![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 59. Go back in thread:
Posted by Ilene on January 26, 2003, at 20:21:04
In reply to fighting anhedonia by increasing reward pathway, posted by hok on January 24, 2003, at 13:19:37
> Unfortunately, I still have found that frequent dosings of coffee and nicotine are superior to Focalin or Adderal XR, and cause less adverse effects (besides the obvious health probs caused by the smoking). Most stimulants cause me way too much hyperfocus, agitation, and rebound effect.
>
Interesting that you find smoking helpful. So do many schizophrenics. Unfortunately, the effect is so transitory they become chain smokers. When I did a casual pubmed search on it, I found a few abstracts that said, in essence, "This is interesting, someone should explore it."> If anybody else is battling treatment-resistant depression and has found success with some sort of dopamine augmentation via supplements or medication, I'd like to know about it.
>
You and me both.> Specifically, has Dex been more effective in fighting anhedonia or is Methylphenidate the obvious winner still? I've never tried Dex and remain curious.
>
No. I took small amounts of dexedrine (10-20 mg.) for a couple of years. It kept me awake and somewhat more alert, but had no effect on my other symptoms. My pdoc at the time finally diagnosed a sleep disorder, which I now control (sort of) with light therapy and provigil (modafinil).I took ritalin (methylphenidate) first and it was *awful*.
It was very difficult to buy the dexedrine, because I needed to get a new script every month--no refills--and the pharmacies didn't always keep it in stock. And then when I changed pdocs the new one just sat and stared at me for a long time, until I got so flustered I started yammering like an idiot. He finally wrote script for two weeks, and when I came back for the 2nd appt. as fat as before he interrogated me about my appetite and sleep. He finally admitted he wasn't familiar with dexedrine but figured I wasn't "abusing" it. Argh.
> As for the Wellbutrin angle, I tried it for a couple of weeks and found it way too agitating.
> Don't think it was for me but might be open to another trial down the line.
>
> Any suggestions?I tried wellbutrin a few years ago and couldn't tolerate it. Then I started taking the sustained release formulation last year and found it tolerable. I switched to the regular version because I can take 50 more mg. a day. (Many of the original clinical trials used dosages that are higher than the current maximum.) It makes it easier to resist lying in bed for most of the day. Plus it helped counter the anorgasmia I had with ssris.
Posted by hok on January 27, 2003, at 14:44:37
In reply to Re: fighting anhedonia by increasing reward pathway, posted by JohnL on January 25, 2003, at 5:27:22
thanks for the input so far, everyone.
just touching on some of the points that people have brought up so far...
Yes, I have tried Buspar. It had a minor effect on my mood and motivation. On the negative side, it caused more irritability than it was worth.
As for the MAOIs, I have never tried one of the A-types. Considering that I am an atypical depressive, this would seemingly make sense. My doctor and I tend to believe that the MAOIs will probably help my mood better than some of my past SSRI treatments. In the bigger picture though, my extreme sensitivity to most meds to increasing my atypical symptoms of tiredness, cravings, brain fog, and low libido make MAOIs a poor candidate.
Right now, I am content with my combo of nicotine, caffeine, omega-3, lots of vitamins, and low dose of Lexapro. As I mentioned, nicotine seems to be the best component of this combo. It's the best thing for curing my brain fog and increasing my concentration and mood. The primary reasons...
1. and the most ovbvious: boosts NE, dopamine, and acetylcholine, as well as its effect on MAO.
2. The inhalation medium allows for frequent onset and steady-state administration of its effect -- unlike with most oral means. This is importance considering I'm such a poor metabolizer (PM) and rebound effects have been a big issue.Eventually, if I try to quit, my best method of replacement might just be small dosages of the MAOI-B selegine (2-3 times daily) added to phenylamine.
Other things I'm going to try...
DHEA (known to help boost dopamine levels and energy). I tried it about a year ago and it helped. Although it did bring with it some minor hostility and irritability. Since then I have rearranged my med combo, and so a retrial might be in order. Along the same lines, I might even consider a small dose of Testosterone therapy as an option.
Even more on the radical side of things down the line, I'd be open to exploring any of the opiates as an option, since many potentiate dopamine release. Any ideas there (e.g., buprenorphine, oxycodone)?
And no, I haven't tried NADH or Siberian Ginseng yet (though I've tried the regular version), but I'm up for a trial of anything.
Everybody's input has been extremely helpful, so any other suggestions would be welcome.
HK
Posted by Ritch on January 27, 2003, at 23:10:53
In reply to Re: fighting anhedonia by increasing reward pathway, posted by hok on January 27, 2003, at 14:44:37
> thanks for the input so far, everyone.
>
> just touching on some of the points that people have brought up so far...
>
> Yes, I have tried Buspar. It had a minor effect on my mood and motivation. On the negative side, it caused more irritability than it was worth.
>
> As for the MAOIs, I have never tried one of the A-types. Considering that I am an atypical depressive, this would seemingly make sense. My doctor and I tend to believe that the MAOIs will probably help my mood better than some of my past SSRI treatments. In the bigger picture though, my extreme sensitivity to most meds to increasing my atypical symptoms of tiredness, cravings, brain fog, and low libido make MAOIs a poor candidate.
>
> Right now, I am content with my combo of nicotine, caffeine, omega-3, lots of vitamins, and low dose of Lexapro. As I mentioned, nicotine seems to be the best component of this combo. It's the best thing for curing my brain fog and increasing my concentration and mood. The primary reasons...
> 1. and the most ovbvious: boosts NE, dopamine, and acetylcholine, as well as its effect on MAO.
> 2. The inhalation medium allows for frequent onset and steady-state administration of its effect -- unlike with most oral means. This is importance considering I'm such a poor metabolizer (PM) and rebound effects have been a big issue.
>
> Eventually, if I try to quit, my best method of replacement might just be small dosages of the MAOI-B selegine (2-3 times daily) added to phenylamine.
>
> Other things I'm going to try...
>
> DHEA (known to help boost dopamine levels and energy). I tried it about a year ago and it helped. Although it did bring with it some minor hostility and irritability. Since then I have rearranged my med combo, and so a retrial might be in order. Along the same lines, I might even consider a small dose of Testosterone therapy as an option.
>
> Even more on the radical side of things down the line, I'd be open to exploring any of the opiates as an option, since many potentiate dopamine release. Any ideas there (e.g., buprenorphine, oxycodone)?
>
> And no, I haven't tried NADH or Siberian Ginseng yet (though I've tried the regular version), but I'm up for a trial of anything.
>
> Everybody's input has been extremely helpful, so any other suggestions would be welcome.
>
> HK
>
Have you ever tried or considered sibutramine (Meridia)? That's what I am going to bring up with my pdoc this week as a substitute for Effexor. It has far more noradrenergic and dopaminergic activity. It bombed clinical trials for depression, but its metabolite is in clinical trials now for ADHD and looks hopeful. I've got ADHD and bipolar and if I can find an effective treatment for ADHD that doesn't make me hypomanic (perhaps a "weak" antidepressant such as sibutramine), or increase anxiety (like stims), AND has some serotonergic activity (which Straterra lacks), it might just work. I like the idea of selegiline a lot-however pdoc won't go for it, perhaps the patch though.
Posted by hok on January 29, 2003, at 12:40:25
In reply to Re: fighting anhedonia by increasing reward pathway » hok, posted by Ritch on January 27, 2003, at 23:10:53
No, I never thought of Meridia as an option. Let me know how it goes.
As for the selegine/phenylamine trial, I don't expect to try it until a couple of months down the line. Too bad the FDA snubbed the patch though.
In the meantime, I think I'm going to try another go with DHEA, or even a low dose of Androgel (my endocrinologist is willing to prescribe) to see how this works. Hopefully I won't see any irritability/hostility this time.
I long for the days when something like amineptine was still available. I think that would have been the closest thing to the real answer.
Posted by Ron Hill on February 4, 2003, at 14:48:04
In reply to fighting anhedonia by increasing reward pathway, posted by hok on January 24, 2003, at 13:19:37
> Also, has anybody been trying any supplement (e.g., NADH) and had any success?
--------------------------Hok,
I started taking NADH (coenzyme 1) ten days ago, and although it is too early to tell if it will provide long term benefit, the initial results are remarkable. I am somewhat reluctant to post my positive results because last year I posted extensively regarding the positive benefits I was obtaining with SAM-e only to have the supplement induce severe irritability after five months of excellent benefit. At the same time, however, I feel that I have an obligation to the participants of this board to report this anecdotal NADH experience just in case it might help someone else.
I don’t know your dx nor do I know you medication history, and I do not presume to know if NADH will help you. However, based on what I’ve read and my own preliminary results with the coenzyme, I would recommend that anyone suffering with the type of depression characterized by anhedonia and anergy read the literature written about ENADA NADH.
It is thought that NADH stimulates tyrosine hydroxylase, the key enzyme for the production of dopamine. It is also reported that NADH increases the levels of serotonin and norepinephrine, but its primary action is thought to be dopaminergic. Please note, however, that some in the medical community (e.g. Ray Sahelian, M.D. in his book “”Mind Boosters””) contend that, although NADH provides initial relief for depression, tolerance is quickly developed to the coenzyme and, as a result, the over-the-counter product loses its effectiveness.
Here’s a Reader’s Digest version of my situation and how ENDA NADH is currently providing a benefit: I am bipolar II and I take 600 mg/day of Lithobid. The Lithobid does a good job of controlling my hypomanic symptoms but does little or nothing for the depressive phase of my illness. Over the years, I’ve tried several SSRI’s, SNRI’s, and other types of antidepressants but in the end they all left me with apathy, anhedonia and anergy. {As a side note, I have never tried any of MAOI’s and, if ENADA NADA poops out on me, I might try an MAOI.}
My most recent depressive phase began in November 2002 and lasted until ten days ago when I took the ENDA NADH. It was bad to the point of not even having enough motivation to shower and shave for days on end. I was sleeping mega hours and I just could not pull myself out of it. My wife is used to me cycling into depression, but this time it was lasting longer than usual, so she called my pdoc and set up an appointment. While doing some research on the internet in preparation for my upcoming pdoc appointment, I came across NADH information.
For some time now it has been my opinion that my depressive phase (characterized by anhedonia and anergy) is dopaminergic in nature. Therefore, when I read that NADH stimulates tyrosine hydroxylase, the key enzyme for the production of dopamine, and that NADH is present in every living cell, and that NADH supplementation does not cause any side effects, I decided to try some.
ENADA NADH is the stabilized form of NADH and, therefore, suitable for oral administration. ENADA NADH comes in two forms; 10 mg sublingual (under the tongue) tablets and 5 mg enteric coated (down the hatch) tablets. As chance would have it, I purchased the sublingual variety.
As I left the nutritional store, I placed a tablet under my tongue. Within thirty seconds, I began to feel relief from my three-month long depression and within two hours it was gone. Ten days later I’m still doing well on 10 mg/day. Will it last? I hope so, but time will tell. Will it help you? I hope so, but you would know more about that than I.
Here are some of the links discussing NADH:
http://www.healthwell.com/hnbreakthroughs/mar98/nadh.cfm?path=hw
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8101444&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9247090&form=6&db=m&Dopt=b
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9013405&form=6&db=m&Dopt=b
http://www.nadh.com/site7/SYSact20.htm#Top
http://www.nadh.com/site7/RSdprs05.htm#Top
http://www.smart-drugs.com/article-JamesSouth-NADH.htm
http://www.nadh-priceinfo.org/
http://qualitycounts.com/fpnadh.html
http://www.immunesupport.com/library/showarticle.cfm/id/3118/T/Both/
http://www.immunesupport.com/library/powersearch2.cfm (Note: enter “NADH” as keyword)
Posted by jrbecker on February 4, 2003, at 17:19:30
In reply to Re: fighting anhedonia and winning with ENADA NADH » hok, posted by Ron Hill on February 4, 2003, at 14:48:04
Ron,
NADH sounds promising. Please keep us updated on how it's going. I think we're all curious to see whether this keeps up for you. Hopefully there won't be too much of a buildup of tolerance to it.
JRB
Posted by hildi on February 7, 2003, at 0:24:36
In reply to Re: buspirone and ssri s/e's » jflange, posted by not exactly on January 26, 2003, at 15:21:10
This is interesting. So some of you are having positive results from the combo of buspar and SSRI's I was on buspar many years ago, and although it did help a bit, it didn't really take care of the anxiety I have, nor did it touch the depression.
Dr. insisted I go on prozac and finally I did, and I took the buspar/prozac combo for quite a while. After a while I got hypomanic and extremely sad. My sadness became constant and so did mania. Finally it turned into worse depression. I read many 'brain books' and med books, and came across information that said you shouldn't ever combine the two: prozac and Buspar. Well, by the time I came across this article I had been so depressed I was crying all the time and sexually obsessed- (not a good thing when it is an obsession) and I had already quite the buspar and was only taking prozac. After a while I felt good again.
I never did make a copy of that article I read, but I do have another source of information from another book on meds that also states this: the combination of SSRI's and buspar can produce negative effects.
This is definately what happened to me.
The negative effects far outwieghed the positive.
Hildi
Posted by zeugma on February 7, 2003, at 12:33:05
In reply to Re: buspirone and ssri's-not for everyone!, posted by hildi on February 7, 2003, at 0:24:36
> This is interesting. So some of you are having positive results from the combo of buspar and SSRI's I was on buspar many years ago, and although it did help a bit, it didn't really take care of the anxiety I have, nor did it touch the depression.
> Dr. insisted I go on prozac and finally I did, and I took the buspar/prozac combo for quite a while. After a while I got hypomanic and extremely sad. My sadness became constant and so did mania. Finally it turned into worse depression. I read many 'brain books' and med books, and came across information that said you shouldn't ever combine the two: prozac and Buspar. Well, by the time I came across this article I had been so depressed I was crying all the time and sexually obsessed- (not a good thing when it is an obsession) and I had already quite the buspar and was only taking prozac. After a while I felt good again.
> I never did make a copy of that article I read, but I do have another source of information from another book on meds that also states this: the combination of SSRI's and buspar can produce negative effects.
> This is definately what happened to me.
> The negative effects far outwieghed the positive.
> Hildi
The info I've come across states that Buspar and Prozac diminish each other's effects. Maybe that's why many find Buspar a paltry med? It also lowers serotonin levels, so that might explain your sadness (actually that is the diminishment effect). But it might interact more favorably with a more noradrenergic med (like the TCA I'm on).Strange as it it sounds, my depression doesn't take the form of excessive sadness- more of an 'out-of-it,' disjointed feeling (something like mild dissociation, which was extreme during adolescence) and the Buspar seems to partially counter that. My therapist thinks maybe I should go on a stimulant sometime- Provigil maybe? or if I can gain enough weight on my current meds, I might consider trying Ritalin again. Until then, I am dependent on caffeine for the alertness factor- my work suffers terribly when I don't have my cup of coffee.
Posted by lostsailor on February 8, 2003, at 14:10:30
In reply to Re: buspirone and ssri's-not for everyone! » hildi, posted by zeugma on February 7, 2003, at 12:33:05
Hi. I tried buspar years ago with ssri (paxil and luvox, I think) with a goal of being able to, and despite my pdocs advice but reluctantly allowed, to diminish bezo use. He claimed and I now agree that once one responds to benzos the likelihood of that is almost nil.
A few years later we tried augmenting celexa with buspar to increase the efficacy of the celexa and know what??? Gee, I had my first manic episode, too. He explained that this is the case usually the case for BP's but thought with my mood stabilizer I should have been fine, but instructed me to call and d/c if I noticed any manic thinking or behavior. I called a week later.
Fact is that they do play a synergetic augmenting role with the right ssri and the right people.
yeah, ~tony
Posted by hildi on February 8, 2003, at 20:25:27
In reply to Re: buspirone and ssri's-not for everyone! » hildi, posted by zeugma on February 7, 2003, at 12:33:05
> > This is interesting. So some of you are having positive results from the combo of buspar and SSRI's I was on buspar many years ago, and although it did help a bit, it didn't really take care of the anxiety I have, nor did it touch the depression.
> > Dr. insisted I go on prozac and finally I did, and I took the buspar/prozac combo for quite a while. After a while I got hypomanic and extremely sad. My sadness became constant and so did mania. Finally it turned into worse depression. I read many 'brain books' and med books, and came across information that said you shouldn't ever combine the two: prozac and Buspar. Well, by the time I came across this article I had been so depressed I was crying all the time and sexually obsessed- (not a good thing when it is an obsession) and I had already quite the buspar and was only taking prozac. After a while I felt good again.
> > I never did make a copy of that article I read, but I do have another source of information from another book on meds that also states this: the combination of SSRI's and buspar can produce negative effects.
> > This is definately what happened to me.
> > The negative effects far outwieghed the positive.
> > Hildi
>
>
> The info I've come across states that Buspar and Prozac diminish each other's effects. Maybe that's why many find Buspar a paltry med? It also lowers serotonin levels, so that might explain your sadness (actually that is the diminishment effect). But it might interact more favorably with a more noradrenergic med (like the TCA I'm on).Strange as it it sounds, my depression doesn't take the form of excessive sadness- more of an 'out-of-it,' disjointed feeling (something like mild dissociation, which was extreme during adolescence) and the Buspar seems to partially counter that. My therapist thinks maybe I should go on a stimulant sometime- Provigil maybe? or if I can gain enough weight on my current meds, I might consider trying Ritalin again. Until then, I am dependent on caffeine for the alertness factor- my work suffers terribly when I don't have my cup of coffee.
>
>
Odd. The information I came across stated something along the lines that buspar increased prozacs effects, possibly causing adverse reactions such as too much serotinin- I do agree that the combo with a TCA may be different.
Also interesting is that my depression was never one of sadness and deep crying tangents until I went on the buspar, which increased the crying/sadness, but stopped the 'anxiety shakes'. It seemed to open a floodgate or something- or maybe it's too many years on ad's, but I get the sadness and meloncoly (sp?)-and sometimes tearful episodes now when I try to go off the AD's, but still get a different kind of depression while ON the meds,too.
I also have that 'out of it' dissassociative sort of feeling at times, too.
Sometimes I don't know if my SSRI is making my depression worse- but when I go off I fall apart-and I've tried just about every AD there is, except MOAI's. And I can't tolerate noradrenergic ad's-I get too jittery.
Hildi
Posted by zeugma on February 9, 2003, at 11:29:21
In reply to Re: buspirone and ssri's-not for everyone! » zeugma, posted by hildi on February 8, 2003, at 20:25:27
> > > This is interesting. So some of you are having positive results from the combo of buspar and SSRI's I was on buspar many years ago, and although it did help a bit, it didn't really take care of the anxiety I have, nor did it touch the depression.
> > > Dr. insisted I go on prozac and finally I did, and I took the buspar/prozac combo for quite a while. After a while I got hypomanic and extremely sad. My sadness became constant and so did mania. Finally it turned into worse depression. I read many 'brain books' and med books, and came across information that said you shouldn't ever combine the two: prozac and Buspar. Well, by the time I came across this article I had been so depressed I was crying all the time and sexually obsessed- (not a good thing when it is an obsession) and I had already quite the buspar and was only taking prozac. After a while I felt good again.
> > > I never did make a copy of that article I read, but I do have another source of information from another book on meds that also states this: the combination of SSRI's and buspar can produce negative effects.
> > > This is definately what happened to me.
> > > The negative effects far outwieghed the positive.
> > > Hildi
> >
> >
> > The info I've come across states that Buspar and Prozac diminish each other's effects. Maybe that's why many find Buspar a paltry med? It also lowers serotonin levels, so that might explain your sadness (actually that is the diminishment effect). But it might interact more favorably with a more noradrenergic med (like the TCA I'm on).Strange as it it sounds, my depression doesn't take the form of excessive sadness- more of an 'out-of-it,' disjointed feeling (something like mild dissociation, which was extreme during adolescence) and the Buspar seems to partially counter that. My therapist thinks maybe I should go on a stimulant sometime- Provigil maybe? or if I can gain enough weight on my current meds, I might consider trying Ritalin again. Until then, I am dependent on caffeine for the alertness factor- my work suffers terribly when I don't have my cup of coffee.
> >
> >
> Odd. The information I came across stated something along the lines that buspar increased prozacs effects, possibly causing adverse reactions such as too much serotinin- I do agree that the combo with a TCA may be different.
> Also interesting is that my depression was never one of sadness and deep crying tangents until I went on the buspar, which increased the crying/sadness, but stopped the 'anxiety shakes'. It seemed to open a floodgate or something- or maybe it's too many years on ad's, but I get the sadness and meloncoly (sp?)-and sometimes tearful episodes now when I try to go off the AD's, but still get a different kind of depression while ON the meds,too.
> I also have that 'out of it' dissassociative sort of feeling at times, too.
> Sometimes I don't know if my SSRI is making my depression worse- but when I go off I fall apart-and I've tried just about every AD there is, except MOAI's. And I can't tolerate noradrenergic ad's-I get too jittery.
> Hildi
>
Noradrenergic meds do make me kind of jittery too. Considering the side effects I've had to so many other drugs, I felt like I'd gladly tolerate the edginess I was feeling on even a low dosage of nortriptyline. Some of that too was healthy- the fog was beginning to disperse and I was noticing things more, and getting irritated by things I never would have noticed before.Is it possible that the Buspar was actually counteracting the Prozac- i.e. causing SSRI withdrawal? Someone at this board said the Buspar induced the same feelings as SSRI withdrawal. I have never been on an SSRI long enough to feel the emotional blunting so many have described, but I have heard many people say they can't cry on an SSRI- that it closed the floodgates of sadness for better or worse. My ex girlfriend was going through Celexa withdrawal recently, and she told me she felt overwhelmed with sadness and had long crying spells. Isn't this consistent with too little serotonin, not too much?
FWIW I've never had this effect on a TCA- even years ago when I was on 75 mg nortriptyline, it was if anything easier to cry than it had been before I had started taking it.
Posted by missinglynxx on February 9, 2003, at 17:43:04
In reply to Re: buspirone and ssri's-not for everyone! » hildi, posted by zeugma on February 9, 2003, at 11:29:21
ability to feel normal emotions on the Nortriptyline. I dont want any numbness, I just want cheerfulness and enthusiasm when its appropriate
Someone said Tricyclics dont change your "core" personality,, (someone on here) so Im hopeful NOrtriptyline is a keeper wish me luck
And great luck to you on whatever it is you have been prescribed...(what exactly is your current situation)?
Posted by zeugma on February 9, 2003, at 18:26:03
In reply to Thats fascinating Zeugma... .about the, posted by missinglynxx on February 9, 2003, at 17:43:04
> ability to feel normal emotions on the Nortriptyline. I dont want any numbness, I just want cheerfulness and enthusiasm when its appropriate
>
> Someone said Tricyclics dont change your "core" personality,, (someone on here) so Im hopeful NOrtriptyline is a keeper wish me luck
>
> And great luck to you on whatever it is you have been prescribed...(what exactly is your current situation)?
>Good luck missinglynxx! And thanks for wishing me luck... I am taking 40 mg nortriptyline and 30 mg buspirone per day. That's been my routine for the last 3 weeks when I increased the buspirone to 3x a day (10 mg tabs). I found the nortriptyline by itself to be helpful for depressive and ADD symptoms (unable to sleep or eat properly, couldn't concentrate, was in a fog all the time and had bad SP which made interactions with others stressful and unproductive) but the dosage had to be kept low because of hypotensive s/e. Quite frankly I felt like it was like the melting of a glacier- an almost imperceptible process that would suddenly produce significant improvement in some area of life. Unfortunately though, it's true in life that the more you are able to do, the more is expected of you, and I was also impatient and wanting some improvement in *everything* and *now*. Which wasn't going to happen. My pdoc was convinced the nortrip was helpful so he wasn't really receptive to my belief that I needed something else to make things speed up a little. Finally he let me try to the Buspar at the lowest possible dose to start with. The combo of nortrip and buspirone is definitely the closest I've felt to *normal* probably ever.
About the way TCA's seem to leave core personality unchanged... yes that is my impression too. I think of the SSRI's as being crisis meds- if you are overwhelmed with sadness because something has happened, numbness may be the best condition in those circumstances. I think this may be because the TCA's are a lot less selective; they cause a more subtle, because more dispersed, effect in the nervous system. That is just a speculation.
Posted by missinglynxx on February 9, 2003, at 21:51:52
In reply to Re: Thats fascinating Zeugma... .about the » missinglynxx, posted by zeugma on February 9, 2003, at 18:26:03
Thanks for the support,, Zeugma.. Buspar EH? I guess me and you go for the less popular combinations. haha
I do feel so bizarre on one dose of an SSRI,,,, Thank GOD We have a choice to go to the Old standbys. Its strange that Nortriptyline still makes me act like myself.. (which isnt this amazing thing) but on SSRIS I get very very paranoid and quiet, and just dont enjoy strangers company like I normally Thrive on,,
It makes me want to HIDE out in the Caves of Kabul...
I guess you are getting a serotonin adjunct with the Buspar. Hopefully you can get up to 75 mgs of Nortriptyline,, I think the hypotension will END FOR You soon . Exericise does help if you can work around the hypotension. I did alot earlier today,, It does help the depression. Great luck later on this.
Posted by hildi on February 10, 2003, at 0:17:23
In reply to Re: buspirone and ssri's-not for everyone! » hildi, posted by zeugma on February 9, 2003, at 11:29:21
> > > > This is interesting. So some of you are having positive results from the combo of buspar and SSRI's I was on buspar many years ago, and although it did help a bit, it didn't really take care of the anxiety I have, nor did it touch the depression.
> > > > Dr. insisted I go on prozac and finally I did, and I took the buspar/prozac combo for quite a while. After a while I got hypomanic and extremely sad. My sadness became constant and so did mania. Finally it turned into worse depression. I read many 'brain books' and med books, and came across information that said you shouldn't ever combine the two: prozac and Buspar. Well, by the time I came across this article I had been so depressed I was crying all the time and sexually obsessed- (not a good thing when it is an obsession) and I had already quite the buspar and was only taking prozac. After a while I felt good again.
> > > > I never did make a copy of that article I read, but I do have another source of information from another book on meds that also states this: the combination of SSRI's and buspar can produce negative effects.
> > > > This is definately what happened to me.
> > > > The negative effects far outwieghed the positive.
> > > > Hildi
> > >
> > >
> > > The info I've come across states that Buspar and Prozac diminish each other's effects. Maybe that's why many find Buspar a paltry med? It also lowers serotonin levels, so that might explain your sadness (actually that is the diminishment effect). But it might interact more favorably with a more noradrenergic med (like the TCA I'm on).Strange as it it sounds, my depression doesn't take the form of excessive sadness- more of an 'out-of-it,' disjointed feeling (something like mild dissociation, which was extreme during adolescence) and the Buspar seems to partially counter that. My therapist thinks maybe I should go on a stimulant sometime- Provigil maybe? or if I can gain enough weight on my current meds, I might consider trying Ritalin again. Until then, I am dependent on caffeine for the alertness factor- my work suffers terribly when I don't have my cup of coffee.
> > >
> > >
> > Odd. The information I came across stated something along the lines that buspar increased prozacs effects, possibly causing adverse reactions such as too much serotinin- I do agree that the combo with a TCA may be different.
> > Also interesting is that my depression was never one of sadness and deep crying tangents until I went on the buspar, which increased the crying/sadness, but stopped the 'anxiety shakes'. It seemed to open a floodgate or something- or maybe it's too many years on ad's, but I get the sadness and meloncoly (sp?)-and sometimes tearful episodes now when I try to go off the AD's, but still get a different kind of depression while ON the meds,too.
> > I also have that 'out of it' dissassociative sort of feeling at times, too.
> > Sometimes I don't know if my SSRI is making my depression worse- but when I go off I fall apart-and I've tried just about every AD there is, except MOAI's. And I can't tolerate noradrenergic ad's-I get too jittery.
> > Hildi
> >
> Noradrenergic meds do make me kind of jittery too. Considering the side effects I've had to so many other drugs, I felt like I'd gladly tolerate the edginess I was feeling on even a low dosage of nortriptyline. Some of that too was healthy- the fog was beginning to disperse and I was noticing things more, and getting irritated by things I never would have noticed before.
>
> Is it possible that the Buspar was actually counteracting the Prozac- i.e. causing SSRI withdrawal? Someone at this board said the Buspar induced the same feelings as SSRI withdrawal. I have never been on an SSRI long enough to feel the emotional blunting so many have described, but I have heard many people say they can't cry on an SSRI- that it closed the floodgates of sadness for better or worse. My ex girlfriend was going through Celexa withdrawal recently, and she told me she felt overwhelmed with sadness and had long crying spells. Isn't this consistent with too little serotonin, not too much?
>
> FWIW I've never had this effect on a TCA- even years ago when I was on 75 mg nortriptyline, it was if anything easier to cry than it had been before I had started taking it.
>
> Gosh, I am way deep into the emotional blunting now. I almost don't care about anything now. This was/is one of the reasons I keep trying to find a different med that will help with both my depression and focus/motivation and also my major anxiety. I hate feeling this numb..I want to be able to feel things and think clearly.
I just read the rxlist for buspar again, and it stated buspar increased serotonin. Maybe too much serotonin affected me adversely? I also know there are different serotonin receptors, but I don't understand what each means, and how the prozac serotonin receptor differs from that of buspar. Prozac also stays in your body a long time-especially if you've taken it for long- so I think I had some sort of reaction to these two sources of serotonin. Buspar also has a weak affinity for dopamine. Maybe I'm sensitive to that, too. (I always hated cocaine, so maybe dopamine and I do not agree) Just some theories . . .I wish I knew! What I do know is that when I take less of the prozac, and not everyday, I feel better than standard mg doses and daily. Like my body can't handle too much of it.
You are on the nortriptyline now? The adding of buspar is giving you a 'better' effect? Were you looking for a calming effect or more focus? You mentioned the ritalin earlier, but also that some TCA's can make you jittery, the noradenergic (sp?)ones at least (same as the SSRI's I suppose that work on these same receptors).
Hildi
Posted by hildi on February 10, 2003, at 0:55:58
In reply to Re: Thats fascinating Zeugma... .about the » missinglynxx, posted by zeugma on February 9, 2003, at 18:26:03
> > ability to feel normal emotions on the Nortriptyline. I dont want any numbness, I just want cheerfulness and enthusiasm when its appropriate
> >
> > Someone said Tricyclics dont change your "core" personality,, (someone on here) so Im hopeful NOrtriptyline is a keeper wish me luck
> >
> > And great luck to you on whatever it is you have been prescribed...(what exactly is your current situation)?
> >
>
> Good luck missinglynxx! And thanks for wishing me luck... I am taking 40 mg nortriptyline and 30 mg buspirone per day. That's been my routine for the last 3 weeks when I increased the buspirone to 3x a day (10 mg tabs). I found the nortriptyline by itself to be helpful for depressive and ADD symptoms (unable to sleep or eat properly, couldn't concentrate, was in a fog all the time and had bad SP which made interactions with others stressful and unproductive) but the dosage had to be kept low because of hypotensive s/e. Quite frankly I felt like it was like the melting of a glacier- an almost imperceptible process that would suddenly produce significant improvement in some area of life. Unfortunately though, it's true in life that the more you are able to do, the more is expected of you, and I was also impatient and wanting some improvement in *everything* and *now*. Which wasn't going to happen. My pdoc was convinced the nortrip was helpful so he wasn't really receptive to my belief that I needed something else to make things speed up a little. Finally he let me try to the Buspar at the lowest possible dose to start with. The combo of nortrip and buspirone is definitely the closest I've felt to *normal* probably ever.
>
>
> About the way TCA's seem to leave core personality unchanged... yes that is my impression too. I think of the SSRI's as being crisis meds- if you are overwhelmed with sadness because something has happened, numbness may be the best condition in those circumstances. I think this may be because the TCA's are a lot less selective; they cause a more subtle, because more dispersed, effect in the nervous system. That is just a speculation.
>
> I just came across this article and want to say thanks to you both! This answers a previous question I submitted to zeugma (I think) and thanks to missinglynxx for bringing this up- I feel seriously enthused. I am going to check into nortriptyline (sp?). All this information about the TCA's not changing your core personality, nortript effective for ADD and depression, and the explaination of SSRI's as 'crisis meds"- really hits home with me and seems very accurate. The numbness one feels would be appropriate for some situations, ceasing the tears and the feelings. But to feel this way everyday makes me even more depressed. It's a lose-lose situation.
Thank you both so much. Good info here that I'm going to check into further.
Hildi
Posted by missinglynxx on February 10, 2003, at 17:48:48
In reply to Thats fascinating: Zeugma. and missinglynxx, posted by hildi on February 10, 2003, at 0:55:58
Hey COOL,, Im glad Zeugma's and my rambling gave you some ideas.. At least my rambling helped you out haha. WHY NOT just call your MD and ask for a trial of Nortriptyline.?/ I think thats a fantastic idea.. Keep in touch when you decide on your next move,, Hildi! Nortriptyline is what Im taking,, ITS No miracle, but I notice Glimpses of mental toughness, and NO emotional blunting!!!!!! Nada, zilch,, which is what I seek
Emotions are valuable stuff Good luck, Hildi
Posted by zeugma on February 10, 2003, at 19:45:53
In reply to Re: Thats fascinating: Hildi, posted by missinglynxx on February 10, 2003, at 17:48:48
> Hey COOL,, Im glad Zeugma's and my rambling gave you some ideas.. At least my rambling helped you out haha. WHY NOT just call your MD and ask for a trial of Nortriptyline.?/ I think thats a fantastic idea.. Keep in touch when you decide on your next move,, Hildi! Nortriptyline is what Im taking,, ITS No miracle, but I notice Glimpses of mental toughness, and NO emotional blunting!!!!!! Nada, zilch,, which is what I seek
> Emotions are valuable stuff Good luck, HildiHildi,
Good luck from me too. I've had a similar response to nortrip as missinglynxxx... it's been a rough ride at times, it does increase NE and hence irritability, but it is great for cutting through the fog that is typical of severe ADD as well as depression.
Posted by hildi on February 12, 2003, at 23:39:57
In reply to Re: Thats fascinating: Hildi, posted by missinglynxx on February 10, 2003, at 17:48:48
Oh good! I'm glad you're also liking nortripyline. I will ask to try this- I go into my new dr. next week -on the 20th. I never considered taking this before because my anxiety is so unbelievable, but who knows- It is worth a try. I want to feel again. I want to care about things, about life. I feel like a 'stepford wife", a robot, right now. My last dr. said: "What are you complaining about, at least you're not crying". I am serious-can you believe that response!
I told him I expect more than just not to cry, and the dr. said that "I'm expecting too much". I kid you not. I'm telling you, I honestly don't how I would have dealt with all this crap from the dr. and the way I've been feeling if not for finding this board and discovering how much we have in common and discovering new ideas and getting support from so many people I don't know. It is nice to talk to others who know how I feel and be able to talk about this without being patronized.
Hildi
Posted by hildi on February 13, 2003, at 0:02:13
In reply to Re: Thats fascinating: Hildi, posted by zeugma on February 10, 2003, at 19:45:53
Thanks for the support. I am thinking of asking my dr. for a trial of this when I go in next week. I just mentioned to missinglynxx that I worried it would increase my anxiety, but I do think it is worth the 'risk' of that to give this a try. Irritability I can deal with more than increased nerviousness and anxiety.
I wonder though, if I have ADD or if it is bipolar tendencies -brought on by the ad's possibly. I get racing thoughts, restlessness, and hyperness at times- actually every day. I can't sit still- I have to keep moving unless I take a ton of benzos. I thought it was just the anxiety, but the benzos don't really take care of the anxiety, just help slow me down. But I still feel agitated and I wonder if it's a tad of BP or ADD. I try to get as much information as I can on these subjects but still don't know.
Cutting through the fog, like you said the nortrip does- I remember many years ago feeling that way for a very brief period of time when I started prozac- but then it all went downhill and the fog is thick, very thick now. The benzos I take along with the prozac probably add to the fog, but do slow down some of the hyperness and desire to rearrange things all the time! I can't sit still and talk to someone- I have to jump up and fix a slanted picture or do something 'busy' that doesn't require thought, just movement.
So, anyway, I mystify myself. I don't know what I have-beside a major anxiety d/o and depression.
My question is: if I am BP, would a TCA, would nortrip, make it worse? (I read somewhere that TCA's make BP worse-but I don't know if I am BP and even if so, it would probably be BPII) It helps ADD so that sounds interesting . . .
Wish I knew what my real diagnosis was/is, but who cares if I can find something that works. Labels don't always make the best resources for prescribing meds since people respond so differently to the meds, anyway.
Hildi
Posted by zeugma on February 13, 2003, at 20:11:14
In reply to Re: Thats fascinating: Hildi » zeugma, posted by hildi on February 13, 2003, at 0:02:13
> Thanks for the support. I am thinking of asking my dr. for a trial of this when I go in next week. I just mentioned to missinglynxx that I worried it would increase my anxiety, but I do think it is worth the 'risk' of that to give this a try. Irritability I can deal with more than increased nerviousness and anxiety.
> I wonder though, if I have ADD or if it is bipolar tendencies -brought on by the ad's possibly. I get racing thoughts, restlessness, and hyperness at times- actually every day. I can't sit still- I have to keep moving unless I take a ton of benzos. I thought it was just the anxiety, but the benzos don't really take care of the anxiety, just help slow me down. But I still feel agitated and I wonder if it's a tad of BP or ADD. I try to get as much information as I can on these subjects but still don't know.
> Cutting through the fog, like you said the nortrip does- I remember many years ago feeling that way for a very brief period of time when I started prozac- but then it all went downhill and the fog is thick, very thick now. The benzos I take along with the prozac probably add to the fog, but do slow down some of the hyperness and desire to rearrange things all the time! I can't sit still and talk to someone- I have to jump up and fix a slanted picture or do something 'busy' that doesn't require thought, just movement.
> So, anyway, I mystify myself. I don't know what I have-beside a major anxiety d/o and depression.
> My question is: if I am BP, would a TCA, would nortrip, make it worse? (I read somewhere that TCA's make BP worse-but I don't know if I am BP and even if so, it would probably be BPII) It helps ADD so that sounds interesting . . .
> Wish I knew what my real diagnosis was/is, but who cares if I can find something that works. Labels don't always make the best resources for prescribing meds since people respond so differently to the meds, anyway.
> Hildi
>Hildi-
I don't know if you have BP or are just more efficient than I am (ha). I know nortriptyline is not recommeded for BP's- causes phase change, as the insert from Rite Aid said. Nortriptyline helps with ADD though. It makes things like writing much easier- I always had trouble getting my thoughts out- the movements seemed too complex- I can express myself a lot more clearly these days (good thing because I'm in graduate school and should be writing every day). It also helped with anxiety but in a subtle way. I obseved that certain things were less scary, but I had to stop and think about it for a minute before realizing it.
Btw I totally understood where you were coming from when you described your meeting with your dr. in your reply to missinglynxx. Generally doctors aren't concerned with whether you're meeting your life goals - as long as you're not breaking down in front of them. I've been thinking a lot about what I hope to achieve with these meds, as well as how I actually want to feel on them. For me getting the self-loathing and fearfulness and fog under control is a big part of it- so is being able to function in a more normal way and being able to work more and advance on earning a living. Maybe it's too ambitious, but if I didn't have these goals I don't think I'd be getting the most out of the meds. I'd hate to think I was tweaking my brain chemistry for nothing. I think you're totally justified in wanting more from your meds.
Good luck,
z
Posted by hildi on February 13, 2003, at 22:51:02
In reply to Re: Thats fascinating: Hildi, posted by zeugma on February 13, 2003, at 20:11:14
Too ambitious? No way. I don't expect a miracle from medicine, but I want to be able to live a life where I can achieve my goals, and not to feel 'self-loathing' or 'fearful'; also not to feel drugged or in a daze. I quite drugs so I wouldn't be in a daze-also booze (but then, I'm an alcoholic so I had no choice: quit drinking or die in a gutter somewhere).
Without being able to have my goals and the ability to acheive them, I would feel like I'm living a half a life- my goals-school, career, more financial security, etc- give me something to look forward to, work towards, be productive and good at, and be excited about, but even more than that and I think you understand.
I am an undergrad still, but soon will be graduating and going on to further my education.
For me, the writing can get hard because I'm such a perfectionist I tend to over-do it, or if I'm having a really bad day I sit and stare with not a thought in my head. What to write? Where to start? Very scary. All the reading freaks me out too, because I have such a hard time sitting still and concentrating- I have to keep reading same passage over and over again, or the words seems to 'bounce' off the pages. Also scary.
But I don't think it's too much to ask to try to find the right meds and formula, nutrients, etc . . to make the most that we can out of our lives and our brains. I think we deserve it. I want the rest of my years to be good ones. Not drugged, spaced out, doing nothing years, but good, productive, happy ones.
Hildi
Posted by missinglynxx on February 14, 2003, at 10:38:17
In reply to Re: Thats fascinating: Hildi » zeugma, posted by hildi on February 13, 2003, at 22:51:02
Great Post Hildi!
Ill get right to the point,, Nortriptyline is a VERY clear drug. I feel you would do great on it. It doesnt cause a loss of IQ (sadly It doesnt increase your IQ either haha) BUT what drug does, IN other words IT doesnt have any of the "dumbing" down affects of Alcohol & some of the drugs mentioned here, I wont name names cuz youve already committed them to memory
Just go for it and expect side effects !
after all they were discovered in the 50's NOT exactly a very high tech era in America
Go FETCH some Nortriptyline,, Hildi
BTW which university are you at?
Posted by hildi on February 14, 2003, at 22:26:42
In reply to Re: Thats fascinating: Hildi, posted by missinglynxx on February 14, 2003, at 10:38:17
Roosevelt University in Chicago Illinois. Majoring in psychology- and will continue my graduate studies in just what, haven't pin-pointed it down yet-something with law/social justice/advocacy-
I was an environmental science major at first, but changed majors due to several reasons, and I know that if I cannot/do not go that route I still want to do something in educating/protecting people against social injustice/environmental degradation, etc. . .
What is your major (in both undergrad and Grad),and what school do you go to?
Hildi
Posted by not exactly on February 14, 2003, at 23:39:55
In reply to Re: Thats fascinating: Hildi, posted by missinglynxx on February 14, 2003, at 10:38:17
Your posts about nortriptyline have been informative and inspiring. In fact, your positive experiences (along with similar reports from other psycho-babblers) enabled me to overcome my fears & prejudices about TCAs.
I tried amitriptyline once, and found the sedation, thought-clouding, and other side effects so severe that I felt like I'd been poisoned. So I concluded that the entire TCA category was not for me. Web research had bolstered that negative opinion - many sites (such as biopsychiatry.com, which seems to have otherwise informed and enlightened views) refer to TCAs as "dumb drugs" which are best avoided.
Last month, I considered trying Strattera, but when I found out that my insurance would not cover the Rx, I started searching for other norepinephrine-enhancing meds. When I learned that desipramine was almost as NE-specific as Strattera (and WAY cheaper), I decided to give it a try. My experience so far (exactly 2 weeks) has been encouraging. Side effects have been minimal and are now virtually unnoticable. My mood, motivation, and overall meaningful connection to life have improved. The improvement has not been dramatic, in fact it's been surprisingly subtle. But each day things are a bit better than the day before, and there's no sign that I've leveled off yet. I know that delayed onset and gradual improvement are traditional for antidepressants, but this has never been the case for me before. In the past, every other AD I've tried (and there have been a bunch) "did its thing" (for better or worse) within the first few days.
Anyway, I'm now wondering about how desipramine & nortriptyline compare. Have either of you tried desipramine? My understanding is that nortriptyline is slightly more serotonergic, antimuscarinic, and sedating compared to desipramine. If desipramine turns out to be an incomplete solution, do you think nortriptyline would be worth a try?
I'm also intrigued by the idea of augmenting a TCA with Buspar. I may try this next once I see where the desipramine plateaus out.
- Bob
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