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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 15 to 39 of 39. Go back in thread:
Posted by ed_uk on March 6, 2005, at 10:31:54
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 6, 2005, at 7:13:01
Hi Scott,
>You mentioned that you had brief, psychotic, manic reactions to some antidepressants.
What were you main symptoms when you were manic? I hope you don't mind me asking.
Ed.
Posted by SLS on March 6, 2005, at 16:46:09
In reply to Re: Mania » SLS, posted by ed_uk on March 6, 2005, at 10:31:54
> Hi Scott,
>
> >You mentioned that you had brief, psychotic, manic reactions to some antidepressants.
>
> What were you main symptoms when you were manic? I hope you don't mind me asking.
>
> Ed.
I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.That was a rather sane episode as psychotic episodes go.
(Don't tell anyone that I got the job).
- Scott
Posted by Sarah T. on March 7, 2005, at 23:58:25
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 6, 2005, at 7:13:01
> > > > Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared,
>
> An infrequently embraced observation is that amphetamine can act as an antimanic agent.That's fascinating. I'd like to understand how that is possible. I'd also like to know how some antidepressants induce mania in susceptible individuals. By the way, did Parnate alone cause problems for you, or was it only when it was combined with the other medications? Have you ever taken dexedrine as monotherapy?
> > > and my circadian rhythms improved.
>
> How so?When I was on Parnate alone, I had "attacks" of severe daytime somnolence, almost like narcolepsy. When the urge to sleep hit, I HAD to sleep. This was most inconvenient, not to mention dangerous. I'd sleep whenever the urge hit, which was usually during the day, and then I couldn't sleep at night. I'd go to bed around the time that most people wake up. I went to a new doctor who was familiar with this problem. He prescribed a small amount of Ritalin, which I took in the morning and at noon. I think it was either 2.5 or 5mg, twice a day. That stopped me from sleeping during the day, and I was better able to sleep at night. My circadian rhythms were still out of phase, but not nearly as bad as they had been. I have been interested in trying Selegiline if it ever comes out in the patch, but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well. You are probably aware of this, but just in case you haven't heard, several of the newer dopamine agonists that are prescribed to patients with Parkinson's Disease also cause those uncontrollable daytime sleep attacks. As I mentioned in the previous post, Parnate is considered to be one of the most dopaminergic AD's. I wonder what it is about dopamine that causes "narcolepsy."
> Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
What are its metabolites? Selegiline is converted to several amphetamines, but I think they are the "nasty" ones, the l-isomers, which cause the unpleasant/intolerable peripheral effects, like tremor, palpitations, etc.
> Did you glean any antidepressant effect from Parnate at all?When I took Parnate, I thought it had an antidepressant effect, but that was probably because I was so glad to be off of the "dumb drugs," like Elavil and imipramine. In retrospect, I think that Parnate functioned primarily as a stimulant for me, and that is most definitely not the same as an antidepressant. When I wasn't having the sleep attacks, I was pretty active physically and I lost the TCA-induced weight gain and edema, but my mood was pretty negative. I also had tremendous difficulty reading on Parnate. I'm not dyslexic. I love to read and usually don't have problems with it. I still don't know why I couldn't read well. When I was able to read, I had a lot of difficulty retaining what I read or learning. Perhaps that was caused by the sleep disruption. Aren't memories consolidated during certain stages of sleep?
> > The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
Just recently I read that REM sleep and dreaming occur in different parts of the brain. I will try to find the reference.
> With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures.
It sounds like a nightmare. That would have made me so depressed, I would have walked out. Did you actually stay at NIMH for nine months? My insurance company wouldn't pay for nine days, or nine hours for that matter. I have another medical condition that requires follow-up CT scans and MRIs at regular intervals. The last time my doctor ordered a CT and MRI, my insurance company refused to pay for both. They said that they would pay for one or the other, but not both, as if they were interchangeable! Oh-oh, this is another one of those "Don't get me started" topics.
> In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well.What was their priority?
As far as the other subgroup is concerned, they seemed to be much more dedicated to sending their patients home healthy. Unfortunately, their approaches were not at all novel. I felt they were actually several years behind the state of the art.
>
That's disappointing and disturbing to hear that NIMH, of all places, was behind the state of the art. Was/is there any place that is state of the art?Is there a seasonal variation to your depression? Do you feel better during the spring and summer? Do you have seasonal affective disorder? As I mentioned above, I was interested to know whether you've ever tried Dexedrine as monotherapy, or has it been prescribed only as an augmentor to another AD? I thought Dexedrine was a much better antidepressant for me than Parnate. Unfortunately, most people find that frequent "drug holidays" are necessary to stave off tolerance.
Posted by Sarah T. on March 8, 2005, at 0:04:03
In reply to Re: Mania » ed_uk, posted by SLS on March 6, 2005, at 16:46:09
> > > > > > I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so.> - Scott
>
>OK, this is far-fetched for real life, but it would make a great movie plot.
Posted by SLS on March 8, 2005, at 8:33:43
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 7, 2005, at 23:58:25
> By the way, did Parnate alone cause problems for you, or was it only when it was combined with the other medications?
For me, Parnate alone has not precipatated a manic reaction. It seems that it will if a TCA enters the picture.
> Have you ever taken dexedrine as monotherapy?
Yes. I received some mild benefit from it for about 3 days.
> > > and my circadian rhythms improved.
> but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.I don't think that is accurate. It seems to be pretty specific to Parnate.
> > Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
> What are its metabolites?
I don't know. I don't think that Parnate has been studies well enough to have elucidated this. It seems to be a mystery. You know, Parnate has a 1/2 life of about 1-2 hours. Perhaps much of it is excreted unchanged.
> > The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
> Just recently I read that REM sleep and dreaming occur in different parts of the brain. I will try to find the reference.
That's interesting.
> > With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures.
> It sounds like a nightmare. That would have made me so depressed, I would have walked out. Did you actually stay at NIMH for nine months? My insurance company wouldn't pay for nine days, or nine hours for that matter.
It was "free". Again, they seemed to get more out of it than I did.
> > In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well.
> What was their priority?
Obtaining P.E.T. scan images of me while taking various drugs.
> That's disappointing and disturbing to hear that NIMH, of all places, was behind the state of the art. Was/is there any place that is state of the art?
I think Harvard / Massachusetts General is high up on the list.
> Is there a seasonal variation to your depression?
No.
> I was interested to know whether you've ever tried Dexedrine as monotherapy, or has it been prescribed only as an augmentor to another AD?
I have used it both ways. Once, I was taking a combination of Parnate + desipramine + amphetamine + T4 thyroid.
How demoralizing.
- Scott
Posted by Sarah T. on March 8, 2005, at 23:54:32
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 8, 2005, at 8:33:43
> > > > but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.
>
> I don't think that is accurate. It seems to be pretty specific to Parnate. >
> > > > > > - ScottIt occurs with Parnate and Nardil. This has been documented in various journal articles over the years. Most of the references I'm aware of were published before selegiline was used, and I haven't checked to see whether there is anything in the literature about selegiline causing the same problem. One reference I'm aware of regarding Nardil and Parnate is the following:
Teicher MH, Cohen BM, Baldessarini RJ, Cole JO. "Severe Daytime Somnolence in patients treated with an MAOI." AMERICAN JOURNAL OF PSYCHIATRY. 1988 Dec; 145(12): 1552-6.
When I had this problem, one of my doctors called Dr. Teicher at McClean Hospital. I spoke with Dr. Teicher, also, and I must say that he was very helpful and very kind to me.
Posted by SLS on March 9, 2005, at 7:48:06
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 8, 2005, at 23:54:32
Hi Sarah.
> > > > > but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.
> >
> > I don't think that is accurate. It seems to be pretty specific to Parnate. >
> > > > > > > - Scott
>
> It occurs with Parnate and Nardil. This has been documented in various journal articles over the years. Most of the references I'm aware of were published before selegiline was used, and I haven't checked to see whether there is anything in the literature about selegiline causing the same problem. One reference I'm aware of regarding Nardil and Parnate is the following:
>
> Teicher MH, Cohen BM, Baldessarini RJ, Cole JO. "Severe Daytime Somnolence in patients treated with an MAOI." AMERICAN JOURNAL OF PSYCHIATRY. 1988 Dec; 145(12): 1552-6.
>
> When I had this problem, one of my doctors called Dr. Teicher at McClean Hospital. I spoke with Dr. Teicher, also, and I must say that he was very helpful and very kind to me.My experience is anecdotal, of course, but I found that the initial daytime sedation associated with Nardil disappeared and was replaced by a pleasant stimulation. I hope this can be generalized to the majority of people. The paper you cited described 8 people out of the 100s that McClean had treated. In addition, they didn't enumerate how many of the 8 had been on Nardil. I still think the profound daytime sleepiness is more common with Parnate and perhaps even specific to that drug based on the number of people reporting it on PB.
Have you tried Nardil and Parnate? I found them to be very different drugs in many respects.
- Scott
Posted by ed_uk on March 9, 2005, at 8:52:18
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 8, 2005, at 23:54:32
Hello,
>Dr. Teicher
Isn't that the guy who wrote some of the first reports of intense suicidal ideation due to fluoxetine (Prozac)?
Ed.
Posted by ed_uk on March 9, 2005, at 8:54:48
In reply to Re: Mania » ed_uk, posted by SLS on March 6, 2005, at 16:46:09
Hi Scott,
>I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.
Wow, that's interesting! How was this episode resolved?
Ed.
Posted by Sarah T. on March 9, 2005, at 22:24:52
In reply to Re: Sometimes there's no choice, posted by SLS on March 9, 2005, at 7:48:06
Hi Scott. I've tried both Parnate and Nardil, but I was on Nardil for a very short period. I was on Parnate several times, for at least 6 months each time. Can you tell me a bit about Nardil? I wasn't on it very long, so I never bothered to learn much about it. Prior to the availability of the dopamine agonists that are used primarily in Parkinson't Disease, Parnate was considered to be one of the most dopaminergic medicines. Both the dopamine agonists and Parnate can cause daytime sleep attacks. I wonder what it is about all that excess dopamine that causes this problem is susceptible people.
Posted by Sarah T. on March 9, 2005, at 22:27:13
In reply to Re: Sometimes there's no choice » Sarah T., posted by ed_uk on March 9, 2005, at 8:52:18
Hi Ed. I think you are right about Dr. Teicher. He's very prolific. If you look him up on PubMed, there must be a zillion citations with his name.
Posted by SLS on March 10, 2005, at 10:07:04
In reply to Re: Mania » SLS, posted by ed_uk on March 9, 2005, at 8:54:48
> Hi Scott,
>
> >I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.
>
> Wow, that's interesting! How was this episode resolved?
>
> Ed.
Forcibly. I was committed. This was in 1990. It was actually a manic rebound from discontinuing Nardil while already in a hypomanic state.lithium + Thorazine if I remember correctly.
- Scott
Posted by ed_uk on March 10, 2005, at 11:00:02
In reply to Re: Mania » ed_uk, posted by SLS on March 10, 2005, at 10:07:04
Hi Scott,
I think I read somewhere that you find Li makes your depression a bit worse. Will you tell me a bit more about what effect it had on you while depressed?
Regards,
Ed.
Posted by SLS on March 10, 2005, at 11:09:09
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 9, 2005, at 22:24:52
> Hi Scott. I've tried both Parnate and Nardil, but I was on Nardil for a very short period. I was on Parnate several times, for at least 6 months each time. Can you tell me a bit about Nardil?
The first time I took Nardil, I experienced a sort of sedation and fatigue during the first few weeks, whereupon it became activating. I could actually catch a bit of an energy boost within minutes of dosing. When it worked, I liked it much better than Parnate. Parnate leaves me with residual anhedonia. Nardil was definitely more of a "mood-brightener" than Parnate for me. I believe that Nardil is somewhat more pro-serotonergic than Parnate. I am susceptible to serotonin syndrome when combining imipramine with Nardil, but not with Parnate. Perhaps it is the pro-serotinergic effects of Nardil that account for the mood-brightening I experience with it. That's nothing more than a silly guess.
I believe most of, although not all of, the weight gain with Nardil is the result of increased carbohydrate intake resulting from cravings. The rest might be metabolic. Nardil might mess around with glucose/insulin dynamics. Another silly guess.
> Both the dopamine agonists and Parnate can cause daytime sleep attacks.
I never made this connection. You are right.
> I wonder what it is about all that excess dopamine that causes this problem is susceptible people.
Hmm. Interesting.
With DA receptor agonists, I think it might have something to do with pre-synaptic receptor downregulation. One last silly guess.
:-)
- Scott
Posted by ed_uk on March 10, 2005, at 12:49:55
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 10, 2005, at 11:09:09
Hi,
>Nardil was definitely more of a "mood-brightener" than Parnate for me.
Perhaps you got a greater % MAO inhibition from the dose of Nardil that you were taking. Maybe Parnate would have been just as good if the dose was higher.
Ed.
Posted by SLS on March 10, 2005, at 21:36:39
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 10, 2005, at 12:49:55
> Hi,
>
> >Nardil was definitely more of a "mood-brightener" than Parnate for me.
>
> Perhaps you got a greater % MAO inhibition from the dose of Nardil that you were taking. Maybe Parnate would have been just as good if the dose was higher.
>
> Ed.How's 150mg?
:-)
- Scott
Posted by Sarah T. on March 11, 2005, at 23:59:24
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 10, 2005, at 11:09:09
Hi Scott. None of those were silly guesses! You have very interesting ideas.
I'm just very discouraged right now about psychopharmacology and psychopharmacologists. I really wish I'd never taken any of these medications. I think they've made me worse than I was when I started.
Posted by ed_uk on March 15, 2005, at 10:24:57
In reply to Re: Sometimes there's no choice » ed_uk, posted by SLS on March 10, 2005, at 21:36:39
Hi Scott!
>How's 150mg?
Did you ever combine 150mg Parnate with any other ADs?
Ed.
Posted by SLS on March 15, 2005, at 13:43:30
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 15, 2005, at 10:24:57
> Hi Scott!
>
> >How's 150mg?
>
> Did you ever combine 150mg Parnate with any other ADs?
>
> Ed.
You're really testing my poor memory now! :-)I combined Parnate 120mg + desipramine 200-300mg + Dexedrine 20mg + T4 thyroid ?mcg
I really like that you brainstorm ideas for other people. That is very compassionate of you.
- Scott
Posted by ed_uk on March 16, 2005, at 10:19:12
In reply to Re: Sometimes there's no choice » ed_uk, posted by SLS on March 15, 2005, at 13:43:30
Hi Scott!
>I combined Parnate 120mg + desipramine 200-300mg + Dexedrine 20mg + T4 thyroid ?mcg
I wondered whether you ever took 150mg Parnate with imipramine. I thought that *if* you were able to take so much Parnate with imipramine w/o developing the serotonin syndrome, the % MAO inhibition might not have been as high as expected. Based on that theory you might benefit from an even higher dose.
Did you ever take imipramine with a high dose of Parnate?
>I really like that you brainstorm ideas for other people. That is very compassionate of you.
Thanks, that's a really nice thing to say :-)
Best regards,
Ed.
Posted by ed_uk on March 16, 2005, at 10:52:31
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 16, 2005, at 10:19:12
>Based on that theory you might benefit from an even higher dose.
Not so much that you'd develop the SS though!
Ed.
Posted by ed_uk on March 17, 2005, at 13:19:48
In reply to Re: Sometimes there's no choice, posted by ed_uk on March 16, 2005, at 10:52:31
Hi Scott,
Have you ever added L-Tryptophan to an AD?
I know you've been on *many* different drugs, have you combined them with vitamins like folic acid etc? I guess you have but I though it was worth asking!
Ed.
Posted by ed_uk on March 19, 2005, at 16:26:42
In reply to Re: Above post to SLS, posted by ed_uk on March 17, 2005, at 13:19:48
Posted by SLS on March 19, 2005, at 16:43:01
In reply to Re: Above post to SLS, posted by ed_uk on March 17, 2005, at 13:19:48
Hi Ed.
Still here.
:-)
> Have you ever added L-Tryptophan to an AD?
A long time ago. I guess I could try 5-HTP, but I don't know if I should take it with Parnate.
> I know you've been on *many* different drugs, have you combined them with vitamins like folic acid etc?
No. I'm thinking about adding folate and DHEA, but I haven't looked into it very seriously. I keep meaning to stop in a vitamin store near me, but always manage to forget.
> I guess you have but I though it was worth asking!
Gosh, I hope there are truckloads of things I haven't thought of yet. Even better, let my doctors come up with a few of their own!
- Scott
Posted by ed_uk on March 19, 2005, at 19:29:48
In reply to Re: Above post to SLS » ed_uk, posted by SLS on March 19, 2005, at 16:43:01
Hi Scott!
>I'm thinking about adding folate.
Do it!
I hope it helps,
Ed.PS. Perhaps you could add a B-complex as well.
This is the end of the thread.
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