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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Brainbeard on July 18, 2012, at 4:18:30
Just letting y'all know that I drastically changed my cocktail and am now doing better than well on 250mg of Zoloft (sertraline) with 1800mg of gabapentin (aka Neurontin) in the morning and if necessary an extra 600mg later in the day. I'm still taking 75mg of clomipramine, but I have to say that high dose clomipramine (225mg boosted by 50mg of Luvox (fluvoxamine)) never made me as happy as I am now. It's probably temporary hypomania, but I'm gonna like it for as long as it lasts.
Synchronically, I have discovered that I LOVE Buddy Holly.
Posted by SLS on July 18, 2012, at 4:47:48
In reply to Brainbeard in psychopharmacotherapeutical heaven, posted by Brainbeard on July 18, 2012, at 4:18:30
> Synchronically, I have discovered that I LOVE Buddy Holly.
I believe that this is a diagnostic criteria to be added to the new DSM V. Scoring high in the Buddy Holly affinity dimension indicates remission.
Good luck.
- Scott
Posted by Brainbeard on July 18, 2012, at 4:52:42
In reply to Re: Brainbeard in psychopharmacotherapeutical heaven » Brainbeard, posted by SLS on July 18, 2012, at 4:47:48
Posted by Phillipa on July 18, 2012, at 10:00:06
In reply to Re: Brainbeard in psychopharmacotherapeutical heaven » Brainbeard, posted by SLS on July 18, 2012, at 4:47:48
What about the hypomania? I thought this was something that wasn't good? I understand that you feel good but is it something you are aiming for or true remission? Phillipa
Posted by Brainbeard on July 18, 2012, at 16:17:46
In reply to Re: Brainbeard in psychopharmacotherapeutical heaven, posted by Phillipa on July 18, 2012, at 10:00:06
> What about the hypomania? I thought this was something that wasn't good? I understand that you feel good but is it something you are aiming for or true remission? Phillipa
Hi Philippa. I don't believe in true remission. Yes, I am aiming for hypomania. It is my belief that the SSRI's induce a long-lasting hypomanic state that offers therapeutical benefits as well as serious drawbacks. I had some great years on Paxil where in retrospect, I definitely was hypomanic.
Notice that the SSRI's lead to full-blown mania in the bipolar.
Maybe true remission exists, and the path that leads to it runs through the doorway of suffering. The meds offer relief on the side of unproductive suffering. For productive suffering, I may not be ready yet. Or I'm simply fed up with suffering. Like Sparklehorse sang: 'All I want is to be a happy man'.
Posted by phidippus on July 26, 2012, at 21:09:25
In reply to Brainbeard in psychopharmacotherapeutical heaven, posted by Brainbeard on July 18, 2012, at 4:18:30
250 mg of Zoloft! Jeezus, you're heading for seratonin syndrome. Why even bother with the Clomipramine?
Eric
Posted by Brainbeard on July 27, 2012, at 13:31:32
In reply to Re: Brainbeard in psychopharmacotherapeutical heaven » Brainbeard, posted by phidippus on July 26, 2012, at 21:09:25
> 250 mg of Zoloft! Jeezus, you're heading for seratonin syndrome. Why even bother with the Clomipramine?
>Hi Eric, always good to hear from you;
Serotonin syndrome is a myth, mostly. I'm not saying that it doesn't exist; but it's very rare to begin with, and apart from that it can be caused by ANY SRI on its lonely self, even a weak one like Effexor (venlafaxine), and even on a moderate dose. I don't believe that with the heights of SRI I had already reached with clomipramine + fluvoxamine, and longer ago on Paxil (paroxetine), I will be surprised by serotonin syndrome anymore.
Serotonin syndrome is feared much too much in light of its rarity; also, it doesn't make sense that it is particularly feared when combinations of SRI's are used, since combining SRI's doesn't seem to be what causes it in the first place.
Why even bother with the clomipramine? Well, I'm trying to taper off of it (I'm on only 37.5mg now), but that's because of the dry mouth it gives me plus the anticholinergic dumbing; clomipramine is a superb drug otherwise, and it has a strong advantage over SSRI's, since it doesn't make one listless, but rather keeps adrenaline pumping because of its strong NRI properies. I have yet to see wether Zoloft on its own leaves me listless or not.
How are you, by the way?
Posted by phidippus on July 28, 2012, at 14:17:55
In reply to The Serotonin Syndrome Myth And Not Being Listless » phidippus, posted by Brainbeard on July 27, 2012, at 13:31:32
>Serotonin syndrome is a myth, mostly. I'm not >saying that it doesn't exist; but it's very rare >to begin with
Easy for you to say...I've already suffered seratonin syndrome twice this year-it is not a pleasant thing to go through, all shakes and sweats, increased anxiety, visual disturbances, fever, hallucinations. The culprits: 60 mg Viibryd combined with 1200 mg lithium and 80 mg Latuda. Once I stopped the Latuda and lowered my Viibryd, my symptoms started to reside.
Its rare because most people don't push their meds like you or I do!
I found Viibryd to be more effective than Clomipramine. And Clomipramine made me anorgasmic and cognitively bleh.
Why don't you augment with an antipsychotic? Lower those dopamine levels in your nucleus acumbens (it is found people with OCD have higher levels of ddopamine in the nucleus accumbens-in deep brain stimulation an electrode is attached to the niucleus accumbens to lower symptoms)
By the way, I'm doing great. my OCD has taken a vacation and I'mm going back to school for psychology, actually neuroscience to be exact. What are you up to?
Eric
Posted by Brainbeard on July 28, 2012, at 17:58:41
In reply to Re: The Serotonin Syndrome Myth And Not Being Listless » Brainbeard, posted by phidippus on July 28, 2012, at 14:17:55
>
> Easy for you to say...I've already suffered seratonin syndrome twice this year-it is not a pleasant thing to go through, all shakes and sweats, increased anxiety, visual disturbances, fever, hallucinations.Oh boy... I'm afraid I've been overgeneralizing. Maybe my shrink, who IS afraid I'll get SS, is right after all... But I don't get it, your situation would disprove the hypothesis that SS is caused by 5HT2 over-stimulation... Since Latuda antagonizes 5HT2A-receptors. WTF??
>
> Its rare because most people don't push their meds like you or I do!We are brave.
>
> I found Viibryd to be more effective than Clomipramine. And Clomipramine made me anorgasmic and cognitively bleh.Unfortunately, we don't have Viibryd here in Holland, neither do we have Latuda. We're always 40 years behind the United States...
>
> Why don't you augment with an antipsychotic? Lower those dopamine levels in your nucleus acumbens (it is found people with OCD have higher levels of ddopamine in the nucleus accumbens-in deep brain stimulation an electrode is attached to the niucleus accumbens to lower symptoms)I gotta read into deep brain stimulation. My psychiatrist is suggesting I should volunteer for an implant with a professor in Utrecht who is pioneering in this area. So it is in fact anti-dopaminergic? But only in the nucleus accumbens? Boy, I gotta read up.
But hey - I do take an antipsychotic; it's flupentixol, brand name Fluanxol. It's a lesser known AP; it is an oldie but it has a pharmacological profile more akin to the AAP's. So there is some D2-antagonism going on in my brain. But maybe I would need more.
>
> By the way, I'm doing great. my OCD has taken a vacation and I'mm going back to school for psychology, actually neuroscience to be exact. What are you up to?
>That's great! I'm enjoying my job, mostly... It may be insane, but I really like going to work and hanging out with my colleagues.
I find the family life harder to swallow. Not to speak of my marriage.
I'm trying to start up again creatively and musically, but it's still pretty hard, even with all the feel-good meds I take.Neuroscience... Interesting enough.
See you around!
-Marten
Posted by phidippus on July 29, 2012, at 10:57:37
In reply to Re: The Serotonin Syndrome Myth And Not Being Listless, posted by Brainbeard on July 28, 2012, at 17:58:41
>Since Latuda antagonizes 5HT2A-receptors. WTF??
I know! But, remember, Latuda is a potent 5ht1a agonist and Viibryd is a 5ht1a partial agonist. Maybe the combo was too much.
>I should volunteer for an implant with a professor >in Utrecht who is pioneering in this area. So it >is in fact anti-dopaminergic?
DBS iterferes with the electrical signals produced by the nucleus acumbems, sort of short circuiting it.
>So there is some D2-antagonism going on in my >brain. But maybe I would need more.
You can always play with a higher dose and see how it effects you.
I didn't know you were married!
Eric
Posted by Brainbeard on July 29, 2012, at 14:20:17
In reply to Re: The Serotonin Syndrome Myth And Not Being Listless » Brainbeard, posted by phidippus on July 29, 2012, at 10:57:37
> >Since Latuda antagonizes 5HT2A-receptors. WTF??
>
> I know! But, remember, Latuda is a potent 5ht1a agonist and Viibryd is a 5ht1a partial agonist. Maybe the combo was too much.Aaaaaah you're right. 5HT1A-agonism is probably the culprit of serotonin reuptake inhibition's effectivity.
>
> >So there is some D2-antagonism going on in my >brain. But maybe I would need more.
>
> You can always play with a higher dose and see how it effects you.Good idea.
>
> I didn't know you were married!
>I'm sorry, Eric. ;)
-Marten
This is the end of the thread.
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