![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 101 to 125 of 125. Go back in thread:
Posted by detroitpistons on March 21, 2006, at 23:40:42
In reply to Re: Never thought I'd hear this..... » detroitpistons, posted by SLS on March 21, 2006, at 10:41:50
> > I had way too much energy.
>
> In what way?I couldn't sit still. For example, it's not uncommon for me to come home from work, have some dinner and watch TV. Sitting down and watching TV was something that became very undesirable. It was too "slow." I couldn't relax.
> > I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
>
> Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
>I would pretty much race from one thing to another without completing the first thing. I was disorganized and had a hard time remembering what I had been doing a moment ago. I was sleeping less and not feeling tired. Normally, I need 7-8 hours of sleep. During this time, I could sleep 5 hours and still feel fine. My libido wasn't increased, but Effexor may have had something to do with that. But I've never had a high libido. In fact, I think I have a pretty low libido, even when not on AD's.
Driving too fast? Don't even have the option with the traffic here. Although, one day the traffic was so bad and I was so frustrated, that when I finally got the chance (far enough out of the city where traffic had dissipated), I went up to 130 mph out of frustration.
I thought that I was quicker than other people in mundane ways (like they would be too slow crossing the street when I was trying to turn), but I didn't necessarily feel smarter than other people, simply because I could barely concentrate on any one thing at any given time. I felt as though I was cognitively impaired.
Posted by SLS on March 22, 2006, at 6:38:01
In reply to Re: Never thought I'd hear this..... » SLS, posted by detroitpistons on March 21, 2006, at 23:40:42
This sounds like hypomania to me. I guess it takes one to know one.
:-)
- Scott
> > > I had way too much energy.
> >
> > In what way?
>
> I couldn't sit still. For example, it's not uncommon for me to come home from work, have some dinner and watch TV. Sitting down and watching TV was something that became very undesirable. It was too "slow." I couldn't relax.
>
> > > I actually did some cleaning (I normally have a very difficult time cleaning--I wait till something is covered in dust to clean it).
> >
> > Did you pace yourself or did you race from one task to another? Did you find that you were not completing all the tasks you began? Were you organized or disorganized? How many hours of sleep did you get? Increased libido? Did you find yourself driving too fast? Did you find that other people were too slow and that you were quicker and smarter?
> >
>
> I would pretty much race from one thing to another without completing the first thing. I was disorganized and had a hard time remembering what I had been doing a moment ago. I was sleeping less and not feeling tired. Normally, I need 7-8 hours of sleep. During this time, I could sleep 5 hours and still feel fine. My libido wasn't increased, but Effexor may have had something to do with that. But I've never had a high libido. In fact, I think I have a pretty low libido, even when not on AD's.
>
> Driving too fast? Don't even have the option with the traffic here. Although, one day the traffic was so bad and I was so frustrated, that when I finally got the chance (far enough out of the city where traffic had dissipated), I went up to 130 mph out of frustration.
>
> I thought that I was quicker than other people in mundane ways (like they would be too slow crossing the street when I was trying to turn), but I didn't necessarily feel smarter than other people, simply because I could barely concentrate on any one thing at any given time. I felt as though I was cognitively impaired.
>
>
Posted by SLS on March 22, 2006, at 6:39:42
In reply to Re: Never thought I'd hear this..... » SLS, posted by linkadge on March 21, 2006, at 21:18:23
In my experience, Nardil had much more of a "mood brightening" effect than Parnate.
- Scott
> I only tried parnate, but I would like to try nardil at some point.
>
> Parnate was a mixed bag. I think it helped somewhat, but I had a spontainious hypertensive crisis so I had to discontinue.
>
> I think that it did give me a slightly elevated heart rate. It actually kindof made my mood dark in some ways. I didn't find it was a mood brigtener. It helped anhedonia much more than say, sadness.
>
> Doctors here in canada either prescribe them or refuse to. I remember inquiring about one, but the doctor refused straight out, he wanted me go back on zoloft, for the thousanth time.
>
>
>
>
> Linkadge
>
Posted by SLS on March 22, 2006, at 7:05:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 22, 2006, at 6:39:42
Stimulants and mania:
-----------------------------------------------
Panel Weighs New Warnings on ADHD Drugs
By ANDREW BRIDGES
Associated Press WriterMarch 22, 2006, 4:36 AM EST
WASHINGTON -- A month after advisers told the government some attention deficit hyperactivity disorder drugs should bear stronger warnings of cardiovascular risks, officials are asking a second panel whether to add warnings about psychosis or mania.
Small numbers of reports of adverse psychiatric events, including hallucinations, in children are associated with all of the increasingly popular drugs used to treat ADHD, according to recently released Food and Drug Administration documents.
The FDA is asking its pediatric advisory committee to review those reports and then recommend how to communicate the potential risks to doctors and parents. It's asking the same about a report of increased risks of heart attack, stroke and hypertension associated with some ADHD drugs.
The panel was to meet Wednesday.
Last month, the FDA's Drug Safety and Risk Management advisory committee voted to recommend adding "black-box" warnings to stimulants used to treat ADHD, alerting doctors, patients and parents of the uncertainty regarding the risk the drugs may pose to the cardiovascular system. The warnings are the most serious that prescription drugs may bear.
The FDA is not required to follow the recommendations of its advisory committees, but usually does.
The latest reviews show that psychosis or mania can occur in some juvenile patients at normal doses of any ADHD drug. The reviews included roughly 90 studies of the drugs as well as reports from doctors, parents and others.
The ADHD drugs include Ritalin, manufactured by Novartis Pharmaceuticals Corp. and in generic form by other companies; Adderall, made by Shire Pharmaceuticals Inc.; and Strattera, produced by Eli Lilly and Co.
FDA officials say patients and doctors should be aware that the small number of psychiatric events could represent side effects of the drugs, although they cannot point to a definitive link. However, they noted a "complete absence" of similar reports in children treated with dummy pills during dozens of clinical trials of the drugs. In many children, the events ceased once they stopped taking the drugs -- and resumed if they restarted.
McNeil Consumer & Specialty Pharmaceuticals said in briefing documents that it is customary to weigh the "therapeutic benefits and potential risks" of treatment and warned of the negative effects of leaving ADHD untreated. The unit of Johnson & Johnson makes Concerta, a long-acting form of methylphenidate, the drug in Ritalin.
In the United States, nearly 3.3 million people age 19 and younger used an ADHD drug in 2005, according to Medco Health Solutions Inc., a prescription drug benefit program manager.
-----------------------------------------------There are a couple of ways to look at this. I would like to here some comments before offering any of my own.
- Scott
Posted by linkadge on March 22, 2006, at 15:03:39
In reply to Re: Never thought I'd hear this....., posted by SLS on March 22, 2006, at 7:05:10
I think there are two possibilities. I think that a drug can certainly activate preexisting mental health issues in people. But on the other hand, the drugs are strong, and they have side effects. So I think it is possible for some of those side effects to mimick other conditions.
Linkadge
Posted by tessellated on March 22, 2006, at 16:29:29
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 22, 2006, at 15:03:39
I actually partook in surgically implantedamphetamine capsules into rats, then treat the behaviors with thorazine....
Amphetamines are short ticket to depression for me, and often psycosis is present with any chronic abuse of a mphetamines due to the hyper sensive of the dopamine reptors...]
its really curious also the way scientist/mathematicians/weather guys go crazy...
http://salmon.psy.plym.ac.uk/year1/schizophrenia.htm#developing_animal_model_schizophrenia
Posted by corafree on March 22, 2006, at 17:20:33
In reply to Re: Never thought I'd hear this....., posted by SLS on March 22, 2006, at 7:05:10
Was working my way from bottom up and thought quickly throw in my 2cents.
Ex-boyfriend w/ mania, manic depression, age 46, was on Ritalin as a child. It controlled his racing mind. Unfortunately, so does meth'. He manages his life very well on meth', though just as w/ his illness, he 'comes down for a few to more days' after.
He is a very good artist.
He was put on Depakote, gained 100lbs all around his mid section (self-esteem gone) and stopped drawing/painting/sculpting (artist gone).
I feel so bad for him. What an awful choice to have to make?! I've oftened wondered why he has never been tried on an ADHD drug? They introduce it to him as a child, then they just d.c. it!
What if tapped into something that has never stopped emitting its contents???
Everyone seen the movie, Mr. Jones, w/ Richard Gere?
Maybe I've said the above here before. (The ole' memory prob' .. on narcotic re: spinal column injuries)! cf
Posted by SLS on March 23, 2006, at 7:54:53
In reply to Re: Never thought I'd hear this....., posted by linkadge on March 22, 2006, at 15:03:39
> I think there are two possibilities. I think that a drug can certainly activate preexisting mental health issues in people. But on the other hand, the drugs are strong, and they have side effects. So I think it is possible for some of those side effects to mimick other conditions.
>
> Linkadge
I agree.
I think we need some numbers here.1. What percentage of ADHD childen being treated with a stimulant develop this manic/psychotic syndrome?
2. What percentage of children diagnosed as ADHD are bipolar?
3. What percentage of ADHD adults treated with stimulants develop this manic/psychotic syndrome?
4. What percentage of non-ADHD adults treated with stimulants develop this manic/psychotic syndrome?
• There might be a difference between #1 and #3. Perhaps the young brain is more susceptible to this manic/psychotic reaction to stimulants.• There might be a diffence between #3 and #4. Perhaps ADHD confers greater susceptibility to the manic/psychotic reaction.
• If #1 = 5%, then the rate of occurrence of the manic/psychotic reaction is equal to the occurrence of bipolar disorder in the general population. If this is true, then it is possible that the only children who react this way to stimulants are those who have a comorbid bipolar disorder.
• If #2 > 5%, then there is a positive association between ADHD and bipolar disorder. One might then expect a rate of occurrence of the manic/psychotic reaction to be greater in these children than that seen in the general population.
• Etcetera...
Problems arise with:1. The accurate diagnosis of pediatric ADHD versus bipolar disorder versus comorbidity.
2. The lack of differentiation between mania and a non-manic psychosis.
The same question arises: Does a manic/psychotic reaction to stimulants in pediatric ADHD indicate comorbid bipolar disorder?I'm sure that this is true of a certain percentage of these reactions.
Is this association exclusive? Probably not. My guess is that a certain percentage of these reactions occur in the absence of bipolar disorder. The question is, does it happen more frequently in children than in adults? Is there something about the young developing brain that is still in the process of pruning that confers a greater risk of hosting this manic/psychotic reaction?
I have a bunch more questions and possible scenarios conceived, but not the mental energy to list them. Maybe you can track down some of the statistics I mentioned.
My guess is that the published report exaggerates the risk or conveys the wrong message about the potential risk of the manic/psychotic reaction occurring in ADHD children because it does not take into account the comorbid occurrence of bipolar disorder. Nor does the report specify how common or uncommon this reaction really is. If the rate of occurrence approaches the rate of bipolar disorder, then stimulants cannot be blamed for anything other than unmasking a disorder that already existed in those affected. This might not always be a bad thing.
We need those statistics.
- Scott
Posted by Tony P on March 24, 2006, at 2:39:10
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 23, 2006, at 7:54:53
A fascinating thread ... I'm one of those diagnosed with _maybe_ BP3 (or 4 depending how the classification shakes out) -- certainly I react badly to most of the common AD's. Paxil made me sweat nails, Celexa gave me an out-of-body experience, Wellbutrin pushed me manic (according to my family -- I felt _fine_ ;), and Effexor induced terror. Luckily my pdoc, while convinced I fit somewhere on the BP spectrum, is open to trying alternatives (after 2 years on Lamictal I'm experimenting with tianeptine at the moment).
...to go back to the original post, I've read of studies showing that AD therapy alone and counselling/psychotherapy alone each have about a 30-50% remission rate in depression, but AD + counselling is much more successful than either alone. Sorry no references -- I plead guilty in advance to quoting the conventional wisdom here. Perhaps others have citations.
What matters, of course, is treating people. You can go ahead and diagnose me as bipolar mixed treatment-resistant cyclothymic XVII as long as the treatment makes me feel better and function better!
Hopefully,
Tony
Posted by SLS on March 24, 2006, at 7:19:02
In reply to Re: Never thought I'd hear this....., posted by Tony P on March 24, 2006, at 2:39:10
Hi Tony,
> A fascinating thread ... I'm one of those diagnosed with _maybe_ BP3 (or 4 depending how the classification shakes out) -- certainly I react badly to most of the common AD's. Paxil made me sweat nails, Celexa gave me an out-of-body experience, Wellbutrin pushed me manic (according to my family -- I felt _fine_ ;), and Effexor induced terror. Luckily my pdoc, while convinced I fit somewhere on the BP spectrum, is open to trying alternatives (after 2 years on Lamictal I'm experimenting with tianeptine at the moment).
How are you doing on the tianeptine? Any side effects? How much are you taking?Have you ever tried an MAOI or tricyclic?
> ...to go back to the original post, I've read of studies showing that AD therapy alone and counselling/psychotherapy alone each have about a 30-50% remission rate in depression, but AD + counselling is much more successful than either alone. Sorry no references -- I plead guilty in advance to quoting the conventional wisdom here. Perhaps others have citations.
If subjects are selected according to a strict set of criteria for moderate to severe major depressive disorder, psychotherapy alone does quite poorly. I have seen this reported several times in literature. Medication is far more effective in these cases. However, adding CBT to medication increases the success rate significantly. It is important to remove as much psychosocial stress as possible.
> What matters, of course, is treating people. You can go ahead and diagnose me as bipolar mixed treatment-resistant cyclothymic XVII as long as the treatment makes me feel better and function better!Yup. I still think that an accurate diagnosis can assist a physician in choosing treatments that will increase one's chances of responding. This should be particularly true in the future when there are more drugs available and these illnesses better understood.
> Hopefully,
Also hopefully,
- Scott
Posted by corafree on March 24, 2006, at 22:55:17
In reply to Re: Never thought I'd hear this....., posted by SLS on March 21, 2006, at 16:08:37
Scott:
What are some of the drugs in the MAOI class?
Tks,cf
Posted by Tony P on March 25, 2006, at 0:59:21
In reply to Re: Never thought I'd hear this..... » Tony P, posted by SLS on March 24, 2006, at 7:19:02
> Hi Tony,
> How are you doing on the tianeptine? Any side effects? How much are you taking?
>
I was taking the manufacturer's suggested 12.5 mg 3x/day (12.5 -- weird number -- I suppose they did their first trials with 100 or 50 mg then titrated down by halves). I stopped taking it in order to a) see if it was having a real effect, b) get a new emotional baseline without the Lamictal. I may re-start the tianeptine earlier than I had planned as I am getting fairly depressed fairly fast, and also experiencing some anxiety.I got an immediate lift from it (which might have been placebo) and felt like it was helping moderately with both depression & anxiety, but I figured the only way to be sure it was doing something real was to stop and restart. The only side-effect I experienced was a slight digestive upset; I felt at times like there was something caught in my throat or I'd eaten too much. I need to lose weight anyway ;)
I wonder if the anxiety today might be Lamictal withdrawal -- it has a long half-life so it's hard to be absolutely sure; I'm going down from 200 mg/day by 50 mg every three days and this is day 4 (my pdoc suggested 50 mg every 2 days) - how does that sound to anyone with experience with this AD?
> Have you ever tried an MAOI or tricyclic?
>
Never tried an MAOI, was always put off by the potential side-effects and forbidden foods list, and the profile didn't sound right for me -- I don't do well with a lot of NA activation; the newer selective MAO-B ADs like selegeline might be OK.Tried Elavil (amitriptyline) and Sinequan (doxepin) years ago, Elavil was a bit too activating, Sinequan at 25 mg tid (if memory serves) drove me straight up the wall -- intolerable anxiety around day 7-10.
Cheers,
Tony
Posted by SLS on March 25, 2006, at 8:33:58
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 24, 2006, at 22:55:17
> Scott:
>
> What are some of the drugs in the MAOI class?
>
> Tks,cf• Parnate (tranylcypromine)
• Nardil (phenelzine)
• Marplan (isocarboxazid)
• EmSam/Eldepryl (selegiline)All of these drugs work in basically the same way. They increase the amount kept in storage of the three major monoamine neurotransmitters: dopamine (DA), norepinephrine (NE), and serotonin (5-HT). These drugs accomplish this by inhibiting the enzyme, monoamine oxidase (MAO), that is used by the body to break down the three neurotransmitters. In other words, an MAOI destroys the factories that are responsible for disassembling excess neurotransmitter molecules. Without the enzyme, the levels of neurotranmitter inside the presynaptic neuron rise. It is thought that increasing the amount of one or more of the three neurotransmitters is responsible for the therapeutic antidepressant effect of the MAOIs.
The catch is, the MAO enzyme is responsible for breaking down other substances in the body. One of them is tyramine. Tyramine is found in some types of food and is derived from protein. If the body fails to disassemble this substance, it builds up and can cause a dangerous rise in blood pressure. Therefore, one must adhere to a special diet and avoid the foods that contain tyramine. I never found the diet very restricting, though.
- Scott
Posted by SLS on March 25, 2006, at 8:55:21
In reply to Re: Never thought I'd hear this..... » SLS, posted by Tony P on March 25, 2006, at 0:59:21
Thanks for responding.
The rate at which you are reducing the dosage of Lamictal seems reasonable, as long at you are not prone to seizures. Lamictal is weird. Some people experience a temporary improvement when they reduce the dosage. Others, like me, report having a rebound depression with anxiety.
I don't think the immediate improvement you experienced upon restarting tianeptine was a placebo effect.
> Never tried an MAOI, was always put off by the potential side-effects and forbidden foods list, and the profile didn't sound right for me -- I don't do well with a lot of NA activation; the newer selective MAO-B ADs like selegeline might be OK.
It is sometimes counterproductive to try to outwit the brain. We just don't understand enough about how it works or why the drugs we use to treat depression produce their therapeutic effect. In other words, I don't think we are smart enough to be able to confidently exclude specific drugs from consideration - especially the broader spectrum drugs like MAOIs.
> Tried Elavil (amitriptyline) and Sinequan (doxepin) years ago, Elavil was a bit too activating, Sinequan at 25 mg tid (if memory serves) drove me straight up the wall -- intolerable anxiety around day 7-10.
You might be right about the NE reuptake inhibitors. Can you be a little more specific as to how these drugs affected you? You sound like you might be a Nardil responder.
- Scott
Posted by corafree on March 25, 2006, at 21:47:01
In reply to Re: Never thought I'd hear this..... » corafree, posted by SLS on March 25, 2006, at 8:33:58
I just checked tyramine containing foods and those are the foods I love, and some that I am allergic to, i.e., lactose and monosodium glutamate! A lactose intolerant pill works, but constipates afterwards. And soy sauce? I love it, and has no monosodium glutamate in it, at least the brand I have. Been using vanilla soy milk for yrs now. Surprised to see spinach; recalling one time I ate some bright green cooked (had been frozen I believe), and got high (literally); same w/ yogurt from a shop once (very happy)! What did those foods do to my head that made me so happy?
I would hate to take away anything that has made me happy in my life, via chemicals or taste!
Eating wheat crackers w/ cream cheese on top is a daily ritual w/ me. I crave wheat!
Is Nardil the MAOI that tolerates tyramine the best?
tks,cf
Posted by SLS on March 25, 2006, at 22:07:59
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 25, 2006, at 21:47:01
Hi CF.
What did you use as a reference for the MAOI diet?
It really isn't all that restrictive.
Some of the listings you find will be out of date. The more recent research has found that many of the foods appearing as forbidden on the older lists are not justified to be avoided.
I find the following thread to be helpful, and reflects what I have found myself to be accurate:
http://www.dr-bob.org/babble/20010814/msgs/75408.html
You can keep your cream cheese, wheat, yogurt, spinach, and soy milk.
- Scott> I just checked tyramine containing foods and those are the foods I love, and some that I am allergic to, i.e., lactose and monosodium glutamate! A lactose intolerant pill works, but constipates afterwards. And soy sauce? I love it, and has no monosodium glutamate in it, at least the brand I have. Been using vanilla soy milk for yrs now. Surprised to see spinach; recalling one time I ate some bright green cooked (had been frozen I believe), and got high (literally); same w/ yogurt from a shop once (very happy)! What did those foods do to my head that made me so happy?
>
> I would hate to take away anything that has made me happy in my life, via chemicals or taste!
>
> Eating wheat crackers w/ cream cheese on top is a daily ritual w/ me. I crave wheat!
>
> Is Nardil the MAOI that tolerates tyramine the best?
>
> tks,cf
Posted by Phillipa on March 26, 2006, at 0:50:58
In reply to Re: Never thought I'd hear this..... » SLS, posted by corafree on March 24, 2006, at 22:55:17
Corafree I didn't know you had taken an MAOI.love Phillipa
Posted by corafree on March 26, 2006, at 14:01:21
In reply to Re: Never thought I'd hear this..... » corafree, posted by SLS on March 25, 2006, at 22:07:59
I feel like 'I'm the secretary in the chemistry department!' .. Ha!
I just searched 'MAOI diet'.
That's good news tho' re: current diet and the foods I like!
I guess maybe I was thinking of selegiline (Eldepryl) and phenelzine (Nardil), when searched, since those were two you were discussing.
I'm positive (Well, 90% at least!) I've never been on an MAOI.
I find this discussion interesting because I, I believe like Tony, am 'nonresponsesive' (There I go using the wrong word again!) to a lot of ADs.
Am I correct Tony?
(Can I have a long lunch break? There's this frozen yogurt shop ... Hmmm, that reminds me, I've never had 'happy reaction .. my old state of just being happy' to store yogurt in the cartons, just to frozen!?)
RU sick of me yet? 'Yes' is perfectly acceptable. (I'm laughing inside.) Hmm .. is this 'borderline behavior' I wonder. (Still laughing. I know, I'm bad!)
While have your attn(?), pls share proper word for 'being nonresponsive to different classes of ADs' or word for 'nothing seems to work for depression anymore and maybe never did'.
Appreciate it.
sincerely .. really, cf
Posted by corafree on March 26, 2006, at 15:10:37
In reply to Re: Never thought I'd hear this....., posted by Phillipa on March 26, 2006, at 0:50:58
Hey my friend. (How do you always find me?!)
I have been (found the word) 'treatment-resistant' to so many ADs.
I'm thinking maybe I've missed one that would have worked. So, I'm going backwards, to the older ADs and pondering maybe giving them a test drive. Can only recall a trial on one tricyclic, Elavil, and it 'might' have been a manic reaction and scared me. Think I only gave it 4 days at best.
And, no, I've never been on an MAOI (just pondering).
Ya' know how I was telling you about the new P that I disliked. I requested his intake; I have it. He was thinking 'Lamictal' in notes.
I dismissed him and asked for another P. New P (like him ok) did bring up and told him I'd had a trial of Lamictal recently (bad reaction), Trileptal (bad reaction), and that's when we just tried Abilify (bad reaction).
The prior makes me tend to rule out that any little part of me is bipolar at all (Never been dx'd bipolar.).
But now science is, I don't know, thinking everyone falls into some sort of bipolar disorder. It seems someone is realizing 'we've not come far enough' and 'people aren't getting well', and I'm glad that's happening. But, saying we're all bipolar of some sort.. could that be true or are our scientists just running out of money?
The Eff-XR class and Prozac class didn't really help me much; unless 'feeling nothing' is helping me.So, I'm just 'searching for a clue at the scene of the crime' .. and have a P that seems to like having his clients 'suggest options'.
I'll be honest here and say Seroquel really didn't bother 'my head' all that much, in fact I felt a 'little happy/funny feeling'. It had no physical adverse reactions, but one 'big fat' one .. weight gain! And no, it's not all about vanity re: below.
With the physcial diagnoses of 'plumbing fall out' and 'rule out toxic megacolon' (I just learned my great grandmother died with the latter.), there was no way I'd have been able to tolerate that 'blowing up of my mid section' which occurred almost immediately.
Has anyone heard about a drug on the rise that will be taken alongside 'weight gainers' to soften that effect?
Practically, knowing myself, psych dxs for me now are, (ok) call it depression, and anxiety when just doing NADLs.
I need to start poking around in the alternatives board. Oh, we 'feel for them', huh?
I'm in a strange/funny mood this day. Maybe this is what it's like to feel alive!? I've been selfishly secluded lately. Too much is too much to handle.
I apologize if strange/funny is causing anyone a problem. (I'll stand in the corner!)
tksphillipa, cf
Posted by Tony P on March 30, 2006, at 0:17:35
In reply to Re: Never thought I'd hear this..... » Tony P, posted by SLS on March 25, 2006, at 8:55:21
> The rate at which you are reducing the dosage of Lamictal seems reasonable, as long at you are not prone to seizures. Lamictal is weird. Some people experience a temporary improvement when they reduce the dosage. Others, like me, report having a rebound depression with anxiety.
> ...[snip]...
> > Tried Elavil (amitriptyline) and Sinequan (doxepin) years ago, Elavil was a bit too activating, Sinequan at 25 mg tid (if memory serves) drove me straight up the wall -- intolerable anxiety around day 7-10.
>
> You might be right about the NE reuptake inhibitors. Can you be a little more specific as to how these drugs affected you? You sound like you might be a Nardil responder.
>
>
> - ScottHi Scott,
Sorry to be so slow responding - I find if I'm leaning toward depression I just don't want to post.
I'm definitely experiencing more depresssion and anxiety as I cut the Lamictal back to 0 -- so a worthwhile experiment, even if unpleasant, now I know it was having a positive effect. Other indicators -- besides reluctance to post here, and how I feel generally, I've been sleeping a lot but disturbed sleep, and my consumption of OTC drugs (principally methocarbamol) went way way up -- always a danger sign for me.
My experience with the two TCA I mentioned was really not good; on Elavil after the first week or so I felt mildly stoned but stimulated and shaky at the same time -- sweats, trouble concentrating, uncomfortable anxiety, some visual disturbances (bright flashes, trailers). On Sinequan at the standard starting dose (25 mg tid), I couldn't stop sleeping for about the first week; then I very quickly flipped to high anxiety, a feeling that something was desperately wrong. I felt stuck because I figured that if I stopped taking it the anxiety would only be worse - I was non-functional, living from momemnt to moment of free-floating terror and couldn't leave my apt; somehow I tapered off and was none the worse a week or so later, but I never wanted to repeat that experience. Effexor recently at 75 mg/day had somewhat the same effect on me, just not quite as intense.
Possibilities I am looking at now: some combination of:
Lamotrigine
Tianeptine
Buspirone
Ropinirole
Bupropion (_low_ dose, it tends to push me manic)
Gabapentin (currently taking 600 mg hs)
Seroquel (currently taking 25-50 mg hs)I just don't want to get into the perpetually progressive cocktail "well that worked a bit; let's try adding this -- and this -- and this" At the same time I know combinations can work well for me -- Nefazodone and Buspirone were the best for me for several years.
Tony
Posted by SLS on March 30, 2006, at 6:22:19
In reply to Lamictal vs TCA WAS : Never thought I'd hear..... » SLS, posted by Tony P on March 30, 2006, at 0:17:35
Hi Tony.
I read along another thread that you feel Wellbutrin prevents nefazodone from working. Have you tried to go back to what worked?
Mania is not necessarily a bad thing. If Wellbutrin can bring you to mania, you could then stabilize to normothymia by adding Zyprexa or increasing Seroquel.
What kind of mania do you experience with Wellbutrin?
- Scott
> Possibilities I am looking at now: some combination of:
> Lamotrigine
> Tianeptine
> Buspirone
> Ropinirole
> Bupropion (_low_ dose, it tends to push me manic)
> Gabapentin (currently taking 600 mg hs)
> Seroquel (currently taking 25-50 mg hs)
>
> I just don't want to get into the perpetually progressive cocktail "well that worked a bit; let's try adding this -- and this -- and this" At the same time I know combinations can work well for me -- Nefazodone and Buspirone were the best for me for several years.
Posted by Tony P on March 30, 2006, at 11:48:16
In reply to Re: Lamictal vs TCA WAS : Never thought I'd hear.. » Tony P, posted by SLS on March 30, 2006, at 6:22:19
> Hi Tony.
>
> I read along another thread that you feel Wellbutrin prevents nefazodone from working. Have you tried to go back to what worked?
>
> Mania is not necessarily a bad thing. If Wellbutrin can bring you to mania, you could then stabilize to normothymia by adding Zyprexa or increasing Seroquel.
>
> What kind of mania do you experience with Wellbutrin?
>
>
> - ScottNefazodone is no longer available in Canada - is it still around in the US? If it were, I may have had a long enough holiday (2 1/2 years) to benefit from it again.
I haven't written Wellbutrin off totally. What I experienced with it was productive activation and a good feeling about life in general, but high anxiety, not just physical shakiness but anxiety that made me want to avoid normal activitities, plus severe insomnia. At the "normal" dose of 300 mg XR/day my family let me know I was definitely over the line into hypo-mania; the incident everyone recalls was a dinner when I explained to my daughters how you could identify whether someone was a Serb or Croat by their head-shape! a)I'm not an anthropologist b)we're all pretty typical lib/socialists who don't normally think racial stereotyping's a good thing, and c) I don't usually make bland pronoouncements like that.
I can chop the Wb 150 or 100 XR in half - I've done so; I'm not seizure-prone. Mostly I want to avoid getting back on the benzo/zopiclone treadmill to cope with the anxiety and insomnia from the Wb. I'm familiar with Seroquel; tell me more about Zyprexa.
If there's a better AD out there that leans toward the DA agonist side I'll take it. In a day or two (when the Lamictal's out of my system) I'll try the tianeptine again with my pdoc's OK.
At least I feel like I have options, and it looks like the Lamictal _was_ exerting some AD effect (which I had doubted).
Thanks for your interest,
Tony
Posted by JudeS on March 30, 2006, at 23:02:48
In reply to Re: Never thought I'd hear this..... » linkadge, posted by SLS on March 17, 2006, at 7:38:46
Here's a trial in which S-adenosyl methionine induced an "elevated mood state" in most bipolar patients but in none of the uniplar patients:
> > That is exactly my point. If mood stabalizers serve as antidotes to manic episodes (of any origin), then there is no way to determine what exactly caused the manic episode.
>
> My point is this: The cluster of behaviors that we see with the administration of amphetamine, and that you have listed, is not a sufficient criterion for true mania such that these investigators needed to find other models to use. They judged the validity of their models based upon the capacity of mood stabilizers to reverse them. The hyperlocomotive and hyperlibidinal effects produced by psychostimulants are thus not equivalent to mania, and the presence of these behaviors is not sufficient to presume a valid animal model. Otherwise, I imagine they would have used cocaine. So far, I don't believe that they have been able to reproduce mania in rodents using SSRIs. Hopefully, they will develop a strain of rodent that exhibits such a reaction so as to serve as a model for mania. Of course, this would only go to reinforce the notion that there must be a genetic bipolar diathesis present to display a manic reaction to antidepressants.
>
> My mania lasted for weeks after the antidepressants were discontinued, despite lithium treatment. I think this is one factor that leads me to believe that a manic reaction to antidepressants is fundamentally different from the acute behavioral states produced by psychostimulants. Mania involves a self-perpetuating process, most likely effected by kindling and probably facilitated through second messenger events. My guess is that antidepressant-induced mania gains inertia the longer it is allowed to continue. The sooner it is recognized and the offending drugs discontinued, the more quickly the mania will dissipate.
>
> I wish Depakote were around when I became manic the first time. I believe that it would have been best if I were allowed to continue taking the antidepressants and just have added Depakote. My current treatment resistance probably developed because Nardil was given and withdrawn multiple times within a short period of time and the precipitation of severe mania followed by severe depression on each occassion. Again, Depakote would have prevented this as my mania are very responsive to it. It is also responsive to Zyprexa, but not to the older APs. I should think that combining Nardil and Zyprexa would be a great combination for bipolar depression.
>
> I'm not saying that it is impossible for an SSRI to produce a manic reaction in someone who is not bipolar. Prednisone seems to be sufficient to do that. However, I think the odds are that for someone who has an affective disorder, the precipitation of mania by the administration of an antidepressant is reflective of bipolar disorder.
>
>
> - Scott
>
>
Posted by detroitpistons on May 26, 2010, at 15:13:34
In reply to Re: Never thought I'd hear this....., posted by cecilia on March 15, 2006, at 1:43:36
Bump. I never went back into therapy. I'm of the opinion that traditional psychotherapy is junk. By now, we've seen enough examples of how it can be detrimental, not to mention expensive. However, I do think that you need to sort out the events of your life at some point. Talking to someone and verbalizing your thoughts can really help to figure things out. Even writing can accomplish that.
I think I'm at the point in my life where I understand why I am how I am. Things have sort of crystallized. I don't think traditional counseling is necessary for me anymore. BUT, I would entertain the possibility of Cognitive Behavioral Therapy (CBT). Has anyone tried it? Was it good?
> Psychotherapy can definitely be a bad thing. It's far more addicting than any drug ever made and can have far worse side effects. I wasted an enormous amount of money on therapy that made me more depressed. Cecilia
Posted by Dr. Bob on May 28, 2010, at 13:49:24
In reply to Re: Never thought I'd hear this....., posted by detroitpistons on May 26, 2010, at 15:13:34
> I don't think traditional counseling is necessary for me anymore. BUT, I would entertain the possibility of Cognitive Behavioral Therapy (CBT). Has anyone tried it? Was it good?
Sorry to interrupt, but I'd like to redirect follow-ups regarding CBT to Psycho-Babble Psychology. Please do feel free to continue this there. Here's a link:
http://www.dr-bob.org/babble/psycho/20100425/msgs/949265.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.