![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by tensor on December 15, 2004, at 10:17:29
Hi,
recently been to my pdoc, she said my depression is difficult to treat. She mentioned ECT, which i'm very reluctant to try. But most important, she will discuss my situation with her colleagues tomorrow and then she will call me back and tell me how to proceed. Maybe i'll get lithium or lamictal, i don't know. Meanwhile she wanted me to lower the remeron dosage and stepping up zoloft to 200mg.
Do you have any thought about this? Ed, do you have any ideas about this?Kind regards,
Mattias
Posted by ed_uk on December 15, 2004, at 11:22:52
In reply to After the appointment, posted by tensor on December 15, 2004, at 10:17:29
Hi Mattias :-)
Regarding ECT..... I think it's too early to be considering ECT. There are so many other treatments that you haven't yet tried! If ECT produces an improvement, it generally only lasts about 4 weeks. To maintain the effect, you would need to have 'maintenance' ECT every few weeks.
Reducing the dose of Remeron will probably make you feel a lot better! Do you have side effects from the Remeron? eg. drowsiness, weight gain.
My experience of high doses of SSRIs (sertraline 200mg) is that they tend to be effective in 'numbing' unpleasant emotions eg. sensitivity to criticism, anxiety.
Lamictal could be a helpful drug to add to your current treatment. It can elevate mood and improve motivation. People often complain that it 'poops out' though...... Lithium is especially useful for people who are feeling suicidal.
Other treatments to consider... nortriptyline (Noritren), Aurorix and the old MAOIs. Did you ask whether the MAOIs are on the market in Finland?
Regards,
Eddie.
Posted by tensor on December 15, 2004, at 12:00:34
In reply to Re: After the appointment, posted by ed_uk on December 15, 2004, at 11:22:52
Hi Ed!!
> Regarding ECT..... I think it's too early to be considering ECT. There are so many other treatments that you haven't yet tried! If ECT produces an improvement, it generally only lasts about 4 weeks. To maintain the effect, you would need to have 'maintenance' ECT every few weeks.
excellent point!
> Reducing the dose of Remeron will probably make you feel a lot better! Do you have side effects from the Remeron? eg. drowsiness, weight gain.
just a little weight gain, nothing serious. Yes, i'm stepping down from this day.
> My experience of high doses of SSRIs (sertraline 200mg) is that they tend to be effective in 'numbing' unpleasant emotions eg. sensitivity to criticism, anxiety.
Thats good, but i have a feeling it won't lift my depression. But it's worth a try i guess as long as the side effects doesn't multiply.
> Lamictal could be a helpful drug to add to your current treatment. It can elevate mood and improve motivation. People often complain that it 'poops out' though...... Lithium is especially useful for people who are feeling suicidal.
Hmm.. poops out, that is what my drugs have done so far. How about the s/e of lithium?
> Other treatments to consider... nortriptyline (Noritren), Aurorix and the old MAOIs. Did you ask whether the MAOIs are on the market in Finland?
If i won't respond to sertraline 200mg + lithium/lamictal, then i guess it's hospitalization next. I forgot to ask about MAOI, but as far as i understand, they will only administer them at hospital to begin with. I asked about aurorix, but it's cleverest to try an 'add-on' to my current regime e.g. lithium first, because wash out of current meds is needed and then i'll have to start from scratch.
/Mattias
Posted by ed_uk on December 15, 2004, at 12:15:57
In reply to Re: After the appointment » ed_uk, posted by tensor on December 15, 2004, at 12:00:34
Hi Mat!
Yes, I agree that it's worth trying the higher dose of Zoloft and adding Lamictal. Some psychiatrists actually combine Aurorix with SSRIs but this is risky because it can cause the serotonin syndrome! ...hence the washout.
Do you feel that you need to be in hospital? ...or would the main reason for going into hospital be that they'd probably be more likely to let you try an MAOI?
Ed.
Posted by ed_uk on December 15, 2004, at 12:18:57
In reply to Re: After the appointment » ed_uk, posted by tensor on December 15, 2004, at 12:00:34
From the British National Formulary.... Btw, if there is a Finnish equivalent to the BNF it would be worth getting a copy because a formulary tells you all the drugs which are available in a particular country. Maybe you've got a Finnish National Formulary.
Lithium.
Side-effects: gastro-intestinal disturbances, fine tremor, renal impairment (particularly impaired urinary concentration and polyuria), polydipsia, leucocytosis; also weight gain and oedema (may respond to dose reduction); hyperparathyroidism and hypercalcaemia reported; signs of intoxication are blurred vision, increasing gastro-intestinal disturbances (anorexia, vomiting, diarrhoea), muscle weakness, increased CNS disturbances (mild drowsiness and sluggishness increasing to giddiness with ataxia, coarse tremor, lack of co-ordination, dysarthria), and require withdrawal of treatment; with severe overdosage (serum-lithium concentration above 2 mmol/litre) hyperreflexia and hyperextension of limbs, convulsions, toxic psychoses, syncope, renal failure, circulatory failure, coma, and occasionally, death; goitre, raised antidiuretic hormone concentration, hypothyroidism, hypokalaemia, ECG changes, exacerbation of psoriasis, and kidney changes may also occur.
Posted by tensor on December 15, 2004, at 12:49:52
In reply to Re: To Mr. Mattias, posted by ed_uk on December 15, 2004, at 12:15:57
Hi Mr. Ed :)
> Yes, I agree that it's worth trying the higher dose of Zoloft and adding Lamictal. Some psychiatrists actually combine Aurorix with SSRIs but this is risky because it can cause the serotonin syndrome! ...hence the washout.
Yes, tomorrow we will discuss how to proceed, maybe just remeron 15mg + zoloft 200mg for two weeks and then adding lamictal or adding lamictal instantly. On one hand, it's clever to go for just 200mg zoloft+rem for two weeks just to be sure if the problem was the dosage or not, but on the other hand two weeks is a long time and i can feel i want a new drug now, a change.
> Do you feel that you need to be in hospital? ...or would the main reason for going into hospital be that they'd probably be more likely to let you try an MAOI?
I believe they only want to administer MAOI under controlled conditions, monitoring vitals etc, hence the hospital. But, no i don't need a hospital. There are a lot of drug combos i want to try before MAOI and i don't want to stay a week or so in a hospital, i'd be bored to death.
/Mattias
Posted by ed_uk on December 15, 2004, at 12:59:58
In reply to Re: To Mr. Mattias » ed_uk, posted by tensor on December 15, 2004, at 12:49:52
Yes, trust me, hospital is boring! Been there, done that, got the T-shirt. Hope your appointment goes well :)
Ed.
Posted by tensor on December 15, 2004, at 13:07:31
In reply to Re: To Mr. Mattias, posted by ed_uk on December 15, 2004, at 12:59:58
Posted by banga on December 17, 2004, at 18:46:03
In reply to Re: To Mr. Mattias, posted by ed_uk on December 15, 2004, at 12:59:58
One thing also to keep in mind RE Lamictal and when to start. Due to the risk of rash, it is typically started at a very very low dose and augmented up slowwllyy. So if you wait to start it, you will be perhaps pushing out the benefits more than a month away....
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.