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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 24 to 48 of 49. Go back in thread:
Posted by ChicagoKat on October 26, 2012, at 14:59:45
In reply to Re: I give up » gilmourr, posted by SLS on October 26, 2012, at 5:39:39
> > > > > Hi Kat.
> > > > >
> > > > > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> > > > >
> > > > >
> > > > > - Scott
> > > >
> > > >
> > > > Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.
> > >
> > > Yes. I have read your posts.
> > >
> > > > 60 mg can actually undo the work.
> > >
> > > How so? What do you experience when the work is undone?
> > >
> > >
> > > - Scott
> > >
> >
> > I experience severe mood swings that remind me exactly of major depression (they lasted for 4 hours, and didn't get better) over 3 weeks.
> >
> > Lessening of the effect of anxiety relief, more anxiety to sounds (kind of like a very heightened reflex), MAJOR COLD INTOLERANCE (still waiting for it to go away), urinary retention where I almost needed a cathedar.
> >
> > At 45 mg after 70-75 days I only had constipation and a 70% relief of anxiety and depression.
> >
> > Few days after taking 60 mg it started messing it all up and continued to get worse.
> >
> > Maybe there is a balanced SERT/NE ratio at 45 mg and at 60 mg it is way more NE based? Would explain the coldness, urinary retention, reflexes etc. Iunno, it was bad though.
>
>
> With Nardil, I experienced an antidepressant effect when I either increased or decreased the dosage. The improvement was, however, extremely short-lived. It would last from a few hours to a few days. I found myself adjusting the dosage of Nardil daily in order to stay in the "zone" of response. Did you know that one can feel better transiently when the dosages of various drugs are decreased? These include, but are not limited to, TCA, MAOI, Depakote, and Lamictal. Those are just the ones that affected me that way. In fact, severe mania can result from drug discontinuation. I experienced my worst mania as the result of Nardil discontinuation.
>
> To me, it sounds like you might not have allowed your CNS to reach an equilibrium at the higher dosage of Nardil. For having followed a pattern of continually adjusting the dosage of Nardil up and down, you have become sensitized to many of its side effects. Urinary retention is an example of a side effect that can worsen by jumping up and down in dosage. You are not allowing time for the drug to produce its therapeutic antidepressant effect and only make side effects worse.
>
> If you can't maintain an acceptable antidepressant response to 45 mg/day of Nardil taken daily for 4 - 6 weeks, I would suggest that you remain at that dosage steadily for 1 - 2 weeks before making any changes. You could then increase the dosage by 7.5 mg/day every 1 - 2 weeks as tolerated until you find an effective dosage in the range of 60 - 90 mg/day.
>
> How much time and effort you invest in using Nardil to treat your illness might depend upon how many drugs you have left to try. If there a bunch of treatments yet untried, then perhaps it makes sense to change drugs now. If your alternatives are now limited because of previous treatment failures, it makes sense to give Nardil more time, particularly since you are at least partially responsive to it.
>
> When one hits an effective dosage of Nardil, they often feel weird for a few days to a week. It is not a return of depression, but rather a brain fog that can flatten affect and produce cognitive difficulties. It just doesn't feel "right". However, this can be a good sign that biological events are occurring that are producing a more complete antidepressant response.
>
>
> - ScottHi Scott, as I said in a previous post, I went ahead and upped my dose to 60mg/day, which was the dose that led to remission the first time I was on Nardil. At that time I had very quickly been ramped up to that dose, increasing my dose by 15mg/day until I reached 60mg/day, so it was just a matter of days.
I do plan to remain on the Nardil, at 60mg/day, plust the Nortriptyline, until I see my pdoc in a week and a half. We'll see what he has to say at that point. And to answer your post, I have absolutely no other drugs left to try. :(
Thanks for all the advice, advice from you really means a lot cos I know you really know your stuff.
Kat
Posted by TemporarilyBob on October 26, 2012, at 15:44:49
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 14:51:28
> Hi, nice of you to post. My official diagnosis is major depressive disorder. And I'm treatment resistant.
Been there, been called that. That's why I asked. And anxiety is an issue for you if I remember correctly? Just want to check again before I open my mouth. Or unleash my fingers. Whatever..... ;)
Posted by Hugh on October 26, 2012, at 15:57:48
In reply to Re: Menninger, posted by jono_in_adelaide on October 25, 2012, at 22:13:36
> Well, they cured Richard Carpenter of his Qualude habit, and its where they sent the posessed kid in The Exorcist!
It's where Elmer Green, author of Beyond Biofeedback, did his pioneering work in the '60s and '70s. William Gibson, author of The Miracle Worker, wrote a novel based on the Menninger Clinic called The Cobweb. Both books are well worth reading.
Posted by phidippus on October 26, 2012, at 17:10:44
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 26, 2012, at 14:46:10
Did it poop out?
Eric
Posted by ChicagoKat on October 26, 2012, at 20:28:07
In reply to Re: I give up » ChicagoKat, posted by TemporarilyBob on October 26, 2012, at 15:44:49
> > Hi, nice of you to post. My official diagnosis is major depressive disorder. And I'm treatment resistant.
>
> Been there, been called that. That's why I asked. And anxiety is an issue for you if I remember correctly? Just want to check again before I open my mouth. Or unleash my fingers. Whatever..... ;)Yes, anxiety is an issue for me. That is the one thing the Nardil is helping with, thank goodness. I still get 'breakthrough' anxiety though, but I have gabapentin for that and it really helps.
Kat
Posted by ChicagoKat on October 26, 2012, at 20:29:40
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 17:10:44
> Did it poop out?
>
> EricDo you mean the Nardil? If so, yes, it seems to be not working :(
Posted by phidippus on October 26, 2012, at 21:23:50
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 26, 2012, at 20:29:40
The Lexapro-did it poop out?
Eric
Posted by phidippus on October 26, 2012, at 21:28:07
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 20:28:07
Let me get this straight, Nardil helps with the anxiety but not the depression.
What is the nature of your depression?
Eric
Posted by TemporarilyBob on October 27, 2012, at 9:23:51
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 20:28:07
> > > Hi, nice of you to post. My official diagnosis is major depressive disorder. And I'm treatment resistant.
> >
> > Been there, been called that. That's why I asked. And anxiety is an issue for you if I remember correctly? Just want to check again before I open my mouth. Or unleash my fingers. Whatever..... ;)
>
> Yes, anxiety is an issue for me. That is the one thing the Nardil is helping with, thank goodness. I still get 'breakthrough' anxiety though, but I have gabapentin for that and it really helps.
> KatWell, just sharing my experiences then. Been diagnosed as Major Depressive Disorder longer than I can remember, but eventually got into treatment because of my anxiety. Still, was treated for depression with meds, not anxiety. Got manic, got paranoid, got psychotic, had anxiety so bad I was hallucinating -- I recall walking down Central Park South in NYC ... southern border of Central Park with highrises on the side opposite of the park ... and recall seeing the building bending over from the top as if they were out to collapse on top of me. Had to run to a subway entrance to get underground and safe. Then, about 7 years ago, finally had a pdoc up with current research who suggested bipolar. Not I or II but bipolar spectrum. It's evolved somewhat over the years, docs don't quite agree on the terminology, from "there is a spectrum of types of bipolar disorder" to right now some calling for a bipolar III and even a bipolar IV classification. I'm not up on the literature myself, I'm mostly just sharing what my latest pdoc has said to me about me. (1) That there are types of bipolar disorder that do not involve mania, unless it's triggered by substance use (including prescription meds). (2) That some docs still scoff at this, the research base is that thin. (3) That people who fall into this category and get medicated as traditionally done for either depression or anxiety can wind up worse for it, no matter the good intentions of their pdocs.
So, with me hearing familiar things in your story I just wanted to raise this idea of a bipolar dx as a possibility for you. For me, right now, it's meaning nortriptyline and seroquel. I also have clonazepam because it's helped with my anxiety in the past but my current pdoc is really hesitant about using benzos to treat my anxiety -- seroquel has been shown to be effective against anxiety but the FDA won't approve it for single drug therapy against anxiety because of it's side-effect profile compared to traditional anti-anxiety meds. As always, YMMV, but it sounds like you're at the end of your rope so I thought I'd toss out a different one.
Posted by ChicagoKat on October 27, 2012, at 16:34:17
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 21:23:50
> The Lexapro-did it poop out?
>
> EricAs far as helping my depression yes, it pooped out. But it still helps my anxiety.
Posted by ChicagoKat on October 27, 2012, at 16:36:22
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 21:28:07
> Let me get this straight, Nardil helps with the anxiety but not the depression.
>
> What is the nature of your depression?
>
> EricI have major depression, treatment-resistant. I was at one time told my depression is of the atypical variant, even though I now have trouble sleeping...it used to be the opposite for me, I could sleep forever.
Posted by ChicagoKat on October 27, 2012, at 16:40:41
In reply to Re: I give up, posted by TemporarilyBob on October 27, 2012, at 9:23:51
Thanks for sharing your experience. I will broach the possibility of some sort of bipolar thing going on with me, but I can tell you I've used Lithium in the past and it did nothing for me. All the pdocs and therapists I've ever seen for decades now say I have unipolar depression
Posted by phidippus on October 27, 2012, at 18:14:05
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 27, 2012, at 16:36:22
I'm curious as to what your symptoms are.
Eric
Posted by ChicagoKat on October 28, 2012, at 11:27:51
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 27, 2012, at 18:14:05
> I'm curious as to what your symptoms are.
>
> EricHi Eric...my symptoms are pretty typical: a sad state, anhedonia, lack of motivation, hopelessnes, helplessnes, crying spells, low self-esteem, feelings of guilt, comfort eating (way too much), insomnia, anxiety when it's not controlled, suidical thoughts (that I would never act on, I just couldn't do that to my loved ones), even somatic symptoms like pain all over and a nauseated stomach, isolating.
That's pretty much it. Hope you are doing better than all that!
Kat
Posted by phidippus on October 28, 2012, at 15:42:03
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 28, 2012, at 11:27:51
And you've tried ECT?
Why not look into deep brain stimulation?
Eric
Posted by schleprock on October 28, 2012, at 19:26:22
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 28, 2012, at 11:27:51
Hi Chicagocat. I'm dissapointed that you haven't found your magic bullet yet. I'm also deeply sorry that we can't give you your due attention at the moment due to a crisis with one of our older members of the community. Please don't feel neglected, but we're really trying to contain something disasterous at the moment. Once we get this resolved, we'll hopefully be able to give you some more support, as well as all the other members of psychobabble.
Posted by TemporarilyBob on October 29, 2012, at 0:28:44
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 27, 2012, at 16:40:41
> Thanks for sharing your experience. I will broach the possibility of some sort of bipolar thing going on with me, but I can tell you I've used Lithium in the past and it did nothing for me. All the pdocs and therapists I've ever seen for decades now say I have unipolar depression
I tried Lithium as well. It left me extremely agitated, to say the least. I can't remember if it was in combination with Zoloft. Prozac, or Nortriptyline -- this was 10 years or so ago ... but it was used in combination with an AD and it left me feeling far worse.
Hmm ... now that I think about it, it might have been Prozac and my response to it might have been what pushed my pdoc at the time to trying me on nortriptyline.
One of the things about the newer variants of bipolar that are coming out in the literature is that they are treatment resistant -- particularly in not responding well to "traditional" single or multiple drug therapies. It's not just an issue of the traditional approaches not working, but quite possibly them making matters worse. SSRIs are classic cases for these and poor response to SSRIs is used by some as a diagnostic criterion for these other dx's on the bipolar spectrum.
So, if your pdoc is up on the lit on this he should know not to take a standard approach. If he's not up on the lit, he might want to look into bipolar spectrum research and see what new directions it's being taken.
Posted by Lamdage22 on October 29, 2012, at 6:45:27
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
> I have now been on Nardil for 3 1/2 weeks, and feel as terrible as I did before I started it. That never happened the first time I took it. I just know in my gut that it's not gonna work. Oh, and I've been on Nortriptyline too, and that's doing squat for me.
>
> I've tried everything there is. I remember before I started Nardil this time that I told my husband that if it didn't work it was gonna be either suicide or heroin addiction for me. I was only half-joking. I just can't face a life of feeling so awful all the time. Of course, my pdoc will probably put me back on Ritalin, and I will have to fight with it (tolerance builds up to it really quickly in me) for the rest of my miserable existence.
>
> If anyone has any ideas, I'd love to hear them, but I just don't think anything's gonna work anymore.I give up, too, honey. We are all going to hell
Posted by ChicagoKat on October 29, 2012, at 16:12:07
In reply to Re: I give up, posted by schleprock on October 28, 2012, at 19:26:22
Thanks for the update, I much appreciate it.
Kat> Hi Chicagocat. I'm dissapointed that you haven't found your magic bullet yet. I'm also deeply sorry that we can't give you your due attention at the moment due to a crisis with one of our older members of the community. Please don't feel neglected, but we're really trying to contain something disasterous at the moment. Once we get this resolved, we'll hopefully be able to give you some more support, as well as all the other members of psychobabble.
Posted by Zyprexa on November 1, 2012, at 23:26:07
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 28, 2012, at 11:27:51
Have you tried zyprexa? It helps all those symptoms.
Posted by AlexCanada on November 2, 2012, at 9:17:29
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
> I have now been on Nardil for 3 1/2 weeks, and feel as terrible as I did before I started it. That never happened the first time I took it. I just know in my gut that it's not gonna work. Oh, and I've been on Nortriptyline too, and that's doing squat for me.
>
> I've tried everything there is. I remember before I started Nardil this time that I told my husband that if it didn't work it was gonna be either suicide or heroin addiction for me. I was only half-joking. I just can't face a life of feeling so awful all the time. Of course, my pdoc will probably put me back on Ritalin, and I will have to fight with it (tolerance builds up to it really quickly in me) for the rest of my miserable existence.
>
> If anyone has any ideas, I'd love to hear them, but I just don't think anything's gonna work anymore.Rhodiola Rosea. It was the first thing that allowed me to actually function and work for a bit and I have been dealing with severe melancholic depression + anxiety for over a decade.
It is worth a shot because it isn't just one option. You can think of it as two or three. The herb (and I have tried many, most with very little relief) functions differently depending on dosage. Low doses of about 250mg-500mg a day can be activating/stimulating yet ironically calming. Moderate doses of 500mg-1000mg can be less activating yet cognitively quite enhancing. High doses of 1000mg+ can be sedating (if you need it for sleep), far less activating, yet maintain a good level of motivation and productivity.
From the dozens of meds I have tried in my treatment resistant depression + anxiety there have been almost none which have allowed me to be as productive as I have been on Rhodiola Rosea. It really does something for motivation and to some extent a partial restoration of interest.
It functions as an herbal MAOI, but of course without any diet restrictions.
Of course it effects everyone differently. My mother felt a lot more lively and less aggressive. For me it sometimes causes aggression but it's been a small price to pay for the ability to get my life slightly back on track.
Unfortunately after 1 and a half years Rhodiola has built up tolerance within me. It doesn't help as much as it used to but I was at least able to get much done in the mean time.
If you do choose to try it please consider 2 brands since branding can make a huge difference. NOW brand caused a lot of cognitive improvement for me, allowed me to feel even a bit intellectual, such as how I was when I was very young and healthy but it caused fair amount of aggression.
Mind Body and Spirit brand is a bit more calming and feels less potent in it's pro-motivation and pro-cognitive effects.
It can feel quite different depending on formulation.
Posted by ChicagoKat on November 2, 2012, at 9:55:38
In reply to Re: I give up » ChicagoKat, posted by Zyprexa on November 1, 2012, at 23:26:07
> Have you tried zyprexa? It helps all those symptoms.
Thanks, but I've been on zyprexa before, and it actually gave me akathisia. all the atypicals make me feel agitated.
Posted by ChicagoKat on November 2, 2012, at 9:58:27
In reply to The Case for Rhodiola Rosea, posted by AlexCanada on November 2, 2012, at 9:17:29
Thanks for the suggestion, Alex, I will mull it over. I'd have to go through a wash of my Nardil before starting it, don't you think?
Posted by AlexCanada on November 2, 2012, at 12:32:24
In reply to Re: The Case for Rhodiola Rosea » AlexCanada, posted by ChicagoKat on November 2, 2012, at 9:58:27
> Thanks for the suggestion, Alex, I will mull it over. I'd have to go through a wash of my Nardil before starting it, don't you think?
They can be taken together but would be best likely to try it after wash out to best assess how it effects you. Do try an alternate dose if one does not work out for you. rhodiola really behaves differently, almost like a completely different medication when changing dosage.
also time of day can play a factor. early afternoon usually is what has worked for me.
Posted by huxley on November 6, 2012, at 4:09:54
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
> I have now been on Nardil for 3 1/2 weeks, and feel as terrible as I did before I started it. That never happened the first time I took it. I just know in my gut that it's not gonna work. Oh, and I've been on Nortriptyline too, and that's doing squat for me.
>
> I've tried everything there is. I remember before I started Nardil this time that I told my husband that if it didn't work it was gonna be either suicide or heroin addiction for me. I was only half-joking. I just can't face a life of feeling so awful all the time. Of course, my pdoc will probably put me back on Ritalin, and I will have to fight with it (tolerance builds up to it really quickly in me) for the rest of my miserable existence.
>
> If anyone has any ideas, I'd love to hear them, but I just don't think anything's gonna work anymore.
I quit all my meds.
Zyprexa, Pristiq, Lactimal & Provigil.
Took me 3 years and was very hard and dangerous.
One at a time I tapered them.
I started exerisizing regualrly, completly changed my diet to a healthy one. Quit smoking and Quit Drinking.
I figured I was at the end of the line so I had to do something and this was all I could think of after 10 years of failure in the Psych system.
On my meds I fit in here perfectly. All sorts of wacky horrible symptoms. Agitation, Depression, Anxiety, Panic Attacks, Warped thinking. Moods up and down. Dizzyness. Mental slowness, mind fog.
I was fat, looked about 10 years older than I really was.all the usual stuff.
After time, Off my meds I am competly fine. Have none of the above sysmptoms too a level that concern me.
I am happy, Optimistis, reasnable, likeable, social. I enjoy my life.
sometimes i get a bit down, i am anxious about stuff.
this is just my opinon and my story. Not suggesting you go down the same path.
Just an alternate version to the 'A mighty medication cocktaiol' will be your salvation that gets pushed arround here.
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