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Dr. Bob is Robert Hsiung, MD,
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Posted by JohnLA on March 12, 2012, at 23:20:38
In reply to Re: Adding Parnate and prazosin. » SLS, posted by europerep on March 12, 2012, at 11:23:43
europerep-
take a chill pill as we say in the US. i'm sure you have better things to do than to question scott about his depression, ability to write, etc.
silly discussion really. depression is so unique to each of us that to make blanket statements about what one can and cannot do while depressed makes absolute no sense.
how about this? i'm thinking english is not your first language and something is getting 'lost in translation' in your posts to scott? maybe i'm wrong on this.
regardless, let it go.
ps where is lou pilder when you need him?!
Posted by SLS on March 13, 2012, at 7:03:28
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Anyway...
The last three days have been the best yet. The improvement is unmistakable, albeit gradual and uneven. I try to evaluate my condition in terms of weeks and months rather than days. That is not to say that I don't get frightened and frustrated when I experience a period of worsening. These valleys are not as deep as they had been, though. Along with the progression of higher and higher peaks, I conclude that the outcome of my treatment follows a trend towards further improvement.
Far out!
I am currently taking:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgIt appears that each drug contributes a therapeutic effect that is complementary to the others. Attempting to remove any one of these drugs results in relapse.
I think that some people might profit from making a list of those drugs from which they experienced a partial response, and then consider using them in developing a polypharmaceutical treatment. That's basically what I did. My choices were based upon clinical, empirical observation rather than theory. Pondering theories for why these drugs work for me is interesting, but retrospective.
As I have noted, I hand-picked the first 5 drugs on the list that I was taking. I gleaned only a minimal partial improvement, however. My doctor then proposed the brilliant idea to add prazosin. I would never have thought to do this myself. However, it is obvious that prazosin is not sufficient to operate monotherapeutically for me. As Ed_UK so insightfully noted, it seems that prazosin might be effective when combined with a noradrenergic drug. Of course, both Parnate and nortriptyline are noradrenergic. That is not to say that prazosin wouldn't augment serotonergic drugs just as well.
I do not use theory to exclude drugs from consideration. I do use it to include drugs for consideration.
I feel so relieved to think that my pain and frustration of depression might be coming to an end. <deep breath> Phew.
A few more prayers to the higher power wouldn't hurt.
- Scott
Posted by Beckett on March 13, 2012, at 7:38:11
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on March 13, 2012, at 7:03:28
>A few more prayers to the higher power wouldn't hurt.
You got 'em
Serendipity and a systematic approach
:-)
Posted by europerep on March 13, 2012, at 8:27:59
In reply to Re: Adding Parnate and prazosin. » europerep, posted by SLS on March 12, 2012, at 19:08:52
Look Scott, you seem to think that I don't like you or something. Or that I want to question whether you are really suffering from depression, or whether your suffering is legitimate. None of the above is true.
What it comes down to here is this: I see quite a few of logical flaws in the story that you tell about yourself. That doesn't mean that they are necessarily there, but they might be. Even if you don't want to consider these things, others here on the forum have a right to hear what people (such as me) think, just as they have the right to then dismiss my opinion.
If you go back to my initial post and read it from a neutral perspective, it is neither flaming nor insulting, and it's not even impolite. It is blunt and to the point, yes. If I should have wrapped my thoughts in more if's, maybe's, please's or possibly's, then how about this: welcome to the internet.
Your attempt to dissect my words and draw me into a lengthy discussion is pointless, especially since you at the same time reject everything I'm saying and yet pretend to want to hear more or to have me explain things. You are an intelligent person, all the info is there, and you can basically take it or leave it.
Posted by europerep on March 13, 2012, at 8:30:48
In reply to europerep, posted by JohnLA on March 12, 2012, at 23:20:38
> silly discussion really. depression is so unique to each of us that to make blanket statements about what one can and cannot do while depressed makes absolute no sense.
True, that would make no sense, but I haven't done that.
And there is nothing lost in translation here, at least as far as I can see. My thoughts on this subject are actually fairly simple.
Posted by ed_uk2010 on March 13, 2012, at 15:42:44
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on March 13, 2012, at 7:03:28
One thing I'm unsure about is how your prazosin dose was determined. Is 6mg the most you can tolerate without excessive hypotension? .....although I have no idea whether >6mg would be any more effective.
FWIW, I don't think anyone is trying to upset you on this thread, I think they are simply commenting on the eloquence of your posts, which is much greater than most people who have read many books!
Posted by SLS on March 13, 2012, at 17:07:52
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 13, 2012, at 15:42:44
> One thing I'm unsure about is how your prazosin dose was determined.
Clinical titration. My starting dose was 3 mg. I actually felt better at this dosage, but I would lose the benefit towards the end of a dosing period. I take prazosin t.i.d. At 6 mg, things evened out. Who knows, I might have responded just as well to 4 or 5 mg. Since the prazosin was so tolerable, I felt that there was no harm in giving myself some headroom with the 6 mg dosage.
> Is 6mg the most you can tolerate without excessive hypotension?
No. I was able to tolerate more, but there was no additional benefit from going higher. I went to 9 mg.
Man, it feels good to feel good. Things are so much brighter and clearer.
- Scott
Posted by ed_uk2010 on March 15, 2012, at 18:13:13
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 13, 2012, at 17:07:52
Given prazosin's very short half-life, how do think you would fare on 1mg to 1.5mg four times a day?
Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular. Doxazosin is much more widely used than prazosin as an antihypertensive due to its long duration of action and less precipitous initial fall in BP.
I am delighted at your recent progress, by the way :)
Posted by SLS on March 15, 2012, at 18:34:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 15, 2012, at 18:13:13
> Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular.
Does doxazosin cross the BBB as readily as prazosin?
> I am delighted at your recent progress, by the way :)
Thanks, Ed. I appreciate it.
- Scott
Posted by SLS on March 16, 2012, at 13:19:26
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 15, 2012, at 18:13:13
> > Also, what is the role (if any) of other non-selective alpha blockers in psych disorders? I was thinking of doxazosin (Cardura) in particular.
> Does doxazosin cross the BBB as readily as prazosin?
I couldn't find an answer to this question. Maybe you will have better luck.
I found a few studies that reported doxazosin as being effective in treating PTSD. It would certainly be an attractive alternative to prazosin if this were true.
- Scott
Posted by ed_uk2010 on March 17, 2012, at 13:59:08
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 16, 2012, at 13:19:26
>Does doxazosin cross the BBB as readily as prazosin?
I did find a bit of information. It said that doxazosin is less lipid-soluble than prazosin and may not cross the BBB very well. So, I guess doxazosin might not be as effective.
One thing about prazosin is the short half-life, apparently only 2-3 hours. What do you think of the idea of taking smaller doses more frequently?
>
> I couldn't find an answer to this question. Maybe you will have better luck.
>
> I found a few studies that reported doxazosin as being effective in treating PTSD. It would certainly be an attractive alternative to prazosin if this were true.
>
>
> - Scott
Posted by SLS on March 22, 2012, at 7:49:16
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on March 17, 2012, at 13:59:08
Hi Ed.
I apologize for waiting so long to respond to your insightful post.> One thing about prazosin is the short half-life, apparently only 2-3 hours. What do you think of the idea of taking smaller doses more frequently?
It actually took about 36 hours for me to relapse when I discontinued prazosin abruptly. I wanted to be sure that it was contributing to my improvement since I added Parnate and prazosin at the same time. Upon rechallenge with prazosin, I was able to recover the therapeutic response rather quickly. It seems that t.i.d. dosing is sufficient.
As usual, thanks for your concern and valuable feedback and advice.
- Scott
Posted by SLS on March 22, 2012, at 7:58:06
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on March 22, 2012, at 7:49:16
Still responding...
Things are not happening fast enough for me, though. However, it appears that I am still progressing towards remission, albeit gradually. I still experience brief periods of feeling worse. However, each peak is higher than the one before, and each valley less deep. Robert Post would explain to his chronic TRD patients to expect this sort of thing, even when the ideal treatment for an individual is found.
At this rate of improvement, I am hoping to return to work within a year. I am already getting out to socialize more. Socializing in large gatherings is still uncomfortable, especially because I have nothing to say so as to engage in "chit-chat".
- Scott
Posted by Beckett on March 22, 2012, at 8:12:53
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 22, 2012, at 7:58:06
Chit-chat may be a pleasant skill, but it is overrated,
Just saying. Even the well among us will often avoid chit-chat.
Anyway you go, you Go Scott:) !
Posted by Phillipa on March 22, 2012, at 20:55:17
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 22, 2012, at 7:58:06
This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Posted by SLS on March 23, 2012, at 0:33:09
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on March 22, 2012, at 20:55:17
> This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Yup. Thanks.
:-)
- Scott
Posted by SLS on March 24, 2012, at 9:58:08
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on March 23, 2012, at 0:33:09
Yesterday was the best day yet - maybe 35% improved.
The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
- Scott
Posted by Bob on March 24, 2012, at 15:50:40
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
> Yesterday was the best day yet - maybe 35% improved.
>
> The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
>
>
> - Scott
>Indeed. Unfortunately I have found that sexual dysfunction really wears you down over time. That's me though.
Posted by sigismund on March 24, 2012, at 18:13:16
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So you are on 6mg/d, Scott?
Posted by Phillipa on March 24, 2012, at 20:18:04
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So what if you now have or are getting a life there are lots of other things. What if you had a serious medical condition that rendered you this way like prostrate cancer? Phillipa
Posted by SLS on March 25, 2012, at 5:27:35
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 24, 2012, at 18:13:16
> So you are on 6mg/d, Scott?
Yes. I take 2 mg three times a day. In the grand scheme of things, this is a fairly low dose. I experienced an improvement in depression at 3 mg/day, but my "mood" was too variable during the day, and it was obviously at its worst at the end of a dosing period. I don't doubt that 3 mg/day will be sufficient for some people, though.
I'm sure you saw that the dosage range of prazosin for treating hypertension is 6 - 20 mg/day; with some people going as high as 40 mg/day.
When I first started 6 mg/day, I experienced fatigue and sleepiness. However, those things disappeared within a week.
Prazosin caused a diminution of my sex-drive almost immediately. I imagine that some libido will emerge as my depression remits. Prazosin has NOT produced erectile dysfunction nor anorgasmia. I can still enjoy sex once I get started.
- Scott
Posted by phidippus on April 3, 2012, at 18:44:29
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
Its upregulating dopamine! How is it killing your sex drive???
Eric
Posted by SLS on April 3, 2012, at 20:40:58
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 3, 2012, at 18:44:29
> Its upregulating dopamine! How is it killing your sex drive???
I really don't know, but I'm not particularly happy about it.
Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though. I began looking into this only after I recognized a major reduction in sexual appetite. If this is as bad as side effects get for me, it is worth the trade-off. I am hoping that I will recoup some libido as the depression evaporates.
In certain areas of the brain, NE alpha-1b receptors act as a gate to allow throughput for dopamine circuits afferent to the limbic system. Closing the gate by blocking these receptors serves to attenuate the increased locomotor activity produced by psychostimulants like cocaine. I don't know if this is also true of appetitive drives and cravings.
- Scott
Posted by phidippus on April 5, 2012, at 16:11:25
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
Are you planning on taking up cocaine?
Eric
Posted by sigismund on April 5, 2012, at 16:38:14
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
>Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though.
Some people said that on askapatient.
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Dr. Bob is Robert Hsiung, MD,
[email protected]
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