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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by pedr on May 24, 2024, at 7:46:26
👋 Hi folks,
I am happy to see some of the old hands are still here and that this server is (just about) still kicking :) - PeterMartin, SLS, Hugh, Roslynn, Lamdage22 - and sorry to those Ive not mentioned/forgotten (the ol ECT, depression and the mountains of anti-depressants dont help with recall I find).
This is my first post in many a year and Ill say up front, with my treatment-resistant {Depression,OCD,ADHD}, please dont be put out if I dont reply promptly. Writing anything is often very, very difficult.
Enough bluster already, rando guy! - to my point: I recently reached the 12 month mark of VNS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990624/) without responding, which meant that yet another treatment had failed me and my PDoc who was managing the VNS said Have you tried Auvelity? I hadnt, and now I have, and after 3-4 days, my World expanded and some light was shone into it. It was surreal.
However (theres always a however, isnt there?), I am now 14 days in and am experiencing some of the most intense exhaustion/somnolence/spotaneous sleeping Ive ever experienced - AND IVE BEEN ON NARDIL!!! /j
Basically, I know that a bunch of you are some of the smartest cookies on tinternets about drug cocktails, their SEs and the like and I thought Id see if anyone can spot any likely candidate interactions/? that might be behind this crushing exhaustion (I am squinting *incredibly hard* just to be able to see the text Im typing). So heres my regimen. Its a big one, inflated by pain management meds for spine surgery last year :
- 25 Lexapro,
- ad-hoc 100mg provigil,
- 15 Buspar
- ~60mg Oxycodone
- 2.5 Abilify
- 2mg Lorazepam
- 600 Lyrica
- ~100 Ritalin
- 100-150 Trazodone (usually I cannot sleep and this helps best of anything Ive tried)
- Auvelity
- Fetzima 40mg
- Baclofen (I thought this was the cause but Ive trialled skipping it and the somnolence is unchanged)
- 2400mg Ibuprofen (Surgeon prescribed)
- 20mg Omeprazole (for NERD)Oh, also, if anyone knows any good Auvelity forums where I could also ask about this bonkers exhaustion, I would be violently appreciative 🙏🏻
Pedr
Posted by SLS on May 25, 2024, at 3:37:07
In reply to Auvelity responded but now incredible exhaustion, posted by pedr on May 24, 2024, at 7:46:26
First quick comment: You cannot take dextromethorphan with an MAOI.
- Scott
Posted by SLS on May 25, 2024, at 21:29:35
In reply to Auvelity responded but now incredible exhaustion, posted by pedr on May 24, 2024, at 7:46:26
> 👋 Hi folks,
>
> I am happy to see some of the old hands are still here and that this server is (just about) still kicking :) - PeterMartin, SLS, Hugh, Roslynn, Lamdage22 - and sorry to those Ive not mentioned/forgotten (the ol ECT, depression and the mountains of anti-depressants dont help with recall I find).
>
> This is my first post in many a year and Ill say up front, with my treatment-resistant {Depression,OCD,ADHD}, please dont be put out if I dont reply promptly. Writing anything is often very, very difficult.
>
> Enough bluster already, rando guy! - to my point: I recently reached the 12 month mark of VNS (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990624/) without responding, which meant that yet another treatment had failed me and my PDoc who was managing the VNS said Have you tried Auvelity? I hadnt, and now I have, and after 3-4 days, my World expanded and some light was shone into it. It was surreal.FuckingBingo!
When I was a patient at the NIH, the clinical researchers were of the opinion that the type of improvement you experienced, should it not last but for a few days early in treatment, it was an indicator that a full response is likely to emerge later.
> However (theres always a however, isnt there?), I am now 14 days in and am experiencing some of the most intense exhaustion/somnolence/spotaneous sleeping Ive ever experienced - AND IVE BEEN ON NARDIL!!! /j
.
A few things to consider:
1. Not everyone reacts to Nardil with fatigue and tiredness. For me, it has always been stimulating.
2. Many side-effects appear at the beginning of treatment and either mitigate or disappear altogether as time passes. These are known as "startup side effects".
3. The same drug can have opposite effects on the same person, even if only one medication was taken in between trials. Simply said, the same drug is being administered to an altered, and therefore, a different brain.
4. Historically, people on Psycho-Babble picked up some critically counterproductive habits - the biggest one being not giving sufficient time to produce a clinical effect. They were switching between drugs, adding, subtracting, changing dosages, or using them intermittently.
> Basically, I know that a bunch of you are some of the smartest cookies on tinternets about drug cocktails, their SEs and the like and I thought Id see if anyone can spot any likely candidate interactions/? that might be behind this crushing exhaustion (I am squinting *incredibly hard* just to be able to see the text Im typing). So heres my regimen. Its a big one, inflated by pain management meds for spine surgery last year :> - 25 Lexapro,
> - ad-hoc 100mg provigil,
> - 15 Buspar
> - ~60mg Oxycodone
> - 2.5 Abilify
> - 2mg Lorazepam
> - 600 Lyrica
> - ~100 Ritalin
> - 100-150 Trazodone (usually I cannot sleep and this helps best of anything Ive tried)
> - Auvelity
> - Fetzima 40mg
> - Baclofen (I thought this was the cause but Ive trialled skipping it and the somnolence is unchanged)
> - 2400mg Ibuprofen (Surgeon prescribed)
> - 20mg Omeprazole (for NERD)That looks like a hell of a mess, but it could be the only way to treat your condition, which you should describe detail, including family history.
It might be very productive to make two lists:
1. Those treatments that produced an unequivocal improvement, even if only for a few days.
2. Those treatments that produced a significant increase in the severity of depression.
3. Those treatments that you were unable to tolerate because of side-effects. Were these startup side-effects?
4. Treatments for which you may not have fully explored higher dosages.
5. Treatments using "standard" antidepressants that you aborted prematurely - less than 6-8 weeks.
- TCA
- MAOI
- SSRI
- SNRI
- bupropion (Wellbutrin)
- nefazodone
- trazodone* More recently, non-standard antidepressant substances have been found that can produce an therapeutic response within hours to 2-3 days after the first dose. These include ketamine and esketamine (NMDA receptor antagonist), and psilocybin (5-HT2a agonism via its metabolite, psilocin). The FDA has sanctioned the study of psilocybin for depression. Results from clinical trials are encouraging.
Consider trying combinations of only those drugs that appear on list #1.Avoid those drugs that made you feel worse in the past.
Which drugs are you currently taking that you think might not be necessary?
- Scott
Posted by Hugh on May 26, 2024, at 7:29:23
In reply to Auvelity responded but now incredible exhaustion, posted by pedr on May 24, 2024, at 7:46:26
It's good to hear from you again after all this time. Welcome back.
Posted by pedr on June 1, 2024, at 14:38:18
In reply to Re: Auvelity responded but now incredible exhaustion, posted by SLS on May 25, 2024, at 21:29:35
Hi SLS,
its been so long that Ive been asked insightful questions about my regimen that my head is spinning lol. I also have crippling OCD about replying to lengthy messages (OF COURSE I DO!!!) so please excuse me if I take a little bit to compose a worthy reply.
It is good to hear from you again, whether you remember who I am/was or not SLS 🤜🏻
Pete
Posted by SLS on June 1, 2024, at 20:36:42
In reply to Re: Auvelity responded but now incredible exhaustion » SLS, posted by pedr on June 1, 2024, at 14:38:18
I remember you very well, Petters.
There is nothing you could possibly write that would be less than worthy. I look forward to conversing with you.
- Scott
Posted by SLS on June 1, 2024, at 21:01:47
In reply to Re: Auvelity responded but now incredible exhaustion » SLS, posted by pedr on June 1, 2024, at 14:38:18
Also...
I consider Hugh to be the most valuable resource on Psycho-Babble. This is especially true of his surveying the medical literature for the most recent neuroscience research and novel clinical treatments. He helped me to appreciate the value of psilocybin and other substances that increase neuroplasticity - even if only briefly. It's an exciting focus of research. His most recent posts regarding the use of targeted ultrasound treatments to open up specific sites along the blood-brain barrier is totally new to me.
I am grateful to Hugh anytime he pays Psycho-Babble a visit. He is a reliable and objective source of information. He is more objective than I am.
- Scott
Posted by Hugh on June 2, 2024, at 21:32:52
In reply to Re: Auvelity responded but now incredible exhaustion » pedr, posted by SLS on June 1, 2024, at 21:01:47
That means a lot to me, Scott. I admire your perseverance in acquiring knowledge, for decades, in order to make yourself better, and I admire the efforts you've gone to to help others.
> Also...
>
> I consider Hugh to be the most valuable resource on Psycho-Babble. This is especially true of his surveying the medical literature for the most recent neuroscience research and novel clinical treatments. He helped me to appreciate the value of psilocybin and other substances that increase neuroplasticity - even if only briefly. It's an exciting focus of research. His most recent posts regarding the use of targeted ultrasound treatments to open up specific sites along the blood-brain barrier is totally new to me.
>
> I am grateful to Hugh anytime he pays Psycho-Babble a visit. He is a reliable and objective source of information. He is more objective than I am.
>
>
> - Scott
>
This is the end of the thread.
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