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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by steel on July 14, 2007, at 19:17:32
Ok i havent posted a actual question i dont believe in a lil bit so here goes.
I see my doc on parnate in a few days.This is my plan,to eith add a second drug to a combo that does work which is parnate/caffiene/neurontion/
However it doesent last,it last about 4 hours,cant be repeated,benzos dont work to help and i basicaly have to use this short time to do as much as possable,and it works as far as i feel ok,not added anti depressant effect,motivation etc,just actualy a stablization feel.
Now my only options left i feel are to ask the doc to add something such as keppra etc to this to maybe enhance the benifit,and just help it.
I cant even imagine what to add,i wont take lamicatal so thats out,i dont want anti psychs,so keppra whic i here has a synegy with neurontion seems to be the most viable option.
If this doesent happend,then i will lower my parnate dose,and add small doses of liq deprenyl to parnate.I have a few other ques,but ill let this one ride first,any ideas on these two appraches?
Im so fed up with parnate.
Posted by Fivefires on July 15, 2007, at 18:14:07
In reply to May i be blunt, posted by steel on July 14, 2007, at 19:17:32
Why can't parnate/neurontin be repeated?
Sorry to add another ? in your ?s!
5f
Posted by steel on July 16, 2007, at 9:42:18
In reply to Re: May i be blunt, posted by Fivefires on July 15, 2007, at 18:14:07
> Why can't parnate/neurontin be repeated?
>
> Sorry to add another ? in your ?s!
>
> 5f
No its me im simply bad with words.What i mean there is its not as simple as the one combo dose taken,works to a degree,then i can simply say....
i waited,now i repeat the same combo,i get the benifit from the first time of the combo,and thats it,if i tried to simply lower the dose and repeat the initial med combo it wont work well,make sense?Kinds like a big coffee works great in your am,does what you like,however 4 hrs after no more benifit,then repeating that coffee,at the same size or lower wont be the same.Lol hope this analogy helps a little.
Seeing my doc today,im hoping to add keppra in.
Posted by Fivefires on July 16, 2007, at 22:57:00
In reply to Re: May i be blunt, posted by steel on July 16, 2007, at 9:42:18
I get ya'. May it have something to do w/ your lifestyle?
This is kinda' crazy, but, I take a narcotic 3x a day. I can feel when my a.m. dose wears off around 3p. Since I don't work, I'll take the dose and go lie down and wait, ... wait until I feel that same first initial relaxed feeling of the a.m. dose, then revel in it a bit, then get up for another 4-5hr till 6-7p dose, and repeat.
But, if I'm not home to take these drug/nap combos, pain will alert me, I'll take the dose, but I can't lie down to feel it work and revel in it, like I'm robbed of that 'first sweet relief'. But, of course, it is still working. The proof is reaching 5-6p w/o immobilizing pain.
My Pdoc allowed me to start Provigil 1 to 1/2 of the 200mg tablets once in a.m. because I'm on the narc and on Xanax, both 'downing'.
Initially I thought there was something dangerous about 2nd and 3rd doses parnate/neurontin.
Just one more thing - I metabolize some drugs very quickly. Where most people on extended release tabs get relief for 8hrs, I only get it for 4hrs. I need like a XXR or something!
I don't know if any of what I've added trips any triggers, but hope I've not wasted your time.
Tks for explaining.
goodeve, 5f
Posted by Oppycat on July 17, 2007, at 8:43:33
In reply to Re: May i be blunt, posted by steel on July 16, 2007, at 9:42:18
> > Why can't parnate/neurontin be repeated?
> >
> > Sorry to add another ? in your ?s!
> >
> > 5f
> No its me im simply bad with words.What i mean there is its not as simple as the one combo dose taken,works to a degree,then i can simply say....
> i waited,now i repeat the same combo,i get the benifit from the first time of the combo,and thats it,if i tried to simply lower the dose and repeat the initial med combo it wont work well,make sense?
>
> Kinds like a big coffee works great in your am,does what you like,however 4 hrs after no more benifit,then repeating that coffee,at the same size or lower wont be the same.Lol hope this analogy helps a little.
>
> Seeing my doc today,im hoping to add keppra in.I took Adderall XR with Parnate. It enough to get me through the work day. I also got a boost from my afternoon dose of Parnate, which most people don't seem to get, unfortunately. By the way, how much Parnate are you taking?
Posted by steel on July 18, 2007, at 16:29:02
In reply to Re: May i be blunt, posted by Fivefires on July 16, 2007, at 22:57:00
> I get ya'. May it have something to do w/ your lifestyle?
>
> This is kinda' crazy, but, I take a narcotic 3x a day. I can feel when my a.m. dose wears off around 3p. Since I don't work, I'll take the dose and go lie down and wait, ... wait until I feel that same first initial relaxed feeling of the a.m. dose, then revel in it a bit, then get up for another 4-5hr till 6-7p dose, and repeat.
>
> But, if I'm not home to take these drug/nap combos, pain will alert me, I'll take the dose, but I can't lie down to feel it work and revel in it, like I'm robbed of that 'first sweet relief'. But, of course, it is still working. The proof is reaching 5-6p w/o immobilizing pain.
>
> My Pdoc allowed me to start Provigil 1 to 1/2 of the 200mg tablets once in a.m. because I'm on the narc and on Xanax, both 'downing'.
>
> Initially I thought there was something dangerous about 2nd and 3rd doses parnate/neurontin.
>
> Just one more thing - I metabolize some drugs very quickly. Where most people on extended release tabs get relief for 8hrs, I only get it for 4hrs. I need like a XXR or something!
>
> I don't know if any of what I've added trips any triggers, but hope I've not wasted your time.
>
> Tks for explaining.
>
> goodeve, 5fNo i think i catch your drift,and its possable its my case as well.
Posted by steel on July 18, 2007, at 16:33:23
In reply to Re: May i be blunt » steel, posted by Oppycat on July 17, 2007, at 8:43:33
> > > Why can't parnate/neurontin be repeated?
> > >
> > > Sorry to add another ? in your ?s!
> > >
> > > 5f
> > No its me im simply bad with words.What i mean there is its not as simple as the one combo dose taken,works to a degree,then i can simply say....
> > i waited,now i repeat the same combo,i get the benifit from the first time of the combo,and thats it,if i tried to simply lower the dose and repeat the initial med combo it wont work well,make sense?
> >
> > Kinds like a big coffee works great in your am,does what you like,however 4 hrs after no more benifit,then repeating that coffee,at the same size or lower wont be the same.Lol hope this analogy helps a little.
> >
> > Seeing my doc today,im hoping to add keppra in.
>
> I took Adderall XR with Parnate. It enough to get me through the work day. I also got a boost from my afternoon dose of Parnate, which most people don't seem to get, unfortunately. By the way, how much Parnate are you taking?
>
>A older doc gave me ritalin with parnate,shes long gone,has moved.Ive racked my brain just going through local docs in the are who would eve simply keep me on my already established parnate dose,or parnate period.
I have one now,however i think hed cringe if i mentioned adding adderall lol.My dose is 40 mg 2 a day but at times ill attempt to break it up to possably 20 mg then then etc trying to get my brain to snap out of the possably appearent adaptaion it has accustomed itself to with me.
Keppra set me angry as a pit bull on day two,least im almost sure of it,scared to start it again.I just think i need additonal anti depressant effect,and is why all these bipolar meds,lamictal etc one after the other being added never help my situation.
I am thinking of adding liquid deprenyl in small doses soon to parnate?
Posted by dewdropinn on July 20, 2007, at 9:19:13
In reply to Re: May i be blunt, posted by steel on July 18, 2007, at 16:33:23
Deprenyl at any dose would probably be not such a good idea -- even at a tiny dose, it would increase the MAO-B inhibition that's already occuring with Parnate. While you wouldn't need fear serotonin syndrome, you would be at serious risk of triggering a hypertensive crisis. The internet drug vendors are doing a major disservice by presenting Deprenyl as a drug with boundless potential while glossing over the dangers -- selegiline is a great drug -- I can't say enough positive things about the patch when taken at the higher dosage levels -- and it's a very safe drug, so long as you are aware of the drug-drug interactions. As a final note -- I almost bought the farm by combining low dose selegiline with Zoloft years ago, which is why I'm urging caution on this one. As you note, the classic stimulants are definitely a viable and proven augmentation option with MAOIs -- I've taken dexedrine with selegiline in the past, and it posed no problems whatsoever.
I wonder -- why are you dead set against lamictal? So long as you follow the titration schedule, it's one of the safest and least toxic drugs available -- and unlike every other mood stabilizer on the market, it does not significantly impact liver or kidney function, it has minimal to no endocrine side effects (unlike all anti-psychotics and just about every other anti-convulsant), and virtually no cognitive side effects for the vast majority of people who take it. Epileptics take the drug at truly heroic doses, and it has proven safe and effective for long-term use even when taken at ludicrously high doses. Keppra is extremely non-toxic, but it has a major impact on mood -- like you, I literally became a rageaholic overnight, so for the sake of my social life, I bagged it within days of starting. So from a safety, tolerability, and efficacy standpoint, you probably won't find a better first-line option. I have taken 400mg daily for several years, and it's been a godsend -- it enhances mood, energy, clarity of thought, reduces anxiety. It's the foundation of my regiment. I currently take 400mg of Lamictal along with the 9mg EMSAM patch.
Best of luck,
Drew
> > > > Why can't parnate/neurontin be repeated?
> > > >
> > > > Sorry to add another ? in your ?s!
> > > >
> > > > 5f
> > > No its me im simply bad with words.What i mean there is its not as simple as the one combo dose taken,works to a degree,then i can simply say....
> > > i waited,now i repeat the same combo,i get the benifit from the first time of the combo,and thats it,if i tried to simply lower the dose and repeat the initial med combo it wont work well,make sense?
> > >
> > > Kinds like a big coffee works great in your am,does what you like,however 4 hrs after no more benifit,then repeating that coffee,at the same size or lower wont be the same.Lol hope this analogy helps a little.
> > >
> > > Seeing my doc today,im hoping to add keppra in.
> >
> > I took Adderall XR with Parnate. It enough to get me through the work day. I also got a boost from my afternoon dose of Parnate, which most people don't seem to get, unfortunately. By the way, how much Parnate are you taking?
> >
> >
>
> A older doc gave me ritalin with parnate,shes long gone,has moved.Ive racked my brain just going through local docs in the are who would eve simply keep me on my already established parnate dose,or parnate period.
>
> I have one now,however i think hed cringe if i mentioned adding adderall lol.My dose is 40 mg 2 a day but at times ill attempt to break it up to possably 20 mg then then etc trying to get my brain to snap out of the possably appearent adaptaion it has accustomed itself to with me.
>
> Keppra set me angry as a pit bull on day two,least im almost sure of it,scared to start it again.I just think i need additonal anti depressant effect,and is why all these bipolar meds,lamictal etc one after the other being added never help my situation.
>
> I am thinking of adding liquid deprenyl in small doses soon to parnate?
Posted by steel on July 22, 2007, at 23:44:44
In reply to Re: May i be blunt, posted by dewdropinn on July 20, 2007, at 9:19:13
Sorry i missed this,i think your reasoning to not adding deprenyl makes a lot of sense,i agree its portrayed by sellers too easly.
But in that respect,lo what isint right?Luckly we have places like these to hear the REAL DEAL sometimes.
Im not dead set aganist Lamictal because of the drug itself,i have seen it used a lot with success,I am dead set aganist it because i have given it too many trials,and appts costing what they do,the time frame,the urgency of my need for help and so on,i simply dont want to re try drugs which i have had several attempts at already.
Lamictal is just not for me,same as neurontion does nothing for so many but helps me a lot.
FYI i did get what i asked for,KEPPRA,and although i cant say for sure as it would be unfair,it does seem the possability that its high profile of mental side effects deems true,as i experianced them all it seems on day two, i had anger i never felt before.I have since stopped,and im back to where i begain,should i give the drug a fair chance?or go with my gut and not let myself fall victim to that rage again,ah drugs these are the times that make them so fun huh (sorry frustrated sarcasim there)
Thank you again for the response.
Posted by dewdropinn on July 23, 2007, at 12:06:12
In reply to Re: May i be blunt, posted by steel on July 22, 2007, at 23:44:44
I completely agree with you concerning the accessibily of drugs overseas -- if it weren't for the fact that I purchased liquid deprenyl on my own and enjoyed some success with the drug, there's absolutely no way that I would ever have been given the opportunity to take EMSAM. I think the marketing is somewhat sketchy, but for people like us -- people who have tried and failed just about every FDA approved treatment -- it's important to have options and alternative sources of information.
Too bad about your response to lamictal -- just goes to show, there isn't a one-size-fits all treatment. It's also unfortunate that most of the available mood stabilizer option have gnarly side effects -- lithium and depakote were pretty vicious; I couldn't function on Seroquel and Geodon; Abilify had all the side effects of a classic stimulant without any of the benefits; the list goes on and on. Personally, I think the best of the bunch is Tegretol -- the new time-release formulations eliminate most of the annoying side effects, the drug has all of the benefits of depakote w/o the brutal side effects, and it definitely helps with insomnia -- sadly, it can't be taken with MAOIs, so it's probably not an option in your case.
As far as the remaining options go -- I have nothing but positive things to say about EMSAM -- the 6mg dose wasn't effective, but the 9mg patch was a whole different story -- improvements across the board w/o any side effects. I find that it's important to remove the patch at night so as to avoid insomnia, and you've gotta watch out for drug-drug interactions, but otherwise it's incredibly user friendly and effective. So that would be a definite option. EMSAM and klonopin worked nicely -- my insomnia resolved after going up to 9mg, so I was able to ditch klonopin, but if sleep and anxiety are a problem, this could be an effective combo; EMSAM and low dose seroquel appear to be effective for some, but I simply couldn't deal with the sedation and cognitive side effects -- so it was bad for me, but apparently good for others. So these may be options for you.
There's one other super unorthodox, but super effective combo you may want to explore. After on pharmacological catastrophe after the next, I managed to hook up with a doctor who was more research oriented. He came up with a cocktail that included low dose Lexapro (10mg) and low dose selegiline (5mg) -- apparently, there have been studies involving the combo, and it is occasionally prescribed for Parkinsons patients suffering from depression. Theoretically, this should be a very dangerous combination, but I guess so long as the selegiline remains well below the threshhold for inducing MAO-A inhibition, you can avoid triggering a hypertensive reaction or serotonin syndrome(it's MAO-B selective until you get to around 10mg -- so it only impacts dopamine and norepinephrine.) Even though 10mg is supposed to be MAO-B selective, it's poses risks -- one time I inadvertently took 10mg, and came very close to calling 911. The other thing to remeber is that you can only take low dose selegiline with Celexa and Lexapro -- all other SSRIs have some impact on dopamine or norepinephrine, so they aren't an option. In any event, Lexapro/Celexa and selegiline is a combo well worth exploring.
Last but not least -- I'm sure that you've seen a number of posts about the European anti-psychotic Amisulpride. If taken at a low dose, it agonizes select dopamine receptors (actually it's a post-synaptic dopamine blocker, which channels more of the neurotransmitter to the presynaptic receptors -- at high doses, it blocks both the post and pre-synaptic dopamine receptors and becomes a classic anti-psychotic with all the classic anti-psychotic side effects.) Amisulpride was like a depression cure for me -- within an hour of taking 25mg, the anxiety and depression disappeared -- simply an amazing drug that deserves more attention and research. Unfortunately, it also raises prolactin levels -- which rendered me totally impotent -- which is why I stopped taking it on a regular basis. This side effect doesn't occur with many who take the drug at low doses -- so you may get lucky. It's a great drug to have in your back pocket -- now that I'm on an effective combo (400mg Lamictal & 9mg EMSAM), I can tuck my stash of Amisulpride back in the medicine chest -- but before then, I would occasionally take it when I needed to be "at my best" (e.g. client meetings, projects with imminent deadlines, etc.) You've already ventured into the world of foreign pharmaceuticals, so you should be able to track down amisulpride fairly easily. My source stoppped shipping to the US years ago, and I've been out of the foreign drug loop for a while -- so I can't provide any recommendations, but it's not a difficult drug to obtain.
Hopefully this helps -- I can't tell you how much I empathize with your struggle. I took over 20 medications and every imaginable combination over the course of a decade -- some combos proved effective, but presented side effects that forced me to stop -- others just produced side effects. Ultimately, I decided that I would never achieve total remission -- I started evaluating medications based on net improvement (benefits minus side effects = net improvement), and if I acheived some nominal degree of improvement, I was thankful, where before, I would have been frustrated because, in spite of the medication, I was still living a compromised life. So, self-acceptance, adopting realistic expectations, and accepting the realities of treatment resistant depression were all a big part of my recovery. Ironically enough, about a year after I adopted this attitude, I found a combination that produced near complete remission. So, there are many available options, and so long as you've got options, you've got cause for hope.
Drew
> Sorry i missed this,i think your reasoning to not adding deprenyl makes a lot of sense,i agree its portrayed by sellers too easly.
>
> But in that respect,lo what isint right?Luckly we have places like these to hear the REAL DEAL sometimes.
>
> Im not dead set aganist Lamictal because of the drug itself,i have seen it used a lot with success,I am dead set aganist it because i have given it too many trials,and appts costing what they do,the time frame,the urgency of my need for help and so on,i simply dont want to re try drugs which i have had several attempts at already.
>
> Lamictal is just not for me,same as neurontion does nothing for so many but helps me a lot.
>
>
> FYI i did get what i asked for,KEPPRA,and although i cant say for sure as it would be unfair,it does seem the possability that its high profile of mental side effects deems true,as i experianced them all it seems on day two, i had anger i never felt before.
>
> I have since stopped,and im back to where i begain,should i give the drug a fair chance?or go with my gut and not let myself fall victim to that rage again,ah drugs these are the times that make them so fun huh (sorry frustrated sarcasim there)
>
> Thank you again for the response.
Posted by shasling on July 24, 2007, at 6:11:34
In reply to Re: May i be blunt, posted by dewdropinn on July 23, 2007, at 12:06:12
Drew,
Just curious, have you ever tried Stablon, and if so, what did you make of it?
Thanks,
Suzie
Posted by dewdropinn on July 24, 2007, at 13:14:22
In reply to Re: May i be blunt » dewdropinn, posted by shasling on July 24, 2007, at 6:11:34
Believe it or not I have! In my experience, Stablon is a pretty weak antidepressant -- almost along the lines of Buspar if you've ever gone down that road -- somewhat helpful for anxiety, not so much for depression. The manufacturer has studies that suggest that it's comparable to SSRIs, but my understanding is that European psychiatrists opt for other options -- not because of safety issues, but because of efficacy.
Servier developed Stablon when Amineptine got pulled from the world market because of concerns over the potential for abuse -- Stablon is closely related to Amineptine, but it has an affinity for serotonin rather than dopamine -- so there's no potential for abuse, but there's also none of the magic that made Amineptine so popular. Amineptine was one of the legendary anti-depressants of all-time, and arguably one of the most effective -- Stablon was marketed as a drug that would recapture Amineptine's glory, but seems to have fallen short of the mark. I'm sure that there are others who would disagree -- and every so often I notice a flurry of Stablon posts on this site -- so people are certainly taking it, and I'm sure that some people benefit from it. If nothing else, it's very safe -- it certainly won't hurt you -- aside there's no harm in trying, aside from the out of pocket expense.
> Drew,
>
> Just curious, have you ever tried Stablon, and if so, what did you make of it?
>
> Thanks,
>
> Suzie
Posted by Fivefires on August 1, 2007, at 13:05:14
In reply to Re: May i be blunt, posted by dewdropinn on July 24, 2007, at 13:14:22
This is a good thread. I have a few ? when someone has time to respond.
Is Amineptine off the market?
My anxiety is larger than my depression, so I've been wondering about Stablon.
Are or were either available in U.S.?
thinkin'boutmovin, 5f
This is the end of the thread.
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