![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
But I'm already experiencing quickness to cry, am isolating somewhat, feeling a little less resilient. Yet, every time I go off of meds for a little while, I can see that the meds have dulled me, allowed me to stay in situations that have not been right for me or good for me. They've made me a touch indifferent.
I've also noticed that, at least on Prozac, I had more anxiety. It almost seemed to exacerbate some symptoms of OCD. And I sometimes had thoughts that were a touch on the irrational side. I don't seem to be experiencing those things without the Prozac.
I'm on Ativan and a bit of Trazodone. It's the antidepressants I'm afraid to go back on. The only SSRI or SNRI I have left to try is Luvox, which I will have a prescription for, on Tuesday, or Cymbalta, which I don't even want to bother trying.
I don't know...could I be weepy because my taper off Prozac lasted all of one week? Isn't it possible to survive without ADs? Can't I just take some 5-HTP and not bother will all this?
I hate my life on ADs. I just hate it. I'm not myself as much, I'm exhausted all the time, and I'm not making smart decisions. I love how being in DBT (Dialectical Behavioral Therapy) has helped me actually control some emotions, like panic attacks and rage--all drug free. If I go back on meds, what will I have to work on in DBT? When will I ever heal myself if I am always on meds?
And I think to myself--can't I do learn to deal with my depression the way I have with rage and anxiety? But I feel myself slipping, just some subtle signs, subtle things like wanting my spouse to deal with the carpenter, not feeling up to that, not feeling up to going to the gym...I try to fight against the tide of...apathy?...but it's not quite working...if I could just get to the gym and exericse an hour a day, how much better would I feel, and without ADs?
I know of almost nobody who gets off the AD merry-go-round. Why is that?
Posted by seldomseen on June 21, 2009, at 19:46:21
In reply to I don't want to go back on antidepressants, posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
How long have you been off prozac?
Seldom.
Posted by Amelia_in_StPaul on June 21, 2009, at 19:56:21
In reply to Re: I don't want to go back on antidepressants, posted by seldomseen on June 21, 2009, at 19:46:21
About 12 days, seldomseen.
Posted by Phillipa on June 21, 2009, at 22:00:49
In reply to Re: I don't want to go back on antidepressants » seldomseen, posted by Amelia_in_StPaul on June 21, 2009, at 19:56:21
Luvox low dose generic is good. Prozac hsngs around a long time. What does you doc say and therapist about ad free? Love Phillipa
Posted by morganpmiller on June 22, 2009, at 2:10:15
In reply to Re: I don't want to go back on antidepressants » Amelia_in_StPaul, posted by Phillipa on June 21, 2009, at 22:00:49
Maybe stay off medication for at least a few months and see how things go. It is normal for you to be emotional this early. Who knows, in time with all of the right moves, you may be ok. Do you take fish oil? that could help some.
Or, start prozac again now if it was working for you, and don't get off it until your life is really good and you are more ready to get off medication.
Prozac, unless it is giving you unbearable side effects, is not going to be bad for as long as you take good care of yourself otherwise.
I got off zoloft after 8 years, it was one of the biggest mistakes I ever made. If I had only known that antidepressants can boost your immune system(no wonder I never got sick) and zoloft was being investigated as a treatment for melanoma.
I just never should have done it. Antidepressants are not all bad.
Posted by InsideOut on June 22, 2009, at 5:57:37
In reply to I don't want to go back on antidepressants, posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
Amelia, you say that you do not want to even bother trying Cymbalta may I ask why not?
Posted by Alexanderfromdenmark on June 22, 2009, at 10:45:45
In reply to I don't want to go back on antidepressants, posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
> But I'm already experiencing quickness to cry, am isolating somewhat, feeling a little less resilient. Yet, every time I go off of meds for a little while, I can see that the meds have dulled me, allowed me to stay in situations that have not been right for me or good for me. They've made me a touch indifferent.
>
> I've also noticed that, at least on Prozac, I had more anxiety. It almost seemed to exacerbate some symptoms of OCD. And I sometimes had thoughts that were a touch on the irrational side. I don't seem to be experiencing those things without the Prozac.
>
> I'm on Ativan and a bit of Trazodone. It's the antidepressants I'm afraid to go back on. The only SSRI or SNRI I have left to try is Luvox, which I will have a prescription for, on Tuesday, or Cymbalta, which I don't even want to bother trying.
>
> I don't know...could I be weepy because my taper off Prozac lasted all of one week? Isn't it possible to survive without ADs? Can't I just take some 5-HTP and not bother will all this?
>
> I hate my life on ADs. I just hate it. I'm not myself as much, I'm exhausted all the time, and I'm not making smart decisions. I love how being in DBT (Dialectical Behavioral Therapy) has helped me actually control some emotions, like panic attacks and rage--all drug free. If I go back on meds, what will I have to work on in DBT? When will I ever heal myself if I am always on meds?
>
> And I think to myself--can't I do learn to deal with my depression the way I have with rage and anxiety? But I feel myself slipping, just some subtle signs, subtle things like wanting my spouse to deal with the carpenter, not feeling up to that, not feeling up to going to the gym...I try to fight against the tide of...apathy?...but it's not quite working...if I could just get to the gym and exericse an hour a day, how much better would I feel, and without ADs?
>
> I know of almost nobody who gets off the AD merry-go-round. Why is that?I'd advice you to go AD free for a month or a few months. If you want to go back on an AD why not try an AD that is not an SSRI? I've hear great things about Agomelantine, Stablon, Emsam, parnate and the lot. These won't numb you up and give you crappy sexual side effects. I you can get your hands on Agomelantine, i think you should try it if you go back on AD's
Posted by Amelia_in_StPaul on June 22, 2009, at 11:00:23
In reply to Re: I don't want to go back on antidepressants, posted by morganpmiller on June 22, 2009, at 2:10:15
I'm not sure why, but it does seem to be normal to experience this early for me.
Prozac has been bad. I ended up with such bad apathy I could barely move. And it has stopped working. I was suicidal while on it, depressed, etc. Adjunct therapy with Wellbutrin had already been tried, worked for awhile, then started giving me panic attacks. Adjunct therapy with abilify is out of the question since prozac inhibits the 2D6 enzyme that I have a mutation from, and abilify needs that 2d6 enzyme to be metabolized. As I said, this is the crux of the problem. IM (intermediate metabolizers) do okay on a drug at a lower dose than normal for awhile, but eventually the drug builds up in their system--the side effects are bad then.
I do know what you mean about going off a med and it being a big mistake. I have been down that road before, but I wasn't taking care of myself to compensate.
Are you saying you got cancer after going of Zoloft??
> Maybe stay off medication for at least a few months and see how things go. It is normal for you to be emotional this early. Who knows, in time with all of the right moves, you may be ok. Do you take fish oil? that could help some.
>
> Or, start prozac again now if it was working for you, and don't get off it until your life is really good and you are more ready to get off medication.
>
> Prozac, unless it is giving you unbearable side effects, is not going to be bad for as long as you take good care of yourself otherwise.
>
> I got off zoloft after 8 years, it was one of the biggest mistakes I ever made. If I had only known that antidepressants can boost your immune system(no wonder I never got sick) and zoloft was being investigated as a treatment for melanoma.
> I just never should have done it. Antidepressants are not all bad.
Posted by Amelia_in_StPaul on June 22, 2009, at 11:06:06
In reply to Re: I don't want to go back on antidepressants, posted by InsideOut on June 22, 2009, at 5:57:37
Because I just had an allergic reaction to pristiq, which matched a reaction I had to effexor years before that. I am staying far away from snris.
Posted by Amelia_in_StPaul on June 22, 2009, at 11:20:40
In reply to Re: I don't want to go back on antidepressants, posted by Alexanderfromdenmark on June 22, 2009, at 10:45:45
These are great ideas. Stablon isn't metabolized by 2d6 or p450 in general--that's great news for me. Why isn't it available in the US? Can someone PM me who takes Stablon? Also, are there any trials going on with Agomelatine?
> > But I'm already experiencing quickness to cry, am isolating somewhat, feeling a little less resilient. Yet, every time I go off of meds for a little while, I can see that the meds have dulled me, allowed me to stay in situations that have not been right for me or good for me. They've made me a touch indifferent.
> >
> > I've also noticed that, at least on Prozac, I had more anxiety. It almost seemed to exacerbate some symptoms of OCD. And I sometimes had thoughts that were a touch on the irrational side. I don't seem to be experiencing those things without the Prozac.
> >
> > I'm on Ativan and a bit of Trazodone. It's the antidepressants I'm afraid to go back on. The only SSRI or SNRI I have left to try is Luvox, which I will have a prescription for, on Tuesday, or Cymbalta, which I don't even want to bother trying.
> >
> > I don't know...could I be weepy because my taper off Prozac lasted all of one week? Isn't it possible to survive without ADs? Can't I just take some 5-HTP and not bother will all this?
> >
> > I hate my life on ADs. I just hate it. I'm not myself as much, I'm exhausted all the time, and I'm not making smart decisions. I love how being in DBT (Dialectical Behavioral Therapy) has helped me actually control some emotions, like panic attacks and rage--all drug free. If I go back on meds, what will I have to work on in DBT? When will I ever heal myself if I am always on meds?
> >
> > And I think to myself--can't I do learn to deal with my depression the way I have with rage and anxiety? But I feel myself slipping, just some subtle signs, subtle things like wanting my spouse to deal with the carpenter, not feeling up to that, not feeling up to going to the gym...I try to fight against the tide of...apathy?...but it's not quite working...if I could just get to the gym and exericse an hour a day, how much better would I feel, and without ADs?
> >
> > I know of almost nobody who gets off the AD merry-go-round. Why is that?
>
> I'd advice you to go AD free for a month or a few months. If you want to go back on an AD why not try an AD that is not an SSRI? I've hear great things about Agomelantine, Stablon, Emsam, parnate and the lot. These won't numb you up and give you crappy sexual side effects. I you can get your hands on Agomelantine, i think you should try it if you go back on AD's
Posted by terrysb on June 22, 2009, at 18:23:48
In reply to Re: I don't want to go back on antidepressants » Alexanderfromdenmark, posted by Amelia_in_StPaul on June 22, 2009, at 11:20:40
> Also, are there any trials going on with Agomelatine?
>
There are four active phase 3 clinical trials of Agomelatine ongoing in the US. Two are past their completion date, one is completing in June and the fourth is completing in September. None of these trials is recruiting.Novartis has marketing rights in the US to the drug.
It has already been approved in Europe and is currently available in Russia and the Ukraine.
The one issue to be aware of with this medication is that there is a risk of liver injury and that there are cases where serum transaminases have been driven to high levels (e.g., 3X). They also mention that this has been primarily at the 50mg dosage level.
Due to the above the prescribing information suggests transaminase tests at initiation and then two more tests at 6 and 12 weeks.
Posted by morganpmiller on June 23, 2009, at 0:19:46
In reply to Re: I don't want to go back on antidepressants » morganpmiller, posted by Amelia_in_StPaul on June 22, 2009, at 11:00:23
>Yeah sorry I didn't read your post carefully before. I would have known why you got off prozac.
I did not get melanoma after Zoloft. I did have atypical cells removed almost a year after and after I had a very stressful mixed episode. I was just saying that if I had known that Zoloft was being studied as a possible treatment for melanoma, that may have influenced me to stay on it. If I knew I had the potential for such a mixed episode, I would have stayed on it as well. At the time I thought I was doing my body a favor by getting off of it. Being that it may have boosted my immune system as well, I'm not so sure that was the case.
Read the post about Stablon, it might be a good option for you. Just sucks you have to take it 3 times a day. At least that is what most do. You can order it online. Someone who may be able tell you a good place to buy some is David Pierce. You can contact him at dave@hedweb.com. I think he has used Stablon before.
I'm not sure why, but it does seem to be normal to experience this early for me.
>
> Prozac has been bad. I ended up with such bad apathy I could barely move. And it has stopped working. I was suicidal while on it, depressed, etc. Adjunct therapy with Wellbutrin had already been tried, worked for awhile, then started giving me panic attacks. Adjunct therapy with abilify is out of the question since prozac inhibits the 2D6 enzyme that I have a mutation from, and abilify needs that 2d6 enzyme to be metabolized. As I said, this is the crux of the problem. IM (intermediate metabolizers) do okay on a drug at a lower dose than normal for awhile, but eventually the drug builds up in their system--the side effects are bad then.
>
> I do know what you mean about going off a med and it being a big mistake. I have been down that road before, but I wasn't taking care of myself to compensate.
>
> Are you saying you got cancer after going of Zoloft??
>
>
> > Maybe stay off medication for at least a few months and see how things go. It is normal for you to be emotional this early. Who knows, in time with all of the right moves, you may be ok. Do you take fish oil? that could help some.
> >
> > Or, start prozac again now if it was working for you, and don't get off it until your life is really good and you are more ready to get off medication.
> >
> > Prozac, unless it is giving you unbearable side effects, is not going to be bad for as long as you take good care of yourself otherwise.
> >
> > I got off zoloft after 8 years, it was one of the biggest mistakes I ever made. If I had only known that antidepressants can boost your immune system(no wonder I never got sick) and zoloft was being investigated as a treatment for melanoma.
> > I just never should have done it. Antidepressants are not all bad.
>
>
Posted by desolationrower on June 24, 2009, at 20:59:43
In reply to Re: I don't want to go back on antidepressants » Alexanderfromdenmark, posted by Amelia_in_StPaul on June 22, 2009, at 11:20:40
i found tianeptine to make things a little brighter.
have you tried a tca?
-d/r
Posted by Amelia_in_StPaul on June 24, 2009, at 21:32:23
In reply to Re: I don't want to go back on antidepressants, posted by desolationrower on June 24, 2009, at 20:59:43
but it's not available in the US???
> i found tianeptine to make things a little brighter.
>
> have you tried a tca?
>
> -d/r
Posted by 49er on June 25, 2009, at 19:43:57
In reply to I don't want to go back on antidepressants, posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
>> I know of almost nobody who gets off the AD merry-go-round. Why is that?
I almost am. After starting meds several years ago, I started tapering off of 4 meds in 2006. I am down to one and expect to be off this year or next.
The key is you have to taper slowly at 10% of the current dose every 3 to 6 weeks. Prozac is easy to do it that way since it comes in the liquid form.
I use a form of self CBT to manage my thoughts. I am not saying that everyone can be med free but it is definitely possible.
49er
Posted by bleauberry on June 26, 2009, at 18:52:20
In reply to I don't want to go back on antidepressants, posted by Amelia_in_StPaul on June 21, 2009, at 19:21:07
I have learned a great deal from these sources:
1. Observing pbabble patients for many years.
2. The writings of Dr gillman at psychotropical.com.
3. My personal med journeys.
4. My LLMD.
5. The mistakes of my psychiatrists.
6. Case studies on pubmed.Putting all that together, I can see two strategies that could be rewarding to you.
The first is a norepinephrine serotonin combination. That does not mean a SNRI. Their action on NE is so insignificant it seems ingenuis to call them SNRIs. What I mean is, something like Zoloft and Nortriptyline (or Desipramine). Or Amitriptyline. Zoloft could actually claim to be a Serotonin Dopamine reuptake inhibitor more than Effexor can claim to be a Serotonin Norepinephrine reuptake inhibitor.
The effect you are talking about is not uncommon with strategies that are prominentaly strong on serotonin. There needs to be balance with norepinephrine. And it needs to come from two different molecules, not one. That is so the balance can be manipulated. Two different molecules work in different ways than a single molecule. The onset of efficacy is faster as well.The second thing is, dose. My LLMD has taught me that the usual doses of meds are very often extremely too much. He starts patients on, for example, 2mg Lexapro. Some of them end up there as the final remission dose. One patient is healed at 1mg. Another at 3mg. Zoloft 5mg. Nortriptyline 20mg + Zoloft 12.5mg combination. Stuff like that. The drawback is that these supposedly subtherapeutic doses take longer to work, unless it is the serotonin-norepinephrine combination, in which rapid results can be expected.
The effects of how you felt on antidepressants are the results of two things:
1. Too much emphasis on serotonin.
2. Too high of a dose.My two cents.
All that said, I do not believe any manipulation of the brain will bring us back to where we were pre-illness. We can end up somewhere feeling completely better, in remission, but it is never exactly the same as where we came from. It can be very close, but little things will be different. Everything is in constant motion evolving, so there is no way to ever go back and recapture what was. We can however reach a non-apathetic, motivated, happy, interested, caring, remission, by exploring serotonin-norepinephrine combinations and using lower than common doses.
Posted by Amelia_in_StPaul on June 26, 2009, at 20:42:08
In reply to Re: I don't want to go back on antidepressants, posted by bleauberry on June 26, 2009, at 18:52:20
What is it about SNRIs that lead me to have such reactions if they do nothing for norepinephrine? There's something, but what? Because the reactions I have on those is so much different than the reactions I've had to SSRIs (even though neither SNRIs or SSRIs have been tolerable).
I agree that pdocs have started me on way, way too high of doses. And have overemphasized serotonin. I was, however, on small doses of fluoxetine for a few months (5 mg) and felt no relief. Do you think I wasn't on it for long enough?
Maybe you are right about Zoloft. But then again, I tried it and was taken off b/c of chest pains (4 days). I was not on a high dose, at all. Something really small, for Zoloft, but I can't remember what.
Is LLMD "lovably languid medical doctor"? Or "lama loving medical doctor"? I'm confused.
I have read your references to psychotropical.com. It would be nice to be able to consult with him. I believe I may have been suffering from low-level serotonin syndrome for many years.
I do pubmed searches a lot. That's how I know that the pdocs I've seen in the last 2 years are $hite. This recent idiot wants me to try Abilify ALONE for mmd. My genetics report shows polymorphisms that are, and this is a quote, likely to cause "significant weight gain." Sure, what I need for my self-esteem that is already in the toilet, not to mention my history of anorexia, is to be put on something that causes massive weight gain. Bravo, pdoc.
And do you want to know something really weird? This only started happening in the last two years, but every time *every time* I am taken off of Prozac, after 10-21 days, I start getting hypnagogic and hypnopompic hallucinations. This only happens when I go off the Prozac. It shouldn't happen, but maybe if my body is not breaking down the Prozac, and it is building up in my system--? It's possible.
> I have learned a great deal from these sources:
>
> 1. Observing pbabble patients for many years.
> 2. The writings of Dr gillman at psychotropical.com.
> 3. My personal med journeys.
> 4. My LLMD.
> 5. The mistakes of my psychiatrists.
> 6. Case studies on pubmed.
>
> Putting all that together, I can see two strategies that could be rewarding to you.
>
> The first is a norepinephrine serotonin combination. That does not mean a SNRI. Their action on NE is so insignificant it seems ingenuis to call them SNRIs. What I mean is, something like Zoloft and Nortriptyline (or Desipramine). Or Amitriptyline. Zoloft could actually claim to be a Serotonin Dopamine reuptake inhibitor more than Effexor can claim to be a Serotonin Norepinephrine reuptake inhibitor.
> The effect you are talking about is not uncommon with strategies that are prominentaly strong on serotonin. There needs to be balance with norepinephrine. And it needs to come from two different molecules, not one. That is so the balance can be manipulated. Two different molecules work in different ways than a single molecule. The onset of efficacy is faster as well.
>
> The second thing is, dose. My LLMD has taught me that the usual doses of meds are very often extremely too much. He starts patients on, for example, 2mg Lexapro. Some of them end up there as the final remission dose. One patient is healed at 1mg. Another at 3mg. Zoloft 5mg. Nortriptyline 20mg + Zoloft 12.5mg combination. Stuff like that. The drawback is that these supposedly subtherapeutic doses take longer to work, unless it is the serotonin-norepinephrine combination, in which rapid results can be expected.
>
> The effects of how you felt on antidepressants are the results of two things:
> 1. Too much emphasis on serotonin.
> 2. Too high of a dose.
>
> My two cents.
>
> All that said, I do not believe any manipulation of the brain will bring us back to where we were pre-illness. We can end up somewhere feeling completely better, in remission, but it is never exactly the same as where we came from. It can be very close, but little things will be different. Everything is in constant motion evolving, so there is no way to ever go back and recapture what was. We can however reach a non-apathetic, motivated, happy, interested, caring, remission, by exploring serotonin-norepinephrine combinations and using lower than common doses.
Posted by Amelia_in_StPaul on June 26, 2009, at 21:03:02
In reply to Re: I don't want to go back on antidepressants, posted by bleauberry on June 26, 2009, at 18:52:20
hmmm, just remembered, I have OCD too, and when the depression goes away, the OCD kicks in (and vice-versa: I'll have a spike of OCD, and then the depression will come when it's died down). OCD requires much higher doses of antidepressants (SSRIs usually, though anafranil is used with great success)...I can't handle the dosages needed to take care of my OCD. A paradox.
> I have learned a great deal from these sources:
>
> 1. Observing pbabble patients for many years.
> 2. The writings of Dr gillman at psychotropical.com.
> 3. My personal med journeys.
> 4. My LLMD.
> 5. The mistakes of my psychiatrists.
> 6. Case studies on pubmed.
>
> Putting all that together, I can see two strategies that could be rewarding to you.
>
> The first is a norepinephrine serotonin combination. That does not mean a SNRI. Their action on NE is so insignificant it seems ingenuis to call them SNRIs. What I mean is, something like Zoloft and Nortriptyline (or Desipramine). Or Amitriptyline. Zoloft could actually claim to be a Serotonin Dopamine reuptake inhibitor more than Effexor can claim to be a Serotonin Norepinephrine reuptake inhibitor.
> The effect you are talking about is not uncommon with strategies that are prominentaly strong on serotonin. There needs to be balance with norepinephrine. And it needs to come from two different molecules, not one. That is so the balance can be manipulated. Two different molecules work in different ways than a single molecule. The onset of efficacy is faster as well.
>
> The second thing is, dose. My LLMD has taught me that the usual doses of meds are very often extremely too much. He starts patients on, for example, 2mg Lexapro. Some of them end up there as the final remission dose. One patient is healed at 1mg. Another at 3mg. Zoloft 5mg. Nortriptyline 20mg + Zoloft 12.5mg combination. Stuff like that. The drawback is that these supposedly subtherapeutic doses take longer to work, unless it is the serotonin-norepinephrine combination, in which rapid results can be expected.
>
> The effects of how you felt on antidepressants are the results of two things:
> 1. Too much emphasis on serotonin.
> 2. Too high of a dose.
>
> My two cents.
>
> All that said, I do not believe any manipulation of the brain will bring us back to where we were pre-illness. We can end up somewhere feeling completely better, in remission, but it is never exactly the same as where we came from. It can be very close, but little things will be different. Everything is in constant motion evolving, so there is no way to ever go back and recapture what was. We can however reach a non-apathetic, motivated, happy, interested, caring, remission, by exploring serotonin-norepinephrine combinations and using lower than common doses.
Posted by manic666 on June 29, 2009, at 13:04:40
In reply to a wrench in the works » bleauberry, posted by Amelia_in_StPaul on June 26, 2009, at 21:03:02
my p doc asked me what i wanted from him .i said if you find me a ad that work,s i would gladly stay on it for life,lets face it if you have taken your fair share of ad,s you dont ever really feel good off them , every little illness you will think its because your off your meds,we are not like the normals as i call them ,soon than later you need them again so why go off them , i dont try even to get of my 4mg ativan , i would just go through sh*t an later be back on them,
This is the end of the thread.
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