![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 30 to 54 of 54. Go back in thread:
Posted by SLS on September 24, 2021, at 15:11:14
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 24, 2021, at 5:49:11
> Lamotrigine started to work at 100 mg, but I titrated up to 200mg. There was not much difference between 100 and 200 mg, but I did not feel myself, until I added 2.5mg olanzapine. I then felt I was in remission, although the unpleasant cognitive side effects of loss of memory, nightmares and loss of hair were still there. I felt in remission for 3 months,and then it slowly stopped working.I increased the dose of lamotrigine, but it made no difference. Hence the title of this thread - nardil, parnate and lamotrigine have all stopped working for me.
>
> That is why I want to try marplan, as it is the only maoi which I have not yet tried Both Nardil and Parnate stopped working. I will keep taking Lamotrigine, as you suggest, but will it make much difference if it is not working? At this point, I doubt that increasing it any more will make much difference, and the memory loss and hair loss are really upsetting me.I would be upset, too. I would not want to see you suffer such upsetting side effects from lamotrigine if you can find remission without it.
For me, the difference between 200 mg/day and 300 mg/day is the difference between my successfully designing and building a couch by reading a book versus being able to only vegetate on one, staring into space.
That was a very silly simile, but it is absolutely accurate.
For me, the difference between 200 mg/day and 300 mg/day of lamotrigine is the difference between agony and remission.
Mine is just one anecdote. It is impossible to know that it would also be crucial to an effective treatment for you. I found Zyprexa to have:
1. Anti-manic properties - including manic psychosis.
2. Antidepressant properties.
3. The ability to think more clearly.If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic. I think the two drugs are chemically related, but I'm not sure.
I'm curious where your decision-making process is headed.
As always, good luck. You are in my thoughts.
- Scott
Posted by undopaminergic on September 25, 2021, at 0:44:15
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 24, 2021, at 14:39:31
> > >
> > > UD: I find that your thoughts contain what one might consider esoteric information from which you construct creative and plausible arguments and explanations.
> > >
> >
> > Interesting observation. Do you have examples?
>
>
> "esoteric" (Merriam-Webster): Requiring or exhibiting knowledge that is restricted to a small group."
>Yes, I know what it means.
> Examples? 99.9% of your posts. I'm joking, of course, but it's not far from the truth. :-)
>OK, but what (for example) is esoteric of what I post?
> > > Just don't turn around. You might see smoke.
>
> > Can you clarify that?
>
>
> It's an allusion to someone "blowing smoke up your *ss".Who would be doing the blowing?
-undopaminergic
Posted by undopaminergic on September 25, 2021, at 0:55:27
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 24, 2021, at 15:11:14
>
> If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
>Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
> I think the two drugs are chemically related, but I'm not sure.
>They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
-undopaminergic
Posted by SLS on September 25, 2021, at 6:22:26
In reply to Re: Why do meds constantly stop working for me?, posted by undopaminergic on September 25, 2021, at 0:44:15
Dear UD
I can see how someone could look upon the word "esoteric" and perceive a negative connotation. Most of the people who had posted on Psycho-Babble before Lou Pilder managed to disrupt the board possessed esoteric knowledge that I still judge to be absent in every clinician who treated me. That makes your knowledge and understanding esoteric. The audience that you direct your knowledge and understanding to is very small indeed - thus, "esoteric".
> > It's an allusion to someone "blowing smoke up your *ss".> Who would be doing the blowing?
Me, of course!
Sincerely,
Scott
* P.S. - That should be enough flattery for you to get by today. If not, you'll have to wait until tomorrow.<smile>
Posted by SLS on September 25, 2021, at 7:19:24
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 25, 2021, at 0:55:27
> >
> > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> >
>
> Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.
> > I think the two drugs are chemically related, but I'm not sure.
> >
>
> They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity. Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic. Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.
The following is one of my many rants:
I have yet to hear of a single case of someone becoming physiologically dependent on tramadol. My guess is that if there are, they must be very few in number. I have not seen an avalanche of medical literature reporting such sequlae with tramadol. The point is that the clinicians who prescribe tramadol think of it as an addictive opioid to be avoided if possible. And then, they are very reluctant to prescribe it as a long-term treatment as an analgesic. Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy. I'm thinking that the weak opioid activity of tramadol is amplified by the extant reuptake inhibition of norepinephrine and serotonin (SNRI), leaving tramadol much less liable to produce opioid dependence and an opioid discontinuation withdrawal syndrome.
Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering. You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.
Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
By the way, there is a new product that combines ibuprofen with acetaminophen (in one pill). Of course, it is much cheaper to buy the two generic products separately. It works stunningly well for my mother, for whom tramadol isn't always sufficient.
- Scott
Posted by undopaminergic on September 25, 2021, at 10:50:19
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 7:19:24
> > >
> > > If there is any drug worse than Zyprexa (olanzapine) for producing weight gain, it would be clozapine (Clozaril), the original atypical antipsychotic.
> > >
> >
> > Olanzapine (Zyprexa) is a little worse according to what I've read, at least as far as diabetes risk is concerned.
>
>
> I didn't know that, but I very much trust your esoteric knowledge. <wink> Thank you.
>I'm exceptional enough to have lost weight on clozapine. That is quite esoteric knowledge.
> > > I think the two drugs are chemically related, but I'm not sure.
> > >
> >
> > They both have the three rings like TCAs, and one additional, piperazine, ring, making them tetracyclic.
>
>
> Remember, adding a single chlorine atom turns imipramine into clomipramine (Anafranil). Sometimes, a very small change in chemical structure can make a huge difference in pharmacodynamic and clinical activity.
>Of course.
> Tramadol (Ultram) is labelled an "opioid". However, it does other things pharmacologically. Tramadol is a derivative on venlafaxine (Effexor), yet possesses some, but insufficient, antidepressant activity to be given an indication by the FDA to treat MDD or BD.
>The opioid effect is also an antidepressant action, although perhaps only in the short term due to tolerance.
> Tramadol is a only weak agonist at the opioid receptor compared to all other opioid analgesics. I didn't want to hit my mother's doctor with "esoteric" facts, but, like venlafaxine, tramadol is an SNRI if you discount its opioid receptor agonism. Of course, we can't, but it is conceivable to me that the inhibition of both the serotonin and norepinephrine transporters (reuptake inhibition) works synergistically with opioid agonism to produce a stronger analgesic.
>Yes, or a stronger antidepressant effect.
> Duloxetine (Cymbalta), another SNRI, was touted as being particularly capable of reducing the sensation of pain (nociception) when it is used to treat depression. In fact, this property was the focus of mass-media advertisements by Johnson & Johnson.
>It seems that a number of drugs not traditionally regarded as analgesics can be useful in the treatment of pain, sometimes alone and sometimes in combination with some other class of drug.
> Many people get significantly greater pain relief from tramadol than they get from ibuprofen or naproxen monotherapy.
>And NSAIDs (such as ibuprofen) can produce gastrointestinal ulcers.
> Tramadol is not one of the "evil" opioids that are invaluable, but now avoided because members of the public at large use it recreationally. Excuse me. F*ck the law-breaking, hedononistic members of the public who abuse this drug illegally, and therefore make opioids out to be in alliance with the Devil. Meanwhile, people in severe, and often chronic intractable pain can't find a doctor who is willing to mitigate their suffering.
>Right. It's like with the MAOIs (ie. doctors are afraid to prescribe them).
> You can't blame doctors, though. Some legally prescribed opioids are extremely problematic when it comes to physiological dependence and severe withdrawal symptoms. Not everyone experiences euphoria, gets "high", when taking an opioid. I don't have any statistics to produce, but my guess is that a sizeable percentage, likely the majority, do not receive a euphoric effect from Percocet. Those who do are screwed, though.
>Euphoria, or more specifically a powerful rush, is more likely with intravenous use, and also depends on dose. And at first there are side effects like nausea and sleepiness that may outweigh any pleasant effects.
> Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
>If you mean potency per unit of weight, I think etorphine is the most powerful.
-undopaminergic
Posted by undopaminergic on September 25, 2021, at 11:50:50
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 6:22:26
> Dear UD
Dear SLS
> I can see how someone could look upon the word "esoteric" and perceive a negative connotation.
>I'd say I have mixed feelings about it. It is an honour to be in the know about things few know anything about. On the other hand, if you mean the knowledge is of interest (or use) only to a few, it could be regarded as negative.
> Most of the people who had posted on Psycho-Babble before Lou Pilder managed to disrupt the board possessed esoteric knowledge that I still judge to be absent in every clinician who treated me. That makes your knowledge and understanding esoteric. The audience that you direct your knowledge and understanding to is very small indeed - thus, "esoteric".
>What clinicians today, more than ever, lack is first-hand experience with the drugs and treatments they prescribe. First hand knowledge is indeed esoteric.
> Sincerely,
> ScottYours truly,
Undopaminergic
Posted by SLS on September 25, 2021, at 13:49:15
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 25, 2021, at 10:50:19
> > Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
> If you mean potency per unit of weight, I think etorphine is the most powerful.
I had never heard of it, but you are right. In the US, etorphine is listed as a Schedule I drug. Fentanyl is listed as a Schedule II drug. So I guess it would be hard to have a doctor prescribe etorphine. Can cancer pain be treated with a Schedule I drug? I know cocaine can be used for topical ophthalmic indications, but it is only Schedule II.
- Scott
Posted by undopaminergic on September 25, 2021, at 14:51:26
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 25, 2021, at 13:49:15
> > > Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
>
> > If you mean potency per unit of weight, I think etorphine is the most powerful.
>
> I had never heard of it, but you are right. In the US, etorphine is listed as a Schedule I drug. Fentanyl is listed as a Schedule II drug. So I guess it would be hard to have a doctor prescribe etorphine. Can cancer pain be treated with a Schedule I drug? I know cocaine can be used for topical ophthalmic indications, but it is only Schedule II.
>It is mainly used as a tranquiliser for large animals, such as elephants.
-undopaminergic
Posted by rose45 on September 28, 2021, at 12:04:35
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 24, 2021, at 15:11:14
Scott,
An interesting thing has happened.
4 days ago, the unbearable anxiety which I have been having to endure, started to disappear, and I have been getting better ever since. I hadnt had any change in lifestyle, and then I noticed that 6 days ago, I had collected my new supply of generic lamotrigine. I am convinced that is the reason for my new-found peace of mind. (My depression is mainly anxious depression)
I will give it some more time, to make sure that this is not a 4 day wonder. The brand name of the generic is Accord. It could very well be, from what I have read on other threads, that some generics are really bad. I am going to ask my gp if he can prescribe the GSK lamictal to see if that also makes a difference. Not sure he will agree. But at least if i have to stick to a generic, I will stick with Accord. I didnt make a note of all the generic lamotrigine packets I have receivd in the past year. That would have helped.
This is totally miraculous. It would be great if it could avoid me having to withdraw from the parnate and go on to marplan.
So right now, Im taking:
125mg lamotrigine
40 mg parnate
25mg olanzapine
Posted by Lamdage22 on September 29, 2021, at 11:19:30
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 28, 2021, at 12:04:35
Hypothesis: Because there is an underlying issue (psychological and/or physiological) that needs to be adressed?
Posted by Lamdage22 on September 29, 2021, at 11:20:41
In reply to Re: Why do meds constantly stop working for me?, posted by Lamdage22 on September 29, 2021, at 11:19:30
Or even spiritual.
Posted by rose45 on September 30, 2021, at 5:51:36
In reply to Re: Why do meds constantly stop working for me?, posted by Lamdage22 on September 29, 2021, at 11:20:41
That is very interesting Lamdage. I definitely have many psychological and spiritual issues which need to be addressed - but does that explain why I seem to be in remission simply by taking a different generic of lamotrigine? ( See my last post if you havent read it).
Posted by SLS on September 30, 2021, at 6:32:33
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 25, 2021, at 11:50:50
Dear UD
:-)> > Dear UD
> Dear SLS
>
> > I can see how someone could look upon the word "esoteric" and perceive a negative connotation.
> >
>
> I'd say I have mixed feelings about it. It is an honour to be in the know about things few know anything about. On the other hand, if you mean the knowledge is of interest (or use) only to a few, it could be regarded as negative.
I (now) agree with you.After your post above, I gave some more thought to my use of the word "esoteric" to describe you. Your interpretation of the dictionary definition I referred to is accurate, and I don't think it applies to you.
My apologies.
- Scott
Posted by SLS on September 30, 2021, at 6:42:45
In reply to Re: Why do meds constantly stop working for me?, posted by undopaminergic on September 25, 2021, at 14:51:26
> > > > Fentanyl is often the only substance that has the ability to relieve cancer patients of the severe pain they experience. To my knowledge, Fentanyl is the most powerful opioid analgesic in the world. Now, everyone is screwed. Damned public.
> > > If you mean potency per unit of weight, I think etorphine is the most powerful.
> > I had never heard of it, but you are right. In the US, etorphine is listed as a Schedule I drug. Fentanyl is listed as a Schedule II drug. So I guess it would be hard to have a doctor prescribe etorphine. Can cancer pain be treated with a Schedule I drug? I know cocaine can be used for topical ophthalmic indications, but it is only Schedule II.> It is mainly used as a tranquiliser for large animals, such as elephants.
It's a good thing that my memory sucks, and I therefore can't be mistaken for an elephant.
Still, I would like to have my hippocampus (the college grounds for waterhorses) (Boo) to demonstrate that neurotrophic plasticity that it is so famous for. My memory is unequivocally improving, but I would say that it is the last thing to recover upon the process of attaining remission. My worst symptom of memory impairment remains the almost total inability to remember conversations.
- Scott
Posted by SLS on September 30, 2021, at 7:35:33
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 28, 2021, at 12:04:35
> Scott,
>
> An interesting thing has happened.
>
> 4 days ago, the unbearable anxiety which I have been having to endure, started to disappear, and I have been getting better ever since. I hadnt had any change in lifestyle, and then I noticed that 6 days ago, I had collected my new supply of generic lamotrigine. I am convinced that is the reason for my new-found peace of mind. (My depression is mainly anxious depression)
>
> I will give it some more time, to make sure that this is not a 4 day wonder. The brand name of the generic is Accord. It could very well be, from what I have read on other threads, that some generics are really bad. I am going to ask my gp if he can prescribe the GSK lamictal to see if that also makes a difference. Not sure he will agree. But at least if i have to stick to a generic, I will stick with Accord. I didnt make a note of all the generic lamotrigine packets I have receivd in the past year. That would have helped.
>
> This is totally miraculous. It would be great if it could avoid me having to withdraw from the parnate and go on to marplan.
>
> So right now, Im taking:
>
> 125mg lamotrigine
> 40 mg parnate
> 25mg olanzapineRose.
I am elated to hear this. Very. May your improvement continue indefinitely beyond 4 days. I know only too well my disappointments when an antidepressant wouldn't last beyond 3 days.
Several comments:
1. Ask your doctor to prescribe GSK Lamictal - with no substitution - telling your prescription insurer that you have tried at least 2 generics without an acceptable improvement according to your doctor.
2. That you have had a noticeable improvement at 125 mg/day of lamotrigine leads me to believe that you have room to increase the dosage if necessary. My guess is that your going above 200 mg/day will be unnecessary, but I would not give up on your entire treatment regime without moving up *gradually* to 200 mg/day to lamotrigine first.
3. In my opinion, the effective range of Parnate is 40-90 mg/day. Again, you have room to work with, and again, I would not abandon Parnate until that range is explored. 60 mg/day is probably the sweet spot statistically, but 40 mg/day could easily be *your* sweet spot.
4. Marplan can help people for whom no other drug does. Of the MAOIs that I've tried, including the EMSAM preparation for selegine, Marplan had the mildest side-effect profile, and the brief improvement I experienced felt than Parnate. It felt sort of like a hybrid improvement of Parnate and Nardil. Like Nardil, Marplan is a hydrazine derivative. Parnate is not. Nardil is well known to be significantly better for anxiety disorders than Parnate, including social anxiety disorder, generalized anxiety disorder, and panic disorder. For me, Nardil is also "pro-social". Parnate is not. However, the improvement I experienced with Marplan lasted for only a few days. Thereafter, it made me feel significantly worse. If you don't have success with Marplan, try Nardil if you haven't yet done so *with* the other drugs that you are currently taking. I would say that the effective range for Nardil is 60-90 mg/day. I have only rarely seen someone report that 45 mg/day of Nardil was optimal - maybe 1-2 people.
5. Nardil can take up to 3 months (12 weeks) to produce a robust antidepressant effect. That assumes that you are taking the dosage that is your sweet-spot - the lowest effective dosage - for at least 4-6 weeks (my estimation).
6. Nardil can produce moderate-severe side effects which includes hypotension and urination "hesitancy" (delayed micturition) to total urinary retention. These things have always plagued me in the past. This time, I played out a hunch and began at 1/2 a pill and increased more gradually than in the past. My guess was that if I don't *trigger* these side effects, they might not emerge at all or be greatly mitigated. Good hunch. At 120 mg/day, I had absolutely no hypotension (orthostatic or otherwise) and a short period of mild urinary hesitancy.
* Again, I am (cautiously) optimistic for you - especially if you get beyond your 4-day window.
Good luck.
- Scott
P.S. I am not proof-reading this. I'm sure you'll figure it out.
Posted by undopaminergic on September 30, 2021, at 8:30:37
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 30, 2021, at 6:42:45
> > [Etorphine] is mainly used as a tranquiliser for large animals, such as elephants.
>
> It's a good thing that my memory sucks, and I therefore can't be mistaken for an elephant.
>Haha...
Do you think your remission is doing anything for your sense of humour?
> Still, I would like to have my hippocampus (the college grounds for waterhorses) (Boo)
>Not bad!
> to demonstrate that neurotrophic plasticity that it is so famous for. My memory is unequivocally improving, but I would say that it is the last thing to recover upon the process of attaining remission. My worst symptom of memory impairment remains the almost total inability to remember conversations.
>It sounds like your remission is really comprehensive. It reminds me that I should perhaps demand more from my depression treatments. Maybe complete remission *is* possible.
-undopaminergic
Posted by rose45 on September 30, 2021, at 8:36:46
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 30, 2021, at 7:35:33
Scott
Thank you for your message. I am also hoping this is not just a 5- day wonder. Past experiences have made me cautious.
1. I did ask my gp to prescribe GSK Lamictal, but unfortunately he can only give it to me on a private prescription ie I have to pay for it, as opposed to getting the generic free on the NHS. I have found on the net, Lamictal manufactured by GSK in Turkey for much cheaper than the one manufactured in UK, but not sure if the formulation is exactly the same?? I found the following post on www.epilepsy.com:
'
I was on Lamictal, then the generic came out. My doctor wanted me to go on it, because it was cheaper. However, if you do your research, you will learn that the brand name drug comes from a single factory, therefore a standard is established and you can be sure that you are getting the same exact ingredients in your pill every time, every Rx. The generic can be produced from something like thirty different factories, and they have a 20% - 30% swing on what they can use as fillers. Therefore you could be getting lamotrigne from Factory A in the month of September, with 20% different ingredients than the brand name, and then in October, you might get lamotrigne from Factory X that has 30% different from the brand name and no guarantee that the 30% for October and the 20% for September have the same binders, either! If you could pinpoint a single generic lamotrigne producer and were sure you were only getting your drugs from this one place, you'd probably be fine, as long as there weren't any side effects other than the ones you already experience on the brand name. But pinpointing it would probably be hard to do. Because this is an AED that's messing with your mind, I would try to stay on the brand name. I am still on Lamictal -- the lamotrigne made me very sick.'2. I really dont want to increase the dosage, because as I mentioned in my earlier post, it has seriously affected my memory and made me lose a lot of hair. So I dont want to increase those side effects.
3. I did well on 30 mg of parnate for six years before I reduced it. I am now on 40 mg and cannot tolerate any higher.4. I was on Nardil 45 mg for 22 years before it pooped out on me. I far prefer parnate - less side effects, and for me just as good for social anxiety and anxiety in general.
I dont know whether it is worth the pain of withdrawing from parnate and going on to marplan, if my present state of seeming remission continues.
Posted by undopaminergic on September 30, 2021, at 8:36:55
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 30, 2021, at 6:32:33
> Dear UD
>
>
> :-)Dear SLS :-)
>
> My apologies.
>
>
> - ScottNo problem!
On another note, we are terminating the lurasidone (Latuda). Now down to 2x37 (74) mg/day from 111 mg. That is esoteric knowledge, not of interest to anyone else, right?
-undopaminergic
Posted by SLS on September 30, 2021, at 10:22:05
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 30, 2021, at 8:36:46
Hi, Rose.
> 2. I really dont want to increase the dosage, because as I mentioned in my earlier post, it has seriously affected my memory and made me lose a lot of hair. So I dont want to increase those side effects.I forgot about that.
> 3. I did well on 30 mg of parnate for six years before I reduced it. I am now on 40 mg and cannot tolerate any higher.I found that the hypotensive side-effects of Parnate disappear after awhile.
> 4. I was on Nardil 45 mg for 22 years before it pooped out on me. I far prefer parnate - less side effects, and for me just as good for social anxiety and anxiety in general.Great!
Just in case, I have seen two ways to attack Nardil poop out.
1. Discontinue it and restart it no less than 3 months later.
2. Switch as needed back and forth between Nardil and Parnate.
An old characterization: Marplan is a weak Nardil. However, some people do much better on Marplan than on Nardil.
I'll be watching this thread.
Good luck!
- Scott
Posted by undopaminergic on September 30, 2021, at 10:42:35
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 30, 2021, at 10:22:05
>
> An old characterization: Marplan is a weak Nardil. However, some people do much better on Marplan than on Nardil.
>You probably know this, but Marplan is substantially different from both Nardil and Parnate. It does not have the GABAergic metabolite of Nardil, nor the intrinsic stimulant ("amphetaminergic") effect of Parnate.
-undopaminergic
Posted by SLS on September 30, 2021, at 11:43:01
In reply to Re: Why do meds constantly stop working for me? » SLS, posted by undopaminergic on September 30, 2021, at 10:42:35
"amphetaminergic"
Perfect!
- Scott
Posted by rose45 on September 30, 2021, at 12:38:40
In reply to Re: Why do meds constantly stop working for me? » rose45, posted by SLS on September 30, 2021, at 10:22:05
Scott,
I will definitely keep you informed on this thread.Just wanted to say that for many people,discontinuing and restarting a med is fairly easy to do.
In my case I dont dare change anything. When I just reduced parnate slightly, it stopped working altogether, and I became seriously ill. I increased it up to 40 mg but it didnt make any difference.
When I added 2.5 mg olanzapine to it, it started to work again, so I slowly reduced the olanzapine, and the whole thing stopped working again.
Same with nardil, when I reduced it by just 15 mg, I became totally ill, and it would take 8 weeks to get back to how I was before.
What I am trying to say is that what works for most people, does not work for me - I have no idea why. This is really why I started this thread in the first place. I guess everyone reacts differently, but I do have to be so careful re. reducing anything. For example I would dearly like to reduce the 2.5 mg olanzapine which I am still on, but dont dare do it, in case I return to how I was before.
Posted by undopaminergic on September 30, 2021, at 13:28:02
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 30, 2021, at 11:43:01
> "amphetaminergic"
>
> Perfect!
>
>
> - ScottHaha, yes, but more soberly, it should perhaps be "trace amine-like". Amphetamine is a synthetic analogue of trace amines like tyramine and (especially) phenylethylamine (PEA).
I used-abused PEA chronically myself for its amphetaminergic actions. This was the most harmful psychopharmacological act I ever engaged in, although reboxetine (Edronax) markedly worsened depersonalisation-derealisation. Without either of them, I would (probably) be much better off today.
Before PEA, I deemed methylphenidate (Concerta) not to be worth the money and voluntarily quit it. After PEA, methylphenidate (or its workalikes) was essential just to ward off apathy and suicidal ideation. There are marked similarities between myself and those who are recovering from chronical methamphetamine abuse. Why did I quit? It's pathetic. I ran out of my local supply, and couldn't muster the motivation for a short trip into town to get a refill. I felt like a dirty damp and worn-out old rag, out of which all dopamine had been wrung. That is an analogy that is close to the literal state I was in. I'm still recovering.
Particularly esoteric knowledge: as of today, I'm down to only 37 mg lurasidone (Latuda). Next thursday we'll be going down to 0 mg. Question: should I first (a) substitute clomipramine for trimipramine, or (b) start asenapine?
-undopaminergic
Posted by Lamdage22 on October 1, 2021, at 15:34:12
In reply to Re: Why do meds constantly stop working for me? » undopaminergic, posted by SLS on September 30, 2021, at 6:32:33
You have gotten more remission out of your meds than I did. Like 10 times more. Aside from tweaking meds, I'd try to better these other factors (underlying issues), too. It won't hurt.
This is the end of the thread.
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