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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by SLS on January 27, 2022, at 19:30:32
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
Rose...
I forgot to mention that an old trick to remedy a relapse of depression during ongoing Nardil treatment is to stop taking it for three months and then restarting it.
- Scott
Posted by rose45 on January 28, 2022, at 12:42:53
In reply to Re: marplan for anxiety, posted by SLS on January 27, 2022, at 19:30:32
my baseline is so bad and non-functioning that I could barely survive 2 weeks without a med, let alone 3 months.
Some people on reddit say they decrease the maoi and then increase it, and that seems to work for them. When I reduced the parnate, it just stopped working altogether.
Why oh why do I not react like the majority of people.... ?maybe i could go on marplan for 3 months and then switch back to parnate ? but there is no guarantee that it would work again...
Posted by rose45 on January 28, 2022, at 13:03:51
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
>
> For me, 300 mg/day of lamotrigine is the minimum effective dosage. What side effects do you experience when you increase the dosage beyond 200 mg/day? How long did you spend at the highest one dosage?My highest dosage of lamotrigine was 200mg, but I hated it because of so much loss of hair, that I am now balding, and the loss of memory and ability to communicate are truly scary. Those side effects are still there, even though I have now decreased to 125 mg. I know you are doing well on a higher dose, but I hate this drug. Im also having trouble with my sight, and hearing and tinnitus which started more or less when I started the lamotrigine. Its hard to know if they are connected but the memory loss and general ability to communicate are very scary side effects.>
>
Posted by rose45 on January 28, 2022, at 13:32:42
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
For me, 300 mg/day of lamotrigine is the minimum effective dosage. What side effects do you experience when you increase the dosage beyond 200 mg/day? How long did you spend at the highest one dosage?
>My highest dose was 200 mg but the side effects of losing so much hair, as well as destroying my memory and ability to communicate were so scary, that I reduced to 125 mg. I also started to lose my hearing and eyesight and got tinnitus at more or less 125mg lamotrigine but cant know for sure whether those things are connected. I know 300 mg works for you, but I dont think you are getting all these side effects and you are getting substantial benefits. For me it has worked on and off and stopped working for no particular reason.
I was so happy on parnate - so cruel that it has stopped working. No real side effects apart from insomnia. I should never have reduced it, but how was I to know?
Posted by Lamdage22 on January 29, 2022, at 1:22:00
In reply to Re: marplan for anxiety, posted by rose45 on January 28, 2022, at 13:32:42
I know. It made me somewhat stupid.
Posted by Lamdage22 on January 29, 2022, at 1:46:58
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:22:00
Especially reading and word finding.
Posted by undopaminergic on January 29, 2022, at 9:08:17
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:22:00
> I know. It made me somewhat stupid.
Lamotrigine?
I have no noticeable effects from it.
-undopaminergic
Posted by SLS on January 29, 2022, at 12:11:29
In reply to Re: marplan for anxiety, posted by rose45 on January 28, 2022, at 13:32:42
Rose,
Have you ever tried lithium?
I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
- Scott
Posted by Lamdage22 on January 30, 2022, at 2:15:32
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 29, 2022, at 12:11:29
Interesting. That would explain what I feel. I am on 225 Lithium Carbonate. It works like a charm. No more secure unit visits ever since, altough I started out with Lithium Orotate. To me it has a definite effect against suicidality.
> For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
Posted by rose45 on January 30, 2022, at 12:04:42
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:46:58
so have you stopped taking it?
Posted by rose45 on January 30, 2022, at 12:29:30
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 29, 2022, at 12:11:29
> Rose,
>
> Have you ever tried lithium?
>
> I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
>
>
> - ScottI have suggested low dose lithium to the psychs here, but they insist that they have to go by the blood tests, and take what is indicated, ie higher doses and that is why I have said no to it. In all honesty, Im quite relieved not to take it, as I dont want to have to deal with all the side effects, putting on weight,etc......and I dont think it is indicated for anxiety is it? And Im still taking the lamotrigine, with all its side effects.... they asked me if I want to stop the lamotrigine, and I told them I would prefer to speak to someone who could guide me. There are 2 consultant psychs for 800 patients in the unit. Its like the dark ages, and I just get to speak to a nurse.
I Know Im impossible to help, I know, because I am dealing with a dinosaur almost non existant mental service here in uk. They dont even know how to do the withdrawal from parnate and are taking weeks researching their guidelines re. how to swap from one maoi to the other....
Both parnate and nardil worked for me without any adjuncts, so Im hoping against hope that marplan will too - but I worry that people say it is so much weaker than the other two. You tried it without success, did you not?
Posted by SLS on January 31, 2022, at 21:29:26
In reply to Re: marplan for anxiety, posted by rose45 on January 30, 2022, at 12:29:30
Hi, Rose.
If you are not BIPOLAR, then tell the doctors that you want to treat your UNIPOLAR depression (MDD) with the lower dosage range of lithium currently being used to treat it. If the dosage is too high, it might actually make you feel worse. To my knowledge, no corresponding blood levels have been determined for treating MDD yet. My sweet-spot is 300 mg/day. At 450 mg/day, I begin to feel worse. I relapse at 150 mg/day.
https://www.google.com/search?sxsrf=&q=Low-dose+lithium+for+depression> > Rose,
> >
> > Have you ever tried lithium?
> >
> > I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
> >
> >
> > - Scott
>
> I have suggested low dose lithium to the psychs here, but they insist that they have to go by the blood tests, and take what is indicated, ie higher doses and that is why I have said no to it. In all honesty, Im quite relieved not to take it, as I dont want to have to deal with all the side effects, putting on weight,etc......and I dont think it is indicated for anxiety is it? And Im still taking the lamotrigine, with all its side effects.... they asked me if I want to stop the lamotrigine, and I told them I would prefer to speak to someone who could guide me. There are 2 consultant psychs for 800 patients in the unit. Its like the dark ages, and I just get to speak to a nurse.
>
> I Know Im impossible to help, I know, because I am dealing with a dinosaur almost non existant mental service here in uk. They dont even know how to do the withdrawal from parnate and are taking weeks researching their guidelines re. how to swap from one maoi to the other....
>
> Both parnate and nardil worked for me without any adjuncts, so Im hoping against hope that marplan will too - but I worry that people say it is so much weaker than the other two. You tried it without success, did you not?
>
>
Posted by rose45 on February 1, 2022, at 8:49:14
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 31, 2022, at 21:29:26
scott, I did ask them a while ago and they said that is not how they work.... I am so afraid.... they discharged me when I was better, and now I am back under a nurse as they are so overworked and the nurse doesnt know more than his instructions to wait for the pharmacist to reduce the parnate which im still on and switch to marplan. They only speak to the psych in group meetings. They just dont have the staff. Would the lithium help with the overwhelming anxiety? Im not getting the help I need and am losing all hope. The is England.
Posted by SLS on February 3, 2022, at 11:29:27
In reply to Re: marplan for anxiety, posted by rose45 on February 1, 2022, at 8:49:14
Hi, Rose.
The remedy for your doctors' resistance to employing such a simple and benign treatment - low dosage lithium - might be as easy as using a computer, a printer, and submitting to your doctors on paper the results of your literature search using Google and Pubmed. The number of article you will find will be multitudinous. Identify the most persuasive literature that you find and submit it to your doctors. Tell them you are fighting hopelessness, and don't know how much longer you can hold out. That's a tactful way to convey to your doctors that if they don't try lithium, you might commit suicide. Unfortunately, this not an unrealistic description.
For today, I urge you to continue to struggle forward, at least for now.
My story is nothing less than one of miracles. God has a funny way of rewarding some people for their choosing to suffer indeterminate pain and struggle over death..
The severe depression I experienced began at age 17. It began as an abrupt *switch*. Within 30 minutes, I plunged from (relative) normothymia to severe and paralyzing depression. I was hit with hit depression, anxiety, and feelings of doom. It was an unfamiliar state of consciousness to me. It was genuinely traumatic. I remember looking up at the clock in my physics class. It was 10:50 AM. This time and place was the marker of the beginning of 46 years (16,790 days) of unremitting pain and struggle. I never really had time to catch my breath.
This was "flavor" of my depression:
Psychomotor retardation, anhedonia, amotivation, anergia, cognitive and memory impairments. It has been a fundamentally vegetative existence.
To be honest and accurate, I was close to remission for 6 months in 1987 as the result of treatment with a combination of two antidepressants. This was a critically important event, though. It became the carrot that impelled me to continue suffering while I chased the *possibility* of the nirvana that I learned would come with successful treatment.
I think I have been on 60 different drugs that were used in many more combinations. 1.5 years ago, in the summer of 2020, my doctor and I had run out of ideas. I always had 2-3 treatment ideas lined up just in case my current trial resulted in failure. The addition of Nardil to my treatment regime was the absolute end of the road for me. It was my last chance. Why would I expect it to work when the previous 60+ treatments failed? I had been on Nardil many times previously, and it was used in various combinations with other drugs. In 2009, I was treated with EXACTLY THE SAME DRUGS that I take now, but at DIFFERENT DOSAGES. 100 mg more of Lamictal and 15 mg less of Nardil would have given me 12 more years of life and 12 fewer years of pain and struggle.
Rose, I spent quite a bit of time composing this for you. Please allow my story to be part of your decision-making process and outlook. I don't want to see your name disappear from the board.
Sincerely,
Scott
.
A start for you:https://scholar.google.com/scholar?hl=en&as_sdt=0%2C31&q=%27low+dosage%22+lithium+depression&btnG=
Posted by undopaminergic on February 4, 2022, at 8:15:36
In reply to Re: marplan for anxiety » rose45, posted by SLS on February 3, 2022, at 11:29:27
> I had been on Nardil many times previously, and it was used in various combinations with other drugs. In 2009, I was treated with EXACTLY THE SAME DRUGS that I take now, but at DIFFERENT DOSAGES. 100 mg more of Lamictal and 15 mg less of Nardil would have given me 12 more years of life and 12 fewer years of pain and struggle.
>Didn't you say the key to your current successful period was lowering nortriptyline? I think you also said that before that, you had been increasing and lowering the Nardil intermittently.
-undopaminergic
Posted by rose45 on February 5, 2022, at 4:30:37
In reply to Re: marplan for anxiety » rose45, posted by SLS on February 3, 2022, at 11:29:27
Scott, Thank you SO much for taking the trouble to post such a long and detailed message.
I am having trouble getting on this site, as I get the message that this site is not secure and telling me not to proceed as attackers might steal my information Im getting tons of spam since posting on here too? Is there anywhere else we could communicate?You are right about my state of mind. I am suicidal, and afraid of having to come off parnate for a washout, which will make me more so and no guarantee that marplan will work.
I am so happy for you that you are in recovery, but you are taking a combination of 4 meds, so its not just the lithium that is helping, and here in UK I would have to find a private psych to listen to me because the NHS have just provided a nurse who has been given instructions to put me on a 2 week washout and then on marplan with no leeway to make independent decisions. PLEASE could i speak to you as soon as possible this weekend by private message or on Whatsapp. I would be so grateful.
Is it possible to click on my name and send me a private message, and we could then communicate outside of this site.? I think it would be safer until Dr. Bob does something to make this site secure.
Posted by rose45 on February 5, 2022, at 4:34:35
In reply to Re: marplan for anxiety » rose45, posted by SLS on February 3, 2022, at 11:29:27
Scott, Ive sent you a message on babblemail. I dont feel safe on this site.
Posted by undopaminergic on February 5, 2022, at 5:25:12
In reply to Re: marplan for anxiety, posted by rose45 on February 5, 2022, at 4:30:37
> I am having trouble getting on this site, as I get the message that this site is not secure and telling me not to proceed as attackers might steal my information ...
>
> I think it would be safer until Dr. Bob does something to make this site secure.
>The security problem is a minor one. The only danger is the theoretical possibility that someone, at an intermediate location on the network path between you and dr-bob.org, might eavesdrop. The likelihood of that happening is minor.
-undopaminergic
Posted by rose45 on February 5, 2022, at 5:47:48
In reply to Re: marplan for anxiety, posted by undopaminergic on February 5, 2022, at 5:25:12
I am suddenly getting a whole load of spam In my hotmail. Could that not be related?
Posted by undopaminergic on February 5, 2022, at 5:57:21
In reply to Re: marplan for anxiety, posted by rose45 on February 5, 2022, at 5:47:48
> I am suddenly getting a whole load of spam In my hotmail. Could that not be related?
>No, because you don't use your e-mail address to log into Psychobabble, so there is no way a hypothetical eavesdropper could have stolen it.
-undopaminergic
Posted by rose45 on February 6, 2022, at 4:55:32
In reply to Re: marplan for anxiety » rose45, posted by SLS on February 3, 2022, at 11:29:27
Scott, you have been so kind,and thoughtful, but the system here in uk is so shockingly bad and my anxiety is so overwhelming. Im desperate. I dont think lithium helps with chronic anxiety, does it? I have asked for marplan which they organised with great trouble for themselves, and if I change now, they would probably discharge me. I cant afford £400 an hour for a private psychiatrist.. I am shaking as I write..... will post later if I can calm down... I just dont see any way out.. you are all so lucky to have insurance and be able to work with a psych
Posted by SLS on February 11, 2022, at 2:04:26
In reply to Re: marplan for anxiety, posted by rose45 on February 5, 2022, at 4:30:37
> Scott, Thank you SO much for taking the trouble to post such a long and detailed message.
> I am having trouble getting on this site, as I get the message that this site is not secure and telling me not to proceed as attackers might steal my information Im getting tons of spam since posting on here too? Is there anywhere else we could communicate?
>
> You are right about my state of mind. I am suicidal, and afraid of having to come off parnate for a washout, which will make me more so and no guarantee that marplan will work.
>
> I am so happy for you that you are in recovery, but you are taking a combination of 4 meds, so its not just the lithium that is helping, and here in UK I would have to find a private psych to listen to me because the NHS have just provided a nurse who has been given instructions to put me on a 2 week washout and then on marplan with no leeway to make independent decisions. PLEASE could i speak to you as soon as possible this weekend by private message or on Whatsapp. I would be so grateful.
> Is it possible to click on my name and send me a private message, and we could then communicate outside of this site.? I think it would be safer until Dr. Bob does something to make this site secure."Polypharmacy" has become a bad word for reasons that are arbitrary.
All four drugs are necessary for me, and each drug must be taken at a specific dosage. They have each been optimized according to the degree of response gained.
I am not terribly focused on the number of medications I take. I would take 10 meds 3 times a day and drink them down with horse piss if it meant feeling like I do right now.
Thinking out of the box is your best approach if thinking inside the traditional box yields unsatisfactory results.
- Scott
Posted by Lamdage22 on February 11, 2022, at 2:09:55
In reply to Re: marplan for anxiety, posted by SLS on February 11, 2022, at 2:04:26
You are not coquetting. That is why you got somewhere. I am driving 5 hours a week to get good Psychotherapy.
> I am not terribly focused on the number of medications I take. I would take 10 meds 3 times a day and drink them down with horse piss if it meant feeling like I do right now.
Posted by Lamdage22 on February 11, 2022, at 2:15:33
In reply to Re: marplan for anxiety, posted by Lamdage22 on February 11, 2022, at 2:09:55
Still, the more meds you take the more side effects could ruin your remission. You need to be healthy overall to enjoy, right? It is a fine line.
Posted by rose45 on February 13, 2022, at 14:35:42
In reply to Re: marplan for anxiety, posted by SLS on February 11, 2022, at 2:04:26
Scott, You are fortunate to have had a psych to work with In the whole of UK, it would be difficult to find someone who would be open to thinking that much out of the box and be knowledgeable about maois and willing to add a tca etc... It seems that American psychs are more open to experimentation maybe. Some people in UK order meds from outside of the country and experiment with them, but I dont have the guts to do that.
You are indeed fortunate to have found your 'formula'. In my case, whenever an maoi stops working, I feel as if I have 'brain damage' ie unbearable anxiety and the inability to think or act clearly and a loss of sense of self. But both nardil and parnate worked vry well on their own for me ie I didnt have to add anything- so Im hoping against hope that marplan will too... otherwise I really dont know what to do.
I simply reduced the dosage of parnate, and it stopped working altogether. I then got it to work by adding low dose olanzapine, and when I slightly reduced the olanzapine, it all stopped working again, so Im afraid to play around with meds.
Other people report that lowering the dose of maois and then increasing them, makes them work better again. In my case it was just the opposite.Also I am now reducing the lamotrigine, and I hope that will not be too hard, as it has destroyed my memory, which is very scary.
You and many posters on here are very knowledgeable, and have guided your psychs. I dont know how you can all afford it. I cant even work at the moment, but would never have received insurance anyway.
I am a difficult case, and really dont know what to do. And Im dreading coming off parnate, which apparently can be very painful.
This is the end of the thread.
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