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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 saturn on November 27, 2006, at 16:10:07
I feel kinda selfish with this post but I really trust and respect the quality and helpfullness of advice from babblers. So I'm just gonna lay it all out there and ask a some questions. Here are my problems in order of severity. I apologize for those who've heard my story a million times--please just ignore. I'll probably regret writing this later, but here it goes:
1. Dysthymia w/ bouts of MDD (double depression)
2. ADHD (inattentive--at least moderately severe)
3. insomnia (reasonably treated w/ phototherapy, strict sleep hygiene and lunesta).
4. SP
5. I'm just gonna call this anxiety NOS. Sometimes non-existent, sometimes may manifest as ocd/eating disorder.The sxs of all the rest wax and wane in severity and probably interrelate to some degree (ie ADHD causing anxiety leading to depression and insomnia. Or dysthmia worsening ADHD. etc). Anxiety comes and goes, but dysthymia is always present at least to some degree (by definition)--though sometimes I reach a normal to near-normal mood.
I absolutely can't tolerate stimulants. Also, had a horrible reaction to Zoloft (as in *severe* chest pain). I can't take a TCA. The conversion of selegeline into meth/amphetamine shuns me away from EMSAM and an MAOI would be last line. I think Wellbutrin would be too stimulating from a cardiovascular perspective. Didn't do well w/ Remeron though admittedly didn't give it a fair trial. Though I can't tolerate stimulants they virtually eliminate my ADHD and dysthymia. But they're out of the question--even with a beta blocker. I realize I may be unreasonably dismissive.
Light therapy and fish oil don't appreciably help depression/anxiety (light does help sleep pattern a little). Regular exercise mildly beneficial at best. I continue to stick with them, though.
Sudafed and coffee mildly alleviate depression and ADHD. If I have a stressful social situation such as an interview/speech I do alright with ativan and atenolol prn (on top of the sudafed and caffeine). Sudafed often poops out and is only moderately efficacious, but when it works it does help.
So here's what I'm thinking:
1. Provigil (for ADHD and major depression---I know its unproven and inferior to stimulants)
2. low dose klonopin--for SP, sleep and any Provigil induced anxiety.
3. atenolol if needed for provigil stimulation if any.Knocks out all problems w/ 2-3meds? I know this is all very theoretical and probably overly-idealistic, but I've gotta start somewhere.
I dunno. I'm brainstorming. I've been resistant to new meds for a while due to frightening experiences with Zoloft and stims (going to the hospital with tachycardia and chest pain--and I'm not one to exaggerate symptoms or somatasize anxiety).
Blueberry made a very insightful point recently that if a med isn't helping at all after 2 weeks, move on. I'm sure there's a place for T in my treatment, but I'm focusing here on meds.
I know any p-doc would say start with SSRI. Zoloft gave me horrible chest pain and akathisia. I would consider giving another SSRI a trial (with a start up benzo and beta blocker) if I truly thought it would be beneficial and not worsen my ADHD (or insomnia) and not poop-out. I know--I'm asking for the world, but please indulge me. I'm striving for reasonable mood, attention and functionality (aren't we all?)...not perfection and no side effects.
I think that perhaps my case may not even be that difficult, but I want first and foremost for A. my situation not to worsen from what it already is and B. to get "there" in the most efficient manner.
Perhaps my biggest obstacle is that I'm scared to death after having crushing chest pain from Zoloft. My doc says my heart is fine, but if I can't handle Zoloft I'm very scared of even swallowing a Provigil or Wellbutrin. I kinda also don't want to get on the med "merry-go-round", but am willing to cautiously move forward with a reasonable and systematic plan--not just med after med etc...
I've wondered if Neurontin might have any place in my tx (ie vs a benzo or something).
I know I've covered a lot and this post is a bit fragmented, but I would certainly appreciate any thoughts or feedback, and thank you for just taking the time to read. Peace...Saturn.
Posted by blueberry on November 27, 2006, at 17:00:59
In reply to My self-indulgent post (long), posted by saturn on November 27, 2006, at 16:10:07
The recipe you came up with for yourself is right along the same lines I was thinking as I was reading your post.
Your partial response to sudafed is a good clue that, without going into details, seems to me to support the idea of modafinil.
Another outside possibility is that all of this stuff is due to some kind of instability or overlapped cycling of some kind, in which you might want to put lithium and depakote on your watch list. Both of them stand as good a chance as anything at targeting all of your symptoms. The good thing with either one is that you'll definitely know in a short time if they agree with you or not. I could feel lithium in one day. I felt depakote benefits on depression and anxiety in about 24 hours after the first dose. Just the relief from dysthymia and anxiety might improve ADHD. I'm not saying go try these two things, just to study them and put them on your watch list.
I like your recipe. Any anxiety from modafinil should be short-lived so just focus on how to get through that. It has a mood lifting quality in many people, both anecdotally and in clinical trials.
Posted by saturn on November 27, 2006, at 19:36:26
In reply to Re: My self-indulgent post (long) ?saturn, posted by blueberry on November 27, 2006, at 17:00:59
Thanks blueberry. I really appreciate your input. It's been great to see you so interactive lately--seriously I've noticed how insightful and supportive your posts have been. I hope that's a reflection of your well being.
I hadn't realized Depakote had AD and anxiolytic properties. I will look into it some more, but am still thinking about the Provigil. I guess they could also be combined, but I need to take one step at a time and keep my mind open. I still have the lingering thought of an SSRI in my head, but I need to read up more on the Provigil and Depakote (specifically, how it compares to benzos). Thanks again. Take care. Peace...Saturn.
Posted by Phillipa on November 27, 2006, at 23:25:39
In reply to Re: My self-indulgent post (long) » blueberry, posted by saturn on November 27, 2006, at 19:36:26
Just a stab lamictal? Love Phillipa
Posted by linkadge on November 28, 2006, at 8:25:01
In reply to Re: My self-indulgent post (long) » blueberry » saturn, posted by Phillipa on November 27, 2006, at 23:25:39
I would personally not use depakote for dysthemia. Its a real downer, it gave me dysthemia. Lithium too just gave me more dysthemia.
I think I am like you. I'm not bipolar I'm just sensitive to all these powerful medication.
If you havn't already done so, I'd look at giving a quality SJW preparation a try.
Linkadge
Posted by blueberry on November 28, 2006, at 16:59:11
In reply to Re: My self-indulgent post (long), posted by linkadge on November 28, 2006, at 8:25:01
Linkadge made a great suggestion. For a good brand, look to Kira which is the LI 160 formula used in clinical trials. It is a prescription med in Germany, but is available over the counter to us at Rite-Aid. It stands a good chance of addressing ALL of your problems.
Start by cutting a pill in half. Cut that half in half to get quarters. Take one quarter in the morning and one in the afternoon to get started. You may feel either sleepy or a little wired. Either way, you'll adjust quickly and then can move up to larger doses as quickly as possible.
The half that you don't use that day, throw it away. The contents being exposed to air might, I really don't know, might ruin it a little bit. At about $11 a box, it's no big deal.Anyway, I thought linkadge's suggestion was great. I just thought I would follow up with some tips just in case you were to consider it.
Posted by saturn on November 28, 2006, at 17:20:46
In reply to Re: My self-indulgent post (long), posted by linkadge on November 28, 2006, at 8:25:01
> I would personally not use depakote for dysthemia. Its a real downer, it gave me dysthemia. Lithium too just gave me more dysthemia.
>
>
> I think I am like you. I'm not bipolar I'm just sensitive to all these powerful medication.
>
>
> If you havn't already done so, I'd look at giving a quality SJW preparation a try.
>
>
> Linkadge
>
>
>Thanks Link, I'll check it out.
Posted by saturn on November 28, 2006, at 17:22:40
In reply to Re: My self-indulgent post (long), posted by blueberry on November 28, 2006, at 16:59:11
> Linkadge made a great suggestion. For a good brand, look to Kira which is the LI 160 formula used in clinical trials. It is a prescription med in Germany, but is available over the counter to us at Rite-Aid. It stands a good chance of addressing ALL of your problems.
> Start by cutting a pill in half. Cut that half in half to get quarters. Take one quarter in the morning and one in the afternoon to get started. You may feel either sleepy or a little wired. Either way, you'll adjust quickly and then can move up to larger doses as quickly as possible.
> The half that you don't use that day, throw it away. The contents being exposed to air might, I really don't know, might ruin it a little bit. At about $11 a box, it's no big deal.
>
> Anyway, I thought linkadge's suggestion was great. I just thought I would follow up with some tips just in case you were to consider it.
Very much appreciated blueberry. I just may give it a shot. If so I'll let ya know how it goes. Thanks again. Peace...Saturn.
Posted by linkadge on November 28, 2006, at 18:13:40
In reply to Re: My self-indulgent post (long) » blueberry, posted by saturn on November 28, 2006, at 17:22:40
I mean, Bluberry is right. There is always the possability that one is bipolar, in which case antidepressants can be the wrong way to go.
But, I think that bipolar is overdone on account of antidepressants being hard for a lot of people to tollerate.
Linkadge
This is the end of the thread.
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