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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by rose45 on March 13, 2023, at 16:04:18
there is some technical problem with this board. It will not allow me to post a response to your post, so i am having to post a new one.
>What exactly did you do such that you lost your remission?
I went a little manic on the parnate and reduced the dose and it just stopped working altogether. I increased the dose and it made no difference.
I seem to have a problem with tolerance
I do not have the opportunities that you have to try all those meds. You in the US are fortunate, but it is quite different in the uk.... for reasons i have already explained.
I am not talking about the performance of just one drug
lamotrigine worked for 3 months and then stopped working
lithium worked for 2 months and then stopped working.I simply cannot tolerate a higher dose of parnate. It makes me feel terrible. Dont ask me why.... but I just cannot tolerate it.
You have had great opportunities to try different meds. I dont have those opportunities and I am too ill to travel and barely able to do my shopping.... what is available to you is not available to me.
So what do I do ? I cannot live like this.
I just spoke to this mexican psychiatrist who talked about tolerance.... and he quoted something about lithium, and having to keep swapping drugs every few months because of tolerance.
I have been offered 3 meds by the NHS and that is it...... What hope do I have?
Posted by SLS on March 13, 2023, at 18:48:01
In reply to for SLS, posted by rose45 on March 13, 2023, at 16:04:18
Hi, Rose.
I did not expect to write this much.> > What exactly did you do such that you lost your remission?
> I went a little manic on the parnate and reduced the dose and it just stopped working altogether. I increased the dose and it made no difference.
What does "a little manic" look like for you?
What dosage of Parnate were you taking when the hypomania / mania appeared. What other drugs were you taking along with it?
With hypomania, some doctors elect to allow the patient to remain on the drug(s) that caused reaction if it is not getting in the way of their functioning in society. People with hypomania (not the dysphoric type or mixed state) can just be left alone. Otherwise, adding an anti-manic drug to cap or attenuate the hypomanic reaction makes sense for someone who is very resistant to responding to treatment. Some of the drugs include a few atypical antipsychotics, lithium, anticonvulsants (Trileptal, Depakote, and Topamax are all reasonable choices that I have responded to or observed other people respond to. Before the advent of atypical antipsychotics, psychiatrists would add a benzidiazepine to lithium if lithium by itself was not wholly effective. It works. The dosage of lithium would have to be in the high-doage anti-manic range - 900-1500 mg/day. Take it all at night before you go to sleep. Believe it or not, it puts less stress on the kidneys.
Can you give a little more detail as to what you experienced at higher dosage of Parnate? How long did you remain at the dosage that you had difficulties tolerating?What is your current dosage of Parnate?
What dosage of Parnate were you taking when you relapsed?
What was the top dosage of Parnate that you reached?
60-80 is what I consider to be the therapeutic range of dosages at which Parnate works best in severe or chronic cases.
Increasing the dosage of Parnate too quickly might actually trigger side effects that persist that do not appear during gradual titrations. A good rule of thumb for me is to allow at least 3 weeks to pass between dosage increases. It takes about a 7-10 days for neurotransmitters to reach their maximum levels within the synapse once the dosage is increased.
> I seem to have a problem with tolerance
What do you mean by "tolerance"?
> I do not have the opportunities that you have to try all those meds. You in the US are fortunate, but it is quite different in the uk.... for reasons i have already explained.
Yes. However, I don't know what you have to work with there. Can you find a website that lists all of the approved medications - formulary?
> I am not talking about the performance of just one drug
I'm sure not. Do you feel that you have exhausted all possible combinations at all possible dosages?
If you want, Babble-Mail me with a list your list of drugs. Include:
1. Each treatment you have tried. Include all monotherapies as well as combinations.
2. Dosages.
3. Your reactions. That includes feeling better, feeling worse, or feeling nothing. Side effects should also be listed as reactions.
4. Any other comments about your treatments.
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> What hope do I have?
I can't possibly know. What hope do you have? That's a real and important question that I think would be constructive to have an answer to.You should be able to find hope in uncertainty.
Are you certain that you will never get well, even though you have yet to explore other treatments?
There are a few new antidepressants in the pipeline. Zuranolone has been waiting for FDA approval, and it might come within a few months. Clinical trials by SAGE Pharmaceuticals have reported efficacy for Major Depressive Disorder (MDD) and Post-Partum Depression. SAGE is also looking for an indication for Bipolar Depression.
Dr. Baron Shopsin once asked me what would I do if God came down and told me that I would never get well. I fell mute with tears rolling down my cheeks. No sound. I was virtually paralyzed by the question. What Shopsin did to me was cruel. Well, it turned out that God never came down to tell me that. I am in remission. Of course, I am only one blessed person with a lot of luck.
------------------------------- Scott
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