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Dr. Bob is Robert Hsiung, MD,
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Posted by delna on November 15, 2009, at 12:15:11
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Maxime on November 15, 2009, at 12:04:45
> Hi
>
> I don't have any answers for you I am afraid. It's a shame that you have to take so much Klonopin because that is bad for depression and adding to your tiredness. Have you ever tried as SSRI for anxiety. If I remember correctly you can't anti-psychotics.I respond well to SSRI's for anxiety but not depression.
> Can you take a trip to come and see a specialist in the States or in London. It seems like your case is so complicated.
Am trying to find out about coming to the States but the cost may be too high . But I just contacted my pdoc in UK and told her I want to come back and be admitted. I'm British and am covered by private insurance. although it's not as good as the states, its an option.
> I just want you to know that you are in my prayers and I will be thinking of you.
Thank you so much. It really means alot
Love
D
Posted by Maxime on November 15, 2009, at 12:18:06
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Maxime on November 15, 2009, at 12:04:45
Have you ever tried Lithium or Depokate for the depression?
Posted by delna on November 15, 2009, at 12:42:28
In reply to Re: Dangerously close to the end of the road. Help, posted by Maxime on November 15, 2009, at 12:18:06
> Have you ever tried Lithium or Depokate for the depression?
I replied to this but my post was 'eaten' Hmmm...
Anyway..
Sadly Maxime I have tried both and neither have helped at all. :(
Posted by ricker on November 15, 2009, at 12:46:19
In reply to Re: Dangerously close to the end of the road. Help » Maxime, posted by delna on November 15, 2009, at 12:15:11
> I respond well to SSRI's for anxiety but not depression.
>Hi delna, sorry to hear you are not doing well. Have you considered zoloft / nortriptyline? The zoloft at 50mg should help the anxiety and nortrip at 25/50 mg may help the depression? The mix would work similar to that of effexor? You could probably lower the clonazepam once the zoloft kicked in. Just a thought.
Best of luck, Rick
Posted by SLS on November 15, 2009, at 13:22:00
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
You are taking a good dosage of Lamictal (lamotrigine) to combine with Wellbutrin (bupropion). My doctor uses it every now and then and seems to like it. Wellbutrin can sometimes make anxiety worse, but you would know rather quickly whether or not you react that way. It is unlikely to make you sleepy.
What tricyclic antidepressants are available to you? I believe Prothiadin (dothiepin; dosulepin) is. It might be worth a try as it also helps with anxiety along with depression.
- Scott
Posted by delna on November 15, 2009, at 15:10:37
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 15, 2009, at 13:22:00
> You are taking a good dosage of Lamictal (lamotrigine) to combine with Wellbutrin (bupropion). My doctor uses it every now and then and seems to like it. Wellbutrin can sometimes make anxiety worse, but you would know rather quickly whether or not you react that way. It is unlikely to make you sleepy.
I haven't taken the Wellbutrin for a while now. Not since I stopped the Parnate anyway. I have no idea where this insane anxiety has suddenly come from (although anxiety is one of problems). Maybe it's simply because I have not been properly medicated for months now and have recently even withdrawn my lexapro (for the Parnate). I've just been taking my mood stabilizer and drugs I use purely for stimulation. Wellbutrin being one of them.
A couple of people had mentioned (or maybe it was only Phidippus) that my dose of Lamictal (or infact Lamictal at all) could be contributing to my depression. Do you think a slightly lower dose would allow the effexor to be more 'activating' ie (give me a mild high)? Would that be a bad thing?
Obviously I would never attempt doing that myself and definitely not in this state of complete anxiety but as a treatment option in the long term. Effexor with lower dose Lamictal + the add ons to combat sleepiness and allow me to be fully functional?
>
> What tricyclic antidepressants are available to you? I believe Prothiadin (dothiepin; dosulepin) is. It might be worth a try as it also helps with anxiety along with depression.Scott, I am so intolerant to sedation. Problem is I don't seem to get used to it as my body doesn't adapt to it. I have tried both imipramine and recently nortryptyline and nearly died- I mean i couldn't move or get out of bed.
Is one more likely to develop tolerance to TCA sedation than other drugs like SSRIs and APs? All the TCA's are available here, incidentally and are actually used as first line treatment.
>
>Thanks Scott,
Your input is always so very welcome.
Thanks a million
D
Posted by delna on November 15, 2009, at 15:15:50
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by ricker on November 15, 2009, at 12:46:19
> > I respond well to SSRI's for anxiety but not depression.
> >
>
> Hi delna, sorry to hear you are not doing well.Thanks Rick for your supportive words.
>Have you considered zoloft / nortriptyline? The zoloft at 50mg should help the anxiety and nortrip at 25/50 mg may help the depression?
Its the nortrip I have a problem with. I tried it aftter the Parnate (as a cover) but couldn't tolerate even 25mg taken at night. I was so sedated by it. Sedation is a huge problem with me.
>The mix would work similar to that of effexor? You could probably lower the clonazepam once the zoloft kicked in. Just a thought.
>
> Best of luck, Rick
>
>
>Thanks Rick, for the good wishes and for sharing your ideas. Much appreciated.
love
D
Posted by ricker on November 15, 2009, at 15:54:13
In reply to Re: Dangerously close to the end of the road. Help » ricker, posted by delna on November 15, 2009, at 15:15:50
Hi delna, I understand what you're saying about dropping the lamictal down to 150. Kinda like letting a little fuel out of the airplane for an easier lift-off. Just don't let too much out or you could end up flying too high, or crashing!! Maybe a potential move though when you discuss with your p/doc?
If the anxiety keeps up maybe moving back on to lexapro would help. I know it sure crushed my anxiety!Take care, Rick
Posted by SLS on November 15, 2009, at 16:04:01
In reply to Re: Dangerously close to the end of the road. Help » SLS, posted by delna on November 15, 2009, at 15:10:37
I have never heard of Lamictal preventing an antidepressant from producing a therapeutic effect. Some drugs can produce depression or make depression worse, though. However, I have not seen any reports of that happening with Lamictal. If anything, Lamictal can trigger mania or produce anxiety and insomnia. I guess the caveat with using psychotropic drugs is to expect the unexpected, as there can be such interindividual variability in brain organization. That is almost like saying that anything is possible, but not quite.
Desipramine is a TCA that is usually activating and alerting, although it can be sedating during the first few days. It is selective for norepinephrine (NE). Protriptyline is touted as being the most activating of the TCAs. I find the drug too anticholinergic. It also made my depression significantly worse. Of course, it works perfectly fine for some people.
Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?
- Scott
Posted by delna on November 15, 2009, at 16:40:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 15, 2009, at 16:04:01
> I have never heard of Lamictal preventing an antidepressant from producing a therapeutic effect. Some drugs can produce depression or make depression worse, though. However, I have not seen any reports of that happening with Lamictal. If anything, Lamictal can trigger mania or produce anxiety and insomnia. I guess the caveat with using psychotropic drugs is to expect the unexpected, as there can be such interindividual variability in brain organization. That is almost like saying that anything is possible, but not quite.
Ever since I added the Lamictal I have become the most sedate person around- perhaps lacking a personality as some feel. Also I do not go high at all. Before, even the smallest dose of an ssri (or increase in dose) would make me hypomanic. I realize Lamictal is not blocking the therapeutic effect of effexor- just curbing the benefit of a mild high which I think I desperately need.
> Desipramine is a TCA that is usually activating and alerting, although it can be sedating during the first few days. It is selective for norepinephrine (NE). Protriptyline is touted as being the most activating of the TCAs. I find the drug too anticholinergic. It also made my depression significantly worse. Of course, it works perfectly fine for some people.
>
> Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?I was planning on adding that to the Effexor instead of the wellbutrin. I need the serotonin element for the OCD but of course I can get that from any SSRI like lexapro which is totally non-sedating (but does not impact my depression at all). Do you feel Edronax is a good AD on it's own or only as effective as wellbutrin (which for me only serves as an add-on).
I was under the impression that Edronax was not as powerful an AD as effexor or maybe that was simply my misconception. What do you feel?
Sorry to be such a bother.Thanks again
Love D
Posted by delna on November 15, 2009, at 16:44:41
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by ricker on November 15, 2009, at 15:54:13
> Hi delna, I understand what you're saying about dropping the lamictal down to 150. Kinda like letting a little fuel out of the airplane for an easier lift-off. Just don't let too much out or you could end up flying too high, or crashing!! Maybe a potential move though when you discuss with your p/doc?
> If the anxiety keeps up maybe moving back on to lexapro would help. I know it sure crushed my anxiety!
>
> Take care, RickYay, exactly what I hoped to hear.;) Now I will run that by my pdoc to see if it is wise.
Thanks Rick
Posted by Phillipa on November 15, 2009, at 18:31:02
In reply to Re: Dangerously close to the end of the road. Help » ricker, posted by delna on November 15, 2009, at 16:44:41
Delna doing any better now? How did you spend your day? Love Phillipa
Posted by delna on November 15, 2009, at 20:15:44
In reply to Re: Dangerously close to the end of the road. Help, posted by Phillipa on November 15, 2009, at 18:31:02
> Delna doing any better now? How did you spend your day? Love Phillipa
Hi Phillipa,
Thanks for asking. Am just about to leave to see the new pdoc. Didn't sleep much last night. was quite disturbed. On babble a bit- some really helpful suggestions. Was also writing to my genius (but evil) pdoc in NYC to request him to reply about the abilify (and geodon).
BTW your day is my night. I am 12 hrs ahead of you guys in the US.
Love
D
Posted by Phillipa on November 15, 2009, at 20:39:25
In reply to Re: Dangerously close to the end of the road. Help » Phillipa, posted by delna on November 15, 2009, at 20:15:44
12 hours India and isn't Australia one day ahead 26 hours? Morning Delna good luck and you can do it I know you can!!!!!!!! Love Phillipa
Posted by delna on November 16, 2009, at 0:20:16
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by Phillipa on November 15, 2009, at 20:39:25
> Morning Delna good luck and you can do it I know you can!!!!!!!! Love Phillipa
Hi,
The new pdoc was a total **freak**. Rude, arrogant and clueless.
He has made me feel more hopeless than ever. He basically told me there was no hope for me. He couldn't answer a single question of mine - simple ones like could I have an infection that may explain the fatigue.
He sent me out of the office so he could speak to my parents alone in which time he completely insulted my dad. Of course when I came back in, I bit his head off for sending me out.
Incidentally he didn't even know what abilify was (although it has been available here for years)
He also suggested ECT for me and when I told him that I had been told I was a poor candidate for ECT he said 'yes you are, but still have it anyway'.Now I feel worse. I just hope my pdoc in the US replies about Abilify.
Thanks everyone for the support.
Love D
Posted by emmanuel98 on November 16, 2009, at 2:33:27
In reply to Re: Dangerously close to the end of the road. Help » Phillipa, posted by delna on November 16, 2009, at 0:20:16
I did ECT last year and it didn't help me. But I know people whose lives have been turned around by ECT. Maybe it would help you. Why do you say you're a poor candidate for ECT?
> He also suggested ECT for me and when I told him that I had been told I was a poor candidate for ECT he said 'yes you are, but still have it anyway'.
>
> Now I feel worse. I just hope my pdoc in the US replies about Abilify.
>
> Thanks everyone for the support.
> Love D
>
Posted by delna on November 16, 2009, at 5:57:12
In reply to Re: Dangerously close to the end of the road. Help, posted by emmanuel98 on November 16, 2009, at 2:33:27
> I did ECT last year and it didn't help me. But I know people whose lives have been turned around by ECT. Maybe it would help you. Why do you say you're a poor candidate for ECT?
I have been told by 2 pdocs (including one ECT expert) that I am not a good candidate. I really don't know why. This guy today thought I was not a good candidate for anything...
Anyway, I am open to ECT but not here..... Investigating London or the US
TC
D
Posted by SLS on November 16, 2009, at 7:36:19
In reply to Re: Dangerously close to the end of the road. Help » SLS, posted by delna on November 15, 2009, at 16:40:41
> > Reboxetine (Edronax) is a selective NE reuptake inhibitor. I don't think it has any antihistaminergic properties that would otherwise sedate you. Have you ever tried it?
> I was planning on adding that to the Effexor instead of the wellbutrin. I need the serotonin element for the OCD but of course I can get that from any SSRI like lexapro which is totally non-sedating (but does not impact my depression at all).Clomipramine (Anafranil) might be helpful if it doesn't sedate you. It is good for both depression and OCD. I didn't find it at all sedating. I have seen it recommended to combine clomipramine with an SSRI for treatment resistant OCD. If OCD remains a problem, you can try adding Namenda (memantine). I can't speak from personal experience, but I have read good things about it. I did try Namenda as an augmenter for depression. I did feel a little better in the first week of treatment. Thereafter, it was not helpful to me.
> Do you feel Edronax is a good AD on it's own
No. I think it is a piece of crap.
However, some people do respond well to it. I would rather include things as possibilities than overlook potential treatment success by being too exclusive. I thought that Edronax might offer you NE reuptake inhibition without sedation. I reacted very badly to Edronax. It pushed me into an anxious suicidal state within days of starting it. Yet, desipramine, another selective NE reuptake inhibitor, has treated me well in the past. I guess selective is a relative term. We really don't understand all of the effects of the different antidepressants. In addition, the location of effect is just as important as the effect itself. It is possible that Edronax and desipramine accumulate in different areas of the brain, despite having the same effect on NE reuptake.
> Sorry to be such a bother.
Yes, I lost sleep last night agonizing over how much of a bother you are.
:-) <smile>
Silly.
- Scott
Posted by floatingbridge on November 16, 2009, at 21:02:10
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
Delna,
I've been following your thread. I can only add that Stanford is doing 'new' work in tms, which is supposed to be much less invasive that ect. They are also working on (as probably other institutions) on reducing memory loss that often accompanies ect.
I understand you have had a battery of test to rule out infections, etc. Have you had any sleep studies done?
I wish I had more to offer--my best thoughts to you, Delna,
fb
Posted by delna on November 17, 2009, at 8:39:25
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by SLS on November 16, 2009, at 7:36:19
Posted by delna on November 17, 2009, at 9:00:17
In reply to Re: Dangerously close to the end of the road. Help » delna, posted by floatingbridge on November 16, 2009, at 21:02:10
> Delna,
>
> I've been following your thread. I can only add that Stanford is doing 'new' work in tms, which is supposed to be much less invasive that ect. They are also working on (as probably other institutions) on reducing memory loss that often accompanies ect.I'm really interested in TMS but right now the figures that are being quoted for US hospitals are really high. Not sure I can afford it.
I am considering London (where I am from and am fully insured) but I don't know if they even use TMS there. Waiting to find out....
> I understand you have had a battery of test to rule out infections, etc.Today I sat and carefully examined at my past blood reports and have found that all my tests (over the years) have a raised WBC count. Just slightly raised but still- always raised. Whenever I have had an ESR done it has always been very high which indicates infection. I can't believe that this has been missed or else explained away as 'nothing' Anyway, I am having a blood test tomorrow and then seeing a new physician.
>Have you had any sleep studies done?
I was sent for sleep tests ages ago in London but I didn't fit any of the criteria for a sleep disorder so they never actually conducted the tests. I was thought to have idiopathic hypersomnia. I was on Paxil at the time. When I came off it my sleepiness improved manifold....so finally my pdoc realized that I was super-sensative to sedation.
Having said that, I am currently on no medication apart from lamictal and provigil and am *so* tired I am finding it hard to sit up. I had to sms my mother to come help me get my computer from the floor.
Maybe I need to revisit the sleep avenue too. But for this I will wait till I am back in London.Also I think my depression is getting worse by the second and that is why I am so tired. My pdoc has asked me to choose an AD myself. I cannot continue like this- its crazy.
>
> I wish I had more to offer--my best thoughts to you, Delna,
>
No, you helped alot and thank you for your good wishes.
Love
D
Posted by Katgirl on November 17, 2009, at 11:17:24
In reply to Dangerously close to the end of the road. Help, posted by delna on November 15, 2009, at 7:38:46
(I will preface this post by saying that I haven't read the entire thread because my concentration is just not that good today! So my apologies if I repeat something that has already been stated.)
I'm so sorry you aren't doing well Delna. I have been there and I really feel for you. The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!
Posted by delna on November 17, 2009, at 11:29:54
In reply to Re: Dangerously close to the end of the road. Help, posted by Katgirl on November 17, 2009, at 11:17:24
> (I will preface this post by saying that I haven't read the entire thread because my concentration is just not that good today! So my apologies if I repeat something that has already been stated.)
> I'm so sorry you aren't doing well Delna. I have been there and I really feel for you. The only thing that helped me at that time was rTMS. It didn't cure me, but it took away my suicidality immediately and gave me enough biochemical stability from which to build from. At the time I went, rTMS was not yet approved in the U.S. (it was in trials) so I had it done in Canada. Again, I am so sorry things are so tough for you right now. Take care!Thank you for your reply and good wishes.
Did you try ECT first or straight to rTMS?
TC
D
Posted by maxime on November 17, 2009, at 12:03:38
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 9:00:17
It is so sad how much you are suffering. I thought that were going to try an SNRI like Effexor or Cymbalta. Did you change your mind?
You are in my prayers.
Posted by floatingbridge on November 17, 2009, at 18:15:56
In reply to Re: Dangerously close to the end of the road. Help » floatingbridge, posted by delna on November 17, 2009, at 9:00:17
>
> Today I sat and carefully examined at my past blood reports and have found that all my tests (over the years) have a raised WBC count. Just slightly raised but still- always raised. Whenever I have had an ESR done it has always been very high which indicates infection. I can't believe that this has been missed or else explained away as 'nothing' Anyway, I am having a blood test tomorrow and then seeing a new physician.I, too have an elevated WBC that has always been explained away. I'm not sure what an ESR is, but can google that. My shrink wants to send me to an infectious disease specialist--I ma recording temps daily of 99.4-99.8, and on an odd day, up to 100. Most doctors dismiss this. I hope your visit goes well tomorrow, and you find a physician w/ knowledge plus curiosity.
>> Maybe I need to revisit the sleep avenue too. But for this I will wait till I am back in London.
I think this might be good to revisit.
>
> Also I think my depression is getting worse by the second and that is why I am so tired. My pdoc has asked me to choose an AD myself. I cannot continue like this- its crazy.Delna, I am sorry to hear that your are suffering like this AND have so much to deal with--different doctors, 'mysterious' symptoms. O.K. another question. Have you ever tried a plain stimulant--or does your Dx preclude this?
best wishes and thoughts,
hugs,
fb
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