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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by JohnLA on March 1, 2012, at 22:08:26
in a few weeks my 2 year anniversary of my first ever depressive episode will arrive...
i'm currently on 30mg of remeron and 2mg to 3mg a day of klonopin.
i've tried the following;
lexapro
zoloft
cymbalta
effexor
wellbutrin
celexa
nuvigil
a baby dose of abilify for a few days only
and 12 sessions of unilateral ectall did not help. some kicked my *rs*. (wellbutrin for example.)
i also do talk therapy once a week
with the remeron and klonopin i sleep well and do not get too excited about anything. when my depression started i was extremely agitated, lost a ton of weight, and could not sleep. now, at least i sleep, am calm and am unfortunately getting fat for the first time in my life.
so, in some ways i am better. but overall i am spending most of my time in bed both day and night ruminating. also, part of those ruminations are suicidal thoughts. in 1 month it will be 2 years since i last worked. if i don't go back to teaching in sept they put me on early-retirement at a much lower pension. i really don't want that. i'm only 49.
i am waiting to see 2 doctor's about ketamine this month. 1 does the iv method and the other does it intra-nasal or sublingual.
can someone make a suggestion that might be similar to remeron/klonopin with a little more mood lifting/energy w/out causing anxiety? or, an add-on? maybe a mild old school tca, if it exists. i'm extremely sensitive to meds. the remeron and klonopin have been pretty easy to take. still, i don't dig the weight and lethargy that is settling in.
besides the apathy i have a pretty good case of anhedonia going on too.
i asked these same questions when i first came here 6 months ago. i apologize. i just could use some info when i go to see the psych on monday.
thanks for any help.
john
Posted by Raisinb on March 1, 2012, at 22:22:24
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
Just from your symptoms it sounds like a case for Zoloft or Paxil but it sounds like the SSRIs were not helpful. I have read mixed things about TCAs--some say they are more effective, some say they are the same as SSRIs but better tolerated. Amitryptaline might be a reasonable thing to try. What happened with the Wellbutrin? I am curious because my depression sounds a lot like yours, and Wellbutrin was the only drug that made me manic. It was great while it lasted.
Is your talk therapy turning up anything? I am a fan of deep, struggling, psychoanalytic therapy along with meds.
Posted by JohnLA on March 1, 2012, at 22:33:05
In reply to Re: any suggestions to ask my doc next week?, posted by Raisinb on March 1, 2012, at 22:22:24
thanks raisin for your reply.
the wellbutrin got me out of bed, but the anxiety and my almost purple red face was just too much.
talk therapy is ok. i know what my issues are. the problem is doing something about the issues i can and accepting/letting go of the ones i can't do anything about.
i wonder if they make a baby dose of wellbutrin? ;)
thanks again for your reply. appreciate it.
john
Posted by Raisinb on March 1, 2012, at 22:36:46
In reply to Re: any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:33:05
Yeah, thats pretty much how therapy goes. Good luck with your appointment. My dad, who was suicidally depressed back in the day when nobody diagnosed it, lived normally for the first time in his whole life when they gave him amitryptaline. Worth a shot.
Posted by Christ_empowered on March 1, 2012, at 23:39:44
In reply to Re: any suggestions to ask my doc next week?, posted by Raisinb on March 1, 2012, at 22:36:46
Maybe replace Klonopin with an equivalent dose of Ativan or (better yet, I think) xanax xr? I guess you could try normal xanax, but the xr seems so convenient, what with the once-daily dosing and all. Plus, xanax doesn't cause depression as much as other benzos. Xanax can have a mild antidepressant action all by itself.
Posted by papillon2 on March 2, 2012, at 5:03:20
In reply to Re: any suggestions to ask my doc next week?, posted by Christ_empowered on March 1, 2012, at 23:39:44
The next logical step would be to try a tricyclic anti-depressant.
I vote for Nortriptyline. It's a second generation tricyclic and the active metabolite of Amitriptyline, so has a lower incidence of side effects. (That's not to say the side effects don't suck, just that they could theoretically be worse).
You could also try augmenting with something other than Wellbutrin, such as Lithium or Lamictal.
Posted by SLS on March 2, 2012, at 5:45:17
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
Nortriptyline is a reasonable choice. However, having not responded to previous drug trials might hint at TRD. This condition might require polypharmacy. The suggestion to add Lamictal and lithium is a good one.
Remeron cannot be evaluated at 30 mg. A dosage range of 45 - 90 mg is more appropriate for depression.
Did you experience a partial response to Effexor? Did it help at all?
You original symptoms indicate an endogenous depression rather than an atypical depression. This subtype of depression is thought to respond well to tricyclics.
Possible polypharmacy treatment:Nortriptyline + Effexor + Lamictal (lithium)
- Scott
Posted by Lou Pilder on March 2, 2012, at 6:10:28
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
> in a few weeks my 2 year anniversary of my first ever depressive episode will arrive...
>
> i'm currently on 30mg of remeron and 2mg to 3mg a day of klonopin.
>
> i've tried the following;
>
> lexapro
> zoloft
> cymbalta
> effexor
> wellbutrin
> celexa
> nuvigil
> a baby dose of abilify for a few days only
> and 12 sessions of unilateral ect
>
> all did not help. some kicked my *rs*. (wellbutrin for example.)
>
> i also do talk therapy once a week
>
> with the remeron and klonopin i sleep well and do not get too excited about anything. when my depression started i was extremely agitated, lost a ton of weight, and could not sleep. now, at least i sleep, am calm and am unfortunately getting fat for the first time in my life.
>
> so, in some ways i am better. but overall i am spending most of my time in bed both day and night ruminating. also, part of those ruminations are suicidal thoughts. in 1 month it will be 2 years since i last worked. if i don't go back to teaching in sept they put me on early-retirement at a much lower pension. i really don't want that. i'm only 49.
>
> i am waiting to see 2 doctor's about ketamine this month. 1 does the iv method and the other does it intra-nasal or sublingual.
>
> can someone make a suggestion that might be similar to remeron/klonopin with a little more mood lifting/energy w/out causing anxiety? or, an add-on? maybe a mild old school tca, if it exists. i'm extremely sensitive to meds. the remeron and klonopin have been pretty easy to take. still, i don't dig the weight and lethargy that is settling in.
>
> besides the apathy i have a pretty good case of anhedonia going on too.
>
> i asked these same questions when i first came here 6 months ago. i apologize. i just could use some info when i go to see the psych on monday.
>
> thanks for any help.
>
> john
>
> john,
You wrote,[..could use some info...thanks for any help..].
Now people here could tell you to take this drug or that drug or a combination of drugs or other things that they think would be good for you. But would death be really good for you?
You see, the chemicals in psychotropic drugs do something to your nervous system and brain in particular. The chemicals used in the drugs are of some that were devised in the production of nerve agents to cause death. This goes back before 1933 and after 1945.
Now in my examination of psychotropic drugs, I find a core structure of chemicals that can cause blood disease as in leukemia and agranulocytosis and aplastic anemia and such that could cause death. It is benzene and other chhemicals combined to produce many of these drugs, for benzen can cause leukemia.
I wrote a little about the drug Saphris here concerning its chemical structure that has constituants in it that are in a riot control substance used in the 50's that forms a cloud and cause dibilitation and extreme eye irritation and can cause cancer. I did not finish that exposition but do plan to here.
But now there is to you the aspect to take {nortriptyline}. Do you know what this chemical and its matabolite can do to you? If you did know that, maybe with that information you could make a more informed decision as to even ask your doctor to prescribe it to you.
This drug has a potenntial to induce a mind-alterd stae in the taker of the drug to compel them to want to kill themselves, and other life-ruining conditions as well.
Here is a link to a site and I am requesting that you show it to your prescriber if you are persuaded here by anyone to have this drug put in your system. Notice the chances of induced suicide thinking with this drug in the following link.
Lou
http://www.ehealthme.com/ds/nortriptyline+hydrochloride/completed+suicide
>
>
Posted by polarbear206 on March 2, 2012, at 7:06:41
In reply to Re: any suggestions to ask my doc next week? » JohnLA, posted by SLS on March 2, 2012, at 5:45:17
> Nortriptyline is a reasonable choice. However, having not responded to previous drug trials might hint at TRD. This condition might require polypharmacy. The suggestion to add Lamictal and lithium is a good one.
>
> Remeron cannot be evaluated at 30 mg. A dosage range of 45 - 90 mg is more appropriate for depression.
>
> Did you experience a partial response to Effexor? Did it help at all?
John, I agree with Scott. You may need the benefit of a mood stabilzer to help your AD work properly for you. I can relate to some of your past experiences.I take effexor with lamictal.
>
> You original symptoms indicate an endogenous depression rather than an atypical depression. This subtype of depression is thought to respond well to tricyclics.
>
>
> Possible polypharmacy treatment:
> U> Nortriptyline + Effexor + Lamictal (lithium)
>
>
> - Scott
Posted by SLS on March 2, 2012, at 7:33:10
In reply to Lou's response-nhonhottrp » JohnLA, posted by Lou Pilder on March 2, 2012, at 6:10:28
> Now people here could tell you to take this drug or that drug or a combination of drugs or other things that they think would be good for you. But would death be really good for you?
I'm sorry Lou, but I feel compelled to report this post to Administration. I feel that your over-generalization and exaggerations regarding death from all types of psychiatric drugs warrants this action.
- Scott
Posted by europerep on March 2, 2012, at 8:17:05
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
Hello there...
I am surprised to see that you have not been on either tricyclics or MAOIs. To be honest, I think that if a doctor was willing to give you ketamine before you have ever tried TCAs and MAOIs, that would be a pretty good indicator that this doctor cares more about money than about you.
Also, don't forget that pretty much all the literature there is (or at least that I have seen) on ketamine in TRD describes patients who have been ill for time spans ranging between years and decades. I am 100% sure that they would have never been admitted to a ketamine study without having had TCA and MAOI trials. It is not unreasonable to consider it possible that the high success rates for ketamine in those studies are partly due to the fact that years of unsuccessful treatment have operated some type of "selection" whereby the patients eligible for ketamine present an at least somewhat homogenous type of depression which is more likely to respond to ketamine than the general population of depressed patients.
And let me tell you from my own experience: ketamine is no wonder drug. I too thought it might be the perfect solution for me, but I didn't get any benefits from it whatsoever.
I really don't mean to crush your hopes! Maybe a first ketamine trial to see whether it has positive effects on you is a good idea. Maybe it isn't. That's really for doctors to decide. In any case I would recommend that you keep an eye on other treatments as well, notably TCAs and MAOIs.
I wish you good luck!
ER
Posted by Phillipa on March 2, 2012, at 10:02:19
In reply to Re: any suggestions to ask my doc next week? » JohnLA, posted by europerep on March 2, 2012, at 8:17:05
I picked up the worries of things you can't change as think that could be a big factor. So I always wonder if meds can eliminate worries about things we can't change. I am doing the same. Phillipa
Posted by Lou Pilder on March 2, 2012, at 15:14:26
In reply to Lou's response-nhonhottrp » JohnLA, posted by Lou Pilder on March 2, 2012, at 6:10:28
> > in a few weeks my 2 year anniversary of my first ever depressive episode will arrive...
> >
> > i'm currently on 30mg of remeron and 2mg to 3mg a day of klonopin.
> >
> > i've tried the following;
> >
> > lexapro
> > zoloft
> > cymbalta
> > effexor
> > wellbutrin
> > celexa
> > nuvigil
> > a baby dose of abilify for a few days only
> > and 12 sessions of unilateral ect
> >
> > all did not help. some kicked my *rs*. (wellbutrin for example.)
> >
> > i also do talk therapy once a week
> >
> > with the remeron and klonopin i sleep well and do not get too excited about anything. when my depression started i was extremely agitated, lost a ton of weight, and could not sleep. now, at least i sleep, am calm and am unfortunately getting fat for the first time in my life.
> >
> > so, in some ways i am better. but overall i am spending most of my time in bed both day and night ruminating. also, part of those ruminations are suicidal thoughts. in 1 month it will be 2 years since i last worked. if i don't go back to teaching in sept they put me on early-retirement at a much lower pension. i really don't want that. i'm only 49.
> >
> > i am waiting to see 2 doctor's about ketamine this month. 1 does the iv method and the other does it intra-nasal or sublingual.
> >
> > can someone make a suggestion that might be similar to remeron/klonopin with a little more mood lifting/energy w/out causing anxiety? or, an add-on? maybe a mild old school tca, if it exists. i'm extremely sensitive to meds. the remeron and klonopin have been pretty easy to take. still, i don't dig the weight and lethargy that is settling in.
> >
> > besides the apathy i have a pretty good case of anhedonia going on too.
> >
> > i asked these same questions when i first came here 6 months ago. i apologize. i just could use some info when i go to see the psych on monday.
> >
> > thanks for any help.
> >
> > john
> >
> > john,
> You wrote,[..could use some info...thanks for any help..].
> Now people here could tell you to take this drug or that drug or a combination of drugs or other things that they think would be good for you. But would death be really good for you?
> You see, the chemicals in psychotropic drugs do something to your nervous system and brain in particular. The chemicals used in the drugs are of some that were devised in the production of nerve agents to cause death. This goes back before 1933 and after 1945.
> Now in my examination of psychotropic drugs, I find a core structure of chemicals that can cause blood disease as in leukemia and agranulocytosis and aplastic anemia and such that could cause death. It is benzene and other chhemicals combined to produce many of these drugs, for benzen can cause leukemia.
> I wrote a little about the drug Saphris here concerning its chemical structure that has constituants in it that are in a riot control substance used in the 50's that forms a cloud and cause dibilitation and extreme eye irritation and can cause cancer. I did not finish that exposition but do plan to here.
> But now there is to you the aspect to take {nortriptyline}. Do you know what this chemical and its matabolite can do to you? If you did know that, maybe with that information you could make a more informed decision as to even ask your doctor to prescribe it to you.
> This drug has a potenntial to induce a mind-alterd stae in the taker of the drug to compel them to want to kill themselves, and other life-ruining conditions as well.
> Here is a link to a site and I am requesting that you show it to your prescriber if you are persuaded here by anyone to have this drug put in your system. Notice the chances of induced suicide thinking with this drug in the following link.
> Lou
> http://www.ehealthme.com/ds/nortriptyline+hydrochloride/completed+suicide
> >
> >
> John and friends,
The taking of mind-altering drugs as in psychiatric drugs prescribed today brings up the aspect of if the person taking the drug(s) could have their life shortened, which could mean that death is a result of the drugs.
Here is an article that I think could go a long way to helping people here make a more informed decision as to take these type of drugs or not.
Lou
To see this article:
A. Bring up Google
B. Type in:
[Full Disclosire Needed About Psychiatric Drugs That Shorten Life]
from Psychology Today?
>
Posted by Hugh on March 3, 2012, at 10:31:51
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
Maybe you reacted poorly to Wellbutrin because it increases noreprinephrine levels. Scott mentioned a couple days ago that he's been taking prazosin (Minipress) and likes it. It's an alpha-blocker, so it blocks the noreprinephrine receptors in the brain. I've been thinking of trying prazosin, but my blood pressure is already on the low side. I would try stick to a dose too low to affect my blood pressure, or affect it much.
These sites are about prazosin. They're about using it to treat PTSD instead of depression, but they contain useful information.
http://www.epinions.com/review/Prazosin_1_Mg_200_Pill/content_416253578884?sb=1
http://www.drugs.com/comments/prazosin/for-post-traumatic-stress-disorder.html
Posted by bleauberry on March 4, 2012, at 13:34:54
In reply to any suggestions to ask my doc next week?, posted by JohnLA on March 1, 2012, at 22:08:26
Sorry for the anniversary. :-( I think we've all had enough of those.
FYI, klonpin generally can cause or worsen depression. So I think it has to be considered as a possible culprit in your battles.
Not knowing much about you, any ideas I have are based on what I believe are the best odds for success when someone has the history you have. In terms of meds, that to me means reuptake inhibitors of both serotonin and norepinephrine, separately, for broad spectrum and balanced neurotransmitter support. Read more about this in the writings of Dr Gillman at psychotropical.com. None of the meds singularly on their own will do that, except a few....clomipramine, SSRI + TCA such as nortriptyline+zoloft, MAOIs, savella, SSRI+stimulant. After my ECT failure, 12 bilaterals, the only two things I discovered that were actually quite helpful were savella or amisulpride or parnate, all in very tiny doses since I respond so sensitively.
For longer term more substantial gains though, putting other things on the suspect list and addressing them made more progress....because that's where all my psychiatric stuff is coming from in the first place.
Posted by JohnLA on March 4, 2012, at 20:53:16
In reply to Re: any suggestions to ask my doc next week?, posted by bleauberry on March 4, 2012, at 13:34:54
thanks everyone-
appreciate your generosity of spirit in trying to get me better.
lots to take in and think about. i do think reducing/eliminating or exchanging the klonopin will be a good start.
also, you gave me lots to ask about in regards to adding something to the remeron.
i'll keep you posted.
thanks again.
john
Posted by Avenarius on March 5, 2012, at 10:18:02
In reply to thanks!, posted by JohnLA on March 4, 2012, at 20:53:16
Remeron + Stimulant: Positive results
This is the end of the thread.
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