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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 tom2228 on April 10, 2014, at 12:29:20
wow, funny how when things work, they work..
lithium carb 900mg + Synthroid 50mcg
Lamictal XR 125mg
Abilify 7.5mg
Desoxyn 15-22.5mg
Marplan 30mg
nortriptyline 75mg
Deplin 30mg
Mirapex ER 0.375 -- been off and on, debating getting rid ofSome sedation, memory/ alertness/ cognitive issues from nortriptyline and Mirapex, but only been on nortriptyline a week and a half.
And weight gain.It's not perfect, still working on some issues, but things are rapidly improving.
wish you all a great day
Posted by Louisiana Sportsman on April 10, 2014, at 14:51:38
In reply to feeling GOOD today!, posted by tom2228 on April 10, 2014, at 12:29:20
I absolutely love it when I hear someone is doing well and provide the combo that got them there.
Your PDOC sounds amazing. He's willing to work with you on a MAOI and isn't afraid of concomitant stimulant therapy, notably choosing Desoxyn. Be careful though, you are on the old maximum dosage of Marplan and I wouldn't want a bad interaction with your Desoxyn-- further proof your PDOC is amazing. Mine would likely prescribe me methamphetamine too, but I don't want to push the issue. I already get 60mg. Adderalll and Xanax XR and this is after I revealed that I got addicted to Lyrica. Even after admitting my Lyrica addiction, I received a subtherapeutic 1.200mg. gabapentin script out of empathy since I told her I was done with the abuse and they're the best mood stabilizers I know of lol.
But I digress.
I would discontinue the Mirapex if you're having problems with it and perhaps increase your nortriptyline dose. Good thing about taking lithium means that you can check your nortriptyline levels at the same time you check out your lithium.
Instead of Mirapex, I would go with memantine in the form of Namenda XR 21mg. I think it is a much better option than Mirapex. It may improve cognition and depression. Also, it is coveted by many people taking amphetamines to keep tolerance at bay due to its NMDA properties.
^^^ Stahl puts it perfectly. (Also suggest his book)
I'm looking it myself. I like the idea of Mirapex too, totally see why you did.
Deplin make a noticeable difference? I've always wrote it off... If you never really noticed anything you could simply your regimen even further by removing it along with the Mirapex ER.
I'm thinking that nortriptyline may be my next med. Do you attribute your rapid improvement to it? If it ends up being the cause, may be able to cut out the Lamictal XR. Sounds like it must be the nortriptyline since that's what has changed lately?
But look into Nameda XR.... for me. :p
Posted by tom2228 on April 11, 2014, at 13:30:53
In reply to Re: feeling GOOD today!, posted by Louisiana Sportsman on April 10, 2014, at 14:51:38
> I absolutely love it when I hear someone is doing well and provide the combo that got them there.
>
> Your PDOC sounds amazing. He's willing to work with you on a MAOI and isn't afraid of concomitant stimulant therapy, notably choosing Desoxyn. Be careful though, you are on the old maximum dosage of Marplan and I wouldn't want a bad interaction with your Desoxyn-- further proof your PDOC is amazing. Mine would likely prescribe me methamphetamine too, but I don't want to push the issue. I already get 60mg. Adderalll and Xanax XR and this is after I revealed that I got addicted to Lyrica. Even after admitting my Lyrica addiction, I received a subtherapeutic 1.200mg. gabapentin script out of empathy since I told her I was done with the abuse and they're the best mood stabilizers I know of lol.
>
> But I digress.
>
> I would discontinue the Mirapex if you're having problems with it and perhaps increase your nortriptyline dose. Good thing about taking lithium means that you can check your nortriptyline levels at the same time you check out your lithium.
>
> Instead of Mirapex, I would go with memantine in the form of Namenda XR 21mg. I think it is a much better option than Mirapex. It may improve cognition and depression. Also, it is coveted by many people taking amphetamines to keep tolerance at bay due to its NMDA properties.
>
> http://books.google.com/books?id=zqvVZOea2JAC&pg=PA243&lpg=PA243&dq=memantine+bipolar+depression&source=bl&ots=nWLy0sqIow&sig=JiNcgbXnQH-3L0fsRm3QjL3M-6M&hl=en&sa=X&ei=yPJGU-fzEvC02AXIzIGABw&ved=0CEsQ6AEwBg#v=onepage&q=memantine%20bipolar%20depression&f=false
>
> ^^^ Stahl puts it perfectly. (Also suggest his book)
>
> I'm looking it myself. I like the idea of Mirapex too, totally see why you did.
>
> Deplin make a noticeable difference? I've always wrote it off... If you never really noticed anything you could simply your regimen even further by removing it along with the Mirapex ER.
>
> I'm thinking that nortriptyline may be my next med. Do you attribute your rapid improvement to it? If it ends up being the cause, may be able to cut out the Lamictal XR. Sounds like it must be the nortriptyline since that's what has changed lately?
>
> But look into Nameda XR.... for me. :p
>I am amused, a couple reasons. 1) I am actually between doctors rather than having an amazing one! In fact it's been very difficult to find a doctor who is okay with an MAOI + TCA + stimulant. The original doctor had me on Marplan + Desoxyn and was okay with it, the most recent doctor wasn't and took me off Marplan to start nortriptyline, and I myself added back Marplan in secret a week later when I realized I had once again returned to the sh*tty way that I feel whenever I've been off Marplan in the past. I found a new doctor whom I'm seeing next Thursday who seems to be okay with Marplan + Desoxyn + nortriptyline but wants to see me first. Once I corresponded with her about this I severed ties with the most recent doc and upped Marplan to 30mg. I hope the new doc is okay with me having done this as I was desperate and it IS working.
2) (a) My old doctor didn't choose Desoxyn, but was okay continuing me on it (5 docs so far have been). I had originally suggested it. In fact, this doctor I'd been with for a while before he went on leave didn't seem to care about much except his paycheck and let me call most of the shots. While I appreciated his flexibility and openness, I much prefer to have guidance and support with meds.
(b) Being on 30mg Marplan is more a coincidence with the old maximum. I was actually previously on 50mg Marplan with the Desoxyn for a while without any trouble. Only on 30mg now because of recently restarting it.I very much understand not wanting to push the issue of controlled meds. I too have a history -- I was addicted to crystal meth for 3 years. However, I have no problem with Desoxyn (makes me want to not do drugs because it improves my life and helps me regulate myself), it doesn't cause anxiety like the other stims for me, and works very well, reliably, and without tolerance for the most part. (quick side note: I therefore have no need for Namenda as MAOIs can actually help prevent the development of tolerance to stimulants). Two of my past doctors were actually aware of my history with crystal meth but okay with prescribing me Desoxyn.
But the new doc I will not be telling because it's difficult enough find a doctor who is okay with Desoxyn let alone with MAOIs + TCAs!! Perhaps I could tell her down the line when she trusts me, but I am definitely not willing to push the envelope -- it's simply not necessary and my conscious is clean as my old doctor was fine with the med for me. And if the cat does come out of the bag, I am drug tested weekly by blood and my amphetamine levels are checked. I often come up negative for meth because the level is that low.
Yes, Deplin helps. It is actually a "trimonoamine modulator" in that it increases synthesis of 5-HT, NE, DA, and thus effects greater release. I have a theory that it may be helping replenish neurotransmitters depleted by the Desoxyn. My doc said that Deplin may help sustain remission. Another theory I have as to this is that SSRIs, like other reuptake inhibitors, deplete intraneuronal stores over time, which may contribute to poop-out. Deplin may help by keeping these stores replenished.
---------------
Progress update:I hope I didn't make it seem like I found my silver bullet. I was severely depressed and potently suicidal in the past few months, so to feel good for once was a huge milestone. It's only been a few days feeling better, so this has yet to be sustained, but I am optimistic. I AM doing well, but mind you I am only at about the 70% you alluded to in another post.
I attribute my improvement to starting nortriptyline and adding the Marplan back. The nortriptyline has helped a lot with anxiety and brightening my mood.
As well as halving Mirapex 2 weeks ago. I stopped taking it 2 days ago, then took it yesterday to reassess things, and have decided that was my last dose. No need to replace it with Namenda.
My mood has since faded somewhat since yesterday. I attribute this to the fact that I started nortriptyline only about 2 weeks ago and restarted Marplan a week ago and am adjusting to the initial affects. Raising Marplan from 20mg to 30mg a few days ago is what seemed to jumpstart things -- I am hoping the boost from raising the dose is sustained in the next few weeks and improves.
But there are still problems. Nortriptyline is causing me to be sedated and muggy-brained despite the cognitive improvement from being less depressed. And weight gain.
I am feeling the depression today but reminding myself that I am withdrawing from Mirapex, and hoping that things improve.Lamictal XR I'm staying on for bipolar, borderline personality, and it helps with the depression. Because I'm on so much antidepressant I need the 3 mood stabilizers, and probably need them anyway.
Posted by tom2228 on April 11, 2014, at 13:37:45
In reply to 70%, posted by tom2228 on April 11, 2014, at 13:30:53
Also I'm still lacking motivation/ drive. It's a sticky situation -- raising the nortriptyline would likely help this, but would make me more sedated/ trouble thinking to get the work done that I need the motivation for! And fatter.
Was thinking desipramine may be better for this (lower affinity for H1 and muscarinic receptors than nortriptyline) and better for weight loss, but I might lost the antidepressant and antianxiety effects by switching.
I'm staying with nortriptyline for now. It would be foolish given the improvement I'm experiencing.
Posted by phidippus on April 11, 2014, at 16:27:06
In reply to feeling GOOD today!, posted by tom2228 on April 10, 2014, at 12:29:20
Feeling Good today too!
Lithium 1200 mg
Tegretol 400 mg
Luvox CR 100 mg (just started)
Vyvanse 70 mg
Geodon 160 mgEric
Posted by tom2228 on April 12, 2014, at 19:37:54
In reply to Re: feeling GOOD today! » tom2228, posted by phidippus on April 11, 2014, at 16:27:06
Happy to hear you are feeling well, Eric. I sincerely hope this continues for you as a trend.
Looks like I am back to Abilify 10mg. I had gone down to 7.5mg after discontinuing Marplan because I felt the Abilify became more difficult to tolerate and perhaps too much without the dopaminergic , or more accurately,Marplan-ergic effect. The first few days on 7.5mg felt better, but now it's seemed to have stopped working. Now that I'm back on Marplan I hope 10mg works out.
Back on Mirapex too.
I guess I shouldn't have made any changes to them in the first place since I'm going through two big changes with Marplan and nortriptyline.
Posted by tom2228 on April 12, 2014, at 21:03:05
In reply to Re: feeling GOOD today!, posted by tom2228 on April 12, 2014, at 19:37:54
F*ck. Not feeling right for some reason and can't tell what to do about the Abilify. It and its metabolite have such a long half-life that it's hard to get a quick sense of what an adjustment will do.
Can't tell whether I need that little bit of Mirapex or whether I was feeling bad from the withdrawals and that it would get better.
or whether the increase in Marplan a few days ago has knocked out too much MAOI and would be better at 20-25mg or whether to suggest to increase back to 40-50mg at the new doc appointment Thursday.
Can't tell whether it's the meds, or the fact that my mom told me to kill myself last night. Gotta love supportive parents who keep a roof over your head.
Posted by tom2228 on April 14, 2014, at 19:25:55
In reply to Confused, posted by tom2228 on April 12, 2014, at 21:03:05
The devil incarnate (Mom) is on vacation and meds are working again.
Marplan has built back up in my system and I'm starting to feel back to baseline. My focus and interest in this is back, anxiety better, personality less disordered.
Would like to titrate nortriptyline (and maybe Marplan) up a little but don't want to get more sedation or foggy brain from nortriptyline but would appreciate more of its motivating/ drive-inducing properties. Wrote a paper in 2 days with minimal stress !!
I think the combination with nortriptyline is really doing something for me (!).
Abilify still at 10mg and feeling stable.
No more Mirapex as of this morning. done for good this time; from going back on it a few times I am sure that I want to get off it.
This is the end of the thread.
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