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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 17 to 41 of 56. Go back in thread:
Posted by J Kelly on March 5, 2016, at 16:18:10
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 14:33:00
> When was Geodon first added relative to your discontinuation of Parnate?
Here's the timeline:
-Parnate started/titrated to 80mg
-Ritalin added/good response/ten day remission
-Ritalin replaced with Dexedrine
-Great response
-Parnate 80mg/Dexedrine 40mg
-Full remission/some mania (non psychotic)
-Psychosis (80mg parnate/2 weeks on 40mg Dexedrine)
-Dexedrine removed after 2 weeks
-Psychosis ongoing/Parnate cont'd for 9 months
-3rd hospitalization parnate removed/Geodon added
-2 weeks on Geodon/off parnate/psychosis ends
> > Still think I'm bi-polar I?
>
> I am still leaning in that direction. I am taking into consideration your description of your traveling. It really depends upon how you answered the question regarding the timing of Geodon administration.
>
> Have you ever tried Lamictal? If you think you are bipolar, I would consider adding Lamictal for the long term to help with your present depression and protect you from future depressions.I've never paid much attention to a diagnosis but I'm remembering my first pdoc speculated that I maybe was bi-polar 2. Not sure what that was based on but it was prior to my psychotic episode. I believe I tried Lamictal and Lithium. Its been long enough though that I'd be willing to try one or both again.
>
> IF Nardil doesn't work out, you might end up back on Parnate.No. Unfortunately Parnate is no longer an option. My family will not support that and after what I put them through I just can't go there.
>
> ----------------------------------
>
> One possible aggressive scenario:
>
> 1. Continue Zyprexa.
>
> 2. Begin Nardil on day 1 and titrate to 60-75 mg/day.
>
> 3. Begin Lamictal on day 1. It takes 6 weeks to reach a therapeutic dosage (200-300 mg/day) using a very gradual titration schedule. Screen for the emergence of a rash-reaction.
>
> 4. Add methylphenidate or amphetamine if necessary after being on Nardil 75 mg/day for 3-4 weeks.
>
> 5. Return to Parnate if necessary following a 14 day washout beginning from the last dose of Nardil.
>
> 6. Continue Lamictal.
>
> 7. Continue methylphenidate or amphetamine.
>
> 8. After you have been euthymic for an extended period of time, you might decide to discontinue the stimulant, Nardil, and Zyprexa - in that order.
>
> 9. Remain on Lamictal to prevent future relapses into depression.
>
> * This is meant to give you ideas. It might not end up being the exact protocol that you find yourself following.Other than the parnate, I like these ideas. I don't see my pdoc going for this however. He's pretty conservative. I'd have to find a new pdoc but I'm willing.
>
> ----------------------------------
>
> Hopefully, adding Nardil to Zyprexa will be sufficient. Simple is good. Take one day at a time. Make one decision at a time. Be patient.Wasn't it you who used to say "be a patient patient"? I know I picked that up here :)
> One time when I became manic on Nardil, adding Zyprexa worked within 12 hours and I did not feel at all slowed-down. Actually, Zyprexa gave me an increase in thought clarity. I wish that I had continued to feel that way.I'm curious. Were you aware of your manic state? Or did others call you out?
>
> What are your thoughts?See above!
>
>
> - ScottJade
Posted by SLS on March 5, 2016, at 16:52:41
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 4, 2016, at 6:56:45
________________________________________
DSM V
Diagnosis: 296.53 (F31.4): Bipolar I Disorder
- Most Recent Episode Depressed, Severe Without Psychotic Features* Medication-induced mania qualifiers:
Diagnostic Features
The diagnostic features of substance/medication-induced bipolar and related disorder are essentially the same as those for mania, hypomania, or depression. A key exception to the diagnosis of substance/medication-induced bipolar and related disorder is the case of hypomania or mania that occurs after antidepressant medication use or other treatments and persists beyond the physiological effects of the medication. This condition is considered an indicator of true bipolar disorder, not substance/medication-induced bipolar and related disorder. Similarly, individuals with apparent electroconvulsive therapy-induced manic or hypomanic episodes that persist beyond the physiological effects of the treatment are diagnosed with bipolar disorder, not substance/medication-induced bipolar and related disorder.
Differential Diagnosis
Substance/medication-induced bipolar and related disorder should be differentiated from other bipolar disorders, substance intoxication or substance-induced delirium, and medication side effects (as noted earlier). A full manic episode that emerges during antidepressant treaqtment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar I diagnosis. A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar II diagnosis only if preceded by a major depressive episode.
________________________________________
- Scott
Posted by J Kelly on March 5, 2016, at 17:18:18
In reply to Re: Nardil safe? » SLS, posted by SLS on March 5, 2016, at 16:52:41
Thanks Scott.
I'm realizing it's probably important at this juncture for me to get an accurate diagnosis. No point in making med changes without direction. I promise not to be surprised when my pdoc tells me I'm bipolar. I see him next week.
My brain hurts.
I hope you are feeling better :)
Jade
Posted by SLS on March 5, 2016, at 17:22:25
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 16:18:10
> > When was Geodon first added relative to your discontinuation of Parnate?
> Here's the timeline:
>
> -Parnate started/titrated to 80mg
> -Ritalin added/good response/ten day remission
> -Ritalin replaced with Dexedrine
> -Great response
> -Parnate 80mg/Dexedrine 40mg
> -Full remission/some mania (non psychotic)
> -Psychosis (80mg parnate/2 weeks on 40mg Dexedrine)
> -Dexedrine removed after 2 weeks
> -Psychosis ongoing/Parnate cont'd for 9 months
> -3rd hospitalization parnate removed/Geodon added
> -2 weeks on Geodon/off parnate/psychosis ends
> > > Still think I'm bi-polar I?I can't tell from the timing. It takes 2 weeks for the physiological effects of Parnate to wear off. However, antidepressant-induced mania is considered uncommon in unipolar depression.
It was very stupid of your doctor to leave you on Parnate for 9 months while you presented with mania/psychosis. This makes me very angry.
- Scott
Posted by SLS on March 5, 2016, at 17:30:31
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 17:18:18
> My brain hurts.
I'm sure it does. You've had to process a lot of new information and perspectives.
> I hope you are feeling better :)I'm okay. I'm not in pain. However, I remain conflicted over what I should do with desipramine. I am very tempted to cross-over back to nortriptyline. I guess I should wait, though.
I'm trying to be a patient patient.
:-)
- Scott
Posted by J Kelly on March 5, 2016, at 17:37:47
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 17:22:25
>> It was very stupid of your doctor to leave you on Parnate for 9 months while you presented with mania/psychosis. This makes me very angry.
>
>
> - ScottMy brothers were out for blood. But as I said I was very adept at hiding it. Enough so that not only did my pdoc miss it, so did the pdocs at the first two places I was hospitalized. They just kept giving me parnate. And 80mg. I remember talking the 2nd pdoc into going over the 60mg recommended dose. To be fair, I was good. I think my docs failed me in not listening to my (large) family. A family knows.
Jade
Posted by Lamdage22 on March 6, 2016, at 14:26:25
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 17:37:47
personally i wouldnt trial it if i were you.
If you do trial, please be careful. Dont wait until you are in full blown psychosis. Stop taking it when you can tell that it is going wrong.
Are you able to tell?
Posted by Lamdage22 on March 6, 2016, at 14:29:28
In reply to Nardil safe?, posted by J Kelly on March 1, 2016, at 14:17:16
Do you have psychosis right now? Or only while on Parnate? Do you take Antipsychotics?
Posted by J Kelly on March 6, 2016, at 14:46:27
In reply to Re: Nardil safe?, posted by Lamdage22 on March 6, 2016, at 14:26:25
> personally i wouldnt trial it if i were you.
>
> If you do trial, please be careful. Dont wait until you are in full blown psychosis. Stop taking it when you can tell that it is going wrong.
>
> Are you able to tell?No. And therein lies the rub :(
Posted by J Kelly on March 6, 2016, at 14:51:04
In reply to Re: Nardil safe?, posted by Lamdage22 on March 6, 2016, at 14:29:28
> Do you have psychosis right now? Or only while on Parnate? Do you take Antipsychotics?
>No. No psychosis. Only while on Parnate. I take 10mg Zyprexa for depression. Do you think that would protect me? What if I add a mood stabilizer such as Lamictal?
Jade
Posted by Lamdage22 on March 7, 2016, at 6:48:00
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 6, 2016, at 14:51:04
Considering that you can not tell when you are in psychosis, i would not trial Nardil.
Full blown Psychosis can be much more destructive than Depression.
Posted by J Kelly on March 7, 2016, at 6:56:29
In reply to Re: Nardil safe?, posted by Lamdage22 on March 7, 2016, at 6:48:00
>
> Full blown Psychosis can be much more destructive than Depression.Agreed. Ugh.
Posted by J Kelly on March 7, 2016, at 9:08:48
In reply to Re: Nardil safe?, posted by Lamdage22 on March 3, 2016, at 13:19:24
> i was psychotic on both of these.
Hi. Just curious, when you were in psychosis on Parnate and Nardil, were you also taking the A/P's and mood stabilizer?
I'm thinking about having 10mg Zyprexa and some dose of Lamictal in place when I start the Nardil trial.
Has any other med caused psychosis in you? If so, what was it?
Jade
Posted by Lamdage22 on March 7, 2016, at 14:11:16
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 7, 2016, at 9:08:48
Well if you have someone close to you maybe THEY can monitor you for psychosis because they will notice(hopefully!!!). Do you think you would listen to them when they are saying that its not doing you any good?
Antipsychotics have the culprit of potentially causing very bad side effects... Tardive Dementia, Tardive Dyskinesia, Diabetes (Especially Zyprexa), Weight gain, Obesity, Metabolic Syndrome.
Sometimes i was on APs, sometimes not.
I hope you make the right decision and i am not entirely sure which one it is.
> Hi. Just curious, when you were in psychosis on Parnate and Nardil, were you also taking the A/P's and mood stabilizer?
>
> I'm thinking about having 10mg Zyprexa and some dose of Lamictal in place when I start the Nardil trial.
>
> Has any other med caused psychosis in you? If so, what was it?
>
> Jade
>
>
Posted by Lamdage22 on March 7, 2016, at 14:11:48
In reply to Re: Nardil safe?, posted by Lamdage22 on March 7, 2016, at 14:11:16
Yes i am prone to psychosis. Probably more so than you.
Posted by Lamdage22 on March 7, 2016, at 14:21:55
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 7, 2016, at 9:08:48
You could do the AP thing of course if the antidepressant effect outweighs the potential and actual negative effects of Nardil and the AP.
If you gain weight, you could take Metformin as well. I would definitely recommend that.
Does it have to be Zyprexa though? Which APs do you have experience with?
Posted by J Kelly on March 7, 2016, at 15:13:54
In reply to Re: Nardil safe?, posted by Lamdage22 on March 7, 2016, at 14:11:16
>
> I hope you make the right decision and i am not entirely sure which one it is.
>
>That makes two of us.
Posted by J Kelly on March 7, 2016, at 15:30:24
In reply to Re: Nardil safe?, posted by Lamdage22 on March 7, 2016, at 14:21:55
>
> If you gain weight, you could take Metformin as well. I would definitely recommend that.Yes I've been curious about that. I think I asked my pdoc about Metformin when I gained weight from Zyprexa and he dismissed it. I'll ask again.
>
> Does it have to be Zyprexa though? Which APs do you have experience with?
>
Abilify caused intolerable akathisia (sp?). Geodon caused hypersomnia. I could fall asleep in the middle of a conversation. It was bad. I choose Zyprexa because I feel it calms me, and it erases my tendency towards insomnia. The weight gain IS an issue with Zyprexa but maybe the metformin would help. I don't do well with weight gain.
Thanks for your interest in helping me, a complete stranger hah :)
How are you doing?
Jade
Posted by SLS on March 7, 2016, at 15:33:43
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 7, 2016, at 15:30:24
> >
> > If you gain weight, you could take Metformin as well. I would definitely recommend that.
>
> Yes I've been curious about that. I think I asked my pdoc about Metformin when I gained weight from Zyprexa and he dismissed it. I'll ask again.
Quick Google search:https://www.google.com/?gws_rd=ssl#q=antipsychotic+metformin
- Scott
Posted by J Kelly on March 7, 2016, at 16:51:40
In reply to Re: Nardil safe?, posted by SLS on March 7, 2016, at 15:33:43
> Quick Google search:
>
> https://www.google.com/?gws_rd=ssl#q=antipsychotic+metformin
>
>
> - Scott
J Fam Pract. 2008 Aug; 57(8): 526530.
PMCID: PMC3183916Can metformin undo weight gain induced by antipsychotics?
Sarah-Anne Schumann, MDcorresponding author and Bernard Ewigman, MD, MSPH
John Hickner, MD, MSc, PURLS Editor
John Hickner, Department of Family Medicine, The University of Chicago;corresponding author
Practice changer
"Recommend metformin 250 mg 3 times a day, along with lifestyle modifications, to promote weight loss and decrease insulin resistance in patients who gain more than 10% of their pretreatment body weight on antipsychotic medications."
Strength of recommendation
B: Based on a single, well-designed, randomized controlled trial.
Wu R-R, Zhao J-P, Jin H, et al. Lifestyle intervention and metformin for treatment of antipsychotic-induced weight gain: a randomized controlled trial. JAMA. 2008;299:185-193.1
Good enough for me. Might be looking for a new pdoc. One that will prescribe Metformin and Nardil.
Jade
U of Chicago? Dr Bob? huh
Posted by Lamdage22 on March 8, 2016, at 10:19:05
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 7, 2016, at 15:30:24
I am well, thank you. I have my "Cannabidiol appointment" in two days. Keeping my fingers crossed i will get it prescribed and it works.
Scott, could he take Seroquel with Nardil without serotonin syndrome?
Does Risperdal work for you Jade?
Do you know someone who could monitor you for mania and psychosis? If you dont and you say you dont realize mania/psychosis when you have it, i would be concerned.
Posted by Lamdage22 on March 8, 2016, at 10:34:14
In reply to Re: Nardil safe?, posted by Lamdage22 on March 8, 2016, at 10:19:05
If you had psychosis several times you do notice... at least i do.
But you dont want more episodes. One is more than enough
Posted by J Kelly on March 8, 2016, at 10:52:14
In reply to Re: Nardil safe?, posted by Lamdage22 on March 8, 2016, at 10:19:05
> I am well, thank you.
Hey good to hear :)
> I have my "Cannabidiol appointment" in two days. Keeping my fingers crossed i will get it prescribed and it works.
I think I read someone else here is doing well with Cannabidiol. Good luck!
>
> Scott, could he take Seroquel with Nardil without serotonin syndrome?
>
> Does Risperdal work for you Jade?I've never taken Risperdal.
>
> Do you know someone who could monitor you for mania and psychosis? If you dont and you say you dont realize mania/psychosis when you have it, i would be concerned.Yes, I could be monitored. I've had only one episode of psychosis. Nine months and not once did I recognize I was ill.
Jade
Posted by Lamdage22 on March 8, 2016, at 13:39:51
In reply to Re: Nardil safe? » Lamdage22, posted by J Kelly on March 8, 2016, at 10:52:14
> Yes, I could be monitored. I've had only one episode of psychosis. Nine months and not once did I recognize I was ill.
>
> Jade
>
>That is unfortunate. Your pdoc should have recognized. But now you recognize that you were ill. Do you remember how it started? If yes, then these are the things to look out for. For example: Being suspicious, having weird thoughts. Train of thoughts with no end in sight. Insomnia. Grandiose thoughts, Delusional thoughts. I am sure there are more. To me pre-psychotic thoughts are pretty easy to spot.
If you and your friends/family memebers watch out AND you have a pdoc that asks the right questions, i think you should be fine. Proceed with caution i would say and discuss the AP/Nardil combo with your pdoc. Inform him/her about your fears as well as friends or family member.
You are in pretty deep depression i assume?
Lets wait for Scott to chime in on the AP. Zyprexa is pretty bad in terms of weight gain and metabolic disturbances. IE: Cholesterol and Triglycerides.
Posted by Lamdage22 on March 8, 2016, at 13:46:46
In reply to Re: Nardil safe?, posted by Lamdage22 on March 8, 2016, at 13:39:51
There are pros and cons to what you are wanting to do.
Consider both.
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