![[dr. bob]](/dr-bob-sm.gif)
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 rose45 on March 16, 2023, at 15:22:03
Thank you so much for your kindness and thoughtfulness SLS.I hope Im not taking too much of your time away from your fiancee!
Of course the constant background of anxiety is due to the fact that the parnate is no longer masking it and now the anxiety is so overwhelming I cant see any way out of this dilema.
Your suggestion of swapping to nardil is a good one,but the NHS have refused it, because they dont know what they are talking about, and private psychs in London are booked up years ahead, since Covid, and charging in the region of £700 per hour, so totally unaffordable.
Since the NHS are useless, do you know any psych in usa who knows maois, who I could consult, say over whatsapp, or something similar? I would also need to get a prescription filled and mailed over here - and it is all so complicated. An easier way would be to find some way to augment the parnate, but that has already been done with lamotrigine and nardil and only lasted a few months.Can you see why I have lost all hope?
Posted by SLS on March 16, 2023, at 22:06:49
In reply to to sls again, posted by rose45 on March 16, 2023, at 15:22:03
Hi, Rose.
I'm glad you posted today.
> Can you see why I have lost all hope?Yes.
However, I have logical reasons to believe that you are treatable. The NHS is an impediment to you, though.
Your depression and anxiety are ganging up on you right now. They are affecting your OUTLOOK. My guess is that you are being crushed by feelings of doom. A pessimistic outlook is what brings on or adds to crisis. I am not saying that you don't have legitimate reasons to have a pessimistic outlook. However, you are currently in an altered state of consciousness. That's what depression is. It is impossible to have the same outlook in the depressed state of consciousness as you do in a healthy state consciousness. I am suggesting that you take this into consideration as you evaluate your current thoughts and feelings. From experience, you know how quickly this changes when you begin to respond to treatment and are no longer lost in a cloud of darkness. I am suggesting that you really can't trust your thoughts and feelings while your brain isn't working properly. I disagree with you if you think it is time to stop trying. For now, do things that distract you from your painful thoughts. It's hard to pay equal attention to two thoughts at once.
So yes, I can see why you have lost all hope for yourself. Can you see why I haven't?
The first thing that comes to mind is that 150 mg/day of lithium might not be enough. I don't recall your indicating that you went higher than that dosage. As a low-dosage treatment strategy, I think more people will respond to 300 mg/day of lithium. Like I said, lithium was the augmenter of choice to add to Parnate in the 1980s. Upon the advent of SSRIs, these old tricks were forgotten. Doctors don't know how to use MAOIs anymore. Even if you don't respond fully to lithium in combination with Parnate, I would keep taking low dosages of it indefinitely. First, you can't know right now that lithium won't be a critical component to future treatments. You know it has a positive effect on you, even though it didn't stick. I would not call it tolerance at this point. I don't know. The term just doesn't sit right with me right now in your case. You might have to explore the whole range of dosages for lithium: 150-1500 mg/day. As I mentioned in a previous post, Harvard found that 600 mg/day of lithium in combination with Prozac worked less well than lower dosages.
The second consideration for taking low dosages of lithium indefinitely is that most investigations indicate that it reduces the risk of developing Alzheimer's Disease. This is really not a new finding. It's just that it has escaped everyone's attention. By the way, kidney and thyroid functions are affected by lithium in a dosage-dependent manner. At 300 mg/day, the risk approaches zero. I have been taking low dosages of lithium just for this reason, even if it were no help for depression. I got lucky because of this. It turns out that lithium is necessary for me to achieve remission.
Is there any history of bipolar disorder in your first degree relatives?
You are doing a great job for someone in your position. You ought to appreciate your inner strength. Please don't give up just yet. Right now, the NHS is perhaps your greatest impediment in exploring drugs that will help. By the way, I am not at all surprised that you responded favorably to Zyprexa (olanzapine). It gave me a boost about 25 years ago while I was taking Nardil. Shortly after Zyprexa came out, there were reports that it induced a manic state in some people. I haven't heard a peep since. I think most of the newer "atypical" antipsychotics have the potential to exert a stronger antidepressant response when added to certain antidepressants. I have had brief improvements when I added Zyprexa, Abilify, Saphris, or sulpiride. If you haven't tried amisulpride (Solian) yet, it can help with depression and dysphoria, but only at lower dosages. 25 mg/day seems to be the sweet-spot, but I have seen 50 mg/day used, too.
Hang in there. That's what I had to do for 38 years. You and I had a BIG advantage, though. We both know what it feels like to be live in the absence of depression. Make sure you look back and remember what you felt during you times of remission. Life was more than worth it, right? Let that be your carrot to keep you moving forward.
- Scott
Posted by SLS on March 17, 2023, at 10:37:42
In reply to to sls again, posted by rose45 on March 16, 2023, at 15:22:03
Hi, Rose.
Let me know how you are doing. I posted another message to you just above this one:
http://www.dr-bob.org/babble/20230117/msgs/1121923.html
Please let me know how your outlook has changed after reading it.
I think your first job is to think of ways to navigate the NHS regulations. You will need to find a doctor willing to prescribe Nardil in combination with other drugs, especially TCAs. For me, I absolutely do not respond well to any treatment unless it combines MAOI + TCA. You would want to limit your selection of TCAs to nortriptyline, desipramine, amitriptyline, and doxepin. Trimipramine might be okay, too, but I don't know of anyone who has tried it combination with a MAOI. However, the drugs that you absolutely must avoid when taking a MAOI are ANY that include as one of its properties, serotonin (5-HT) reuptake inhibition.
Examples:
SSRI
SNRI
imipramine
clomipramine
vortioxetine
vilazodone
trazodone
milnacipran
Levomilnacipran
5-HT receptor agonists?* Fenfluramine (FINTEPLA) has been used for weight-loss, but was taken off the market because it caused heart valvulopathy (damage to heart valves). This is not due to serotonin receptor agonism (stimulation). Instead, it is caused by 5-HT2B receptor antagonism (blocking).
* The most dangerous drugs to combine with MAOIs are 5-HT reuptake inhibitors. Serotonin Syndrome is often the result. The only drug I know of that can be used as a remedy for Serotonin Syndrome is cyproheptadine (Periactin). There may be others.
If you haven't tried lithium at dosages above 150 mg/day, you absolutely must try 300-450 mg/day.
- Scott
Posted by rose45 on March 18, 2023, at 8:55:47
In reply to Re: to sls again » rose45, posted by SLS on March 17, 2023, at 10:37:42
Scott, I have written you a long message twice but this website keeps going down and loses the message. I have spent 2 or 3 hours trying to communicate on here and the site just loses the message. I REALLY NEED TO COMMUNICATE with you so please could you contact me on babble mail and let me know some other way, either email or whatsapp, because I dont want to write another message and lose it again. I would be very grateful. Your posts mean a lot. Thank you.
Posted by SLS on March 18, 2023, at 9:32:27
In reply to Re: to sls again, posted by rose45 on March 18, 2023, at 8:55:47
Hi, Rose.
What I do is to compose my post on a text editor or word processor and save the file periodically while you are writing. If you have a PC, you can use the built-in Notepad or Wordpad. I use Microsoft Word. You then copy-and-paste the text to the posting window. If the site goes down, you will always be able to wait until it's back online, and copy-and-paste again.
If you have a MAC, I'm guessing that it has similar programs.
You can Babble-Mail me if you'd like. However, I like the idea of people posting to the entire community on the board so that others can interact, learn, ask questions, and contribute their thoughts and knowledge.
I turned-off a lot of people who no longer post here. That's unfortunate.
- Scott
Posted by rose45 on March 19, 2023, at 6:49:27
In reply to Re: to sls again - Losing members. » rose45, posted by SLS on March 18, 2023, at 9:32:27
Scott,
I had hoped to communicate more privately because of the thoughts I am having which are not appropriate for a public forum.
You respond to so many posts on here, it may be difficult to remember all my posts describing my condition. But I am not in a state to go over it all again - which is why I would have appreciated a private conversation, so as not to keep repeating things over and over.
You have written what has worked for you, and you have described several times the many meds you have taken and how finally you have got to remission.
I have also told you how drastic things are in uk and why I feel so hopeless. My condidition is severe anxiety and depression. I have lost my memory and ability to think clearly. I cannot understand movies or any but the simplest thoughts... I think my mind is frozen with fear.
There is only one psychiatrist available to me here under the nhs in London. The NHS have insisted I come off lamotrigine as they will not allow people to be on more than two meds.
I do believe that lamotrigine has damaged my mind because it is since taking it that problems with memory and understanding happened. I am almost off it now, but still the negative results are there.
I have not been able to come off parnate so am still taking it, and also olanzapine.
The NHS have given me only a choice of 3 meds to add to what I am taking: lithium, pregabalin, or valproic acid. They have refused nardil.
I consulted a mexical psychiatrist by whatsapp and he suggested lithium, which I had to order from Canada, as at that time I was still on lamotrigine, and he also suggested I come off it - and it was easier to come off it once I had started taking the lithium. After 2 or 3 weeks, I was ok again and it felt as if the lithium had re-activated the parnate, but unfortunately this only lasted a couple of months, and I am now back to the hopeless state I have been in for the last 3 years. Unlike you, I do not have the opportunity to try such a huge array of meds, and in fact, for me, nardil worked on its own for 22 years, and parnate worked on its own for 6 yrs, until I reduced it slightly and it stopped working.
Can you see why I have now lost all hope?
Posted by SLS on March 19, 2023, at 16:34:38
In reply to Re: to sls again - Losing members., posted by rose45 on March 19, 2023, at 6:49:27
Hi, Rose.
Please Babble-Mail me.
- Scott
Posted by rose45 on March 21, 2023, at 7:14:20
In reply to Re: to sls again - Losing members. » rose45, posted by SLS on March 19, 2023, at 16:34:38
> Hi, Rose.
>
> Please Babble-Mail me.
>
>
> - ScottScott, I have just send you a babblemail. Thank you so much for caring.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.