![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 40. Go back in thread:
Posted by jono_in_adelaide on October 17, 2011, at 19:38:57
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
Can I suggest that you try taking Lexapro in whatever dose your doctor recomends, and add to it Edronax (reboxetine) 4mg twice a day.
It is a noradrenalin reuptake inhibitor, helps restore drive and pleasure and improves social functioning..... for me it was lifesaving in combination with an SSRI.
Posted by creepy on October 17, 2011, at 19:41:08
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
I also have depression that overlaps ADD and its anyones guess which is causing the problems.
I do well on stims but the anxiety sucks.Have you tried all of the common ADD meds? strattera, ritalin, adderall, dexedrine? I found dexedrine was a little easier on anxiety.
Posted by jono_in_adelaide on October 17, 2011, at 19:45:40
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
www.reboxetine.com
"....Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in anxiety and mood, noradrenaline is essential to maintaining drive, self-assertiveness and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha 2- and beta-adrenoceptors
Posted by jono_in_adelaide on October 17, 2011, at 19:57:43
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:45:40
Also, dodnt write off Zyprexia until you've tried it..... I'm not psychotic, just "neurotic", but found that a low dose (1mg at night)of risperidone helped me through a bad patch by reducing anxiety and stopping the intrusive negative thoughts.
I would realy push for a trial of Edronax, (you're in Australia, right?) or Bupropion
Posted by Chairman_MAO on October 17, 2011, at 20:49:42
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
Dexedrine tends to calm me down overall, but it's much better still with an MAOI (Nardil is the one I combined it with). The drug was more effective and there was hardly any anxiety at all.
I am dysthmic, ADD/ADHD, and have suffered from social phobia/anxiety since age 0.
I am very lucky that I have someone willing to prescribe this combination. I went off of Nardil and am now beginning with Marplan, so I have to have the Dexedrine started off low and raised again over many months ... ugh, but I'm not complaining [too much], at least I have someone willing to do it.
I share all this because the MAOI + Dexedrine is literally the only thing that every worked 100% for me.
Posted by g_g_g_unit on October 18, 2011, at 2:22:44
In reply to Re: what a jip » g_g_g_unit, posted by Phidippus on October 17, 2011, at 17:25:18
> ADHD is so hard to diagnose on a dime. OCD and depression, are easier to spot.
Sure, but that shouldn't be grounds for immediate dismissal, especially when I've been working with my current pdoc (an ADHD specialist) for 5+ months now.
>
> > I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus.
>
> Lexapro is kinda low. Needs to be in the 40 mg range. You're that spaced out from Depakote? Don't be a baby.I don't think it's the Depakote. All SSRIs space me out and worsen my inattentiveness.
> This is not always true. I take a nifty little drug called Vyvanse. Doesn't cause me any anxiety at all.
Pity, 'cos it isn't available where I hail from.
> >he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
>
> I agree
>
Based on what? I'm well familiar with akathisia at this point; it was unmistakable.> You have the wrong Idea. Sampling new medications is fun!
I suppose, though I'd rather be like reading new books and stuff.
Posted by g_g_g_unit on October 18, 2011, at 2:25:56
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:38:57
> Can I suggest that you try taking Lexapro in whatever dose your doctor recomends, and add to it Edronax (reboxetine) 4mg twice a day.
>
> It is a noradrenalin reuptake inhibitor, helps restore drive and pleasure and improves social functioning..... for me it was lifesaving in combination with an SSRI.I asked my GP about Edronax today. He said it can be pretty agitating, and I have a really bad track record with NE-ergic drugs. That said, your idea of maybe trying a higher SSRI dose and then adding a stimulant seems most logical, though I hate the lack of deep sleep SSRIs cause - I do feel more dissociated the higher I raise the dose.
Did the SSRI counter the anxiety from Edronax?
Posted by g_g_g_unit on October 18, 2011, at 2:31:57
In reply to Re: what a jip, posted by jono_in_adelaide on October 17, 2011, at 19:57:43
> Also, dodnt write off Zyprexia until you've tried it..... I'm not psychotic, just "neurotic", but found that a low dose (1mg at night)of risperidone helped me through a bad patch by reducing anxiety and stopping the intrusive negative thoughts.
>
> I would realy push for a trial of Edronax, (you're in Australia, right?) or BupropionI haven't completely written off APs. I was angry because I went to see this guy for a supposedly 'comprehensive' review of my meds and sx., which should have taken the attention issues into account.
If I was strictly going to treat anxiety, I'd just stick with the Lexapro and not bother with an AP, since it's doing an okay job on its own; the problem though is that I currently have a 5 year old's attention span and can't read much, keep track of conversations, or finish anything. Plus, I made notes on all my med reactions, including problems like RLS and akathisia I frequently experience, which were the precise reasons my psych is hesitant to just try a high SSRI dose and which this guy just ignored. It was a waste of time. $400 to be told to just add Zyprexa.
Posted by bleauberry on October 18, 2011, at 5:27:04
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
I'm always a bit hesitant with "academia" types. That's just me. I prefer the "real world" types.
Anyway, I can easily see how the meds you are taking...all by themselves...would cause the very problems you are complaining of. A flood of serotonin (lexapro) aint gonna help cognition in any way. Depakote certainly is going to worsen it.
I like the zyprexa idea except with one catch. That is, lexapro needs to be switched out for prozac. In my own experience, zyprexa+prozac was excellent for cognition, ADHD stuff, ADD stuff, obsessions, depression, anxiety. The only fogginess I had from it was early in treatment and first thing in the morning. Lexapro + zyprexa did not have those same qualities for me. There is something special about the prozac/zyprexa team which cannot be duplicated with other SSRIs.
If your doctors are not going to help with stimulants, and you are not willing to find new doctors, then you still have choices. They are in the botanical medicines, not man made medicines. Ones I am thinking of include:
Rhodiola Rosea
Eleuthero root (siberian ginseng, not a true ginseng)
CordycepsSmall amounts of DLPA or tyrosine could be helpful and are cheap enough to experiment to see if good or bad. They will lead to more production of the same neurotransmitters the stimulants increase.
Of all the options, including meds, the one I favor the most is Rhodiola. Another one, not very well known, and not usually thought of in terms of psychiatric stuff or your particular symptoms is Resveratrol (the kind from Japanese Knotweed, not the kind from grapes). Perfect brand is the 40mg version yellow bottle from Source Naturals. I mention this one because it does a ton of stuff to help...anti inflammation, soaks up toxins, potent antioxidant, on and on.... A friend of mine started taking it just for general brain/heart health and said for the first time in his life he can now remember where he set his car keys every day. It has cleared up a lot of my lyme brain fog. And it's a very good antimicrobial too, so you might not every catch a cold or flu again. Dittos for Rhodiola the same.
Adrafanil. You can study up on and order this one by yourself. I was on it for a few years and I can say from my own experience it is a good choice for what your complaints are. It increased my anxiety for about a week and then after that things just got better and better as the weeks and months went by. And that was with only 150mg starting dose and 300mg maintenance dose, which is only 1/3 of the full dose.
So anyway, in this post are some solid ideas for you to work with. No need to feel trapped or jipped.
> so nearly 3 weeks after my relatively unspectacular 'cry for help', I saw a psych professor for a second opinion today. surprisingly, his sentiments echoed every other stuffy, close-minded psychiatrist I've encountered - namely, despite your lifelong, evidently comprising difficulties with attention, you don't have ADHD (??), but you do suffer from OCD and depression.
>
> anyway, I thank God for my primarily psychiatrist - who recognizes my attentional difficulties, but who's now out of prescribing ideas.
>
> I'm taking 15mg of Lexapro and 500mg of Depakote. I feel numb, dissociated and can't really read or focus. Stimulants kinda help but increase anxiety too much. The professor recommended I increase the Lexapro to 20mg, switch the Depakote for 10-15mg of Zyprexa and stay completely away from psychostimulants.
>
> I know part of my is just being an uncompliant jerk, but I just fail to see how Zyprexa is going to help my social anxiety (which he insisted it will), or my anhedonia, apathy and disastrous executive function. I kinda figured it would just make all that stuff worse? he also said it's "highly unlikely" that I experienced akathisia on only 25mg of Seroquel.
>
> 2 weeks 'til my doc gets back. haven't left bed since I got home from the appointment 5 hours ago. there just doesn't seem to be any end in sight..
>
>
Posted by SLS on October 18, 2011, at 5:45:43
In reply to Re: what a jip, posted by creepy on October 17, 2011, at 19:41:08
> I also have depression that overlaps ADD and its anyones guess which is causing the problems.
> I do well on stims but the anxiety sucks.
>
> Have you tried all of the common ADD meds? strattera, ritalin, adderall, dexedrine? I found dexedrine was a little easier on anxiety.
>I would add desipramine to this list.
- Scott
Posted by SLS on October 18, 2011, at 6:09:03
In reply to Re: what a jip, posted by bleauberry on October 18, 2011, at 5:27:04
> I'm always a bit hesitant with "academia" types. That's just me. I prefer the "real world" types.
I don't see what the difference is between the two. I am not smart enough to be able to separate them. It sounds as if you would have them be mutually exclusive. They aren't.
- Scott
Posted by jono_in_adelaide on October 18, 2011, at 19:43:18
In reply to Re: what a jip » bleauberry, posted by SLS on October 18, 2011, at 6:09:03
desipramine was withdrawn in Australia some years ago (due to low sales I think)
For "clean" NARI's you're looking at reboxetine or nortriptyline
Posted by linkadge on October 18, 2011, at 20:11:24
In reply to what a jip, posted by g_g_g_unit on October 17, 2011, at 5:07:02
The problem is that the medications suck. They just don't work.
Linkadge
Posted by Chairman_MAO on October 18, 2011, at 20:38:47
In reply to Re: what a jip, posted by linkadge on October 18, 2011, at 20:11:24
> The problem is that the medications suck. They just don't work.
>
> LinkadgeYou could try protriptyline--if you can tolerate it! That stuff is powerful.
Posted by jono_in_adelaide on October 18, 2011, at 22:19:04
In reply to Re: what a jip » linkadge, posted by Chairman_MAO on October 18, 2011, at 20:38:47
protriptyline was also discontinued in Australia some years ago now because it didnt sell enough to make it worthwhile for anyone to market it.
The tricyclics still on the market are amitriptyline, imipramine, nortriptyline, clomipramine, dothiepin, doxepin, and trimipramine
There is also reboxetine, an NARI
Posted by jono_in_adelaide on October 19, 2011, at 6:33:02
In reply to Re: what a jip, posted by jono_in_adelaide on October 18, 2011, at 22:19:04
GG, personaly I didnt find reboxetine agitating at all, infact it helped my panic attacks as well as my deoression.
If you want an NA med that is calming, nortriptylinr 75mg at night might be a good one to try (however, dont use this in any crys for help, or it might be the last one you ever make)\\
For me, an SSRI didnt get me over the line, but an SSRI plus an NARI realy did.
If they keep you awake, add somthing to aid sleep, for example, Lexapro in the morning, Edronax twice a day, and 25mg of doxepin or 5mg of nitrazepam at bedtime
at bedtime
Posted by violette on October 19, 2011, at 21:30:24
In reply to Re: what a jip » Phidippus, posted by g_g_g_unit on October 18, 2011, at 2:22:44
"Sure, but that shouldn't be grounds for immediate dismissal, especially when I've been working with my current pdoc (an ADHD specialist) for 5+ months now."
If your current pdoc is an ADHD specialist, and you've gone to several other pdocs before, maybe you would consider thinking about why in the world you are seeking advice from other docs. Repeatedly. Nothing wrong with getting a 2nd opinion but maybe you could find more answers to your questions if you stop and think about what you are doing.
Not being able to convey your medication issues with your current pdoc-adhd-expert is part of therapy. Maybe going from doc to doc over and over means something more than you would think?
Hope you get well sooner than later.
Posted by g_g_g_unit on October 20, 2011, at 3:43:47
In reply to Re: what a jip, posted by violette on October 19, 2011, at 21:30:24
There's no need to take a knee-jerk, presumptive and borderline derogatory tone towards me. This thread was a follow-up to a recent one in which I explicitly conveyed that my psychiatrist had referred me to a professor because he was out of prescribing ideas. I also made reference to that fact in the first post of this thread.
Maybe the reason I go from "doc to doc" is because I was diagnosed as alternatively suffering from schizophrenia (without any reasonable justification) and later Asperger's. Maybe the reason I go from "doc to doc" has something to do with the way attentional issues are explicitly ignored where I live, contrary to the US. Would it better to have succumbed to unjustified diagnoses - derived from, I personally believe, a deliberate bias embedded in diagnosis culture here - or to have doctor-shopped until I found someone who was willing to objectively assess the complete picture?
I'm aware that I have additional, addictive issues, but I'm fully aware of what I'm doing with regards to my current treatment.
> If your current pdoc is an ADHD specialist, and you've gone to several other pdocs before, maybe you would consider thinking about why in the world you are seeking advice from other docs. Repeatedly. Nothing wrong with getting a 2nd opinion but maybe you could find more answers to your questions if you stop and think about what you are doing.
>
> Not being able to convey your medication issues with your current pdoc-adhd-expert is part of therapy. Maybe going from doc to doc over and over means something more than you would think?
>
> Hope you get well sooner than later.
Posted by SLS on October 20, 2011, at 4:57:23
In reply to Re: what a jip, posted by violette on October 19, 2011, at 21:30:24
I am very impressed by your level of knowledge of psychology. You know way more than I do, and I value that knowledge. You offer a VERY important supplement and perhaps a counterweight in the issues discussed here. Perhaps your writing style is misunderstood as being challenging and aggressive, if not condescending. I'm sure you are aware that something you wrote pushed one of my buttons in an earlier post. It is often a good idea to contemplate how your words will be received by others, especially within the context of the limitations that this type of communication offers in conveying emotions and intent. I hope you stick around, despite my having "gone off" on you. I have learned much from your posts in the past.
By the way, you might be better off to do as I say and not as I do. I am not much of a role model for posting with restraint and moderation.
- Scott
Posted by violette on October 20, 2011, at 16:00:05
In reply to Re: what a jip » violette, posted by g_g_g_unit on October 20, 2011, at 3:43:47
GGG,
Yes, I'm familiar with your other threads. I was thinking far from knee-jerk mentality. I was thinking about the whole picture when I commented, not just this thread. I've read many of your threads over the past couple of years.
I will no longer comment on your threads as I take it I might have offended you. It makes me wonder sometimes though why people are so quick to dismiss the opinions of those who are doing well, while at the same time encouraging opinions from those who are not doing well.
Good luck.
Posted by violette on October 20, 2011, at 16:03:47
In reply to Re: what a jip - I hope you stick around » violette, posted by SLS on October 20, 2011, at 4:57:23
Thanks for your feedback Scott.
IDK, sometimes how I feel about the content here is similar to how it appears others might feel about Lou Pilder's posts. I mean in general, not this thread in particular.
Thanks anyway.
Posted by jono_in_adelaide on October 20, 2011, at 19:02:55
In reply to Re: what a jip - I hope you stick around, posted by violette on October 20, 2011, at 16:03:47
ggg - I would realy push for a trial of edronax/reboxetine
you have nothing to lose - if you find it doesnt suit you, you can stop and it will be out of your system in a couple of days, but if it works you stand to get a more robust antidepressant response, help with your motivation and attention issues, and a lot of global improvement.
It realy changed my life.
Posted by SLS on October 20, 2011, at 19:25:50
In reply to Re: what a jip - I hope you stick around, posted by jono_in_adelaide on October 20, 2011, at 19:02:55
> ggg - I would realy push for a trial of edronax/reboxetine
> It realy changed my life.
You are the poster child for reasons to keep as many drugs available as possible - even ones that are viewed as being only minimally effective. Reboxetine is most often looked at as being an inferior antidepressant statistically (a lower rate of response). However, for a few people, it is a miracle drug.
Among the 60 or so psychotropic drugs that I have tried, reboxetine comes in second as having exacerbated my depression the most. Moclobemide (Manerix; Aurorix) was number one. Given the information we had to work with, it was a logical decision to try reboxetine. I don't like its track record, but I would still be willing to try it had I not done so already.
- Scott
Posted by jono_in_adelaide on October 20, 2011, at 19:42:17
In reply to Re: what a jip » jono_in_adelaide, posted by SLS on October 20, 2011, at 19:25:50
I take it along with an SSRI (sertraline 100mg om)
I took high dose Effexor (300mg/day) and didnt get any benifit, nor did any of the SSRI's by them selves help.
I then read on Dr Ken Gillmans site (psychotropical) about combining an SSRI with an NARI for a more robust response. I have tried Sertraline plus Nortriptyline (75/g at night)sertraline with bupropion (300mg/day) and sertraline with reboxetine (4mg twice a day)
All were about equaly effective, but the reboxetine produced fewer side effects than the nortriptyline, and was much cheaper than the buproprion (In Australia it is only aproved for short term use in smoking, and insurance wont pay for long tem use in depression, so if you want it, you pay the fulll cash price..... and unlike most drugs, which are cheaper in Australia, bupropion is more expensive here)
I think that is reboxetines main role (and nortriptylines these days) - as a booster for the SSRI's
I'd encourage ggg to try both nortriptyline and reboxetine (and bupropion if it was a viable alternative in Australia, which sadly it isnt)
Posted by jono_in_adelaide on October 20, 2011, at 19:57:33
In reply to Re: what a jip » jono_in_adelaide, posted by SLS on October 20, 2011, at 19:25:50
"....Reboxetine (Edronax) is a relatively well-tolerated, relatively selective "noradrenergic" agent. Crudely, whereas serotonin plays a vital role in anxiety and mood, noradrenaline is essential to maintaining drive, self-assertiveness and the capacity for reward. There's a fair bit of evidence that chronically depressive people have dysfunctional and atypical noradrenergic systems - particularly their alpha 2- and beta-adrenoceptors. Reboxetine itself typically doesn't have the disruptive effects on cognitive function or psychomotor performance common to older, tricyclic clinical mood-brighteners - though alas antimuscarinic effects are still not completely absent. Indeed for one sub-population of depressives, the new NorAdrenaline Reuptake Inhibitors (NARIs) are possibly under-used. Unfortunately, catecholaminergic strategies to combat depression were eclipsed in the late 1980s and 1990s by the marketing hype surrounding selective serotonin reuptake inhibitors (SSRIs).
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.