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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by g_g_g_unit on April 30, 2013, at 10:43:24
Hey,
Hope everyone is doing well. I realize it's been some time since I last posted. Sadly, my absence hasn't coincided with any form of remission - I finished up with my last psychiatrist and kind of fell into a depressive, suicidal funk over the past few months.
I ended up meeting with a treatment-resistant specialist a few days ago, which went less serendipitously than I'd hoped. His bedside manner left a little something to be desired and he seemed overly concerned with my degree of assertiveness and social isolation (which aren't really my chief priorities right now). He's unable to take me on as a patient and so referred me to a colleague of his, while dictating several suggestions for treatment.
He recommended benzodiazepines in conjunction with Stelazine for anxiety, while foregoing treatment for ADHD for the time being. Given my sensitivity to medication, his prescription for depression is either a low dose of Imipramine or Effexor.
I'm not really in a hurry to try Stelazine. I've spoken to the colleague of his over the phone and he actually seems really nice (he gets glowing reviews on ratemd); he's a psychopharmacologist who specializes in ADHD and complicated depression and seemed happy to address attentional and anxiety comorbidities.
Since I've been through so much already, I thought it might be easier to just list what I haven't tried and what partially worked.
Haven't tried:
1. Concerta/Ritalin preparations
2. Effexor, Cymbalta, Pristiq
3. Reboxetine
4. Wellbutrin
5. Imipramine
6. Lithium
Partially worked.1. Parnate at 60mg - looking back, the 6 months I spent on Parnate were the most active and engaged I've been in years possibly. Discontinued due to insomnia and lack of beneficial effect on anxiety.
2. Nardil - tried about 5 years ago. Really beneficial for depression, though increased anxiety and insomnia. Gave up after 10 months total (including titration); wonder if it may have been premature and whether side-effects would have abated with time.
3. Dexedrine - helps stress, motivation and attention, but makes me very short-tempered, which is a problem at home (poor familial relations, excessive noise levels)
4. Lorazepam - I've used my grandma's from time-to-time (the one benzo my former psychiatrist wouldn't prescribe due to perceived issues with tolerance) and it reliably eases anxiety. Valium and Clonazepam have a sedating effect, which I may have mistaken for an anxiolytic effect.. didn't stay on either long enough to assess. Xanax has a disinhibiting/anxiogenic effect.
5. Neurontin - listing because it's the only thing that's ever had a really significant impact on hypervigilance and excessive physical anxiety, though it left me really dull and unmotivated. Still, wasn't sure if it makes a case for GABAergics?
My diagnosis is officially inattentive ADD, severe OCD, atypical depression with self-diagnosed agoraphobia and bouts of depersonalization and derealization.
I'm very tempted to revisit Nardil, given Ace's ravings. However, I began to obsess about a hypertensive crisis while on Parnate, which became problematic since it had no beneficial effect on my anxiety, though I'm wondering if that wouldn't be such a salient concern were Nardil to help. The downside is my attentional issues would probably persist, since an MAOI + stimulant seems highly unlikely.
Otherwise, I wasn't sure if it would be more logical to try Effexor or Imipramine first, given my fears about the MAOI diet.
I don't really have any intentions of revisiting the SSRIs or APs, since I'm so prone to akathisia/movement issues on them. The list above is kind of it at this point.
Thanks for reading!
Posted by Phillipa on April 30, 2013, at 12:13:56
In reply to been a while, posted by g_g_g_unit on April 30, 2013, at 10:43:24
Simple first low dose effexor or pristiq & ativan. Phillipa
Posted by jono_in_adelaide on April 30, 2013, at 20:46:17
In reply to been a while, posted by g_g_g_unit on April 30, 2013, at 10:43:24
Reading the above, I'd ask your doc anout taking Parnate for depression, Ativan for anxiety and insomnia, and perhaps 1mg risperidone at night to help by its effect on the various 5HT receptors
Posted by jono_in_adelaide on April 30, 2013, at 20:56:37
In reply to Re: been a while » g_g_g_unit, posted by Phillipa on April 30, 2013, at 12:13:56
BTW, I dont think Ativan is any worse than Xanax foir dependency or abuse liability - and given its the one that works best for you, it seemsa no brainer to take it
Posted by Phillipa on April 30, 2013, at 21:37:22
In reply to Re: been a while, posted by jono_in_adelaide on April 30, 2013, at 20:56:37
Jono don't want to hyjack but at one time took ativan and it worked great. Still have a bottle of it. Since the valium & xanax don't relax. What would happen if I substitued an ativan for both of them? Think since a benzo would still not work? Thanks Phillipa
Posted by g_g_g_unit on April 30, 2013, at 23:39:16
In reply to Re: been a while, posted by jono_in_adelaide on April 30, 2013, at 20:46:17
> Reading the above, I'd ask your doc anout taking Parnate for depression, Ativan for anxiety and insomnia, and perhaps 1mg risperidone at night to help by its effect on the various 5HT receptors
Unfortunately, none of the anti-psychotics are really viable. I tried Risperodone in conjunction with Parnate a few years ago and it just made me more agitated and anxious.
I find the benzos help quell physical anxiety, but they don't really have any anti-obsessional properties. So Parnate + a benzo might still not cut it. Does Nardil have a better track record than Parnate for anxiety disorders?
Posted by jono_in_adelaide on May 1, 2013, at 18:40:02
In reply to Re: been a while » jono_in_adelaide, posted by g_g_g_unit on April 30, 2013, at 23:39:16
Yes, Nardil is more anxiolytic than Parnate
Nardil plus a benzo would be the gold standard for anxiety I beleive
Posted by g_g_g_unit on May 9, 2013, at 7:04:32
In reply to Re: been a while, posted by jono_in_adelaide on May 1, 2013, at 18:40:02
So, the good news is that the psychiatrist I saw was great, almost the perfect combination of medical expertise (he heads a pharmacological discussion group here) and amiability.
Based on the fact that the only notable remission I've had from depression was the 6 months I spent on Parnate last year, he's decided to revisit it, beginning at 40mg, moving up to 60mg, and then onwards if necessary.
I'm a little trepidatious that it's the correct choice, since my last trial provoked a lot of anxiety. But he believes that a) Nardil will do nothing to resolve my attentional issues, and b) that I may seem more anxiolytic benefits at doses superseding 60mg. I'm kind of in hell right now as far as anxiety/depression goes, and it was nice to relinquish control to someone else for a chance. At least he's pushing for a speedy titration, so hopefully things go well.
This is the end of the thread.
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