kind of stimuluate my Serotonin Receptors, signaling for my brain to in a sense, give my Dopamine System a break. And hopefully it will "wake up" as I take the SSRI chronically.
Posted by poser938 on February 5, 2014, at 17:25:51
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 4, 2014, at 23:02:58
And yes, I've tried Remeron with no benefit. But not Pamelor.
I do realize my situation is complicated. And there may not really be much advice for it.
Posted by Phillipa on February 5, 2014, at 18:13:03
In reply to Re: Scott (pretty long post), posted by poser938 on February 5, 2014, at 17:25:51
How is your thyroid? Not that it could cause all this. Phillipa
Posted by phidippus on February 5, 2014, at 18:22:39
In reply to Scott (pretty long post), posted by poser938 on February 4, 2014, at 22:11:14
> pushed me into taking Psychiatric medication was after getting out of a relationship with my "first love". I was 17 and i had thought I lost everything after we broke up.
So you were depressed.
>4 different meds all at once on my first appointment.
Ridiculous.
> Adder all made me feel hyped up and I don't think I ever noticed an effect from Cymbalta.
How do you know it was the Adderall and not the Cymbalta?
>But as time went by, I ended up having a panic attack. , my first panic attack ever.
This can happen with treatment with Cymbalta.
>The next day after the panic attack, I felt bad. I ended up discontinuing the meds and my mood never reverted back to normal.
Cymbalta put you in a tailspin. It may have even triggered a mixed mood episode, which you never treated properly.
>I had extreme anxiety, agitation and felt like I was in hell.
All of these can be signs of a bipolar mood episode. If Cymbalta triggered a bipolar mood episode then it makes sense you could have remained that way without proper treatment.
> So, after a year, I went back to the Psychiatrist and tried more meds. Cymbalta again, then Zoloft, then Wellbutrin and then Effexor.
None of which seem to be the right medications.
>I asked to raise (Venlafaxine) to 150mgs. At this dose, I started feeling more agitation
More antidepressant + bipolar mood disorder equals agitation.
>And muscles in my face started tensing up on their own and it was a bit painful.
Did you get rhythmic movements of your tongue and/or lips?
>"Only Antipsychotics can cause that".
Some antidepressants can cause tardive dyskensia, however Venlafaxine is not listed as one of those antidepressants.
>my moods being affected by foods I ate.
How were your moods affected?
> But I kept taking it, and after a few, my emotions went completely blank....
Venlafaxine can cause emotional flattening.
>So I ended up trying Cyproheptadine to counter this. After a few weeks on it, slowly working up the dose, I suddenly felt much better one morning.
Cyproheptadine antagonizes a lot of those receptors implicated inn a mixed or manic episode. As you raised the dose, the effect became more apparent-you felt better because your mood was stabilizing.
>I decided on trying Mirapex.felt a slight benefit for a few weeks, then one day BAM, I was back to feeling I was in hell.
Curious you should choose another medication that can cause mania in patients with bipolar disorder. I take you were agitated and anxious and dysphoric?
>I stopped taking it, after some weeks my mood never went to feeling better.
Of course not-if your bipolar you wouldn't have improved without the help of a mood stabilizer.
>I then tried Tianeptine and after 10 days it made me even worse. Then tried Ritalin, and after the first dose, this worsening was compounded.
More drugs that make bipolar disorder worse.
>I've VERY slowly regressed back. I'm STILL regressing a tiny but every day.This is the nature of bipolar disorder.
> I know my experience might be unheard of by many, but this is just how it as been.
Your's is a complex case, but I think it makes perfect sense. I think you're bipolar and need a mood stabilizer to help you with your moods.
Eric
Posted by phidippus on February 5, 2014, at 18:28:31
In reply to Re: Scott (pretty long post), posted by poser938 on February 5, 2014, at 17:05:25
Dude, you're bipolar. Read my reply to your other post. You need a mood stabilizer.
And, by the way, Cyproheptadine blocks dopamine receptors.
Eric
Posted by SLS on February 5, 2014, at 21:46:20
In reply to Re: Scott (pretty long post), posted by poser938 on February 5, 2014, at 17:05:25
Hey, Poser.
You described your situation well.
A few ideas arranged in no particular order:
* Agomelatine (Vilazadone)? It is a potent 5-HT2c receptor antagonist without affecting the 5-HT2a receptor. This is in addition to stimulating melatonin receptors.
* Nortriptyline (Pamelor)? It combines NE reuptake inhibition with 5-HT2a receptor antagonism. It increases dopamine by stimulating its release.
* Mirtazapine (Remeron)? It combines 5-HT2a/c and 5-HT3 receptor antagonism with presynaptic NE alpha-2 receptor antagonism.
* Nefazodone (Serzone)? It combines 5-HTc receptor antagonism and weak serotonin reuptake inhibition.
* Trazodone (Deseryl)? It combines 5-HTc receptor antagonism and weak serotonin reuptake inhibition. Side effects limit its use, and the mCPP metabolite can produce anxiety and agitation in vulnerable individuals via 5-HT2c agonism.
* Memantine (Namenda)? It produces dopamine release, D2 receptor agonism, and dopamine reuptake inhibition.
* Amantadine (Symmetrel)? It increases dopaminergic activity and acts as an antagonist of the NMDA glutamate receptor.
* Aripiprazole (Abilify)? It acts as a dopamine system stabilizer via dopamine D2/3 receptor partial agonism. It also acts as a 5-HT1a partial agonist and 5-HT2a receptor antagonist.
* Selegiline (Emsam)? It is an irreversible MAO inhibitor that is selective for the MAO-B (dopamine) enzyme at low dosages.
* Tranylcypromine (Parnate)? It is an irreversible and nonselective MAO inhibitor with amphetamine-like properties.
- Scott
Posted by SLS on February 5, 2014, at 21:52:57
In reply to It all makes sense » poser938, posted by phidippus on February 5, 2014, at 18:22:39
I think your conclusion that Poser has bipolar disorder is perfectly reasonable. What treatements do you feel are most likely to improve his condition(s)?
- Scott
Posted by SLS on February 5, 2014, at 21:54:48
In reply to Re: Scott (pretty long post), posted by poser938 on February 5, 2014, at 17:25:51
Phiddipus suggested that you might be bipolar. Do you have any reason to believe otherwise?
- Scott
Posted by SLS on February 5, 2014, at 21:57:15
In reply to Re: Scott (pretty long post), posted by phidippus on February 5, 2014, at 18:28:31
> And, by the way, Cyproheptadine blocks dopamine receptors.
I never heard that before.
- Scott
Posted by poser938 on February 5, 2014, at 23:03:55
In reply to Re: Scott (pretty long post) » poser938, posted by Phillipa on February 5, 2014, at 18:13:03
> How is your thyroid? Not that it could cause all this. Phillipa
Hi Phillipa, I did have my thyroid checked and it turned out fine. But I tried Thyroxinr a few months ago anyway and I also felt zero benefit.
Posted by poser938 on February 5, 2014, at 23:26:06
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 5, 2014, at 21:54:48
That was actually my first idea back in 2006, that maybe, must maybe Cymbalta uncovered Bipolar Disorder in me.
But after more experiences with meds, I started to have every reason that its not Bipolar Disorder. That it is indeed meds affecting me the way I described to you they did.
And you'd have every reason to believe that its not BD as well, if you had taken into account the things I wrote in each of my posts on this thread.
But that's been my experience in Psychiatry. With only a few things I mention being taken into account, while the others are either ignored or they just assume what I must be misled about those experiences. I guess because they don't fit into the narrative they want my situation to fit into.
But its the equivalent to saying that the movie The Matrix was mainly about a love story, and not what it was actually about.Every time I go into detail about my situation, whether its to a new Psychiatrist I'm seeing or someone in a forum, I just get my hopes up that they're going to tell me that there's more to mental health "care" than what I've seen and read about. I mean, really, thank you for your time and your Med suggestions. But I don't believe there much hope for my situation.
I've been already taking an SSRI (lexapro and a few days ago I switched to Prozac) and so far, no manic reactions. Hurray! But I suppose Eric is going to assume that's because my Mania just hasn't kicked in yet. OR that I have qualification to be able to know what I experience, or how I feel. But like I said, that's what you get when you step into the world of Psychiatry, especially if your experience strays from the norm.
Anyway, its clear that there's nowhere to go for me to get any answers, to get some kind of hope. Not that I can actually feel hope. Or love, or Religion or anything else that makes life worth living. Its called Anhedonia. As well as a near absence of Affect.Thats what I have.
Peace!
Posted by poser938 on February 5, 2014, at 23:30:35
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 5, 2014, at 21:54:48
Time going to do my idea with Prozac. And if that doesn't help, though I strongly would love to have DBS at Stanford in California, I doubt it will ever happen. Too expensive and no insurances cover it. But I think I will FINALLY fulfill my desire of giving up.
Posted by poser938 on February 5, 2014, at 23:37:05
In reply to It all makes sense » poser938, posted by phidippus on February 5, 2014, at 18:22:39
Eric, I have taken Adder all WITHOUT Cymbalta as well. And it did the same thing. It "hyped me up".
Liz Spikol, the senior contributing editor of Philadelphia Weekly, wrote of her ECT in 1996,
"Not only was the ECT ineffective, it was incredibly damaging to my cognitive functioning and memory. But sometimes it's hard to be sure of yourself when everyone 'credible' scientists, ECT docs, researchers are telling you that your reality isn't real. How many times have I been told my memory loss wasn't due to ECT but to depression? How many times have I been told that, like a lot of other consumers, I must be perceiving this incorrectly? How many times have people told me that my feelings of trauma related to the ECT are misplaced and unusual? It's as if I was raped and people kept telling me not to be upsetthat it wasn't that bad."
That's a quote someone made on Shock Therapy. Replace "Shock Therapy" with "Psychiatric Medicine", and that quote describes me experience as well.
Posted by SLS on February 6, 2014, at 5:11:39
In reply to Re: It all makes sense, posted by poser938 on February 5, 2014, at 23:37:05
Bipolar? I am not convinced that you are now dealing with a condition that lies along the bipolar spectrum, but it might not hurt to consider the possibility that there is some bipolar stuff going on that was triggered by antidepressants. It would allow you to explore a drug like Trileptal, which often helps people with bipolar disorder who have irritability, agitation, aggression, or impulsivity while in a mixed-state. However, these symptoms occur with major depressive disorder, too, although they are more prevalent during adolescence.
---------------------------------------
http://archpsyc.jamanetwork.com/article.aspx?articleid=1737169
Interpretation on Medscape:
* "The most important finding in this paper is that it confirms...that the majority of people with irritability and depression do not have bipolar disorder," Roy H. Perlis, MD, director of the Bipolar Clinical Program at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School in Boston, who was not involved in the study..."
"Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates.
Results from the longitudinal observational investigation of patients with unipolar MDEs showed that those with current overt irritability/anger were significantly more likely to have increased depressive severity, longer duration of the index MDE, poorer impulse control, and a more chronic and severe long-term course of illness.
Overt irritability and anger were also associated with higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial and personality disorders, greater psychosocial impairment, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives.
The study findings strongly suggest that "concurrent anger/irritability symptoms are important indicators of increased severity, chronicity, and complexity of unipolar major depression," the authors, led by Lewis L. Judd, MD, University of California, San Diego, write. Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates.
Results from the longitudinal observational investigation of patients with unipolar MDEs showed that those with current overt irritability/anger were significantly more likely to have increased depressive severity, longer duration of the index MDE, poorer impulse control, and a more chronic and severe long-term course of illness.
Overt irritability and anger were also associated with higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial and personality disorders, greater psychosocial impairment, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives.
The study findings strongly suggest that "concurrent anger/irritability symptoms are important indicators of increased severity, chronicity, and complexity of unipolar major depression," the authors, led by Lewis L. Judd, MD, University of California, San Diego, write."
---------------------------------------
The list of drugs I gave you was based upon the criteria you set for treatment using your theory. Some are good tools for depression, but would not really address bipolarity per se. You don't have to display mania to have a bipolar diathesis (underlying predisposition). Lamictal might help with the depression aspect, as might adding low dosages of lithium to Prozac. At this point, polypharmacy is probably what is going to get you better. The permutations of combinations of drugs are virtually endless. It is hard to lose hope when so many treatments are left untried. I chose to take lithium at 300 mg/day indefinitely because it does so many things that protect the brain from further damage by my bipolar depression and stress. It turned out that going to 450 mg/day sparked an improvement in depression. Minocycline is another drug with neuroprotective properties which has the potential to treat bipolar depression.
Would you really prefer to have electrodes routed through a hole drilled into your skull rather than taking a mood stabilizing drug?
Let's say that you do not have any family history of bipolar or schizoid illness, and that you are not truly bipolar. Bipolar drugs might still help when so many antidepressant drugs have not. I would consider using Abilify or Latuda in combination with antidepressants before going with DBS. I would also consider adding minocycline. You might actually avoid traditional antidepressants altogether by combining Abilify, Lamictal, and minocycline. I have seen it work very well.
My mind is open, otherwise I would not have produced that list of drugs in one of my previous posts. I hope your mind is just as open to the idea that your current condition includes bipolar features.
- Scott
Posted by Bob on February 6, 2014, at 14:04:09
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 4, 2014, at 23:02:58
>
> Any nausea?
>
> Have you ever tried nortriptyline (Pamelor) or mirtazapine (Remeron)?
>
>
> - Scott
>Scott... are you saying that nortriptyline and mirtazapine are particularly well suited for treating autonomic dysregulation?
- Bob
Posted by Bob on February 6, 2014, at 14:08:48
In reply to Re: Scott (pretty long post) » poser938, posted by SLS on February 5, 2014, at 21:46:20
> * Nefazodone (Serzone)? It combines 5-HTc receptor antagonism and weak serotonin reuptake inhibition.
>>
> - Scott
Wasn't Serzone discontinued almost 10 years ago?-Bob
Posted by phidippus on February 6, 2014, at 16:38:20
In reply to Re: It all makes sense, posted by poser938 on February 5, 2014, at 23:37:05
Well...You've been trying to treat the wrong disorder. Everytime you took antidepressants you succumbed to manic-like symptoms.
Of course you felt raped. Try something that might really help this time: a mood stabilizer.
Eric
Posted by phidippus on February 6, 2014, at 16:47:19
In reply to Re: Scott (pretty long post) » SLS, posted by poser938 on February 5, 2014, at 23:26:06
>...a few days ago I switched to Prozac) and so far, no manic reactions
Is the dose therapeutic and have you been on the dose for at least 4 weeks?
Absence of affect? There's seem to be plenty of emotional undertow inn your writings.
Eric
Posted by phidippus on February 6, 2014, at 17:54:55
In reply to Re: Scott (pretty long post) » phidippus, posted by SLS on February 5, 2014, at 21:57:15
Receptor/Transporter Protein antagonistBinding affinity (Ki[nM]) towards cloned human receptors unless otherwise specified[31]
SERT 4100 (RC)
NET 290 (RC)
5-HT1A 59
5-HT2A 1.67
5-HT2B 1.54
5-HT2C 2.23
5-HT3 228 (MN)
5-HT6 142
5-HT7 123.01
M1 12
M2 7
M3 12
M4 8
M5 11.8
D1 117
D2 112
D3 8
H1 0.06
H3 >10000
H4 201.5
Posted by phidippus on February 6, 2014, at 17:56:10
In reply to Re: It all makes sense » phidippus, posted by SLS on February 5, 2014, at 21:52:57
I'd like to see him try a mood stabilizer.
Eric
Posted by poser938 on February 6, 2014, at 18:15:00
In reply to Re: Scott (pretty long post) » poser938, posted by phidippus on February 6, 2014, at 16:47:19
> >...a few days ago I switched to Prozac) and so far, no manic reactions
>
> Is the dose therapeutic and have you been on the dose for at least 4 weeks?
>
> Absence of affect? There's seem to be plenty of emotional undertow inn your writings.
>
> Eric
It doesn't matter to you what dose I was on. You'd still find some way to explain it away.And there you go again, taking into account some things I write and ignoring others. I wrote "near" absence of affect. One of my psychiatrists used the words "essentially an absence of affect" to describe it.
I can close my eyes while I'm driving and keep them closed and feel as comfortable as I am sitting on my living room couch. With music, I feel a very tiny fraction of it that I used to. Much of the way it sounds, I am oblivious to. There is a high-speed sweeping curve on the interstate close to my town that, before having meds mess me up, I felt a strong g-force when going around it at 80mph. I no longer feel that. I also no longer get an effect from many meds ive tried. Such as AdderlalI . And i tried Yohimbine a few weeks ago, i had tried it before in the past and it made me feel extreme,y anxious and made my heart beat fast. This time, zero effect from it. could go on and on. But the emotions I do express and feel are on a much, much smaller scale than they used to be. But as I continue regressing back to my pre-cyproheptadine state, it will develop into a complete absence of affect.And I have tried a couple of different mood stabilizers, lamictal and a couple of different Atypical Antipsychotics. I got zero effect from them. And yes, I took them in therapeutic doses.
But see, this is why I keep replying. I want to feel more suicidal. I want to have the motivation to follow through with it. Me hearing more and more misunderstanding from people, helps increase my suicidal thoughts. Some time ago I figured I would have followed through with it by now. But, I'm still here!
Write some more back to me, Eric.
Posted by Phillipa on February 6, 2014, at 18:28:14
In reply to Re: Scott (pretty long post), posted by poser938 on February 6, 2014, at 18:15:00
Poser I am writing and truly want to see you get better. Think a short stay inpatient might help? Just a suggestion. I like you and want to see you remain here. One time I took a low very low dose of trileptal. Felt nothing on it. But was the suggestion of pdoc. Phillipa
Posted by poser938 on February 6, 2014, at 18:36:03
In reply to Re: Scott (pretty long post) » poser938, posted by Phillipa on February 6, 2014, at 18:28:14
Thank you, Phillipa. I'm trying everything I can. The main thing keeping me alive right now are my animals. But before too much longer I won't even be able to bring myself to pet the :(
Its part of my absence if affect.I'll look up Trileptal. If it looks like it has potential, I will try it.
Posted by phidippus on February 6, 2014, at 18:50:28
In reply to Re: Scott (pretty long post), posted by poser938 on February 6, 2014, at 18:15:00
Eric,
> It doesn't matter to you what dose I was on. You'd still find some way to explain it away.I just wanted information.
> And there you go again, taking into account some things I write and ignoring others.
I ignored those things I felt unimportant.
>One of my psychiatrists used the words "essentially an absence of affect" to describe it.
What does this mean to you?
> I can close my eyes while I'm driving and keep them closed and feel as comfortable as I am sitting on my living room couch.
Are you trying to crash?
>With music, I feel a very tiny fraction of it that I used to. Much of the way it sounds, I am oblivious to.
Does it matter what kind of music?
>There is a high-speed sweeping curve on the interstate close to my town that, before having meds mess me up, I felt a strong g-force when going around it at 80mph. I no longer feel that.
So you now have a vestibular disorder from the meds you took?
>I also no longer get an effect from many meds ive tried. Such as AdderlalI .
What affect should it have?
>And i tried Yohimbine a few weeks ago, i had tried it before in the past and it made me feel extreme,y anxious and made my heart beat fast. This time, zero effect from it.You may have been nervous the first time around you tried it. You may have been accustomed to
its effect the second time around.>it will develop into a complete absence of affect.
"Brains!" - Zombie
> And I have tried a couple of different mood stabilizers, lamictal and a couple of different Atypical Antipsychotics. I got zero effect from them. And yes, I took them in therapeutic doses.
Great,did you get agitated and anxious on them?
> But see, this is why I keep replying. I want to feel more suicidal.I spend hours a day thinking about suicide, whether I reallly want to or not.
>Me hearing more and more misunderstanding from people
What do you want from us?
Eric
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