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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 51 to 75 of 94. Go back in thread:
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.
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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."
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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
Posted by poser938 on February 6, 2014, at 18:57:29
In reply to Re: Scott (pretty long post) » poser938, posted by phidippus on February 6, 2014, at 18:50:28
I want everyone to know what I experienced was real. I want them to know the reason why I parked my car on the side of the interstate and jumped in front of a big truck going 70 MPH.
Posted by SLS on February 6, 2014, at 19:24:34
In reply to Re: Scott (pretty long post) » phidippus, posted by poser938 on February 6, 2014, at 18:57:29
It doesn't matter who is right and who is wrong. It appears to me that everyone is trying to help you, Poser. The thing is, each of us has a different way of doing this. I am not Phiddipus and Phiddipus is not me. However, I am certain that we both want to see you feel well.
I am listening to you.
- Scott
Posted by SLS on February 6, 2014, at 19:41:47
In reply to Re: Scott (pretty long post) » SLS, posted by Bob on February 6, 2014, at 14:04:09
> > Any nausea?
> >
> > Have you ever tried nortriptyline (Pamelor) or mirtazapine (Remeron)?> Scott... are you saying that nortriptyline and mirtazapine are particularly well suited for treating autonomic dysregulation?
I'm not really sure. :-(
- Scott
Posted by Phillipa on February 6, 2014, at 19:46:55
In reply to Re: Scott (pretty long post) » Phillipa, posted by poser938 on February 6, 2014, at 18:36:03
Poser I do want to help. I may not have the psychiatric knowledge to do so but I can emotionally support you. As I do care. Please stick around. I have no idea what a diagnosis or treatment is for you. But keep trying. I've seen you this way before and you have rallied back. Routing for you. Phillipa
Posted by phidippus on February 6, 2014, at 21:29:04
In reply to Re: Scott (pretty long post) » phidippus, posted by poser938 on February 6, 2014, at 18:57:29
Whether it was real or not isn't important. What matters most is that you move forward and continue to try and treat your illness.
Eric
Posted by baseball55 on February 6, 2014, at 23:01:33
In reply to Re: Scott (pretty long post), posted by poser938 on February 6, 2014, at 18:15:00
> 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.This is a very disturbing post. So the more people respond and fail to completely validate your perception, the more you become depressed and want to commit suicide? And you keep posting to elicit what you see as unhelpful responses to make yourself more depressed so as to increase your motivation to commit suicide?
Well, I, for one, opt out of this game. If you want to commit suicide, I can't stop you and I hope, for your sake, that you don't make this decision. But I'm certainly not going to participate in a conversation in which you perceive yourself as constantly misunderstood and driven by others' misunderstanding to commit suicide.
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