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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by SLS on December 11, 2016, at 20:20:20
Hi, All.
I am experiencing a significant response from my current treatment regime. I have been asking my doctor for a long time that, if I were to be placed on exactly the right drugs at exactly the right dosages, what would he expect as a time-line for improvement of my bipolar depression. He has always avoided giving me an answer, which is understandable.
After playing with Rexulti and a high dosage of nortriptyline with untoward results, I decided to fall back on my previous regime and accept that I would have to wait a long time for other treatments to become available. It was unexpected that, while waiting, I am beginning to respond to my default treatment regime. I guess I have an answer to my question. It would take months to respond to a treatment if that treatment were to be applied consistently. I wish I had been more patient and a less aggressive. Of course, this perspective is the result of 20/20 hindsight. It is difficult to not beg a doctor for changes in treatment when pain and frustration are so intense. It has been a long, long road. I hope that my current improvement continues to grow towards remission. I have not felt this well for this long a period since 1987. I still have a long way to go before I am sufficiently improved to allow me to function well enough to return to employment and rejoin mainstream society. Those are my goals.
This is my current treatment regime:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/dayOne thing that will nag at me for awhile is that all of these drugs were available in 2003. I could have been made well and started building a new life 13 years ago. I am not totally consumed with this fact, though. As I sit here typing, I am quite happy.
We shall see.
- Scott
Posted by rjlockhart37 on December 11, 2016, at 20:37:25
In reply to Responding?, posted by SLS on December 11, 2016, at 20:20:20
glad to hear that's working for you, i've been a down a short road for 5 years trying to get at the correct med regiume, but Parnate is a effective, and strong antidepressant, i wished i could transfer to it but i would have withdrawl from Prozac for 4 weeks and then start it, so...i'm just staying where I am, i've been considered Robxetine adding on to fluoxetine, but its my doctor's call.
there's a similar antidepressant to nortriptyline - protriptyline which is almost idenitical but has more stimulating effects than nortriptyline but in some countries it was discontinued in 2000
Posted by SLS on December 12, 2016, at 4:05:31
In reply to Re: Responding?, posted by rjlockhart37 on December 11, 2016, at 20:37:25
> glad to hear that's working for you, i've been a down a short road for 5 years trying to get at the correct med regiume, but Parnate is a effective, and strong antidepressant, i wished i could transfer to it but i would have withdrawl from Prozac for 4 weeks and then start it, so...i'm just staying where I am, i've been considered Robxetine adding on to fluoxetine, but its my doctor's call.
>
> there's a similar antidepressant to nortriptyline - protriptyline which is almost idenitical but has more stimulating effects than nortriptyline but in some countries it was discontinued in 2000Protriptyline exacerbated my depression and made it much worse.
I am sorry that you are not feeling as well as you would like to. Although reboxetine might help you, I think adding a tricyclic instead gives you a better chance of responding. If you are looking for a selective NE reuptake inhibitor for the treatment of depression and ADHD/ADD, desipramine is a good choice.
- Scott
Posted by Lamdage22 on December 12, 2016, at 6:13:18
In reply to Re: Responding? » rjlockhart37, posted by SLS on December 12, 2016, at 4:05:31
thats good to hear Scott. What are your goals now that u feel better?
Im still not convinced especially with antipsychotics. I am having OCDish symptoms
Posted by baseball55 on December 12, 2016, at 18:03:42
In reply to Responding?, posted by SLS on December 11, 2016, at 20:20:20
I'm so happy to hear this, Scott. It's a great feeing to have depression lift and just deal with the ordinary miseries of daily life (just kidding!). Yes, the drugs have been available for years, but when you're combining so many different drugs, there are so many combinations that it can certainly take years to find the right combo.
I am still stable on 40mg parnate and 300mg lamictal with abilify as an add-on when absolutely necessary. i've thought about tapering off meds altogether, but saw my psychiatrist today and the reminded me of just how bad things were. so i don't know. Side-effects are minimal (really just dry mouth from parnate), but I don't like the idea of being on meds for life.
i'm very happy for you!
Posted by Hugh on December 14, 2016, at 11:57:28
In reply to Responding?, posted by SLS on December 11, 2016, at 20:20:20
That's great news, Scott. How long have you been feeling better?
Posted by SLS on December 14, 2016, at 22:25:23
In reply to Re: Responding?, posted by Hugh on December 14, 2016, at 11:57:28
> That's great news, Scott. How long have you been feeling better?
2-3 weeks. I don't normally experience an improvement that lasts this long.
I have had several mild-to-moderate mood shifts towards depression that have lasted for a day or less followed by further improvement. This will be part of my recovery process. The ascent out of depression does not necessarily occur in a linear fashion. Robert Post, MD once explained this to a fellow patient of mine at the NIH using a napkin and a pencil. Low-tech. 23 years later, she still has it displayed on her refrigerator. Anyway, he drew a saw-tooth pattern of improvement representing periodic worsenings along an upward path.
- Scott
Posted by LouisianaSportsman on December 17, 2016, at 13:03:39
In reply to Responding?, posted by SLS on December 11, 2016, at 20:20:20
Yes, Scott, I have tried Rexulti, EMSAM, Aplenzin, Trintellix, etc. but right now I seem to be "responding" to:
sertraline 100mg. QD
bupropion XL 300mg QAM
amitriptyline 50mg. QHS
aripiprazole 15mg. QD
propranolol 60mg. TID
Deplin (l-methylfolate) 15mg QAM
vitamin B12 0.25mg BID
omega-3 Fish Oil Supplement BID
((gabapentin 300mg. TID))
((baclofen 20mg. TID))
have severe WD from lack of GABA-B agonism as I tend to abuse GABA-B agonists or allosteric modulators; works amazing for generalized anxiety if I actually take it right... it's like I start to feel too normal and I take too many to feel f*ck*d up again because I don't want to accept my reality for what it is)
Posted by Tabitha on January 4, 2017, at 17:56:17
In reply to Re: Responding? » Hugh, posted by SLS on December 14, 2016, at 22:25:23
Hi, SLS. I hope things are still holding. That's interesting about the sawtooth diagram.
I have a similar sort of hindsight regret about not understanding the adjustment to meds. My biggest regret is not understanding that initial side effects may wane over a month or two. I wish pdocs would do a better job preparing people for that and other aspects of med changes.
Posted by SLS on January 5, 2017, at 9:42:20
In reply to Re: Responding?, posted by LouisianaSportsman on December 17, 2016, at 13:03:39
> Yes, Scott, I have tried Rexulti, EMSAM, Aplenzin, Trintellix, etc. but right now I seem to be "responding" to:
>
> sertraline 100mg. QD
> bupropion XL 300mg QAM
> amitriptyline 50mg. QHS
> aripiprazole 15mg. QD
> propranolol 60mg. TID
> Deplin (l-methylfolate) 15mg QAM
> vitamin B12 0.25mg BID
> omega-3 Fish Oil Supplement BID
> ((gabapentin 300mg. TID))
> ((baclofen 20mg. TID))
> have severe WD from lack of GABA-B agonism as I tend to abuse GABA-B agonists or allosteric modulators; works amazing for generalized anxiety if I actually take it right...> ...it's like I start to feel too normal and I take too many to feel f*ck*d up again because I don't want to accept my reality for what it is)
That's interesting. I understand it, though. Nardil is kind of like that for many people.
That's an impressive treatment regime. Are BZDs considered to be allosteric modulators? I'm too lazy to look it up. :-) What does baclofen do pharmacologically, and what does it do for how you feel and function?
- Scott
Posted by SLS on January 5, 2017, at 9:54:51
In reply to Re: Responding? » SLS, posted by Tabitha on January 4, 2017, at 17:56:17
> Hi, SLS. I hope things are still holding.
Thanks. I am in the midst of a slump, but I'm hoping that it is nothing more than a temporary ebb. I have come to expect a path of improvement that is anything but linear.
> That's interesting about the sawtooth diagram.
Yes. My friend sent me a photo of the diagram last week. It is funny that a napkin and pencil should encapsulate the decades of work and wisdom of an accomplished and highly esteemed researcher in biological psychiatry.
> I wish pdocs would do a better job preparing people for that and other aspects of med changes.
I agree.
- Scott
Posted by Horse on January 5, 2017, at 18:48:40
In reply to Responding?, posted by SLS on December 11, 2016, at 20:20:20
I'm glad you're seeing a path to recovery. Thanks for the sawtooth image. Sometimes I am stung by regret, but only when I'm in the valley between saw teeth. Life is imperfect, isn't it?
Glad you're holding steady.
Posted by Lamdage22 on January 10, 2017, at 10:39:43
In reply to Re: Responding? » Tabitha, posted by SLS on January 5, 2017, at 9:54:51
it might be worthwhile to check with others if they think that you are better. For example my roommates think i am more outgoing since i dropped to 22,5mg Zyprexa.
Sometimes it is easier to notice a change good or bad from the outside than from the inside.
Posted by SLS on January 11, 2017, at 5:16:10
In reply to Re: Responding?, posted by Lamdage22 on January 10, 2017, at 10:39:43
> it might be worthwhile to check with others if they think that you are better. For example my roommates think i am more outgoing since i dropped to 22,5mg Zyprexa.
>
> Sometimes it is easier to notice a change good or bad from the outside than from the inside.That's very wise. Thanks you.
- Scott
This is the end of the thread.
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